P 59
Ymchwiliad i’r Adolygiad Blaenoriaethau ar gyfer y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon
Inquiry into the Priorities for the Health, Social Care and Sport Committee
Ymateb gan: Bwrdd Iechyd Prifysgol Caerdydd a’r Fro
Response from: Cardiff and Vale University Health Board
2 September 2016
Priorities for Health, Social Care and Sports Committee
Cardiff and Vale UHB consultation response
Cardiff and Vale UHB are pleased to respond to the consultation to inform the key priorities for the next 12 – 18 months.
1. Integration of Health and Social Care services:Cardiff and Vale UHB would support an inquiry looking into the implementation of the Social Services and Well-being Act and other policies on integration of health and social care services.
We believe that collaborative working and is vital across all of the public sector to deliver the scale of change required and would request that greater pace is given to this agenda that needs to focus not only on the NHS but with partner public sectors and the third sector. We would suggest thatit is important to look at integration across the whole of the public sector, not just integration of service provision, but also integration of policy and priorities to facilitate greater integration. The committee may want to consider metrics as a proxy for integration, such as The National Audit of Intermediate Care 2015 (England) recommendation of a 2 day wait for intermediate care access being a reasonable indicator based on the evidence that patients who wait more than 2 days lose the benefit the service. Something like this would be patient centred, simple to collect, easy to measure and could give a high level indication of improvement in integrated working. The NHS will not be able to meet its challenges without the help of other sectors, especially social services but also those in housing, education, police, fire and criminal justice services.
2. Waiting Times: Cardiff and Vale UHB would support an inquiry considering waiting times but recommend that the remit should look at patient outcomes rather than solely tier 1 targets. Waiting times are a key priority for the NHS and there has been considerable work to focus on improving waiting time. While targets have a role to play, we suggest that this is an opportunity to take a broader view to instigating a system change in the way treatment is delivered to patients and providing the best service we can within the resources available with priorities being based on clinical need. There are examples such as ophthalmology where patients in a follow up cycle may have a greater clinical need that new patients in an RTT phase, therefore a system that is rebalanced to support clinical priorities and outcomes would be welcomed. We believe that this would help address some of the current key pressure areas outlined, and recognise that without some change in waiting time priority services such as diagnostics and therapies will continue to have capacity deficits. It is an imperative that we develop a performance management framework that supports this with attention given to data collection systems and analytical capability and capacity.
3. Primary Care: We would support an inquiry considering primary care to inform the Committee of the pressures for change and the many developments in services across Wales. Cardiff and Vale UHB aims to provide modern, fit for purpose primary care facilities that support and enables the delivery of safe and sustainable care at or close to home and has a fast growing diverse population with increased requirements for a modern primary care service.
We have well developed Primary Care localities and clusters as well as workstreams to develop a “perfect locality” a multidisciplinary and multi-agency approach to maximise our community assets as part of our Bold Improvement Goal programme. We would welcome the opportunity to raise the issues we are facing, but also articulate the solutions we are developing.
4. Efficiency within the NHS and modern management practices: We would support an inquiry considering the efficiency within the NHS. The rise in demand, coupled with constrained financial resources, has made delivering health and care services in the current model increasingly difficult. Cardiff and vale UHB is committed to working more efficiently in order to rise to the challenges that it faces. However, it has become increasingly clear that traditional methods of savings are unlikely to deliver what is needed in the future. We concur with the NHS confederation analysis of the WAO report[i] and the imperative to be realistic about the current and future costs of health and care services and the need to work with all stakeholders to understand the future resources required to secure the system.
5. Neonatal services: Following from the “Bliss baby report 2016: time for change”[ii] we would support the Committee considering the recommendations with the report and the issues highlighted to deliver a sustainable model for neonatal services that meet clinical needs and that is provided by a well trained workforce.
6. Use of antipsychotic medication in care homes: Cardiff and Vale UHB support the Committee considering the scale of the inappropriate use of antipsychotics to control the behavioural and psychological symptoms of people living with dementia, and if required examine possible solutions.
7. Ambulance Services: Cardiff and Vale UHB would support a short inquiry examining the outcomes of the new Clinical Response Model pilot and consider the Review findings of the CRM pilot that will be published next year.
8. Loneliness and isolation among older people: Cardiff and Vale UHB would support a short inquiry considering loneliness and isolation for older people but we would recommend that this is extended to include all age groups due to the fact it is an issue that does not only impact on older people.
9. Gambling addiction: Cardiff and Vale UHB would support the inquiry looking at awareness of gambling addiction, the provision of support services, and the steps that could be taken to reduce harm.
10. Sport and public health: Cardiff and Vale UHB recommend that an inquiry considering public health should be a key priority for the Committee and should consider the role and impact of a preventative approach to health services and work to educate the general public about the preventative agenda, as recommended during the Health and Social Care Committee legacy report as well as being a key pillar of Prudent healthcare.
Prevention and early intervention to improve population health is a national priority for Cardiff and Vale UHB as we all recognise that it is key to improving the health and well-being of the whole population, while helping to manage demand on secondary care. In common with the rest of Wales we face a significant number of public health challenges, including high levels of obesity, drinking above the guidelines, smoking and poor levels of physical activity. The impact of such behaviours on our health is resulting in significant demand being placed on the health service. The Committee could consider the role and impact of a preventative approach to health services, and work to educate the general public about the preventative agenda and this key element of the Prudent health care agenda and future sustainability of health services.