Clinical services plan
We have a shared vision with our communities for us to live healthy, joyful lives.
Due to the nature of service provision across Mid and West Wales, it is recognised that a wide range of services have some fragilities. This was a key driver behind the development of the Health Board’s strategy which seeks to reduce, if not eliminate, the risks to sustainable service provision.
Our strategy called ‘A Healthier Mid and West Wales: Our future generations living well’ (opens in new tab), has the ambition to shift from a service that just treats illness to one that keeps people well, prevents ill-health or worsening of ill health, and provides any help you need early on. Until the strategy is fully implemented, in particular the establishment of the proposed new hospital network, services are having to manage these fragilities on a daily basis.
The pandemic has further exposed these deficiencies, with many services unable to restore pre-COVID activity levels or service models. To respond to this, we are going to review services that are in urgent need of attention so we can develop a set of plans to support key services over the medium-term.
Some of the services included with the Clinical Services Plan programme are:
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Emergency General Surgery
Emergency General Surgery (EGS) is a surgical discipline encompassing predominantly abdominal emergencies. The general surgical service is for the treatment of patients with emergency problems.
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Ophthalmology (eye care)
Ophthalmology is the treatment of eye diseases, injuries, and surgical procedures. Our service is for paediatric and adult patients in our area who have sight problems that need treatment.
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Orthopaedics
Orthopaedics, also known as orthopaedic surgery, is a branch of medicine that focuses on the care of the skeletal system and its interconnecting parts.
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Urology
Urology cares for adult patients with urological conditions. The Urology service focus on the care of the genito-urinary tract system in both men and women (e.g., kidneys, bladder) and the reproductive tract in men (eg, testicular, penile, and prostate).
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Critical Care
Critical Care provides treatment to adults, in a separate and self-contained area of the hospital. The units are dedicated to the management and monitoring of patients with life-threatening and critical conditions. The service offers specialist skills which include medical, nursing, and other personnel experienced in the management of these patients.
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Dermatology
Dermatology services focus on the diagnosis and treatment of diseases of the skin, hair, and nails in both children and adults.
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Stroke
A stroke is a serious life-threatening medical condition that happens when the blood supply to part of the brain is cut off.
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Radiology
Radiology is a medical specialty that uses imaging techniques (such as X-rays) to diagnose, treat and monitor diseases and injuries identified within the body.
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Endoscopy
An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ. - Primary Care Services
Primary Care has been defined, in this context as:
- General Medical Services (GMS)
- Community Pharmacy
- General Dental Services (GDS)
- Optometry Services.
In addition to these four Contractor services the definition of Primary Care also includes Hywel Dda University Health Board’s:
- Community Dental Services (CDS)
- Out of Hours (OOH) service.
Phase 1
As part of the first phase of the review, a survey was shared with patients in October and November 2023, to capture their views of using our services included in the Clinical Services Plan. Staff were also invited to share their views by completing a survey during September and October 2023. The initial phase for Primary Care and Community invited General Medical Services (GMS), Community Pharmacy, General Dental Services and Optometry Services, as well as the out of hours and community dental workforce, to share their feedback through the completion of a survey. The survey was open between November 2023 and January 2024.
An issues paper has been developed that highlights a broad range of factors that impact on our services and includes the feedback gained through the staff, patient and contractor surveys. The issues paper was presented to our Health Board’s Public Board meeting on 28 March 2024. The issues paper can be found here (opens in new tab).
Phase 2
Following the submission of the issues paper to Public Board, the nine service areas (with the exception of Primary Care and Community) reviewed the issues impacting each service at workshops that included service and service user representatives. The workshops developed a set of potential options that will support and improve these services over the coming years. The options development in Phase 2 for delivery of the Clinical Services Plan Programme, is based on the principles of care that is safe, sustainable, accessible and kind.
A graphic below shows an 8-step process that includes establishing interdependencies, establishing hurdle criteria, holding deliberative sessions and developing options. The options are then checked and challenged before they are reviewed and shortlisted. The final step is to score the options ahead of presenting them to the public board meeting in November 2024. Phase two starts in April and ends in September 2024.
The next step for Primary Care and Community is the development of a strategy that will set out the principles and standards required to provide safe and sustainable Primary Care and Community services. A period of early engagement with staff, stakeholders and our communities took place during September 2024, in relation to Primary Care and Community services.
Thank you for your continued support while we work to improve our services.
If you would like to share your views about your experiences of using any of the services outlined in the Clinical Services Plan programme please get in touch by:
- Emailing Hyweldda.Engagement@wales.nhs.uk
- Calling 0300 303 8322 (local call rates)
- Writing to us at: FREEPOST HYWEL DDA HEALTH BOARD
If you would like to be kept informed about developments on one or more of the above services, please share your contact details as above, and note the service/s you wish to be informed about (e.g. Urology /Ophthalmology).
If you would like to kept up-to-date on developments generally within Hywel Dda University Health Board, you can join Siarad Iechyd/Talking Health by contacting the above or go to the Siarad Iechyd/Talking Health website (opens in new tab).
A deliberative event is one type of workshop we are holding. It involves people with different skills and experience talking about an issue or service and giving ideas about what it can look like in the future.
We held a deliberative event for nine healthcare services in April 2024.
We invited representatives from staff, service users, and organisations we work with (stakeholders).
More than 80 people attended to share their skills and experiences.
We discussed nine services in need. These are:
- Critical care
- Emergency General Surgery
- Stroke
- Endoscopy
- Radiology
- Dermatology
- Ophthalmology
- Orthopaedics
- Urology
People attending were able to share their thoughts on further matters they felt were important for the services being discussed.
They also shared their views and ideas on how to set the lowest requirements that future options for these services would need to meet (called hurdle criteria).
People in the event also shared early ideas for future options.
There was discussion on the reasons why change is needed at the event.
There was an understanding of challenges in running lots of units delivering the same or similar services.
There was discussion about the need for balancing local services to people, whilst providing high quality services.
There were examples of both benefits and challenges when services are provided from fewer sites in a larger, centralised way.
Challenges in staffing and recruitment was spoken about, as well as the geography across our area.
People agreed the need for investment in the health service, as well as for equipment and developing staff.
High-level ideas were discussed and covered common themes such as:
- using technology to join up services and deliver them in a better way,
- ensuring care is centred around patients,
- developing the workforce,
- streamlining the way we deliver services,
- working together,
- making services accessible and ensuring equality,
- and using data to make decisions.
Ideas will now be shaped into a long list of options by a clinical group (the Options Development Group).
They will then be shared with the people who are attending the first deliberative event to check.
People involved will then agree the best way to consider and score options.
Options development is when a mixed group of people meet to develop draft options for further consideration. Any draft options must meet hurdle criteria, which is the minimum criteria that any draft option should meet. For our Clinical Service Plan, this has meant staff and organisations we work with (including Llais, the independent voice for patients) thinking about how the nine services could be delivered differently in the next two to four years.
This is when a wider group of people, including service user representatives score options against criteria that is important to people. This includes thinking about an option's strengths, weaknesses, opportunities, and threats.
It is important that all options are thoroughly developed and appraised to meet procedural fairness requirements. The process is important because it helps us make informed, fair and legal decisions and to be open to new ideas. The aim is to ensure that options have been well thought through and that any decision reached is the best possible outcome for people. Early in the process, we think and plan for how we can reduce any negative impacts, especially for people with protected characteristics. This helps us to comply with the Equality Act 2010.
As a Health Board we are committed to working with our people at every stage as we know there is much to learn from different people’s perspectives. Following a thorough process ensures that we have considered as many ideas and options as we can. This helps us to deliver solutions that a fit for purpose for the future.
One of the main risks to engagement and/or consultation on potential changes to services is that the process may be subject to review by the courts (judicial review). There are several previous cases where courts found bodies did not carry out a lawful consultation process. This can mean that change is delayed or cannot happen, can be costly, and can negatively affect public confidence in a public body.
We held the first event (Sprint 1) to create and consider draft options to improve the position of each service in the Clinical Services Plan.
The event was held over two days in April to develop a long-list of draft options. A mix of people attended including clinical, operational, and support staff.
Following this, a virtual ‘Check and Challenge’ event took place in May 2024 to give patient and public representatives, stakeholders, and a wider group of staff, the chance to consider and check draft options from earlier sessions. People were able to discuss the draft options, ask questions and make observations. They were also given a survey to complete where they could share their views and the reason for their opinions.
We held the Second event (Sprint 2) after the check and challenge event. A mix of people attended including clinical, operational, and support staff.
Attendees reviewed the feedback from the Check and Challenge group, and further developed the draft options, before considering the options as a collective group against the hurdle criteria (minimum criteria that must be met) to develop a short list of options.
You can read an output report from the first session (Sprint 1) in the public Health Board papers for the meeting on 30 May 2024. Click here to view board papers containing the output report (opens in new tab).
You can read the feedback from the check and challenge session and the outputs from the second session (Sprint 2), in an output report within the public Health Board papers for the meeting on 25 July 2024. Click here to view the board papers containing these reports (opens in new tab).
For this project, we have already invited people into the group, so there is a mix of staff, service users and people we work with (stakeholders).
However, you can keep up to date with our work on the Clinical Services Plan or express an interest in being involved in future engagement or consultation work by joining our involvement and engagement scheme Siarad Iechyd/Talking Health (opens in new tab).
Detailed updates are also being given often to the public Board Meetings between now and November 2024.
