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Cynulliad Cenedlaethol Cymru |
National Assembly for Wales |
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Y Pwyllgor Iechyd, Gofal Cymdeithasol a Chwaraeon |
Health, Social Care and Sport Committee |
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Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio Adal |
Inquiry into Community and District Nursing services |
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HSCS(5) CDN13 |
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Ymateb gan Fwrdd Iechyd Prifysgol Caerdydd a’r Fro |
Evidence from Cardiff and Vale University Health Board |
Cardiff and Vale UHB welcomes the opportunity to contribute to the Health, Social Care and Sport Committee’s inquiry into community and District Nursing Services. The Cardiff and Vale University Health board ‘Shaping our Future Well-being strategy’ 2015-2025 aims to create a joined up and integrated approach to care for our resident population based on a ‘home first’ principle. Avoiding harm, waste and variation, empowering people and delivering outcomes that matter to them based on and informed by a robust understanding of our population need. District and community nursing are core to this approach and we continue to develop our services to deliver high quality evidence based patient centred care that is planned around the diverse needs of our population
The Health Board’s District Nursing Service provides nursing services to the 3 Localities within the Cardiff and Vale UHB footprint – Cardiff N&W, Cardiff S & E and the Vale of Glamorgan. Each Locality aligns to 3 cluster/neighbourhood areas and District Nursing teams are aligned geographically as far as possible.
The District NursingService works to a singleservice specification which was developed in partnership with key stakeholders to ensure consistency and standards of care and service across the UHB.
The overall aim of the District Nursing Service is to work in collaboration with Community Directors, Primary Care Practitioners and Intermediate Care Services to provide clinically effective and safe, evidence based care to patients who are deemed as house bound, with the focus of care being promotion and maintenance of health, support through ill health, promoting and maximising independence recovery and/ or the terminal stages of life. The service is consistent with the strategic vision set by the Welsh Assembly Government in Setting the Direction, Community Nursing strategy 2009, PrimaryCare Services for Wales up to 2018 and the Framework for the Management of Chronic Conditions.
The District Nursing service is underpinned by the following principles:-
· The availability of an appropriately skilled, competent, qualified and registered nursing workforce
· To work in the best interest of the patient/client, providing high quality generalist and specialist services as part of a whole system approach to intermediate and community care service provision
· The delivery of an equitable and accessible range of serviceswhich provides continuity of care and services to individuals
· The delivery of services based on the principles of Prudent Healthcare
· The delivery of services by the relevantprofessionals at the right place at the right time in the patient pathway.
· Utilisation of new technologies in the delivery of community based healthcare and the development of IT systems that support information sharing within the confines of relevant policy and guidance
· Compliance with the requirements of the All Wales Policiesand Procedures for the Protection of Vulnerable Adults
The District Nursing Service provides predominantly home based services as a single agency or in partnership with other agencies and specialist services, to residents of Cardiff and Vale who are aged 16 years and older through provision of both scheduled and unscheduled care activities
There are a range of specialist nursing teams who operate across the UHB footprint and work closely with the District Nursing and Community Services including specialist wound care, continence and acute response teams.
There are also community nursing roles in the UHB Locality based Community Resource Teams and at cluster level focused on reablement and frailty and the UHB’s vision is to continue to develop the wider community nursing teams in line with the further development of cluster and locality based planning and management of services
· How many district nurse-led community nursing teams are there in your health board area?
· Information about the make-up of these teams i.e. numbers of staff and skill mix (registered nurses and healthcare support workers)?
There are a total of 14 districtnursing teams plus a DistrictNursing Night servicewhich operates across the entire Health Board footprint providing 24 hour access to District NursingServices.
The Locality make up is described below
· North and West Locality – 5 teams
· South and East Cardiff – 5 teams
· Vale of Glamorgan - 4 teams
· The night visiting service covers the whole UHB area
Each team is made of a Band 7 Sister/Charge Nurse who is an experienced community nurse and who has a recognised expertise and knowledge of working within the community setting and is expected to have achieved academic credibility to SPQ/Masters level.
There are a number of Band 6 deputies within each team who are responsible for caseload management and coordination of patient care within a specified zone in a cluster area and who are linked to named GP practices.
The teams also includes band 3 Healthcare Support Workers and band 5 community staff nurses with a skill mix ratio of at least 80:20, (registered: unregistered)
All team also include phlebotomists and administrative support in line with the District Nursing Principles 2017
The health board is working towards all Sisters/Charge Nurses and Deputies having a specialist practitioner qualification (SPQ) in line with the district nursing principles. Currently each team has at least one individual qualified at this level.
Opportunities are being taken currently to expand and develop the workforce and skill mix with the development of a Band 4 HCSW role.
A full break down of District and community nursing staffing over the last 5 years can be seen in Appendix 1
The district nursing service is continually recruiting to posts and is working hard to improve retention levels by focusing on staff and student development programmes across all staff groups.
The Health, Social Care and Sport Committee is calling for evidence about whether community nursing services are likely to play a greater role in the future delivery of healthcare, focusing on:
· Whether we have a clear picture of the district nursing/community nursing workforce in Wales, and the level of need for community nursing services (including future need). Do we have the evidence base to support effective workforce planning.
For the District Nursing Workforce, a clear understanding of the workforce is emerging through the implementation of the CNO District Nursing Principles. Cardiff and Vale has utilised an electronic patient based system for over 10 years which has provedan advantage in being able to more robustly analyse activity and performance information and help to understand and to begin planning to redesign and shape the district nursing workforce in order to comply with the Eight Principles.
A District NursingNovice to ExpertEducational Pathway has been developed and this has enabled the UHB to triangulate this with other performance information to develop more effective workforce plans at a Health Board and Locality level.
The quarterly submission to the CNO reporting adherence and progress against those principles is allowing a National picture to be better understood and co-ordinated.
There is a need for the implementation of an effective and validated workloadacuity tool acrossWales and the All Wales District Nurse Workload and Workforce Group is supporting ongoing collaborative testing of acuitytools with a view to having something in place within the next 2 years which will assist in more effective and improved workforce planning in the future. The rolling out of electronic and mobile IT working solutions to all Health Board areas will also assist in being able to more effectively performance managed and plan.
· Whether there is clear strategy, at national and local levels, about the future direction for district nurse-led community nursing services. How well aligned is this with the development of the primary care cluster model for example,and with the vision for health and care servicesset out in A Healthier Wales.
Nationally the Welsh Assembly Government has set out a clear vision for District and Community Nursing Services with the publication of strategic documents such as Setting the Direction 2009, Community Nursingstrategy 2009, PrimaryCare Services for Wales up to 2018 and the Framework for the Management of Chronic Conditions and in particular with the publication of the CNO District Nursing Principles in 2017.
The CNO Principles include a clear direction that district nursingteams should be aligned with Clusters and the UHB has started to work toward better integrating them and the wider community nursing workforce into cluster and IMTP development and planning. It is acknowledged that there is further work to do locally in this area.
· How effectively community nursing teams are able to work with a range of professionals and agencies (including primary and secondary care services, social care services, and the voluntary sector) to deliver seamless, person-centred care.
Locality/cluster based working and the development and progress on co-location and integration of Local Authority and community based Health Staff has improvedthe ability and effectiveness of working with a range of community based professions and services. Work continues locally on this with ICF investment affording the opportunity to take forward projects across the primary/secondary care interface with the development of patient pathways and discharge to assess models of care and on a cluster basis with the creation of virtual MDT and social prescribing models.
As with any effective multidisciplinary and agency working the ability to access and communicate acrossIT platforms is key to improved communication and partnership workingand the national work WCCIS to develop an integrated health and socialcare system for Wales is welcomed. For District and Community Nursing Services effectivecommunication with GP services is key the UHB would welcome work being taken forward to improve electronic communication and access across this interface.
The UHB is grateful for the opportunity to contribute to this inquiry. There have been a lot of developments over the last 5 years locally to develop and improve District and Community services but it is acknowledged that there is more work to do in developing and integrating this will all of our primary and community based services to realise the vision set out in A Heal heir Wales