The Annual Quality Statement for NHS Wales 2014

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The Annual Quality Statement for NHS Wales 2014

Delivering high quality health services to the people of Wales 1 The Annual Quality Statement for NHS Wales 2014

Contents

Introduction from Andrew Goodall, Chief Executive, NHS Wales

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1. Helping you to stay safe and healthy

4

2. Keeping you safe while you are in our care

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3. Treating you with dignity and respect

12

4. Working with you to make sure you receive the right care

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5. Making sure you receive care quickly and effectively

20

6. Treating you as an individual

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7. A big thank you to everyone who works for NHS Wales

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Our focus for the year ahead 32 More information about NHS services, and the Annual Quality Statement 35

Introducing NHS Wales There are ten organisations in NHS Wales – seven health boards covering the whole of Wales, and three national trusts, the Welsh Ambulance Service, Public Health Wales, and Velindre NHS Trust, which provides expert cancer services to people across the country and also includes the Welsh Blood Service.

NHS Wales is funded by the Welsh Government, which sets the priorities and targets for health services in Wales.

2 The Annual Quality Statement for NHS Wales 2014

Welcome I am pleased to introduce the first NHS Wales Annual Quality Statement, which gives an overview of the excellent work being taken forward by all NHS organisations in Wales to improve the quality of care for people living in Wales.

All of us will be touched by the NHS at some point in our lives and it remains a service at the heart of public expectations with public service values at its heart. It is also a service with millions of contacts with people every year in hospitals, community, mental health and primary care services. However, high-volume services must deliver high-quality care and good patient experiences. This is why quality of care and patient safety are at the

Introduction

core of the day-to-day business for the NHS in Wales.

Overall, the NHS in Wales can be proud of that fact that more than 90% of people in the latest national survey were very satisfied with the care they received.

This statement sets out those areas where we have seen improvements, including preventing infections and how we care for people with cancer; following a stroke or at the end of their lives. Our vaccination levels are at the highest we have seen; we have good population screening in place; cancer survival rates are improving as is life expectancy for the Welsh population.

some wards in two hospitals. We have acted on its findings at a local and a national level.

We have reviewed the way the NHS handles complaints and concerns and are implementing its many recommendations. We have introduced new ways of keeping track of how we are doing and where we need to improve. Our underlying principle is that we must learn from our mistakes.

NHS Wales must continue to improve so it can provide you and your family with high-quality care when you need it most. There are a number of key areas we will focus on over the next year, including:

However, there is still more that we can do to improve care. Meeting patient needs with dignity and respect is very important to the NHS. When this does not happen, we have taken action.

• We want to work with you to help you take care and responsibility for your own health. We know that leading a healthy lifestyle can help prevent us from becoming ill;

The Trusted to Care report was published last year after concerns were raised about standards of care in

• We will continue to develop joined-up services with others so care can be provided closer

3 The Annual Quality Statement for NHS Wales 2014

to people’s homes, while also working to prevent delays in treatment when you do have to go to hospital; • We will continue to act on the Trusted to Care recommendations and the findings from the subsequent spot checks of hospital and mental health wards; • We will make sure we identify people affected by dementia as early as possible so they receive the best possible care.

Above all, we want to provide safe, compassionate, person-centred care.

We are committed to putting things right if we get them wrong. We will act on people’s feedback and work with you to continue to ensure we have a truly National Health Service we can all take pride in.

Andrew Goodall Chief Executive, NHS Wales

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Helping you to stay safe and healthy Good health is a partnership between you as an individual and NHS Wales. We will do everything we can to keep you healthy, but there are many things that you can do to keep yourself healthy too. For example, we can support you to give up smoking, but it depends on your decision to live smoke-free.

When it comes to health we know that small steps can result in big changes.

We also know that staff in the NHS can find living healthily a struggle too.

We are supporting staff to improve their health through the Champions for Health programme. We also want to develop stronger partnerships with organisations outside the NHS so we can support more people in our communities to make healthier choices and avoid becoming ill.

Here are some of the ways we are helping people to make healthy choices and live healthy lives.

4 The Annual Quality Statement for NHS Wales 2014

1. Helping you to stay safe and healthy

Helping our staff to help you Champions for Health helped healthcare staff across Wales make positive changes to their health.

It has encouraged staff to lead fitter, healthier lives and become advocates for healthy lifestyles with their patients and wider communities.

Staff reported significant improvements around exercise, working towards a healthy weight and reduced consumption of alcohol.

DID YOU KNOW? The campaign has given people more confidence to talk to their patients, and also their friends and families about healthy lifestyle choices.

m e a re a l Th is h a s g ive n ’s li k e fo r a t it in s ig h t in to w h g o o d n e w s e m y pa ti e n ts .Th to th e m lk is I c a n n o w ta a t I’ve wh h o n e s tl y a b o u t a n d h o w I do b e e n tr y in g to lw a y s e a s y. k n o w it ’s n o t a Watch Liam talk about how he gave up smoking thanks to Champions for Health here www.bit.ly/liamc4h

, p a rt ic ip a n t – Dr Gl y n Jo n es ea lt h fo r H in C h am p io n s

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Beating flu!

Over two thirds of eligible children have been vaccinated against flu, and we’d like you to help us raise this number next year.

Influenza, known as flu, is a highly infectious disease that can be deadly.

We especially want to protect the elderly, people with long-term health conditions, pregnant women and young children, as they are most at risk of being killed by ‘flu. The best way to protect people is through an annual flu vaccine. The national flu vaccination programme is co-ordinated by Public Health Wales and has helped protect thousands of children and adults. We encourage all NHS Wales staff to be Flu Fighters and get vaccinated. w ww.bit.ly/flufightercymru

1. Helping you to stay safe and healthy

Designed to Smile - improving children's dental health Designed to Smile is a national programme to improve the dental health of young children in Wales. Last year 93,000 children took part in supervised daily tooth brushing with fluoride toothpaste in school or nursery. Children have lessons on how to keep their teeth and mouth healthy, including making healthy food choices. Children are given home dental packs so they can keep up the good habits in the school holidays.

DESIGNED TO SMILE SUCCESSES • The latest Designed to Smile report shows a drop of about 6% in the number of 5 year olds with tooth decay.

• Parents tell us their children enjoy the lessons, and are more likely to brush their teeth at home.

• Tooth decay is still common in children in Wales.

Parents can help their children by making sure children in Wales brush their teeth twice a day with fluoride toothpaste and keeping sugary foods and drinks to mealtimes only.

Read more at www.designedtosmile.co.uk 6 The Annual Quality Statement for NHS Wales 2014

Helping people lose weight Cardiff & Vale University Health Board’s qualified dieticians run short courses for small groups called ‘Eating For Life’. The courses help people change what they eat so they can be healthier.

The health board has also developed Foodwise, a weight management programme run in communities by partner organisations like Communities First and leisure services.

The health board has supported people to change their lifestyle before having non-urgent surgery. Smoking and being overweight both increase the risk of surgical complications, such as s to p b e in g It h e lp e d m e to developing life-threatening I g o to th e . to ta o p h c u o ac blood clots or infections. The e la b e ls fo r th d a re I . s p o sh programme helps people n e a lo t o f o d e v I’ . ts fa lo w to stop smoking and lose o u ld n ’t h a v e w I t a th s g in th weight, reducing the risk e h e lp . th t u o h it w e n do of harm or complications th e by ed p el h , en – K ar as a result of surgery. fe ’p ro g ra m m e ‘Ea ti n g Fo r Li

1. Helping you to stay safe and healthy

The importance of vaccination against diseases was shown by the recent measles outbreak in Wales.

Not being vaccinated means you are at a much greater risk of catching a disease, which could even be fatal.

We know that vaccinating children against measles, mumps and rubella (MMR) is the best way to protect them from these damaging and potentially deadly diseases. The MMR vaccine has been proven to be safe, despite media scare stories in the past.

Low levels of vaccination make it more likely that an outbreak of one of the diseases will occur.

Between November 2012 and July 2013 Wales experienced the largest measles outbreak since

Teenagers at risk received MMR vaccinations

Vaccinating children against deadly diseases the introduction of the MMR vaccine. In total 1,202 notifications of measles were received. Measles can be fatal, and unfortunately one person did die in this outbreak. More than

7 The Annual Quality Statement for NHS Wales 2014

77,000 doses of MMR were given to people across Wales during the outbreak.

We also saw a record uptake of MMR vaccines for children aged two (95.9%) and five (92.9%).

SUPPORTING PEOPLE TO QUIT SMOKING All health boards are working with Public Health Wales to provide sessions for people to give up smoking.

Some of these are provided

by Stop Smoking Wales.

Stoptober was another high profile campaign that encouraged people to try to quit in October.

Expectant mums are also encouraged to stop smoking and are offered quick referrals to sessions to enable them to stop. www.stopsmokingwales.com

DID YOU KNOW? People are four times more likely to quit smoking when they get support rather than by going it alone.

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Keeping you safe while you are in our care We have made patient safety a priority in NHS Wales. We aim to avoid all possible harm when we care for people, whether that’s in hospital, in community services, or in your home.

We have targeted particular areas where we know people can suffer harm. For example, we are addressing issues around infections and also sepsis. We want to make sure medicines are used safely, for example, warfarin, which is used to thin the blood. We know that moving people who are elderly and frail from their home into hospital can also put them at risk so we are working hard to provide more care in the community.

We monitor how safe your care is through staff reporting patient safety incidents, such as falls, pressure ulcers, infections or medication errors. We encourage reporting so we can ensure everyone learns and improves when things go wrong.

When we see themes and trends we issue a patient safety alert setting out clear actions for staff to take. Find out more at www.patientsafety.wales.nhs.uk We know we need to do more, despite our successes so far. We have set clear priorities for all NHS organisations to make care safer and we are keeping a close watch on what happens. You can help us to help you keep safe – by telling us if you are concerned if we missed something or may have done something wrong.

8 The All Wales Annual Annual Quality Quality Statement Statement for NHS 2014 Wales 2014

2. Keeping you safe while you are in our care

Ask about Clots

Reviewing the care of every person who has died in hospital

One patient risk that we work hard to prevent is that from blood clots (thrombosis) that may develop when you are in hospital.

A simple assessment can identify people at risk from blood clots. For those at risk there are drugs that can help prevent blood clots and save lives.

All health boards in Wales review the care of patients who have died in hospital – this is called a ‘mortality review’.

Ask About Clots' PULL UP BANNER English PRINT.pdf

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To help promote the use of assessments and antithrombosis drugs, the national ‘Ask about Clots’ campaign was developed by 1000 Lives Improvement and supported by Lifeblood, the thrombosis charity. The campaign is helping members of the public to understand the risk, so they can ask for an assessment and be given the appropriate treatment. It is also raising awareness among staff to remind them to carry out the assessments and give the necessary drugs.

Find out more at www.askaboutclots.co.uk 9 The Annual Quality Statement for NHS Wales 2014

The notes are checked to ensure patients received the right care and treatment. By looking at patient notes in this way and asking questions we can identify ways to improve care.

In the 6 months to March 2014 NHS Wales completed over 4,000 mortality reviews to see if there were improvements in care that were needed. An independent review during 2014 commended this approach and it is now routine practice in NHS Wales. Through this process we identified the need to improve how to care for very ill people nearing the end of their life and instructions for staff about whether to attempt to resuscitate people. We have developed a new approach to be used across Wales.

Implementing this in 2015 is a key priority for us.

2. Keeping you safe while you are in our care

Driving down infections

Identifying and treating sepsis

18% Deaths from

M RSA re duced by

*2013 sta tistics

Infections can be very harmful. Many infections that people get in healthcare settings are preventable.

Staff across Wales are working hard to prevent patients getting infections while they are in hospital.

This work includes improved cleaning and sterilising techniques, focusing on the importance of handwashing and quick responses if infections do occur.

We also want to prevent the over-use of antibiotics to try and maintain their effectiveness. This means not prescribing antibiotics when they won’t do any good. We are working closely with GPs to make sure antibiotics are not given out if they aren’t needed.

C.difficile is one of the most well known infections that affect people in hospitals and in the community. Concerted efforts by NHS Wales staff

10 The Annual Quality Statement for NHS Wales 2014

34%

across Wales have reduced infection rates, which is very important in providing safer care and enabling people to return home more quickly. We have learned several lessons from an outbreak in Betsi Cadwaladr University Health Board.

Even though we have made progress, levels of infection remain too high so there is still some way to go to meet target figures for preventing infections. This remains a priority focus for NHS Wales.

Sepsis can be a life threatening condition when the body’s response to an infection goes into overdrive and starts to attack its own organs.

It can be caused by something as simple as a cut or insect bite, or an infection like pneumonia.

It is also a risk following surgery, or for women who have just given birth. Sepsis is often a contributory factor when people suddenly get ill and die.

Every health board and trust is actively involved in tackling sepsis. We have issued specific guidance to organisations that they must use if they identify sepsis. These patient safety notices are important to make sure care is given quickly.

2. Keeping you safe while you are in our care

Preventing injuries from falls Falls are a major cause of disability and death in older people in the UK, and cause significant problems for people in terms of pain, loss of confidence and independence. Preventing falls has been a major focus for all NHS Wales health boards and trusts.

ACTIONS TO TACKLE SEPSIS • All NHS Wales organisations take part in World Sepsis Day each year; a global event promoting the best ways of preventing sepsis through raising awareness of the symptoms and action needed.

• Staff in all health boards have had rapid response training to use the six key elements of sepsis prevention – known as the ‘Sepsis Six’.

• We use the National Early Warning Score (NEWS) to monitor the health of patients in hospital.

• Many hospital wards keep kits of anti-sepsis equipment to enable quick treatment as soon as sepsis is identified.

W atch a video filmed in Wales for World Sepsis Day here www.bit.ly/wsd13vid 11 The Annual Quality Statement for NHS Wales 2014

For example, Hywel Dda University Health Board has worked in partnership with the leisure department of Carmarthenshire Local Authority to develop exercise programmes for frail adults to improve stability and encourage people who have had strokes to find ways to exercise. The programmes are delivered in community venues across Carmarthenshire.

A care pathway has been introduced, in partnership with the Welsh Ambulance Service to enable older adults who have suffered a fall to

remain at home, following assessment from paramedics.

These people are followed up by the Community Resource Team who do a falls risk assessment and identify ways to reduce the risk of further falls.

GPs can also refer people who are frail or at risk of falling to the Community Resource Teams for assessment. For those older adults who continue to fall despite receiving help, there is also rapid access to a frailty assessment service with a specialist in caring for elderly people and a multi-disciplinary team.

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Treating you with dignity and respect Everyone has a right to be treated with dignity and respect and we believe this is very important. It means treating people with kindness and compassion. This is something that we must always get right. We are pleased that most people tell us that they are very happy with the care they receive, but we know there are occasions when the quality of the care we provide does not meet the standards we expect. When this happens we take action so that we can learn and put things right. We have ensured all of NHS Wales learnt from the findings of a review called Trusted to Care into standards of care in two of our hospitals.

There are many other ways in which we monitor how well we are doing and where we need to improve. We have set clear standards and we check these regularly. A report is published each year to show progress against these fundamental standards. We have also been working hard to make the improvements identified by the Older People’s Commissioner for Wales following her review.

We have inspectors who visit all NHS Wales hospitals throughout the year to check people are receiving safe and compassionate care. The inspectors publish their reports so everyone can see how well hospitals are meeting expectations.

Vist the Healthcare Inspectorate Wales website here: www.hiw.org.uk

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3. Treating you with dignity and respect

Spot Checks for Quality

Continence care We know that continence is a major concern for people who go into hospital, particularly if they are older.

We needed to make sure the issues raised in Trusted to Care were not widespread in Wales so we made unannounced spot checks of 70 adult acute wards across 20 hospitals in Wales and nearly half of all mental health in-patient wards for older people.

These visits observed care to ensure that patients were receiving medication correctly, including the use of sedation and also that individual drinking and toileting needs were being met. They also provided an opportunity to speak to patients, families, carers and staff about the care provided.

These visits identified lots of good practice as well as areas that we can improve. These areas of improvement include things like improving the storage of medicines on the ward and reviewing the amount of documentation recorded by staff. We are also going to launch an awareness raising campaign across Wales to highlight the importance of drinking more fluids and avoiding dehydration.

Trusted to care: www.bit.ly/TrustedtoCare Spot checks: www.bit.ly/NHSWspotchecks Fundamentals of Care: www.bit.ly/fdmtlcare 13 The Annual Quality Statement for NHS Wales 2014

Continence was looked at very closely in the spot checks. We want people to receive help to go to the bathroom if they need it.

We also want to make sure that catheters are fitted safely if they are needed, to reduce the risk of people getting urine infections.

For three years NHS Wales organisations have taken part in a programme to promote the safer use of catheters. We have introduced a ‘care bundle’ (a combination of the safest ways of working) for catheters, which has reduced the number of infections. In Powys Teaching Health Board

the programme has been extended from hospitals into the community and is being used by community nurses.

A national continence tool is used to assess the needs of patients and assist them if they are incontinent.

These measures are checked through the fundamentals of care reporting system.

Whilst the spot check visits identified many areas of good practice, we also found areas where improvements were needed. These wards have been asked to make improvements. Continence care will be checked by our inspectors during their visits.

3. Treating you with dignity and respect

The number of people with dementia in Wales is increasing because people are living longer.

This means that many patients in hospital have dementia, even though they are often being treated for other things.

It is really important that people who are living with dementia receive appropriate care and are made to feel safe and secure. We are prioritising this in the coming year.

Hywel Dda University Health Board was the first health board in Wales to embed the Butterfly Scheme to identify and provide tailored care for dementia patients in hospitals. More than 1,000 staff have been trained and the health board is planning to appoint ‘Butterfly Champions’ on each ward. The scheme

Making sure we are a dementia friendly service has also been translated into Welsh.

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In Cwm Taf University Health Board a ‘forget-me-not’ is used to identify patients who have dementia or other memory problems.

The forget-me-not reminds healthcare professionals to

provide extra levels of support if necessary. Patients with dementia complete a ‘This is me’ leaflet with the help of family members, which contains information about their preferences and life to help staff provide personalised care.

3. Treating you with dignity and respect

Ensuring dignity at the end of life

We are determined that people receive compassionate and safe care as they approach the end of their lives.

The individual’s needs and wishes must be at the centre of all services and families need to be supported as well. Many people would prefer to die at home rather than in hospital and we would like as many as possible to have their wishes met.

We are proud that Wales is the only UK country to offer 24/7 access to palliative care services. Families of people who have died tell us that overall their experience was positive. We measure this using a rating called iWantGreatCare, and the average score for end-of-life care is 9.5 out of 10.

One of the ways we have improved care is through the introduction of ‘Just in Case’ boxes to ensure that specialist medication can be easily accessed from a number of facilities such as pharmacies and hospitals to ensure that teams are able to give effective drugs to patients outside normal opening hours.

V isit iWantGreatCare Wales www.bit.ly/iwgcwales 15 The Annual Quality Statement for NHS Wales 2014

Dying at home We know that most people would be prefer to die at home, rather than in hospital. And this was certainly the case for Mr T, who was diagnosed with an advanced and untreatable primary cancer which had spread to his liver.

With only his son living nearby, he was keen to be able to die at home and a discharge was planned to enable this to happen. Mr T was a very private man and didn’t want to be seen by lots of different healthcare professionals. He also had specific requests for how he wanted his personal care to be provided.

A clinical nurse specialist from St David’s Hospice Care met with Mr T and was able to explain to him and reassure him about his end of life care. A small team of home nurses were allocated to respond to his request for a minimum number of professionals to be involved. They were also able to support Mr T’s son, who was finding the sudden deterioration in his father’s health difficult to cope with.

Mr T spent the last two weeks of his life at home and died with his son present. The hospice nurse was able to wash Mr T and dress him in the clothes he had wanted to wear and stayed with his son until the funeral director arrived.

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Working with you to make sure you receive the right care We want to work with you to make sure that the care and treatment you receive is appropriate. We do this by ensuring that any treatment has been proven to work based on the best available research. Sometimes we may be the ones finding the evidence, which is why we are committed to taking part in research to find new ways of working and trying out new treatments.

We also want to make sure that everyone in Wales receives effective treatment, wherever they live and whichever organisation is delivering the care. This is our commitment to equity – making sure everybody can be sure they are receiving high quality healthcare. We are finding new ways of delivering services so that people don’t have to travel long distances to hospitals, or even not have to go to hospital at all. We are committed to providing high quality services in different places, not necessarily in every hospital, and as close to peoples’ homes as possible.

To help us achieve these aims we produce delivery plans which provide guidance and direction to NHS Wales on specific areas including: stroke, heart disease, cancer, end of life, respiratory health, critically ill, diabetes and eye care.

All the Delivery plans can be found here: www.bit.ly/delivplans

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4. Working with you to make sure you receive the right care

Improved care for patients with kidney disease

Watch the video at www.bit.ly/nightdialysis

The renal team from Abertawe Bro Morgannwg University Health Board has successfully introduced a night-time home award winner renal dialysis service for patients with chronic kidney disease. This has made a big difference to patients’ quality of life, for example, they are able to spend d a ll more time with their families It h a s im p r o v e li fe a n d doing the things they enjoy, aspects of my . they don’t have to travel to m y fa m il y ’s li fe hospital as often, and they are a n s ea – H a y le ig h , S w experiencing much better health.

MAKING SURE CANCER TREATMENTS ARE THE BEST THEY CAN BE There are many aspects to providing high quality cancer care, including encouraging people to live lifestyles that can help prevent cancer occurring. If people do develop cancer, it is important that it is diagnosed quickly.

Surgery, radiotherapy and chemotherapy options need to be decided quickly so people receive treatment as soon as possible.

people with cancer. The peer reviews are a mix of self-assessments and inspections by experts. Reports have been published on treatments for lung cancer and an all-Wales review of lung cancer services is available. It is essential that we meet the high standards that we want to achieve, so taking part in national reviews and audits are very important. It also means that any problems can be identified and addressed.

NHS Wales conducts ‘peer reviews’ of cancer services to make sure that all organisations are delivering the best possible care for 17 The Annual Quality Statement for NHS Wales 2014

Read the Lung Cancer 2013 Peer Review All Wales Report at www.bit.ly/lcwales

Improved health outcomes from 'Leg Clubs' In Powys Teaching Health Board the district nursing team has established a number of specialist ‘Leg Clubs’ which enable patients to receive treatment in a local community venue rather than hospital.

The new way of delivering care has resulted in much better treatment for people.

It has improved the healing of ulcers and patients say the social aspect of the clubs is really valuable to them. It has also reduced the number of times people have to go into award winner hospital.

4. Working with you to make sure you receive the right care

Better care for mums and babies • Asking women and their partners about their experience of maternity services and using feedback to improve services.

• Supporting women to live healthy lifestyles.

• Improving direct access to a midwife by 10 completed weeks of pregnancy.

Keeping you safe at home Staff in the Welsh Ambulance Services Trust are working to organise care for people in their homes through the alternative care pathways project. Ambulance staff use community services for patients who have fallen or had epileptic or hypoglycaemic episodes. Instead of taking them to hospital, paramedics g n ri su can refer patients to their GP or an Th is w or k is en t os m e th identified community team. p a ti en ts re c ei ve om th e fr , re a p p ro p ri a te c a , a t th e ri g h t ri g h t c li n ic ia n e ri g h t p la c e. ti m e a n d in th el sh ea n , W – Gr ay ha m M cL ce s N H S Tr us t. vi A m bu la n ce S er

18 The Annual Quality Statement for NHS Wales 2014

Our vision for maternity services in NHS Wales is a service where pregnancy and childbirth are recognised as an event of social and emotional significance. We want women and their families to be treated with dignity and respect.

We want pregnancy and childbirth to be a safe and positive experience for every mother, wherever they live and whatever their circumstances. To achieve this Health Boards are:

• Increasing normal birth rates and reducing caesarean sections.

• Encouraging mothers to breastfeed their babies.

A range of support is provided to parents and their children through the Welsh Government’s Flying Start, early years programme.

Parents living in Flying Start areas are provided with an enhanced health visitor service alongside parenting support, part time quality childcare and help for early language development.

4. Working with you to make sure you receive the right care

THE DIFFERENCE YOU CAN HELP MAKE Velindre NHS Trust has opened a new Clinical Research Treatment Unit in the Velindre Cancer Centre.

This means patients will be able to take part in ‘cutting edge’ early phase trials of new drugs for the first time in Wales. Patients have already been recruited to more than 70 research studies.

Helping patients with long-standing 'wounds' to heal People with wounds like pressure ulcers and other damage to skin will be helped by the world’s first centre of excellence in wound prevention and treatment that has opened in Wales.

The Welsh Wound Innovation Centre (WWIC) is a partnership between NHS Wales, Welsh universities, companies and the Welsh Government.

Wounds and skin damage can often occur in patients in hospital or people in the community who have reduced mobility. The new centre will help develop new treatment methods to help people who are suffering with wounds. It will also identify the ways to prevent wounds from developing or getting worse.

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The Welsh Blood Service

DID YOU KNOW?

Male donors can donate blood every 12 weeks and female donors every 16 weeks.

The Welsh Blood Service is part of Velindre NHS Trust and relies on strong relationships with the public to ensure supplies of blood and plasma are available for healthcare organisations in Wales. They have particularly targeted increasing the number of people on the bone marrow donations register to ensure people with very serious diseases can receive vital transplants.

NHS Wales is grateful to everyone who has donated to the Welsh Blood Service. The number of bone marrow donors has exceeded all targets, and many patients have benefited from vital treatment. Thank you.

RESEARCH IN WALES NHS Wales is taking part in research to improve several areas in healthcare. These include: HPVrelated cancer, rehabilitation for Parkinson’s disease, early detection of type 1 diabetes in young people, treating thyroid eye disease, kidney disease in babies and toddlers. We can only do this with so many of our patients helping and taking part. In 2014 the Welsh Government, via NISCHR, distributed £40.5 million to support research in health and social are in Wales.

... To meet the need for blood in hospitals in south, west and mid Wales.

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Making sure you receive care quickly and effectively NHS Wales is committed to making sure you receive the care you need, when you need it.

Many healthcare issues are best resolved quickly so people get back to normal life, or as near as they can get to it quickly. We know that in some areas people are waiting too long to be treated. We are working hard to improve this. We are prioritising services where it really matters so people are being seen and treated on time. We have looked particularly at making sure people can see their GP when they need to.

Our ambulance service and hospital emergency departments have been under pressure.

We are acting to ensure that our emergency services can respond to local needs. This also means providing more services in our communities to prevent the need to go to hospital if there are more appropriate alternatives. We are working closely with our partners in social care and other agencies to provide integrated services which best meet your needs.

But this is not just an issue for emergency care. There are thousands of operations, tests and treatments scheduled every day in NHS Wales. Finding the balance between providing emergency care and ensuring all the planned operations and other procedures can take place is a challenge. We need to provide all our services in a timely way and we are working hard to ensure that people have the care they need without having to wait too long for it.

You can help us achieve this. Please Choose Well when using NHS Wales services.

We know many people already do – thank you!

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5. Making sure you receive care quickly and effectively

Dr Olivia's Guide to A&E Many of the people who come to A&E would find it more useful to use other services, such as the emergency dentist or local pharmacy. Aneurin Bevan University Health Board is explaining that important message in a film featuring Wales’ youngest A&E consultant, Dr Olivia.

Dr Olivia’s Guide to A&E: ‘Is it really an Emergency?’ has already been watched by thousands of people and has featured on the BBC News. It’s a fun way of communicating a very important message.

IMPROVING PATIENT FLOW Staff at Cwm Taf University Health Board have improved ‘patient flow’ in their hospitals, reduced delays and made sure patients receive treatment more quickly.

The ‘Focus on Flow’ project has seen a reduction in levels of demand on accident and emergency services and increased the number of patients handed over into hospital from an ambulance within the 15 minute award winner target.

You can watch it here: www.bit.ly/drolivia

Avoiding unnecessary pressure on our emergency services The Alcohol Treatment Centre (ATC) in Cardiff city centre helps reduce the number of people going to the Accident award winner & Emergency department at the University Hospital of Wales because of alcohol related injuries. 70% of Accident & Emergency admissions at peak times are due to alcohol, increasing the potential for anti-social behaviour and violence, as well as meaning people have to wait longer to be seen.

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It’s important for everybody in Wales to Choose Well. Phone NHS Direct Wales on 0845 46 47 to find out where it’s best to seek help.

Less than 25% of people treated in the ATC were sent to hospital.

Many patients said the care they

Less than

25%

received had helped them to stop drinking to excess again.

5. Making sure you receive care quickly and effectively

Prioritising eye care

STEPS WE ARE TAKING IN WALES

5000

• We are funding 5000 Eye Health Examination Wales (EHEW) appointments across Wales. This has meant that 5000 patients who would have had their appointment in a hospital eye service are able to access eye care at their local accredited optometrist.

• Your local high street optometrist can give We are committed to improving services for people with poor eye health and sight loss. We know some serious eye conditions can need very quick treatment and we know that sometimes treatment has unfortunately not been given quickly enough to prevent people from losing their sight.

We have published a plan which explains what NHS Wales is doing to improve eye-care services to ensure people receive the care they need. We are moving more services out of hospitals to make them easier to access, nearer to where people live.

22 The Annual Quality Statement for NHS Wales 2014

Eye Health Examination Wales

you expert advice on eye problems that need urgent attention and the best way to treat them. They have better equipment than GP surgeries for examining eyes.

• Tackling delays and backlogs in ophthalmology clinics.

• New ‘e-referral’ system to make sure people are seen more quickly.

• Upgrading equipment across Wales to improve scans and tests.

• We are undertaking school projects helping children understand the importance of eye health.

5. Making sure you receive care quickly and effectively

Much faster access to expert advice for heart patients We want to ensure that when patients need expert advice they can access it quickly.

One example of this is Betsi Cadwaladr University Health Board needing to ensure people with heart problems can access expert cardiology advice when they need it.

A new programme of rapid testing in community venues combined with ‘virtual’ links with cardiology consultants has achieved faster, safer care for people by providing services nearer to their homes. There is still some work needed to ensure all treatments are available, but there have been some notable successes.

• Rapid access to expert advice and management dropped from over 30 days waiting to less than 2 days on average.

• 80% of people are safely discharged with the right treatment, without having to go to attend a hospital clinic.

• High patient and GP satisfaction rates with the service.

Find out more in this video: www.bit.ly/bcucardio 23 The Annual Quality Statement for NHS Wales 2014

Improving access to surgery for heart patients Heart surgery is a serious matter, and only performed when absolutely necessary. Once the decision to proceed with heart surgery has been made it is very important that people do not wait too long for their operation.

Cardiff & Vale University Health Board has acted on concerns over waiting times for heart surgery patients.

While the recovery rates for

people who had the surgery were very good, some people were not receiving their operation in time and died while waiting.

To deal with this we increased the number of open heart operations to ensure people get the surgery they need. We are committed to ensuring people who need this important surgery will receive it safely and sooner than before.

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Treating you as an individual The things that matter to you also matter to us. We want to work with you to get your care right ensuring it meets your individual need, involving your family or carers when needed.

We are developing new ways of listening to what people are telling us about our services as we want to know what really matters to people. We also want people to tell us about any concerns they have about their care if they feel they have been let down. We use a process called ‘Putting Things Right’ to deal with issues and complaints raised by patients. We have reviewed this recently so we know we need to make it easier for people to have concerns dealt with. We need your help with this – please take any opportunities to tell us what you think about the care we provide and how we can improve things quickly.

We have found it very helpful to hear stories from patients. Health boards often include a patient story in their meetings. This provides real human context for discussions about quality issues. We would like to thank every person who has told their story. It is incredibly valuable to us as we seek to continuously improve.

24 The Annual Quality Statement for NHS Wales 2014

6. Treating you as an individual

Language matters We want everyone to have the best quality healthcare on offer. We know that some people can only express their needs for care effectively by speaking Welsh, and that especially when people are ill or vulnerable, they can feel more comfortable speaking to a member of staff in Welsh.

We also know that we need to make an ‘active offer’ – people might not ask for healthcare staff to speak Welsh; we need to make sure people are asked what language they would prefer us to use.

There are several examples of how we are extending language choice in all areas of health services. Betsi Cadwaladr

25 The Annual Quality Statement for NHS Wales 2014

University Health Board has launched a bilingual text message reminder service which is helping people keep outpatient appointments. Patients are given a language choice from their very first appointment. Speech and language therapists in Abertawe Bro Morgannwg University Health Board have started using new Welsh-language tools to help children under three years old who speak Welsh.

Over the coming year we need to focus on delivering actions in our national strategy ‘More Than Just Words’ and the upcoming Welsh Language Standards.

More than Just Words: www.bit.ly/mtjwfbl Welsh Language Commissioner: www.bit.ly/comgymg

A VALUABLE TWO MINUTES 2 Minutes of your Time is a survey developed by Cardiff & Vale University Health Board. It is based on issues which have been shown to tell us whether patients feel they have been treated with dignity and respect. In response to the surveys, the health board has prioritised improving patients’ comfort on wards and discharge processes.

6. Treating you as an individual

Service users help develop better directions Hywel Dda University Health Board award winner has worked with people who use their services to develop better hospital way-finding and signage.

The health board worked closely with adults with learning disabilities, staff, the local community health council and patients to design signs that use symbols and colours.

Using colour zones and

Investing in carers

easily recognisable symbols is an effective way of communicating clear directions, particularly for adults with learning disabilities. Feedback from users, particularly people with literacy issues, has been positive. People have found it easier to identify which department they need and how to get there.

Find out more in this video: www.bit.ly/hdsignage

26 The Annual Quality Statement for NHS Wales 2014

Carers play an incredibly important role so we want to support them as best we can. For example, GP practices in Aneurin Bevan University Health Board are working to identify and proactively support people who act as carers for family members in a Local Enhanced Service using the Royal College of GPs Carers Toolkit. GPs are also encouraged to identify and offer particular support to young people who are acting as carers.

In Hywel Dda University Health Board, GP practices, hospitals and pharmacies are taking part in the Investors in Carers scheme, which offers more support to carers. The health board is also developing a Young Carer version to use in partnership with secondary schools to support teenagers who care for a disabled or ill parent or family member.

6. Treating you as an individual

Caring for the mind Mental health is a major area of investment for NHS Wales. There are a number of programmes running throughout Wales that emphasise the importance of mental health in everyday life, for example in our schools.

This year we have developed a strategy to reduce rates of suicide and self-harm in a programme called Talk to Me 2. We are working with several other organisations to prioritise people who are at risk of suicide or self-harm. We are also seeking to learn from incidents in mental health services to help us improve.

We have also started a major programme to ensure children and young people with mental health problems and their families receive the advice and support they need in a timely manner.

‘ACT-ion for Living’ provided by Cardiff and Vale University Health Board consists of weekly sessions of mindfulness-based therapy. It has two main messages, accept what is out of your personal control and commit to action that improves and enriches your life. It helps people clarify what is important and meaningful to them then uses that knowledge to guide, inspire and motivate them to make changes that will make life better.

27 The Annual Quality Statement for NHS Wales 2014

Velindre NHS Trust has developed ‘Top tips’ to help people cope with common difficulties when receiving treatment for cancer. These include fatigue and low mood. Children also need support through a family member’s illness. Staff are being equipped to direct families and carers of patients to information and support from clinical services.

In Powys Teaching Health Board, children and young people are offered ‘blended counselling services’ that includes online therapy services and face-to-face school based counselling. Young people can access face-to-face counselling and benefit from online support without being referred by a doctor.

Improving general hospital care for people with learning difficulties is being rolled out across Wales.

This means taking key steps to ensure: • Early recognition of patients with learning disabilities • Effective communication with patients, carers, family members and clinicians • Dignified, person centred care and treatment • Effective review and discharge planning Abertawe Bro Morgannwg University Health Board piloted the work and now report 100% compliance, other health boards are now at different stages of the roll out, which includes training for all staff.

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A big thank you to everyone who works for NHS Wales The people who work for NHS Wales make the difference in everything we do. Their passion and commitment shines through the services we deliver. We want to recognise and reward this where we can, which is why we run the NHS Wales Awards annually. The innovation and hard work showcased in the Awards is inspiring.

It would be impossible for us to provide so many services and treatments day in day out throughout Wales without the commitment and passion of our staff and primary care contractors. This also extends to the many volunteers and third sector organisations who also provide care, support and practical help to people who need it. I want to take this opportunity to offer a sincere thank you to everyone who works for the NHS and our partner organisations.

28 The Annual Quality Statement for NHS Wales 2014

7. A big thank you to everyone who works for NHS Wales

Our staff

We know staff wellbeing is hugely important. When staff aren’t cared for then the quality of the care they provide can drop.

We are taking steps to ensure staff receive the support they need to carry on providing care to others.

We also want to ensure staff can raise concerns that they may have.

Although we have increased the number of staff overall working in NHS Wales by nearly 10 per cent since 2004, we are seeing issues recruiting to certain roles.

We are increasing our efforts

The number of GPs in Wales has increased by more than 10% since 2004.

to recruit doctors at all levels as we realise we need more medical staff. There are also opportunities for us to explore more innovative working models to make sure we are delivering the care that is needed.

We also want an empowered workforce, recognising there are many people who work for us who are not directly employed by NHS Wales, but work on a contract basis.

We also value the huge input from volunteers and people working in the Third Sector who contribute to providing support and care for people across the country.

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Recruiting more nurses One of the main issues identified in recent reports published about poor care across the UK is the need to ensure there are enough nurses working on hospital wards.

NHS Wales has committed to ensuring there are enough nurses to provide everyone with safe, effective care. We have invested an extra £10m every year since 2013 for health boards to use to ensure the right levels of nursing staff are employed to provide quality services in the future.

We have been increasing the numbers of training places for nurses each year. There are also ‘return to practise’ courses for people who have trained but are not currently working as nurses, and who would like to come back.

7. A big thank you to everyone who works for NHS Wales

Improving Quality Together Over 12,000 NHS Wales staff have completed the first level of Improving Quality Together.

Improving Quality Together (IQT) is the national learning programme for all NHS Wales staff and contractors. It provides a common and consistent approach to improving the quality of services in NHS organisations across Wales.

ty Together Improving Quali whole team just gives the ension and a different dim pective a different pers id off. and it really pa s M an ag er , – Ju li a, B u si n esg H ea lt h B oa rd P ow ys Te ac h in

IQT will help all staff improve the way they work to ensure you receive even better care. It is also helping create better working environments, to make your care safer, reduce the number of delays if you need treatment, and help you return to your normal life as quickly as possible after receiving treatment.

You can find out more about Improving Quality Together online: www.iqt.wales.nhs.uk Watch Julia explain the difference IQT makes: www.bit.ly/iqtjulia

30 The Annual Quality Statement for NHS Wales 2014

DELIVERING EXCELLENT CARE BEYOND OUR BORDERS 55 members of NHS Wales staff were deployed as part of the army reserve unit 203 (Welsh) Field Hospital to Helmand province in Afghanistan in 2013. The six month tour of duty has provided staff with valuable experience that is leading to new approaches to work back here in Wales.

7. A big thank you to everyone who works for NHS Wales

Volunteer team supports older people

NHS Wales values the many people who give up their free time to help provide additional support to those that need it.

For example, the Care Home Ask and Talk (CHAaT) volunteer service was developed in Aneurin Bevan University Health Board in partnership with the NHS Retirement Fellowship. It is a unique volunteer service made up of retired NHS professionals who support older people living in care homes.

award winner

The ChAaT offer ‘face to face’ meetings, providing an

locally within the community.

BRINGING SERVICES CLOSER TO YOU We are investing an additional • Provide skilled healthcare £40 million as part of a plan professionals in your local area. to improve access to primary • Give patients access to GPs, nurses care services across Wales. and pharmacists on the day they Our aim is to allow people to be cared need it, either face to face, on for closer to their homes, helping the phone, by email or video call. people look after themselves and avoid • Have teams of health and unnecessary hospital appointments. social care professionals We want to: working around a patient to • Plan and deliver health services give them the treatment they need.

31 The Annual Quality Statement for NHS Wales 2014

opportunity to talk in private or groups about the experiences of individuals living in a nursing care home. The focus is on quality of life, making sure people living in nursing care homes are safe, well cared for and enjoy living in the home.

There are many other examples of volunteers making important contributions to the ongoing work of NHS Wales – on behalf of everyone who works in NHS Wales, thank you!

Watch the video: www.bit.ly/abchaat

Our focus for the year ahead

Our focus for the year ahead We have given you a summary of the things that we have been doing within NHS Wales to keep improving the services we provide for you. We also want to reassure you that when we identify things that cause concern we will take action. It is also important for us to look forward and ensure that we are clear about what we need to do in the year ahead to make further improvements where we know we need to.

We want to work with you to help you take as much care and responsibility that you can for your own health or that of your family. We know that leading a healthy lifestyle can help prevent us from becoming ill.

‘primary care clusters’ will be coming up with local solutions to meet local challenges and needs. We want to work towards providing as much care as we can within your local community and prevent unnecessary trips to hospital.

We will develop integrated health and social care services with our partners that can be provided as close to peoples homes as possible. To do this we will be investing in our primary care and community services. What we call our

More timely care We want to ensure that we prevent delays in treatments. In some cases, this will take time but we have a number of programmes in place to introduce new ways of working to help

32 The Annual Quality Statement for NHS Wales 2014

achieve this, building on the examples we’ve described in this document.

We will continue to turn the recommendations of the ‘Trusted to Care’ report and our spot checks into action. For example during the summer we will introduce a campaign around preventing dehydration to ensure people are not affected by this easily avoidable condition.

We will continue to prioritise making sure that we identify people affected

Our focus for the year ahead

to meet their need and preventing people from getting ill in the first place.

by dementia as early as possible so they can receive the care that is best for them, especially when they are in hospital. This year we will be taking a range of actions to ensure that Wales becomes a dementia friendly nation.

Respecting people’s wishes We want to ensure we provide dignified care for people at the end of their lives. We want to have conversations with people about whether or not to attempt to resuscitate if they are very ill and close to death. We want to have these conversations well before decisions need to be made so that when people are dying they can have their wishes respected.

We are committed to improving the way that we respond to any feedback

and complaints about the care we provide. We want everyone to feel able to let us know immediately if they are concerned about their care so that we can put things right.

We are taking a number of actions.

This includes making sure that we have good systems to share and act on any learning from when things may go wrong.

A prudent approach The principles of prudent healthcare will be very helpful as we look to develop our services. We want to prevent harm, use treatments that we know work, and make sure our services are sustainable. We especially want to work with the people who use our services to find better ways of caring for people

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Healthcare is ever changing with new treatments and equipment, so we know that we can never stand still. We also need to contribute to this new knowledge so all of our organisations will be taking part in research so that we can continue to introduce innovative ways of working.

Above all, we want to ensure that we provide safe, compassionate, personcentred care. We are committed to putting things right if we get them wrong. We want to act on people’s feedback and work with the people of Wales to continue to ensure we have a National Health Service we can all take pride in.

Thank you for reading this Annual Quality Statement. Our mission is to deliver high quality health services to you. If you would like to comment on this publication or any other aspects of care in NHS Wales please email YourHealth@Wales.GSI.Gov.UK

More information about NHS Services

Where you can find more information about services near you If you would like to read about health services in your area, here are the links to the Annual Quality Statements published by the health boards in Wales for 2013-14.

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1. Abertawe Bro Morgannwg University Health Board www.bit.ly/abmuaqs 2. Aneurin Bevan University Health Board www.bit.ly/anbevaqs 3. Betsi Cadwaladr University Health Board www.bit.ly/bcuhbaqs

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4. Cardiff & Vale University Health Board www.bit.ly/cavaqs

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2

5 4

5. Cwm Taf University Health Board www.bit.ly/ctafaqs 6. Hywel Dda University Health Board www.bit.ly/hddaaqs 7. Powys Teaching Health Board www.bit.ly/powysaqs

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The three NHS Trusts in Wales also produce Annual Quality Statements – here are the links to the publications for 2013-14 Public Health Wales NHS Trust www.bit.ly/phwaqs14 Velindre NHS Trust www.bit.ly/velindreaqs Welsh Ambulance Services NHS Trust www.bit.ly/wastaqs

Additional links My Local Health Service mylocalhealthservice.wales.gov.uk iWantGreatCare Wales www.bit.ly/iwgcwales

Notes about this Annual Quality Statement

Notes about this Annual Quality Statement Delivering high quality health services to the people of Wales – The Annual Quality Statement for NHS Wales 2014 was published by NHS Wales. Much of this material was drawn from the 2013-2014 Annual Quality Statements produced by NHS Wales organisations.

Every effort has been made to check the information contained in this statement are accurate and reflect current working practice in NHS Wales at the time of publication.

Delivering high quality health services to the people of Wales – The Annual Quality Statement for NHS Wales 2014 was written and produced by 1000 Lives Improvement and the ‘Working With Not To’ Co-Production project on behalf of The Welsh Government and NHS Wales.

User-experience accessibility: This report has been checked by Barod CIC to help us make it is easier to use. (www.barod.org). ©2015, NHS Wales.

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This Annual Quality Statement is a review of NHS Wales services, published by the Welsh Government.

The Annual Quality Statement for NHS Wales 2014

Delivering high quality health services to the people of Wales It covers the following topics: • Helping you stay safe and healthy • Keeping you safe while you are in our care • Treating you with dignity and respect • Working with you to make sure you receive the right care • Making sure you receive care quickly and effectively • Treating you as an individual • Our focus for the year ahead