1. North Wales Secondary and Specialist Care Review ‹date/time› BOARD PRESENTATION JULY 2005 ANDREW BUTTERS PROJECT DIRECTOR

2. North Wales Secondary and Specialist Care Review ‹date/time› The Wanless Context The Review of Health and Social Care in Wales (June 2003) said: The current configuration of services places an insupportable burden on the acute sector and its workforce Actions to reconfigure provision… are needed alongside a rebalancing of the system to meet need earlier in the care pathway

3. North Wales Secondary and Specialist Care Review ‹date/time› Designed for life Health Well Being Strategies Health Challenge Wales Healthcare Designed for life Social care Strategy

4. North Wales Secondary and Specialist Care Review ‹date/time› Why Designed for Life ? Designed : Adds value, delivers quality, “Fit for purpose”, achieved through professional team effort For Life : Adds to the quality of life, not just years to life but life to years What is proposed is not a plan but a process

5. North Wales Secondary and Specialist Care Review ‹date/time› 4. Tertiary and highly highly specialised specialised services services 3. Specialised and critical care hospitals 2. Local General Hospitals 1. Services provided at home or in the local community Sustainability : Four levels of Care

6. North Wales Secondary and Specialist Care Review ‹date/time› World class health and social care What might this mean in practical terms? The Wanless prescription is for reconfiguration to achieve better use of hospital services Wanless and Designed for Life argue for clinical and service integration Where are there examples that might inform the North Wales Review?

7. North Wales Secondary and Specialist Care Review ‹date/time› The example of Kaiser Permanente KP is a long established health care organisation Its values are as close to those of the NHS as you will find in the US Analysis shows that for the over 65 population, KP uses only one third of the bed days as the NHS The following data have been standardised to make comparisons like for like, as far as possible

8. North Wales Secondary and Specialist Care Review ‹date/time› Orthopaedics Beds days per 100,000 aged over 65

9. North Wales Secondary and Specialist Care Review ‹date/time› CHD Bed days per 100,000 aged over 65

10. North Wales Secondary and Specialist Care Review ‹date/time› Respiratory Beds days per 100,000 aged over 65

11. North Wales Secondary and Specialist Care Review ‹date/time› Other Bed days per 100,000 aged over 65

12. North Wales Secondary and Specialist Care Review ‹date/time› Hospital utilisation KP’s lengths of stay are much shorter than those of the NHS Discharged is planned before admission or on admission Care pathways and protocols are used extensively Step down facilities support acute hospitals – skilled nursing facilities

13. North Wales Secondary and Specialist Care Review ‹date/time› Pressures in North Wales Health System Governance Resources - people - money The estate Access and activity

14. North Wales Secondary and Specialist Care Review ‹date/time› PROJECT STRUCTURE North Wales Health Planning Forum Project Board Reference Group CommunicationsGroup TASK AND FINISH GROUPS Needs Assessment Clinical Groups Transport EstatesIM&THR Finance + VFM Mental Health Long Term Medical Conditions Paediatrics & Obstetrics Diagnostics Surgical Specialities Emergency Access Existing Clinical Networks & Projects 

15. North Wales Secondary and Specialist Care Review ‹date/time› Who is it?…. BOARD MEMBERS Trefor Jones - Trefor Jones - Chair of the project board, Lord Lieutenant of Clwyd Andrew Butters - Andrew Butters - Project Director Hilary Pepler - Hilary Pepler - Chief Executive of North East Wales Trust and Chair of the Wales Health Planning Forum Derek Griffin - Derek Griffin - North Wales Regional Director, Department of Health and Social Care, WAG David Gozzard - David Gozzard - Medical Director of Conwy and Denbighshire NHS Trust Kate Elis-Williams - Kate Elis-Williams - Finance Director of North West Wales NHS Trust Phil McGreevy - Phil McGreevy - Chief Executive of Flintshire County Council (on behalf of the North Wales Council) Grace Lewis Parry - Grace Lewis Parry - Chief Executive of Gwynedd Local Health Board Janette Fells - Janette Fells - Medical Director of Flintshire LHB Gail Roberts - Gail Roberts - From Clwyd CHC (on behalf of the North Wales CHCs)

16. North Wales Secondary and Specialist Care Review ‹date/time› Reference group NHS STAFF STATUTORY BODIES PROFESSIONALS CHCs HIGHER EDUCATION INDEPENDENT SECTOR VOLUNTARY SECTOR LOCAL AUTHORITIES PUBLIC AND PATIENTS

17. North Wales Secondary and Specialist Care Review ‹date/time› Timescale KEY DATES... PROJECT START FINAL PLAN May July October December January March 2005 2005 20052005 2006 2006 Agree Principles Group Interim Reports Group Final Reports Draft Plan

18. North Wales Secondary and Specialist Care Review ‹date/time› Treatment should be: Patient –focussed Timely Quality Effective Safe Affordable Efficient Principles for the Design of Services

19. North Wales Secondary and Specialist Care Review ‹date/time› Principles for the Project Work In order for the project work to command confidence and deliver a realistic plan within the time-scale, all parties need to follow the principles of: Mutual trust Transparent and open sharing of information Co-operation, for instance in the timely provision of information and responses to correspondence.

20. North Wales Secondary and Specialist Care Review ‹date/time› Conclusions Needs to be North Wales approach Partnership across levels of care Partnership of clinicians, users and management