Tag Archives: health

Enabling staff to make better use of data

Darllenwch y flogbost yn Gymraeg

How can we enable Wales Audit Office staff to make better use of data? Dyfrig Williams reflects on learning from our Cutting Edge Health Audit prototype.

A screenshot of our intranet, which shows the latest health news and data

In my work on the Cutting Edge Audit project, I’ve been looking at how we can bring together data from public bodies in a way that’s open to everyone and easy to access so that we can get further insight as auditors. The Health Team at the Wales Audit Office kindly volunteered to work with us so that we could look at what this might mean in practice.

In order to develop the parameters for the work, I developed personas for staff in various roles so that we could be better informed about what work we needed to undertake. This really helped us to identify how research time is used and who is doing that research.

The feedback that I received was that data is difficult to access, so we’ve developed a prototype to bring useful health data and information together in one place.

Testing approaches

Our initial attempt to bring this data together in one place is very much a proof of concept to see how this could be progressed further. Our initial thinking was to try and create a data one-stop shop for each health board, as well as a page for national work that covers the whole of Wales or the UK. When we thought about what a functioning prototype might look like, we decided to use a national site as our test.

We initially decided to use Sharepoint Online because it gave us the opportunity to look at how we could develop our use of the service to make data more accessible internally. Unfortunately whilst this worked as an initial test, we could only make the site available to a selected number of users, as we’re currently testing it with a small user group. We really wanted to share the results throughout the organisation so that staff could think about whether this type of approach would be useful in their work, so we decided to host the information on our intranet (The Hub), which is a Drupal site.

We used feedback from the Performance Support Officer to bring together information feeds in order to save research time. We created widgets from RSS feeds (Really Simple Syndication feeds, which deliver regularly changing web content from news sites, blogs and other online publishers) where available. We also generated our own widget (a small application that can be installed within a web page) for a Twitter feed that we generated from a Good Practice Exchange Twitter list. We embedded these feeds as IFrames within the site.

Making data more user friendly

We wanted to make data easier to understand and use. There was a strong feeling from the staff that I interviewed that knowledge and understanding of data shouldn’t be siloed, so we looked at how we could make data more accessible.

We decided to use Microsoft’s Power BI (a suite of business analytics tools to develop insight) to make health data sets more accessible and easy to understand. This meant that we didn’t have to buy any software, and that we could host the data directly through the Power BI service. We didn’t use any sensitive data for our test so it wasn’t a problem to publish it directly to the web. There was mixed feedback from staff that I interviewed as to whether the site should include private data, so we will need to look at our options again should we choose to go down this route.

The data sets that we used are publicly available and use APIs (Application Programming Interfaces, which access the features or data of an operating system, application, or other web service). This means that the Power BI data tools are linked directly to StatsWales for the data so that there’s no manual downloading of data after its set up. It also means that we’re always using the most current data that’s available.

Where do we go from here?

The use of our prototype has now been developed and extended so that it can be used as a data tool for a Primary Care project in health so that colleagues can use it to analyse data for their own Health Board, so it’s great to know that the work has already been of practical value.

Our use of widgets and APIs mean that the amount of work needed to maintain the current information that the site holds is very limited. However, if we want to develop the data that it holds, we need to think about who might be responsible for its upkeep, should it be seen as valuable.

The next step for us as an organisation is to use the personas that we generated, as well as informal feedback from this work, to look at what an effective data site and service might look like, and how that might be adapted for other parts of the organisation. That will enable us to learn from any mistakes that we’ve made so that we do things differently in the future, and also to build on our successes. And if we can build on that learning, we’ll be well placed to develop our work in order to be the cutting edge audit office that we aspire to be.

Why we’re focusing on improving services for frequent users

A speech bubble with the title of Designing effective services for frequent usersWhy is the Good Practice Exchange at the Wales Audit Office running seminars that focus on frequent users? Dyfrig Williams outlines our thinking and how services can provide efficient citizen-centred public services.

The Good Practice Exchange at the Wales Audit Office decide on our programme of events based on the following criteria:

  • New legislation and other significant developments affecting public service delivery
  • Work undertaken by the Wales Audit Office
  • Topics that are identified through consultation with key stakeholders

In the case of our seminar on Designing effective services for frequent users, it was a combination of all three.

Legislation

If you’ve attended any of our recent seminars, you’ll have heard the Auditor General for Wales talking about how the Wellbeing of Future Generations Act is a gamechanger for Welsh public services. Organisations are required to integrate and collaborate; to think about prevention and the long term; and to involve people.

The Social Services and Wellbeing Act reinforces this by focusing on people, wellbeing, prevention, partnership and integration. The current public service environment clearly supports public service delivery that centres on citizens. If you’re looking to revamp your service to meet this focus, then these acts provide a framework and a rationale for change.

Audit work

Our colleagues in the Health Audit team approached us to put a seminar together on Designing effective services for frequent users as they were reviewing emergency ambulance services commissioning. Fflur Jones wrote a great post for the Wales Audit Office on joining a Welsh ambulance crew for a night shift, where she says that:

“The calls ranged from the routine to the extreme: from a caller that did not require any urgent treatment who had contacted the service for the third time that night to a patient suffering life-changing injuries as a result of a road traffic collision. I’m assured that the life of a paramedic is never dull…..

“Calling an ambulance is not always the right choice and other alternatives, such as pharmacies and out of hours services can get patients seen quicker and allow ambulances to respond to the cases where they’re most needed. It also taught me that the need for the public sector to work together to provide better services and to provide services for unmet needs and to fill service gaps is greater than ever.”

The Good Practice Exchange have been working on our first piece of audit work on behaviour change, where we’ve worked with Good Practice Wales and a range of other organisations on festivals in Bangor and Swansea. Behaviour Change techniques can potentially improve public services when there are increasing demands placed upon them by enabling people to choose the right service in the right circumstance.

The Wales Audit Office’s Picture of Public Services report also paints a stark picture of the challenges that devolved public services’ face. The report shows that public services have faced significant and growing financial, demand and capacity pressures since the previous report in  2011. Some of the headline messages include that:

  • Organisations are in a position where they have to take well-managed risks to deliver sustainable solutions to financial and demand pressures on public services
  • there are difficult barriers to overcome in order to radically reshape services, including political and cultural barriers
  • ‘What gets measured gets managed’ – public services are increasingly adopting ‘outcome’ measures, but there remains a tendency to measure and manage how much activity is going on and how long it takes
  • public services need to work together through the difficult choices to understand the short and long-term impacts for the public and other public services, and to mitigate those impacts where possible.

From a purely economic perspective, the case for change is clear. Public services will continue to waste valuable resources unless we work together, resources that could be better spent to provide services that people actually want.

And to me that’s the crux of it – more than anything services need to be fit for purpose so that they provide what people really want. On my last day of working for Participation Cymru, I wrote that working with the Citizen’s Panel for Social Services had been the most fulfilling work that I had ever done. Seeing people actively challenge systems that had repeatedly let them down because they believed that things could and should be better was incredible. I’ve been lucky enough to work with some fantastic teams, projects and organisations since working for the Good Practice Exchange, but unfortunately these services are still the exception rather than the norm.

Working with key stakeholders

Every event that we run is developed in conjunction with a range of stakeholders, and this is no different. We’ll have speakers from local authorities, health boards, the Ambulance Service, Fire Service and the Older People’s Commissioner. More than anything though, the event will look to share good practice from delegates’ own experiences and will throw out issues that people are facing to the collective expertise at the event.

We’ll also be ensuring that the focus of the event is firmly on what people want from their services. When I was tasked with working on this event, I immediately thought of a workshop that Simon Pickthall from Vanguard delivered at our Reshaping Services with the public event. In this seminar Simon shared how traditional public service interventions had failed to meet people’s needs because inefficiencies were resulting from maintaining broken organisational processes. These inefficiencies become obvious when we think about how public services work – people are made to fit into organisational silos, instead of organisations working together to meet people’s needs. Simon gives a really good overview of some of what he’ll be talking about at 6:37 in the below video.

The Stoke-on-Trent case study in the Picture of Public Services report (p.108) is an example of the approach that Simon will share. But we won’t be telling people what to do or directing people to use particular methods. We don’t believe that one size fits all – we need to look at the good work that organisations are doing and think about how we might adapt those approaches to suit the needs of people in our areas. And if we can do that, then we’ll be better placed to deliver the best possible services for the people of Wales.

Ageing Well in Wales

Earlier this month, Bethan Smith attended the Ageing Well in Wales communities event in Bangor, hosted by the Older People’s Commissioner for Wales. In this blog, Bethan shares her thoughts on the day…

The Good Practice Exchange team have worked with the Older People’s Commissioner for Wales on a number of occasions now, so we were delighted to be involved in the Ageing Well in Wales event.

To provide some background, Ageing Well in Wales is a national Programme hosted by the Older People’s Commissioner for Wales. It brings together individuals and communities with public, private and voluntary sectors to develop and promote innovative and practical ways to make Wales a good place to grow older for everyone.

There are 5 principles of the programme:

  • To make Wales a nation of age friendly communities
  • To make Wales a nation of dementia supportive communities
  • To reduce the number of falls
  • To reduce loneliness and unwanted isolation
  • To increase learning and employment opportunities

I could tell as soon as I arrived in Bangor that it was going to be a worthwhile morning. There was a real buzz in the room, you could just tell that everyone there had a real passion in helping improve the lives of older people in Wales, and the agenda for the morning highlighted the range of organisations that play a key role in achieving this. With the number of older people in Wales projected to increase, it was great to see so many organisations recognising the importance of supporting this particular community.

I was really pleased to hear the first presentation from David Worrall, British Red Cross, which focused on partnership working in Wales. Partnership working is so important if public services are to deliver the key priorities of the Ageing Well in Wales programme. In a time where budgets are ever decreasing, no single service has the answers alone, which is why we need to pull together and think differently and innovatively when it comes to service delivery.  A speaker at one of our events once said ‘we may not be cash rich in Wales, but we are resource rich’. Older people are a huge resource to Wales, we should be utilising the skills and knowledge they have when redesigning services. Their insight and knowledge is absolutely priceless.

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A great example of partnership working that David shared was the Camau Cadarn initiative. The British Red Cross and Royal Voluntary Service are joining forces to launch a new three-year programme to deliver essential services to older people who find themselves in need of support to regain their independence. You can read more about the project on the British Red Cross website.

Another example of partnership working in North Wales was delivered by Pete Harrison, Artisans Collective CIC. Artisans Collective CIC offer a unique community facility in Prestatyn, where Artisans, Artists and Craftspeople display and sell their handmade art and craft items on the Old Library shelves. Not only that, but Pete and the team have increasingly become involved in community health and wellbeing in Prestatyn. They play a key role in the community working in partnership with various organisations to help signpost residents to relevant services. They are also involved in various initiatives helping to prevent social isolation and anti social behaviour in the town. They are now working alongside Healthy Prestatyn (an innovative model of primary health care) looking into social prescribing, and how their work in the community can assist this. After hearing Pete’s presentation, I went to visit the team in Prestatyn and it’s really clear to see how much of a positive impact they have on the community. This small facility gives groups of potentially vulnerable people a safe place to socialise and learn new skills. Pete has agreed to speak at our seminar on ‘Public Services working in partnership for better health and wellbeing‘ on 7 December in Cardiff, along with Alexis from the Healthy Prestatyn team.

Speaking of learning new skills, we also heard from Hilary Jones from the University of the 3rd Age (U3A). The U3A is an international organisation for retired and semiretired people providing educational, creative and leisure activities. Each U3A is made up of a range of interest groups where the members learn from each other in a friendly, informal atmosphere. The clear message from Hilary was that just because you’ve stopped working, it doesn’t mean you have to stop learning! There are opportunities out there for everyone. The biggest bonus from the U3a programme is not only the learning opportunities, but the friendships made and opportunities to socialise. A great example of a project which is helping achieve several of the key priorities of Ageing Well in Wales.
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These three examples alone demonstrate the positive steps being taken by organisations to help tackle issues facing older people in Wales. There were many other examples shared at the event which I’ll be looking at in my next blog.

So for me, some of the key points I took away from the event were:

  • Going forward, working in partnership is key to help deliver the key priorities of the Ageing Well in Wales programme, to prevent demand on services, and most importantly to help older people maintain independence and quality of life.
  • Older people have a wealth of knowledge and experience which needs to be utilised when designing services – they are the experts, let’s work with them! This should be the case for all citizens, regardless of age.
  • There is a fantastic group of passionate, dedicated people within the Ageing Well in Wales network who are making huge steps in making Wales a better place for people to grow older. The challenge is how we help replicate those steps across all public services (not just health and social care). Something for the Good Practice team to think about when planning our work programme for next year.

I’ll be attending the second Ageing Well event in Cardiff on 15th December, so keep a look out for my next blogs!

YMCA Plas: A vision for a better Roath

How do organisations develop a strategy for a community asset? Dyfrig Williams visited YMCA Plas (formerly Plasnewydd Community Centre) in Roath to find out.

A photo of YMCA Plas

YMCA Plas

Throughout my recent posts on asset transfer, I’ve visited organisations that have gone through the asset transfer process and are now on the other side. My final visit was a bit different, as it took me to an organisation who are developing their business plan for the site. I went to see the YMCA, who have taken on the old Plasnewydd Community Centre building on a leasehold basis for a hundred years from Cardiff Council. They are looking to redevelop the site, and originally wanted the building on a freehold basis to make the most of it.

Like all the other asset transfers in this series, it wouldn’t have been able to take place without working closely with the council. The transfer comes with an agreement for 25 years rent-free, without which the YMCA would not have been in a position to take the asset transfer forward. This has given them breathing space, and enabled them to put the right building blocks in place to encourage growth.

The price of property in Cardiff made it difficult to find suitable premises, especially with the huge increase in the area’s student market. But now the deal has been done, the move will enable the YMCA’s Youth and Community arm to get out from under the homeless remit that YMCA are widely connected to in the area.

The council didn’t want to restrict how the YMCA makes use of the site, but it has stipulated that it must maintain community usage. The Local Authority deliberately didn’t tie the YMCA into a restrictive agreement, and the only other condition is that they can only sub-let 33% of the site. The YMCA maintained throughout the negotiation process that they would be unable to take on the staff through TUPE, as they didn’t have the capacity to do so.

What is the strategy for YMCA Plas?

As the lease for the building is so long, YMCA Plas needs to be multi-use, so that if circumstance change the building can still be functional. Fewer and fewer people have been coming to the building as it’s been earmarked for closure for quite some time, so the YMCA are currently running events to re-engage the community, and are looking to consult on its future.

The aim is for YMCA Plas to be a community hub for local groups and people in the area. They want to develop a sport facility with space for a gym to generate income, which will give the centre a health and wellbeing focus.

The organisation are also developing a childcare strategy and a nursery. There is a lack of affordable childcare in the area, which they’ve identified through working with Communities First. Not many people know that the YMCA is the biggest childcare provider in UK, which the organisation can draw on to take this part of the plan forward. They are also looking to rent out rooms where possible and to rent spaces to organisations whose purpose aligns with their aims and objectives.

The entrance to the building is on the side of the street, so the organisation is looking to move the entrance so that it focuses on footfall from the street. This will clearly show that it’s open and accessible to the public, instead of relying on people to go down the side street.

Lessons learnt

Throughout the process the organisation focussed on the council’s timelines, which meant that the focus wasn’t always as intense on their own requirements. As staff were not transferred over to the organisation, embedding new staff whilst taking over a new facility was a big challenge. This meant that they couldn’t hit the ground running in the way that they would have liked, and the transfer involved so much work it was difficult to focus on what was going to happen afterwards. However the core message in the short term has been to maintain the current business, which doesn’t pay the bills but does contribute to it. Because of effective planning they are able to soak up the immediate losses whilst the business plan is being developed. The challenge now is for the organisation to continue to run the business whilst developing a path forward.

A vision for the future

I’ve lived in Roath for the past few years, and it’s a vibrant and diverse place to live. I’ve given blood at the centre a few times, but I must admit that I haven’t made the most of the facility that’s been on my doorstep.

The area has lots of people living side by side, but who aren’t always integrated. I’m all for anything that brings people together in the area, and I’m excited to see how the YMCA make their vision for the community centre into a reality by involving community groups and the people of Roath.

The Muni Arts Centre: An asset transfer driven by the community

The closure of the Muni Arts Centre in Pontypridd prompted an outcry, which in turn prompted a community led bid to take it over. Dyfrig Williams visited the thriving centre to find out how it’s progressed since the asset transfer.

Chris Bolton wrote a post a while back about how annoying your citizens can lead to community action. It’s a thought-provoking read about how closing a community asset can lead to a strong public response, and that public services can build on the strength of this reaction.

It was fascinating to see how that has happened at the Muni Arts Centre, where a grass roots campaign to save the centre and develop it sprung from the decision to close its doors by the council.

Background

The Muni Arts Centre

The Muni Arts Centre

There was a huge outcry when the decision was made to discontinue the Muni Centre from council cultural services. 150 people attended a consultation event on the future of the building in the space of a couple of hours. A number of groups wanted to make sure it stayed open, and a number of companies expressed an interest in making the building a base for their business. Artis Community, Pontypridd Town Council, Cylch Cymreig and the Coalfields Regeneration Trust came together as the Muni Working Group and quickly formed the newly incorporated Muni Arts Centre Limited. They built on their similarities and strengths to develop the bid, which is remarkably similar to the Assets Based Community Development approach on the Nurture Development site that Chris references in his blog.

In terms of building on the strengths within the community, there’s no better place to start than with the board itself. Taking control of a building like the Muni is a huge responsibility, but the Muni’s board members are well placed to do so and to put strong governance processes in place. Jon Huish, a former councillor, has a great understanding of council processes and the public sector. Alun Taylor of the Coalfields Regeneration Trust specialises in governance. Rob Hughes, the Chair of Cylch Cymreig, runs a festival in Ynys-y-Bwl, and Gethin Williams, Chief Executive of the Town Council is also a Solicitor. Wendy York, the Chief Executive of Artis Community was responsible for much of the groundwork, has extensive experience of the arts and strong voluntary sector networks.

The council faced criticism from the community over its initial decision, and the asset transfers it had previously dealt with were on a much smaller scale. They were clear that they wanted to help the process and created an enabling grant fund. They took a risk in choosing to transfer the asset to the community, when a private sector development would have clear commercial benefits. It’s an example of decision making that focuses on the long term, and it’s the kind of approach that public services will have to show has been considered under the Wellbeing of Future Generations Act.

The community

With such a strong board, it would be easy for them to do what many other organisations have done over the years and use their own individual visions as a roadmap for the Muni. But the business case was based on the vision of the 150 people who attended the consultation event. It is rooted in the community, with the Muni as a hub for the regeneration for the wider area and the arts’ place within it.

A photo of the Think Food Life café inside the Muni

The Think Food Life café at the Muni

The café at the Muni is a social enterprise called Think Food Life, which focuses on people’s health and wellbeing by providing nutritional food. It’s the first café in Pontypridd that can cater for specific dietary requirements, and it aims for 80% of its food to come from local sources. There was interest from Merthyr and Valleys Mind to set up an allotment to provide vegetables for the Muni, and the idea was strengthened by the Muni Project veteran’s group, who proposed work on garden land at the Muni with potential support from the allotments society. The Muni has received funding from the Armed Forces Community Covenant Grant as the recruitment centre used to be next door, which provides opportunities for veterans to take part in the Muni’s work, be it through volunteering or directly in the arts.

A Fit for Life project will also look to connect health and fitness work to the nutritional focus of the café, which shows how the Muni is looking to go beyond a strictly arts focus and be a hub for the entire community. The Muni is also looking at bringing organisations together at a strategic level to enable people to do more for themselves through working with Pontypridd YMCA and the development of the Courthouse, which will support the startup and growth of social enterprise.

Passion

This all shows what is possible when projects are based on the passion and talent of the community. The building itself is really impressive, just like the drive and determination of the board and the community members who’ve put in such incredible effort to make the project a success. If you’re looking to transfer an asset to the community, it’s worth asking how can you genuinely work with the community and build on their strengths?

Standing up for your health….literally

We spend a lot of time sitting at our desks at work. Could standing at our desks help us to be healthier at work? Sophie Knott of the Wales Audit Office gave it a go for a week.

How long do you spend sitting down per day? I sit down A LOT. On the average weekday, I reckon it works out at around 12 hours. Add that to the eight hours I spend lying down asleep, and it makes me feel pretty depressed!

What do I know? I’m not a doctor

Well, it turns out it’s been worrying a few members of the health profession too. A recent study of 50,000 people in Norway found a link between higher levels of sitting and premature death. Even Public Health England are getting involved, co-commissioning a study that recommended that office workers should spend a minimum of two hours on their feet at work, to try and reduce chronic diseases and ultimately live longer.

Blue Peter – eat your heart out

I decided to give standing up at work a go. I don’t have any real health concerns at the moment, but I’d quite like it to stay that way. Two hours a day seemed more than doable. Of course, I’m not the first person to want to stand up in the workplace and there are a plethora of desk options if you have a spare £300+. I wanted to spend £0. I gathered various cardboard boxes, box files and paper and placed them under my monitor, keyboard and mouse until I had everything at a comfortable height.

The transformation was surprisingly easy:

Sophie Knott's adapted deskThe standing up on the other hand was not so easy. After the first 30 minutes, my back hurt and my legs wanted to sit down. I persevered for an hour then gave myself a well-deserved rest. I did another hour later in the day, enduring a bit more physical resistance and a lot of amusement from colleagues.

The next day, I did two more hours, and the next day, two more. Five days in, I’d clocked up ten hours of standing, my back and legs were fine, my workmates hardly batted an eyelid, and I even had a few considering trying it out themselves.

Six weeks later…

I have to admit that three weeks of annual leave and a couple of days of jet lag put paid to the standing for a while. Also, this was very much an unofficial trial, and a few concerned colleagues have queried whether I’m standing correctly and have everything at the right height.

I agree that I don’t want to unwittingly make things worse for myself, and there is no real way of knowing if I am doing myself any significant good. But science tells us that being sedentary is bad, and I’m enjoying my experience to date. Ok, creating your own sit/stand desk might not be as easy for everyone as grabbing a few boxes, and I am now looking into some official equipment so I can do it properly. I’ve been pleasantly surprised at the reaction from some of the senior colleagues in my workplace, and I know it wouldn’t be the same everywhere. But I’d like to think that more of us can take our health into our own hands, and vote with our feet.

A special Wales edition of the Journal of Integrated care – so what?!!!

How can we better integrate health and social care? Stewart Greenwell of ADSS (Association of Directors of Social Services) Cymru shares the lessons from the Wales edition of the Journal of Integrated care.

Stewart GreenwellI guess that writing about what you do is common practice in most professional arena, but normally it is for a very limited audience – the employer, sometimes even service users so that they can see what a professional worker is explaining what they saw, what they did and what they intend to do. Writing for an academic journal is a different piece of work – the audience is wider, the rules feel more complex and the writing comes under more scrutiny.

I have always experienced writing as a way of reflecting on what I have done and the special edition of the Journal of Integrated Care focusing specifically on Wales, hopefully will bring some of our efforts in Wales into a wider public arena, from which others, but particularly policy makers and practitioners in Wales, can benefit.

I have always experienced collaboration and/or integration as the natural way of building alliances to ensure that people are not ‘given the run-around’. Sadly my experience is that the public sector has provided that experience for ordinary people, leaving them with the energy-sapping task of finding their way around systems, places and people to try to find a response to a set of circumstances that is troubling them. So by simply reducing the number of doors to knock, telephone numbers to ring and people to talk to, the path becomes less hazardous, less tiring and more likely to lead to success for the ordinary person.

That becomes the rationale for collaboration and integration – to improve people’s lives and only that end makes it worthwhile.

The people who have contributed to the Wales edition had very little experience of writing for the purposes of publication. They had all written for their own agencies, arguing for a change in practice, arguing for an allocation of some additional resources and the many other reasons that we have to put pen to paper (or fingers to keyboard) for our employers.

It has been a struggle, everything took longer than anticipated and there was always another reference to call on. In many ways it reflects the struggle that is captured by many of the authors, to hold on to a belief that what they were pursuing was worth all the effort, to resist the feeling that ‘I don’t really have anything to say that people want to listen to’.

Their efforts, actually our efforts, since it started with us all talking about the idea in a room in a church centre in Shrewsbury – a good start since it reminded us that you sometimes have to break the rules to achieve something – (in this instance choosing to meet outside of Wales!!) were worth it.

The articles highlight the theme of the WAO events on 14th and 22nd October, that integration and collaboration are less about science and more about craft and graft, continually pushing at the boundaries of traditional thinking and reminding ourselves that there is never a reason not to ‘do the right thing’, but there are often many reasons to simply continue to ‘do things right’. The former is about people and the latter often about little more than adhering to process.

However the process was energising and in the end, successful. It shows the character and
strength of the best practice, the importance of leadership that is unrelentingly determined and the most critical of all, that a focus on what makes a difference to people’s lives pulls you through and beyond the doubters and the resistors!!

Improving GP Care by Aligning Evidence, QI Methodology, IT and Contracts: A New Model for Wales

In the latest All Wales Continuous Improvement Community Awards blogpost, Dr Alastair Roeves of Aneurin Bevan University Health Board tells us how they made the most of resources at their disposal to improve their work.

Aneurin Bevan University Health Board / Bwrdd Iechyd Prifysgol Aneurin Bevan

Atrial Fibrillation is an arrhythmia resulting from irregular, disorganised electrical activity in the atria of the heart; it commonly occurs in association with risk factors, such as hypertension, diabetes and ischaemic heart disease. Evidence has shown that timely management benefits patients.

QP Pathways are clinical components of the GP Contract, designed to reduce unnecessary hospital admissions and outpatient attendances.

An Atrial Fibrillation QP pathway was produced to enable GP Practices in Gwent to implement care bundles, using Quality Improvement Methodology, when identifying, diagnosing and managing patients. It was supported by a guide developed by the Primary Care Quality team in Public Health Wales.

The QP Pathway is optional and was offered to every GP practice in Gwent. Nine practices volunteered to work as a collaborative and implement the care bundle approach to Quality Improvement. Each practice also had to use the Atrial Fibrillation module for Audit+ so the data could be analysed by Public Health Wales.

Each practice was required to show improvement in 3 out of 5 care bundles:

  • Opportunistic screening of over 65s
  • Assess symptoms
  • Perform CHADS2 / CHADS2VASc Score to assess risk of CVA
  • Manage rate and rhythm
  • Check BP, pulse, review medication, undertake anticoag risk assessment

The practices met as a collaborative on 3 occasions and agreed to share practice data between themselves and also share learning from the improvements they had put in place.

Data was extracted fortnightly by Audit+ software, analysed by Public Health Wales and supplied as run charts

Baseline data for each bundle was given to practices at the first collaborative meeting at the end of November 2013 and further data showing improvement was shared at the second collaborative meeting on 30th January 2014. Discussion between the practices identified changes they had made to improve compliance with the bundle. One practice has increased the percent of target population screened from 2 – 10% and there is evidence of improvement in all practices for the recording of pulse rate and rhythm.

Collaboration and working across boundaries: Colwyn Bay Health Care and Wellbeing Precinct

When we heard about Colwyn Bay Health Care and Wellbeing Precinct at the All Wales Continuous Improvement Awards, we instantly knew that we wanted to share what they are doing further. John Hardy will be running a workshop on their work at our Housing and Sport: Improving wellbeing and providing better value for public money seminar on 3 March in Cardiff and 26 March in Llanrwst, and you can hear more about their work below.

Colwyn Bay Health Care and Wellbeing Precinct / Canolfan Gofal Iechyd a Lles Bae Colwyn The project, originally a partnership between Therapy Services and through them to the Conwy and Denbighshire NHS Trust, Age Concern and Conwy County Borough Council and now between Conwy County Borough Council and Betsi Cadwaladr University Health Board, has attracted wide ranging support from numerous agencies in the health and social welfare field and is seen as a ground breaking initiative in the application of physical activity to the prevention and management of chronic conditions, thus lessening the burden on statutory health and social care services

The term ‘Health Precinct’ refers to the development of a place where health and Social Care professionals can work together with leisure professionals to develop innovative and evidence-based solutions to improve the health of the citizens of Conwy through physical activity; whether for ill health prevention, exercise by prescription, chronic disease management or rehabilitation from acute or chronic ill health. This collaboration supports a wide range of citizens to move seamlessly from medically supported therapy to community based physical activity. As part of the on-going evolution of this concept and building on previous work, Conwy County Borough Council’s Social Care and Education Services and Community Development Service are currently working in partnership to develop a programme of community wellbeing activities and information, advice and support to enable citizens to prevent ill-health and promote self-caring and individual ownership of support interventions based on the what matters conversation. Going forward this approach will also be delivered in collaboration with the third and independent care sectors.

What impact has it had?

Groups and individuals who have benefited and will experience greater health benefits as a result of the Health Precinct programme include those living with long term conditions and those undergoing cardiac rehabilitation. The programmes within the Health Precinct help to tackle depression and loneliness and also help participants to build their confidence levels and support people remaining active and living in their own homes. In the long term we hope that this self-caring approach with also lessen the burden of unscheduled care required from health and social care services.

Two examples of programmes developed and being delivered at the Health Precinct:

Aqua Therapy/Warm Water Modality

The Aqua Therapy Warm Water Modality pilot study conducted jointly by leisure staff, Therapy Services from Betsi Cadwaladr University Health Board and Public Health Wales has set the standard for how these projects should be planned and implemented in the future.
Following the study a pathway has been specifically developed aimed at clients with chronic muscle / joint pain which provides far greater access to clients by utilising the local authority swimming facilities.

Early Onset Dementia

The early onset dementia project links closely with the Elderly Mental Infirm Units at Bryn Hesketh and Bodnant. Conwy County Borough Council has developed an exercise class specifically for clients who have been diagnosed with Early Onset Dementia.

The Health Precinct initiative is underpinned by a commitment to strengthen community-based care and a more equal relationship between patient and professionals. It also helps to change the relationship between health social care services and the public, characterised by a shared decision making for care and support with citizens to promote appropriate intervention as well as a securing improved health and wellbeing outcomes. This approach is in line with co-production principles.

NHS Hack Day: Data Visualisation

Data Visualisation / Delweddu DataIt’s been a packed first session at the NHS Hack Day. The pitches have taken place, and people have chosen where to put their energy and efforts. The hard work has begun.

I’ve caught up with Martin Chorley, who’s a lecturer at the School of Computer Science and Informatics at Cardiff University. The group working on his pitch includes students of Computational Journalism, who are looking to make health statistics and data easier to find, view and understand for different areas.

The data will be displayed on a map of Wales, and will clearly and easily convey information around issues like Cancer patient waiting lists, numbers of beds at Hospitals or even the spending levels of their Health Board.

This approach takes inspiration from NHSmaps.co.uk, which shows data for clinical commissioning groups in England, but it will also add further information to what’s available on the site.

NHS Hack Day: Data Visualisation / Diwrnod Hacio'r GIG: Delweddu DataAnybody who works in either local authorities or the NHS in Wales will know that the footprint of public services differ greatly, with the boundary of no one Health Board matching that of a Local Authority perfectly.

Instead of letting this get in the way of creating the tool, they’re cleverly getting around this by amending the metadata of the information they’re collating. This will result in the boundaries displayed on the map being amended according to the details of its information source. There is even the possibility of displaying the information to the level of a Lower Super Output Area.

It’s been impressive to see how people are negotiating issues that have so often been sticking points when we look to improve public services. Proof that working in new and different ways can result in interesting approaches to old problems.

Dyfrig