Geoff Lang Cyfarwyddwr Gweithredol Gofal Cychwynnol, Cymuned a Gwasanaethau Iechyd Meddwl /

1. Pwyllgor Craffu Wrecsam / Wrexham Scrutiny CommitteeDydd Mercher 12 Hydref 2011 / Wednesday 12 October 2011 Geoff Lang Cyfarwyddwr Gweithredol Gofal Cychwynnol, Cymuned a Gwasanaethau Iechyd Meddwl/  Executive Director of Primary, Community & Mental Health

2. Cynllun 5 Mlynedd / 5 Year Plan

3. Ein Nod / Our Aim To provide a “world class” health service in North Wales that: Improves the health and wellbeing of the population Provides an excellent experience no matter who, or where, or what language Reduces the cost of health provision per capita The ‘Triple Aim’ Darparu gwasanaeth iechyd o’r radd flaenaf yng ngogledd Cymru sy’n: • Gwella iechyd a lles y boblogaeth • Darparu profiad ardderchog i bawb, waeth pwy bynnag ydynt, yn lle bynnag maent ac ym mha bynnag iaith • Lleihau cost darpariaeth iechyd y pen Y ‘Nod Triphlyg’

4. Sefydliad sy’n Ymarfer Iechyd Cyhoeddus / A Public Health Practicing Organisation Focused upon improving population health outcomes Services are designed to meet need Support citizens and communities to focus on health and well-being rather than illness • Canolbwyntio ar wella canlyniadau iechyd y boblogaeth • Cynlluniwyd gwasanaethau i gwrdd ag anghenion • Cefnogi dinasyddion a chymunedau i ganolbwyntio ar iechyd a lles yn hytrach na salwch

5. Golyga hyn / This means Continuous quality improvement, reduction in waste, harm and variation More care provided outside of an acute hospital setting through primary and community health and social services Emphasis on independence and supported living at home or in communities Complex care delivered in centres of excellence No longer will healthcare be measured in terms of beds and buildings but rather services and health outcomes • Gwella ansawdd, lleihau gwastraff, niwed ac amrywiadau parhaus • Darparu mwy o ofal y tu allan i leoliad ysbyty llym drwy iechyd cychwynnol a chymuned a’r gwasanaethau cymdeithasol • Pwyslais ar fyw annibynnol a chyda chefnogaeth yn y cartref neu mewn cymunedau • Darparu gofal gymhleth mewn canolfannau rhagoriaeth • Ni chaiff gofal iechyd ei fesur bellach o ran niferoedd y gwelyau ac adeiladau, ond yn hytrach drwy wasanaethau a chanlyniadau iechyd

6. Gyrwyr a galluogwyr newid / Drivers and enablers for change The health of our population Our workforce The money available The need to deliver • Iechyd ein poblogaeth • Ein gweithlu • Yr arian sydd ar gael • Yr angen i ddarparu

7. Iechyd ein poblogaeth / The health of our population Current causes of mortality Variation in outcome Demographic changes Life style choices Emergency services The cycle of life • Achosion marwolaeth presennol • Amrywiaethau mewn canlyniadau • Newidiadau mewn demograffeg • Dewisiadau ffordd o fyw • Gwasanaethau brys • Cylch Bywyd

8. Ein gweithlu – heriau / Our workforce - challenges An ageing and changing workforce Reduction in junior medical staff and distribution of training places EWTD compliance Recruitment • Gweithlu sy’n heneiddio ac yn newid • Lleihad mewn staff meddygol iau a dosbarthiad lleoedd hyfforddi • Cydymffurfiad â CAGE • Recriwtio

9. Rhagolygon Ariannol /Financial outlook Expected no increase in Health Board allocations per year Continuing pay and non-pay pressures increasing the real terms effect Impact of medical advances, high cost drugs & technology Forecast demographic and demand pressures Estimated gap to 2014/15 of £200million Savings target 6.1% for this year • Disgwyl dim cynnydd yn nyraniad blynyddol y Bwrdd Iechyd • Pwysau cyflogau a materion eraill parhaus yn cynyddu’r effeithiau termau real • Effaith datblygiadau meddygol, cyffuriau a thechnoleg drud • Pwysau rhagolygon demograffeg a galw • Amcangyfrifir bwlch hyd 2014/15 o £200 miliwn • Targed arbedion o 6.1% ar gyfer eleni

10. Ein hymateb – Fframwaith Strategol / Our response - Strategic Framework Cydweithrediad • Gyda phartneriaid i integreiddio darpariaeth a chwrdd â chanlyniadau a rennir • Cyllidebau aliniedig; cydweithio • Gydag addysg uwch a phellach i fewnosod ymchwil, dysgu, addysgu a gwerthuso Galluogwyr • Gwasanaethau a rennir a phryniadau integredig a sail asedau (agenda gwasanaeth cyhoeddus) • Buddsoddiad canolbwyntiedig i fwyafu buddion gwasanaeth • Asedau cynaliadwy gyda tharged i leihau ôl troed carbon • Llywodraethu a gwerthoedd cadarn Collaboration • With partners to integrate delivery and meet shared outcomes • Aligned budgets; joint working • With higher and further education to embed research, teaching, learning and evaluation Enablers • Shared services and integrated procurement and asset base (public service agenda) • Focused investment to maximise service benefit • Sustainable assets with a targeted reduction in carbon footprint • Sound governance and values

11. Ein hymateb – Fframwaith Strategol / Our response - Strategic Framework Ansawdd Diogelwch ac ansawdd yn gyntaf – lleihau niwed, gwastraff ac amrywiaeth Gwasanaeth a arweinir a’i ddarparu’n glinigol Rhwystriad targededig i’r mannau bydd fwyaf effeithiol Gofal hunan-reoledig yn canoli ar y claf Gwell perfformiad i ddarparu canlyniadau cyson Symudiad adnoddau i’r gymuned targededig Gweithlu Adolygu ac ailgynllunio Cyflogwr o ddewis Enghraifft dda am hyfforddi Quality • Safety and quality first - reducing harm, waste and variation • Clinically led and delivered service • Targeted prevention to where it will be most effective • Patient centred self managed care • Improved performance to deliver consistent outcomes • Targeted shift of resource to community Workforce • Review and redesign • Employer of choice • Exemplar for training

12. Gwasanaethau Cymuned – Model gofal / Community Services – Model of care Integrated community services – NHS, local authority, voluntary sector working together Moving from reactive crisis management to proactive management and prevention The bridge between primary care and acute hospital • Gwasanaethau cymunedol integredig – GIG, awdurdod lleol, sector gwirfoddol yn cydweithio • Symud o reoli argyfwng yn ymatebol i reoli rhagweithiol a rhwystro • Y bont rhwng gofal cychwynnol ac ysbyty llym

13. Blaenoriaethau ar gyfer blwyddyn 2 / Priorities for year 2 Prevention Localities Efficiency and productivity Mental health Reduce reliance on out of area providers Strategic change • Rhwystro • Cymdogaethau • Effeithiolrwydd a chynhyrchiant • Iechyd meddwl • Lleihau dibyniaeth ar ddarparwyr y tu allan i’r ardal • Newid strategol

14. Arweiniad ar ymgynghori ac ymgysylltu ar newidiadau i’r gwasanaeth iechyd / Guidance for consultation and engagement on health service changes

15. Y Cyd-destun / The context • S183 Deddf GIG (Cymru) 2006...dyletswydd i gynnwys ac ymgynghori • Rheoliadau CIC (Cyfansoddiad, Aelodaeth a Gweithdrefnau) (Cymru) 2010…..rôl y CIC • cyd-gloi cyfrifoldebau’r BI a CIC • Egwyddorion cenedlaethol ymgysylltu â’r cyhoedd yng Nghymru • Ymchwiliad Pwyllgor ar Adolygiadau GIG ac Arweiniad ar Ymgysylltu ac Ymgynghori • S183 NHS (Wales) Act 2006…duty to involve and consult • CHCs (Constitution, Membership and Procedures) (Wales) Regs 2010…..role of CHC • interlocking responsibilities of HB and CHC • National Principles for public engagement in Wales • Committee Inquiry on NHS Reviews and Guidance on Engagement and Consultation

16. Yr arweiniad newydd...prif faterion / The new guidance…key issues • More emphasis on continuous engagement and less on formal consultation • Two stage process – extensive discussion then formal consultation on evaluated proposals • Mwy o bwyslais ar ymgysylltu parhaus a llai ar ymgynghori ffurfiol • Proses dau gam – trafodaeth eang ac yna ymgynghori ffurfiol ar gynigion a werthuswyd

17. At the earliest opportunity With citizens, staff, staff representatives and professional bodies; stakeholders, third sector and partner organisations Considering local interests Equality and diversity Ar y cyfle cynharaf Gyda dinasyddion, staff, cynrychiolwyr staff a chyrff proffesiynol; rhanddeiliaid, y trydydd sector, a sefydliadau partner Cysidro diddordebau lleol Cydraddoldeb ac amrywiaeth Ymgysylltu barhaus / Continuous engagement

18. Lefelau Cynnwys / Levels of Involvement Dyletswyddau cydraddoldeb – ymgysylltu a chynnwys grwpiau cydraddoldeb Equality duties – engage and involve equality groups BCU HB BI PBC Specialised services Gwasanaethau arbenigol 6 counties 6 sir Acute (district general) hospital services x 3 14 Localities 14 Ardal Leol Gwasanaethau ysbyty (dosbarth cyffredinol) llym x 3 Regional services Gwasanaethau Rhanbarthol Individual patient and carer planning Cynllunio ar gyfer claf a gofalwr unigol Community groups Condition or disease specific group Grwpiau cymuned Grŵp yn benodol i gyflwr neu glefyd e.g.: Older people’s forums, Mental Health User and Carer groups e.g.: Heart forums, Diabetes Advisory Groups, Cancer groups e.e. Fforymau Pobl Hŷn, Grwpiau Defnyddwyr a Gofalwyr Iechyd Meddwl e.e. Fforymau’r Galon, Grwpiau Cynghori Diabetes, Grwpiau Canser

19. About substantial change Discussion with advisory forums; staff; CHC; Local Service Boards; other key partners Agree on process and content Minimum of 6 weeks formal consultation CHC can object on process or outcome Am newid sylweddol Trafodaeth â fforymau ymgynghorol; staff; CIC; Byrddau Gwasanaethau Lleol; partneriaid allweddol eraill Cytuno ar broses a chynnwys Lleiafrif o 6 wythnos o ymgynghori ffurfiol Gall y CIC wrthwynebu ar broses neu ganlyniad Ymgynghori ffurfiol / Formal consultation

20. In the interests of the health service OR risk to safety or welfare of patients and staff Must attempt to inform all relevant interests Should then follow usual consultation processes Er diddordeb y gwasanaeth iechyd NEU beryg i les neu diogelwch cleifion a staff Rhaid ceisio hysbysu pawb â diddordeb perthnasol Dylid ddilyn prosesau ymgynghori arferol wedyn Newidiadau gwasanaethau brys / Urgent service changes

21. Urddas mewn Gofal: Ymateb i Adroddiad y Comisiynydd Pobl Hŷn (Mawrth 2011) / Dignity in Care: Responding to the Older People's Commissioner Report (March 2011) 21

22. The report was received on the 14th March 2011. 12 recommendations to improve the care of older people in Welsh hospitals. On March 15th we received the Patient's Association Report: The Lottery of Dignified Care. Health Boards were required to respond by Tuesday 14th June 2011. • Cafwyd yr adroddiad ar 14 Mawrth 2011. 12 o argymhellion i wella gofal pobl hŷn yn ysbytai Cymru. • Ar 15 Mawrth, cawsom Adroddiad Cymdeithas y Cleifion: Y Loteri o Ofal Urddasol. • Roedd gofyn i Fyrddau Iechyd ymateb erbyn dydd Mawrth 14 Mehefin 2011. 22

23. Cymerwyd amser i sicrhau fod Bwrdd y Cyfarwyddwyr yn arwain ar y gweithredu; Rhannwyd yr ymateb rhwng Bwrdd Iechyd Prifysgol Betsi Cadwaladr, Cyngor Iechyd Cymuned Betsi Cadwaladr ac Arweinwyr Awdurdodau Lleol. Cyflwynwyd yr ymateb / The response has been submitted • Time has been taken to ensure that the Board of Directors lead on implementation; • Response shared with Betsi Cadwaladr University Health Board Cadwaladr Community Health Council and Local Authority Leads. 23

24. Bydd gan BIPBC: Siarter Urddas; Cynllun gweithredu ar gyfer gofalu am bobl hŷn a phobl hŷn â dementia; Gwell gofal mewn ymataliad; Gofal a thosturi i fynd â’r agenda urddas a pharch yn ei flaen; Preifatrwydd i drafod – oddi wrth y gwelyau; Gwella cynllunio rhyddhau. Prif Themâu / Key themes BCUHB will have: • A Dignity Charter; • An action plan for caring for older people and older people with dementia; • Improved care in continence; • Care and compassion to take forward the dignity and respect agenda; • Privacy for discussion - away from the bedside; • Improvements to discharge planning. 24

25. Ein sgôr boddhad cleifion / Our patient satisfaction scores • Cyffredinol: graddfa gofal yn dda/ardderchog 92%. • Cyffredinol: meddygon a nyrsys yn cydweithio’n dda 92%. • Meddygon: hyder ac ymddiriedaeth bob amser 82%. • Ysbyty: ystafell neu ward yn lân iawn/gweddol lân 94%. • Ysbyty: toiledau ac ystafelloedd ymolchi’n lân iawn/gweddol lân 90%. • Ysbyty: gel golchi dwylo’n amlwg ac ar gael i gleifion ac ymwelwyr 94%. • Gofal: digon o breifatrwydd bob amser wrth gael eu harchwilio a’u trin 88%. • Llawfeddygaeth: risgiau a manteision wedi eu hegluro’n glir 81%. • Overall: rating of care was good / excellent 92%. • Overall: doctors and nurses worked well together 92%. • Doctors: always had confidence and trust 82%. • Hospital: room or ward was very / fairly clean 94%. • Hospital: toilets and bathrooms were very / fairly clean 90%. • Hospital: hand-wash gels visible and available for patients and visitors to use 94%. • Care: always enough privacy when being examined or treated 88%. • Surgery: risks and benefits clearly explained 81%. 25