May 2012 Serving Swansea, Neath Port Talbot and Bridgend

This booklet is produced by Abertawe Bro Morgannwg University Local Health Local Board

It can be downloaded from http://www.changingforthebetter.org.uk

It is also available in other formats on request

Braille

Talking Book

British Sign Language

Large print version

There is a short video on our website and YouTube as well

Write to: Changing for the Better Team, Room C4B, ABMUHB Headquarters, One Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot, SA12 7BR

Telephone: (01792) 704019

Email: ABM.C4B@wales.nhs.uk

© ABMU Health Board 2012

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Who runs your local NHS?

Abertawe Bro Morgannwg University Health Board (ABMU) is responsible for all local NHS

services in Swansea, Neath Port Talbot and Bridgend, and some specialist services for people

further away. We are responsible for GPs, dentists, chemists and opticians as well as

providing a wide range of community services like district nursing and health visiting. We

also have four main hospitals – Morriston, Singleton, Neath Port Talbot and the Princess of

Wales, as well as our community hospitals. We provide inpatient and community mental

health services and a full range of services for people with learning disabilities. In all of this

we work closely with patients, local authorities and the voluntary sector.

Why should you read this?

There are some major challenges ahead for the NHS right across Wales, including here in

ABMU. This booklet explains them, our ambitions for improving care in the future and

possible changes to get there. We want you to give us your thoughts, views and ideas.

Who should read this booklet?

Everyone who uses our services in Swansea, Neath Port Talbot or Bridgend or who might do

in the future and their families. Also everyone who works in the NHS in the ABMU area. We

want to plan services with you for the next five years to create an NHS which you can

depend on to give you the best possible service if you need it.

We run the local NHS for

the Swansea, Neath Port

Talbot and Bridgend

areas and for people who

live further away for

some specialised services.

That’s over 500,000

people!

It is really important that

everyone who uses the

NHS now, or may do in

the future, has a chance

to help shape the services

we provide for the next

five years.

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In the coming months we will be asking you about some specific changes we think we should

be making. We will ask for your help in shaping the proposals then, but at this stage we just

want to explain why we think your NHS needs to change and how you can be involved. This

booklet sums up lots more detailed information. If you would like to read more, check the

list of documents at the end of this booklet or visit our website

www.changingforthebetter.org.uk

Why are we doing this now?

Last year, in Together for Health, the Welsh Government said that the NHS in Wales is facing

some tough challenges [see box] and should make sure all its services are “sustainable” and

“comparable with the very best”. We agree and are reviewing everything we do to make

sure that our NHS gives the best possible care to local people. We think we must act quickly

but carefully to change how we do things.

Changing for the Better is our programme for the future of the NHS in ABMU. However, the

Health Board is not doing this on its own. Since January nearly 300 people including GPs,

hospital specialists, nurses, therapists and managers as well as patient representatives,

service users, carers, voluntary sector organisations, the local authorities and Swansea

University have come together to start developing proposals. The Community Health Council

is supervising our work and we have invited experts from across the UK to advise us too.

Your NHS faces many big challenges over the next five years

The population is getting older and demand for care is going up

Health has not improved as much for some people as for others

There are serious difficulties in recruiting enough clinical staff for some services

The quality of NHS care has improved but there is still much more to do

Expectations of the NHS

are rising

Funding is very limited and will remain so

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How can you help us?

Please help us by telling us what is important to you for your local NHS. We also want your views about the ideas in this

booklet. If you think they could be improved please give us your suggestions. But it doesn’t end there. As we think about

new ways of doing things we want you to tell us if we could do it better. We really do want to change for the better with

your help. You will find details of how you can help us later in this booklet.

Why do we need to change how we do things?

“The number of people we look after is going up every year

and the difference in health between our communities is getting worse”

ABMU Health Board provides services for over 500,000 people in Swansea, Neath Port Talbot, Bridgend and the

surrounding areas and also for some people who live further away. The population is growing steadily.

Where you live in ABMU makes a big difference to how healthy you are likely to be. Although people are generally living

longer, we know that those who are in well-off areas live on average eight years longer than people in the poorer areas.

We are concerned that this difference is getting wider as time goes by. When we look at how many years of healthy life –

where people don’t suffer from long-term illness - the gap is even greater, up to seventeen years, in fact.

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One of the reasons for this is differences in lifestyle and how we all look after ourselves.

We want to reduce the health gap by supporting our citizens to improve their own health.

We will work with our partners and people in poorer communities to help them live healthily

and also to improve their access to health services when they need them.

Proportion of adults in ABMU who say they smoke (NHS Wales Informatics Service 2012)

Nearly 1 in 4 adults in

ABMU smoke and over

half are overweight or

obese – all factors for

poor health

Nearly a third of

pregnant women in

ABMU smoke before or

during their pregnancy

which means their baby

is more likely to have

health problems too

Only 1 in every 16 adults

eats healthily, takes

regular exercise, avoids

smoking and drinks

sensibly – the key for

good health

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People living in well-off areas of ABMU have on average

seventeen more years of healthy life than those in poorer areas

We know that if we can do more to support people to lead healthy lives and not just treat their illnesses, it will reduce the

need for future NHS care. But we can’t do it without you! Wellness begins at home with a healthy lifestyle; so eating a

balanced diet, exercising regularly, not smoking, and drinking in moderation is very important. Only 1 in every 16 adults in

ABMU says they do all the things recommended by experts for a healthy lifestyle. In ABMU between 49% and 62% of all

adults are overweight or obese, and this increases the chances of heart disease, arthritis, stroke and cancer.

Making sure our children know how to keep healthy is particularly important for their future. Every year more children

are born in our area. We need to cope with this extra work and still provide choice for women on whether they have their

baby at home or in hospital and how much specialist support they may need to be available. If our children are going to

enjoy longer healthier lives, we will need to help them in making healthy choices from birth, through school, college and

beyond.

People are getting older, their health needs are rising but the number of informal carers is falling

People are living longer and we need more and better services for them in the future. Older people tell us that they would

like to be supported in their own homes rather than admitted to hospital. We know that older people can have poor

experiences in hospital, particularly if they have dementia or issues with continence. They are often kept in hospital longer

than they want to be because the help they need to go home isn’t provided quickly enough.

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Already nearly one in every four beds in hospitals is taken up by people with dementia. Most

people admitted to our hospitals now are older people. We have to plan our services to make

sure we can look after more older people in their homes and communities with better and

more responsive services for them and their families. This means that we should move some

services out of our acute hospitals and provide them closer to people’s homes. We should

provide easier ways to get the help that is required. You can tell us about your ideas for this

and what you wish to see available nearer home.

For a long time we have depended on unpaid carers (partners, family, friends and neighbours)

to provide much of the care for people in their communities. As people live longer we will

need more carers to look after them. We will need to support more carers who themselves

will be getting older and under greater strain. We need to plan for this and support the carers

that we have more effectively too.

The number of people with the most common illnesses is increasing

Experts tell us that the number of people with the most common and serious illnesses in

ABMU will continue to increase, particularly as the number of older people rises and they

become more frail too. If we carry on providing care in the same way as now we will find our

services are over-stretched. This will not allow us to look after people as well as we want to.

Different ways of providing care can be much better and more personal as well as being more

cost effective, so that more patients can benefit from our help.

The number of older

people is rising and too

many of them end up in

hospital instead of being

looked after well at

home

We need to do things

differently so fewer of

them are admitted when

it could be avoided

By 2031, if nothing

changes, the number of

admissions for heart

disease will go up by

14%, lung disease 25%,

stroke 45% and cancer

13%

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Money in the NHS is already tight and expected to get even tighter. We

need to spend our money wisely and make it go further

We have all felt the effects of the worldwide economic situation at home and the NHS in Wales

is no different. Just as we all have to manage our household budget, so the NHS has to get the

most out of every NHS £.

Every year there are new calls on the money that the NHS receives from Government, with

new treatments and technologies being created as well as the usual pressures that we all see

every day such as inflation and fuel price rises.

We have already done well to reduce our costs and deliver services within our means up to

now by becoming more efficient - by wasting less and making our services better. But we will

have to do much more in the next few years to make the money go even further. We can do

this by making sure we get things right for patients first time, preventing the harm that

happens accidentally to some patients and by focussing hard on reducing any waste. We will

need to use our staff more effectively and flexibly in the future too.

In the future we will spend more on community-based services, including your local GP

Practice, so more services can be provided for you closer to your home and so we will

spend less on hospital services.

We will do more on preventing illness to help you stay healthy. That will save money for

the NHS in the future

We will ensure the most effective use is made of our staff and resources, and that might

mean having some services in fewer places. The benefit of this will be creating expert teams

We need to make our

money go further by

reducing waste and by

getting things right first

time

We need to spend

more on community

services and preventing

illness so that we need

to spend less on

hospital services, which

can be very expensive

We need to plan for the

changes in our

population that can be

predicted already

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under one roof to improve patient care, rather than spreading a service so thinly that it

becomes unsafe and unsustainable.

Importantly, experience has taught us that improving the quality of care often means it is less

expensive too. It can also mean that more people can be treated better in fewer places. We

know that we will have to make sure that better transport is available where this is necessary.

We need to employ the best staff for the future

We are very proud of our staff who are vital to the quality of care and experience for patients.

If we are to provide world class care we need the very best staff now and in the future.

However, it is already difficult to recruit high quality staff in some areas because there are

shortages and all hospitals across the UK are competing for them. This is particularly true for

some specialist doctors. At the moment, this means that:

We have to rely on temporary staff from agencies to fill gaps. This does not always give us

people with the right skills and qualities, is very expensive and sometimes gives patients a

poor experience of our services. We are spending nearly £3 million each year on

temporary medical staff when we cannot get permanent staff

We cannot always provide the number of junior or consultant doctors we need to run safe

services in all of our acute hospitals: this is already very difficult in some of our hospitals

and in some specialties such as children’s medicine, maternity services, emergency

medicine, casualty departments and psychiatry. This is not expected to get better. In fact

as the proportion of doctors wishing to work part time or have career breaks increases,

this problem may become worse.

Some groups of staff

are in short supply and

it is becoming very

difficult to recruit them

across the UK.

We have particular

problems in some

specialties: children’s

medicine, obstetrics,

A&E and psychiatry

We need to change

how we use our staff to

make our services safe

and sustainable for the

future

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If our services are to keep going and meet increasing demands we need to have the right

number of permanent and well trained staff in each team and this may mean that we

cannot provide all services in every hospital.

Instead, we want our hospitals to work together in a complementary way, developing

specialist centres of excellence rather than having specialist staff spread too thinly, trying to

work across too many different sites. These specialist centres of excellence will have teams of

experts working together, offering you a better and safer service.

We want the quality of care to be as good as the very best every time

Change can be worrying for some people, but in reality NHS care is changing all the time.

Over the past couple of years ABMU has made many changes to the way we deliver care [see

box]. These changes have been designed to improve the outcome for patients – in many cases

giving them better access to clinicians, reducing their time in hospital, a faster recovery time

and better outcomes. Sometimes these changes are urgent. In many cases these changes cost

less than before too, because they are more effective and efficient.

However, it is not enough, and we want - and need - to do even more.

We are proud that some of our services already provide world class care. We have many

teams who are working in new and innovative ways in our communities and in our hospitals

to create an excellent experience for patients and users. We need to build on that excellence

so that it is there for everyone who needs it, when they need it and not just some of the time.

Some people with

chronic lung illnesses

now have most of their

care at home instead of

having to come into

hospital

People with severe

weight problems are

being helped to lose

weight without

expensive drug

treatments

Some patients with

kidney failure are

having dialysis

overnight at home

which helps them lead

more normal lives

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For example, more people survive a stroke in ABMU now and lead independent lives

afterwards because we have streamlined our stroke units. Our services for patients with heart

attack are as good as the best anywhere. But we know that some of our services do not

always give the best outcomes. We want to make changes so that all of our patients get the

best possible standards of care each time.

We know that we could save more seriously ill people by having more of the care provided

directly by consultant specialists and by organising our services more effectively when it is

most busy, particularly in the winter.

We know that we can make childbirth safer for women having their first baby by having

specialist doctors on the labour ward for more hours each day.

We know that by changing the way we look after seriously injured accident victims, more of

them will get back to active lives again.

But we will need to reorganise the way we deliver care to achieve these ambitions.

Delivering the highest standards of medical care is becoming much more complicated.

Keeping up with the latest knowledge and practice is only possible if our consultants work in

specialist teams, sharing knowledge, developing new skills and working closely together to

provide the best care that is needed day in day out. This also makes working in our hospitals

more attractive to new doctors and will help us recruit the specialists of the future.

For some things it is

better to be looked

after in a specialist

centre with round the

clock consultant care

instead of in the

nearest hospital

More people now

survive a stroke in

ABMU because of our

acute stroke units

Patients from across

South West Wales

now benefit from our

state-of-the-art Heart

Attack service

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We will have to concentrate some services in specialist centres across South Wales so that we

can improve the quality of care, the experience for patients and their families and the

outcomes for a whole range of conditions. This may mean that a small number of patients will

need to travel further to a specialist centre of excellence rather than being treated at their

nearest hospital, so that there are enough specialists to provide round the clock care. Of

course, the majority of services which need to be provided in a hospital will continue to be

provided in our local general hospitals.

We also know that our services can be complicated to use and our paperwork is not always as

good as it should be. We want to make it easier for people to use our services and to improve

our “customer care”. We also want to publish a quality report each year that tells our citizens

and staff openly how well our services compare with the best.

We need to increase the choice of where we provide care Patients tell us that they would like to be able to choose to have their care at home or in their

community if possible. To do this we need to build up the services we have outside hospitals

so that we can provide more in the home, in a community centre near home, the GP surgery,

local pharmacy, leisure centre or community hospital. General hospitals and our specialist

hospital will remain for those services that are best delivered safely in hospital. We can use

modern technology to support care outside hospital and keep people safely in their home

rather than attending hospital.

You tell us that you

would prefer to have

care nearer home if it

is safe to do so

All four of our main

hospitals will have an

important part to play

in providing care that

cannot be provided in

the community, but

what each hospital

does may differ

We need to make our

services easier to use

Transport is

something we need to

consider in any

changes we propose

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We need to make our services easier to use

We want to make sure that everyone can get the treatment, test, or see a clinician when they need to.

You tell us that reducing the time it takes to see a GP or practice nurse, for operations, outpatient attendances, blood

tests, X-Rays and treatments is really important to you and can improve the experience and your quality of life

enormously. We know we can do better.

We know that making sure you and your carers can get to our services by car, public transport or ambulance is really

important. We will work with our partners in local authorities, transport and the voluntary sector to improve transport

links and to address the transport impact of any changes we propose.

You tell us that we need to work with you and your carers to plan your care together, explaining options clearly to you

without using jargon and giving you the information you want to help you choose

Summary

We believe that we can provide services in ABMU that are sustainable and consistently as good as the best anywhere, but

to do so we will need to change the way we do things. We will need to work with other Health Boards for some services.

Changing for the Better will describe how we will make those changes and we hope you will work with us now and over

coming months to help us shape the future of the

NHS

for us all

.

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What happens next?

We will continue to work on Changing for the Better through the summer and autumn of 2012 and will be listening to what

you have to tell us before we produce a range of options to be considered. We will work with the ABMU Community Health

Council on how best to engage with our staff and citizens about the changes we think we need to make. We will provide

regular updates through our website.

Publish this booklet and a shorter information leaflet May 2012

Feedback received about this booklet. Proposals for new and better ways of

working developed & appraisal carried out to agree preferred options

May - Aug 2012

“Changing for the Better Strategy” completed October 2012

Health Board will submit proposals to the Health Minister by November 2012

Formal consultation, if required by Community Health Council November – January 2013

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How you can get involved

We want to hear from as many of our staff and

citizens as possible and so we have asked Swansea University, independent of the Health

Board, to develop an online community, “You Tell Us™” to help us do so. Please register

at www.YouTellUs.org, where you can share your views about this booklet and about our

services and share your ideas in confidence. You can also keep up to date with future

plans for our NHS services and help shape your local NHS for the future.

Swansea University will analyse all the information that you provide and share this with

ABMU anonymously. They will publish a summary on “You Tell Us™” so you can see what

other people think. Please encourage your friends and family to sign up too! You will also

find links to our own website there and to the supporting documents referred to in this

paper.

We will work closely with local partners, stakeholders and the Community Health Council to

agree the final plans for our services and to consult on them with you as required.

If you would prefer to write to let us know what you think, please do so to:

Changing for the Better Team, Room C4B, ABMUHB Headquarters, One Talbot Gateway,

Baglan Energy Park, Baglan, Port Talbot SA12 7BR. Telephone: (01792) 704019

Email: ABM.C4B@wales.nhs.uk

Sign up to YouTellUs™

and you can tell us what

you think about this and

help us with the choices

we have to make in the

future.

It’s free and everything

you say is treated in

confidence by the

University.

Visit our website too for

the latest news!

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Key background information (See our website for more) TOGETHER FOR HEALTH http://wales.gov.uk/topics/health/publications/health/reports/together/?lang=en

BEVAN COMMISSION – FINAL REPORT Forging a Better Future http://wales.gov.uk/topics/health/publications/health/reports/betterfuture/?lang=en

FAIR SOCIETY, HEALTHY LIVES: Marmot Report http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

SETTING THE DIRECTION

http://wales.gov.uk/topics/health/publications/health/strategies/settingthedirection/?lang=en

MEASURING INEQUALITIES: Trends in mortality and life expectancy in Wales

http://www.publichealthwalesobservatory.wales.nhs.uk/inequalities

RIGHT CARE RIGHT PLACE FIRST TIME

http://www.rcpch.ac.uk/news/right-care-right-place-first-time

ACUTE CARE TOOLKIT

http://www.rcplondon.ac.uk/sites/default/files/acute-care-toolkit-2-high-quality-acute-care.pdf

EMERGENCY SURGERY: Standards for unscheduled surgical care

http://www.rcseng.ac.uk/publications/docs/emergency-surgery-standards-for-unscheduled-care