Tag Archives: NHS

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!!

Simple questions can make a difference

How can board members help to improve waiting times? Verity Winn from the Performance Audit Health Team looks back at our ‘Asking the Right Questions’ seminar.

NHS Waiting Times ReportPutting on an event to publicise a checklist sounds like an auditors dream… But how do you make it interesting for Independent Members of health boards with busy schedules and no shortage of important issues on their plate? The answer is in making it relevant and focused on practical things they can do to make a difference for patients. And also to create a safe space where they can feel comfortable sharing and working through the issues with people who are in the same boat.

For me a lot was riding on our ‘Asking the right questions’ event on 21st May. I spent most of last year buried in information about the NHS in Wales as one of the team working on our report on NHS Waiting Times. Our findings were worrying – waiting times are getting longer, some patients are coming to harm and more could be done about it. We did a lot of work to understand why waiting times are getting worse including the pressures on the NHS in terms of money, staff, beds and other resources. We also looked at what could be done differently and identified some significant opportunities for health boards to make better use of their existing resources.

All this work filled four reports – but we had the sneaking suspicion that not everyone would have time to read through all of it! We wanted to get our message across in the simplest way to the people who can use it to make a difference. Independent Members have a vital role in scrutinising health boards’ performance and holding them to account. We wanted to create a tool to help them ask the right questions to challenge their health boards – not just about whether waiting times are getting longer, but to understand what they’re doing to bring them down. The tool is our checklist. It sets out a series of questions to understand how the health board is performing on waiting times and how strong their plans to improve are.

The event was a new experience for me. Working in the central national studies team, we tend to move onto a new topic once our reports are published. That means we don’t often get to see the local impact our work has, or meet the people who can use our reports work to make change happen. But this event brought us face to face with Independent Members and reminded me that sometimes the simplest way to get a message across is by talking to people.

The event started with the spotlight on Dave Thomas, Director of the Performance Audit Health Team at the Wales Audit Office and Helen Birtwhistle, Director of the Welsh NHS Confederation. They answered questions about some of the challenges and opportunities facing the NHS in Wales and what needs to be done to improve waiting times for patients. You can watch the full discussion below. The rest of the day was filled with practical workshops based on the topics in our checklist.

It was great to see people sharing experiences and advice in such an open and supportive way. And really positive to see the commitment of Independent Members to putting the patient first and not shying away from difficult questions to make sure this happens. I was particularly interested to hear the suggestions of questions to ask health boards to understand what they’re doing to improve waiting times. At the end of the event, one person told us that the key thing he learnt was to ask questions in ‘the most simple language, hoping to get to the nub of the point’ – for me, he hit the nail on the head.

I was really pleased that the feedback we had from the event was overwhelmingly positive. Not that there isn’t always something to learn about how we could do things a little better next time. We are holding another event on ‘Asking the right questions’ in the Metropole Hotel in Llandrindod Wells on 13 July. If you’d like a place, please email good.practice@audit.wales. I look forward to meeting more of you there.

5 things for public services to think about when using Periscope

How might public services use Periscope? In this guest post, Will Barker, Project Support Officer (Social Media & Digital), 1000 Lives Improvement, looks at ways that we could use the app.


Persicope is a new live streaming app that is linked with Twitter – it’s just over a month old and already it has been sighted as a game-changer in the way social media effects broadcast news, and the next big platform to come along since Twitter.

It works simply by choosing what you want to broadcast, setting a broadcast stream title and clicking ‘broadcast’ this then links with your Twitter stream and your twitter followers can join the broadcast, as well as anyone around the world who is interested in what you are showing.

As with all new technology and social platforms, we have to take these statements with a pinch of salt – many thought that Vine was the app to tick this box, but it has taken a different path to what was first expected. Nevertheless, it is worth exploring how the public sector could potentially use this live streaming app to their benefit, particularly whilst there is still a lot of intrigue around it.

Forums, events and conferences

This could be one of your own, or one that you are attending/ have a stand at. Often, the aim is to ‘join the conversation’ using the conference hashtag. Perhaps Periscope could be used to shape a conversation or create new ones, beyond tweeting each other. Want to discuss key topics and highlights from the day, why not set up a broadcast that does just that, almost like a panel session. At 1000 Lives Improvement (@1000LivesPlus), we did exactly this. At a recent conference, we gave highlights and interviews with our staff via Periscope about what learning they had taken away from sessions, we think it gave an extra element to those following us on Twitter who couldn’t be there.

Question and Answer

Keep getting the same questions asked via your social media channels, or simply have the opportunity to get some key experts in their field in the same room? Through live streaming via Periscope you have an opportunity to answer important questions in more depth and more immediately. You must keep in mind that, though, that if you do open yourself up for a Q&A session, you are open for all types of questions, so it’s worth setting some house rules in place, for example: ‘today we’ll be discussing these set topics, for answers around other topics, you can reach us here’.

Important news

More and more we are seeing people, news outlets and organisations turning to Twitter to break important news. Why not use Periscope? You can keep control exactly what you’re saying, put it across in more than 140 characters and still get the benefit of reaching your audience online. It’s worth noting that with the size of audience that Periscope is bringing, and with it being so new, this type of communication shouldn’t be in isolation, as the majority of the audience is likely to miss it.

Open meetings

Got a planning meeting that isn’t sensitive and would really benefit from input outside of your organisation? Why not open it up to get the thoughts of people across the world, you never know; someone’s suggestion could be the start of your solution.

Showing the work being done/getting behind the scenes

Behind the scenes has been used a lot on Periscope already. Whether it’s the BBC showing behind the scenes of The Voice UK Live Finals, various news organisations giving behind the scenes footage of their election coverage or Cardiff Council giving viewers a guided tour of the RHS Flower Show before it opened. Giving your audience something they wouldn’t get anywhere else is a real perk of Periscope, so why not think about how that could translate to your organisation or project?

Remember what’s out there. Take a look around.

Periscope may be new and exciting to many, but remember that live streaming has been around for many years. It’s worth taking a look around at what else is out there to make sure you are using the right platform for your requirements. With periscope only being (currently) available on iOS devices, linking with Twitter and broadcasting in portrait, is it the right platform to reach your audience, or would other live streaming products like Bambuser fit better? Not to mention the rival to Periscope: the live streaming app called Meerkat, but that’s a whole other story.

There is plenty out there for you to read about Periscope (and Meerkat) for you to make your own mind up, so go and have a look – and if you can, start experimenting with how you might use it in your organisation.

I’d love to hear your thoughts on using Periscope in the public sector, or how you’ve got on if you already have used it. Leave a comment below or tweet me @willdotbarker.

WhatsApp: Could it help you make your community a better place to live?

As the world changes, it’s fascinating to see how public services are changing too. A few years ago, an organisational social media account was a novel thing, like when Helen Reynolds created a MySpace page for Shire Hall in Monmouth. While lots of us are still getting to grips with what social media means for the way organisations interact with communities, it’s embedded in the way that we communicate as individuals on a day to day basis.

WhatsAppIt’s probably no surprise then that there’s a lot we can learn from the people within our communities.

As budgets are shrinking, public services are being asked to do more with less. Organisations are starting to move away from the paternal role that they’ve often played in the past to enabling people to make the most of their opportunities. We shared how the Bromford Deal is doing just that as part of our Adopting Preventative Approaches Seminar last year. You can find out more about the deal in the video below.

I’ve been using WhatsApp personally for a while. I’ve been intrigued as to how it might be used to improve the way we work, but I couldn’t quite get my head round how that might happen. This Storify by Will Barker of the #nhssm Twitter Chat changed that, and I could instantly see how organisations could use it to better inform people about what they’re doing. It’s startling that in the case of the Oxford Mail, WhatsApp has a six or seven times times greater conversion rate to page views than Twitter.

Trafodaethau WhatsApp DiscussionsBy sharing that Storify, I quickly got into a conversation with Ben Black, whose street is using WhatsApp in a really interesting way. The platform gives people the chance to better connect with each other (Ben tells me there’s a fair bit of banter on the thread). It means that when the power’s gone out, there’s a quick way of checking if it affects one house or the whole street. If one resident is heading to the dump, a quick message to the group means that they can take other people’s rubbish while they’re there. When a restaurant on the street applied for licensing, it was used to send feedback from the council meeting. It’s been used to highlight issues that affect the street like potholes, or to see if people can lend or borrow equipment or even each other’s time, such as by cutting each other’s lawns.

I was just thinking about using WhatsApp to communicate with people, but Ben and his neighbours have taken it that step (or five) further and are actively using it to help make their street a better place to live.

I bet if we asked people how they felt about the public services they received, the vast majority would ask “what public services?” Through tools like WhatsApp and Streetbank, people are actually delivering some aspects of services themselves. If we spare a second to think about how we might work differently and take a lead from Ben’s street, I reckon there’s a lot we can do to improve the work we do.


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.

NHS Hack Day: An If This Then That for Health

Grŵp Dr. Keith Grimes / Dr. Keith Grimes' groupKeith Grimes is a GP at a walk in centre in Eastbourne. His commissioning group identified that people were going to Accident and Emergency when there were appointments available at their surgery.

Keith and his fellow group members have come together at the NHS Hack Day to create Gwyb. The name comes from ‘gwybodaeth’, which means ‘information’in Welsh. It aims is to be an ‘If This Then That’ (which can start a range of actions based on something that you do online) for medical or social care. It’s principally a notification system that allows patient and clinicians to create rules which will allow for automated actions to happen should they attend A&E or other services.

This is exciting on a number of different levels. If a patient attends A&E, Gwyb could notify the GP so that they could contact the patient and bring them to the practice for quicker and more appropriate care at their surgery.

Grŵp Dr. Keith Grimes yn Niwrnod Hacio'r GIG / Dr. Keith Grimes' group at the NHS Hack DayThe system could also mean that if a patient goes to Accident and Emergency, the department automatically receives details of their medical history, so that the patient’s needs are identified as quickly and as efficiently as possible.

If a patient was receiving palliative care, the system might also notify the hospice team, so that the patient could receive a personalised response that’s based on their personal circumstances.

Like many good ideas, patient involvement has added massive value by suggesting  other ways it might be effective. For instance the tool might notify the patient’s next of kin, or send a copy of their advance directive to the hospital. Involving patients in the setup of notifications means that patients specify the actions themselves, and that their consent creates the rules.

Excitingly, this idea could be developed further. If it proves to be effective, the scope of actions and triggers could be increased so that things like a patient’s high blood pressure might automatically notify the GP.

Just like with the Hack Day itself, there is a world of possibilities.


Diwrnod Hacio’r GIG: ‘If This Then That’ ar gyfer y gwasanaeth iechyd

Grŵp Dr. Keith Grimes /  Dr. Keith Grimes' group

Mae Keith Grimes yn feddyg teulu mewn canolfan ‘galw i mewn’ yn Eastbourne. Nododd ei grŵp comisiynu bod pobl yn mynd i adran Damweiniau ac Achosion Brys yr ysbyty lleol pan oedd apwyntiadau ar gael yn eu meddygfa.

Mae Keith a chyd-aelodau ei grŵp wedi dod at ei gilydd yn Niwrnod Hacio’r GIG i greu Gwyb, sy’n deillio o ‘gwybodaeth’. Nod Gwyb yw bod yn ‘If This Then That’ (a all gychwyn ystod o gamau gweithredu sy’n seiliedig ar weithred ar-lein) ar gyfer gofal meddygol neu gymdeithasol. Mae’n bennaf yn system hysbysu sy’n caniatáu i gleifion a chlinigwyr i greu rheolau sy’n galluogi camau gweithredu awtomatig i gymryd lle os mae claf yn mynd i adran Damweiniau ac Achosion Brys neu wasanaethau eraill.

Mae hyn yn gyffrous ar lot o lefelau. Os bydd claf yn mynd i adran Damweiniau ac Achosion Brys, gallai Gwyb hysbysu’r meddyg teulu fel bod nhw’n gallu cysylltu â’r claf a dod â nhw at y feddygfa er mwyn cael cymorth cyflymach a mwy priodol.

Grŵp Dr. Keith Grimes yn Niwrnod Hacio'r GIG /  Dr. Keith Grimes' group  at the NHS Hack DayGallai’r system hefyd sicrhau bod yr adran yn derbyn manylion am hanes meddygol y claf yn awtomatig, fel bod anghenion y claf yn cael eu hadnabod mor gyflym ac mor effeithlon â phosibl.

Os bydd claf yn derbyn gofal lliniarol, gallai’r system hefyd roi gwybod i’r tîm hosbis, fel bod y claf yn gallu derbyn ymateb personol sy’n seiliedig ar eu hamgylchiadau personol.

Fel lot o syniadau da, mae cynnwys y claf yn y cynllunio wedi ychwanegu gwerth enfawr i’r gwaith. Mae cleifion wedi awgrymu ffyrdd eraill gallai’r system fod yn effeithiol. Er enghraifft gallai hysbysu  perthynas agosaf y claf, neu gallai anfon copi o’u cyfarwyddeb ymlaen llaw i’r ysbyty. Mae cynnwys y claf wrth setio fyny’r system yn golygu ei bod nhw’n gallu nodi camau gweithredu ei hunain. Ei chaniatâd nhw sy’n creu’r rheolau.

Mae hwn i gyd yn gyffrous achos gallai’r syniad cael ei ddatblygu ymhellach. Os yw’n profi i fod yn effeithiol, gellir cynnwys camau gweithredu a sbardunau bellach fel bod pethau fel pwysedd gwaed uchel y claf rhoi gwybod i’r meddyg teulu yn awtomatig.

Yn union fel gyda Diwrnod Hacio’r GIG ei hun, mae yna bosibiliadau enfawr.


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.


Diwrnod Hacio’r GIG: Delweddu Data

Data Visualisation / Delweddu Data

Mae sesiwn gyntaf Diwrnod Hacio’r GIG wedi bod yn llawn dop. Rydyn ni wedi clywed syniadau pobl, ac mae mynychwyr wedi dewis ble i roi eu hegni a’u hymdrechion. Mae’r gwaith caled wedi dechrau.

Rydw i wedi dal i fyny gyda Martin Chorley, sy’n ddarlithydd yn yr Ysgol Cyfrifiadureg a Gwybodeg ym Mhrifysgol Caerdydd. Mae’r grŵp sy’n gweithio gyda fe yn cynnwys myfyrwyr Newyddiaduraeth Cyfrifiadurol, sy’n edrych i wneud e’n haws i ffeindio a deall ystadegau iechyd ar gyfer gwahanol ardaloedd.

Bydd y data yn cael ei arddangos ar fap o Gymru. Mae’r map yn anelu i arddangos y data mewn ffordd sy’n hawdd i’w ddeall. Fe fydd yn cyfleu gwybodaeth sy’n ymwneud â materion fel rhestrau aros ar gyfer cleifion Canser, nifer y gwelyau sydd mewn ysbytai a hyd yn oed lefelau gwariant Byrddau Iechyd.

Mae’r dull yma’n cymryd ysbrydoliaeth o NHSmaps.co.uk, sy’n dangos data ar gyfer grwpiau comisiynu clinigol yn Lloegr, ond fe fydd hefyd yn ychwanegu rhagor o wybodaeth i beth sydd ar gael ar y safle.

NHS Hack Day: Data Visualisation / Diwrnod Hacio'r GIG: Delweddu DataBydd unrhyw un sy’n gweithio yn awdurdodau lleol neu’r GIG yng Nghymru yn gwybod bod ôl troed gwasanaethau cyhoeddus yn wahanol iawn. Dyw ffiniau’r Byrddau Iechyd ddim yn cyfateb yn union â ffiniau un o’r awdurdodau lleol.

Yn hytrach na gadael i hyn fod yn rhwystr, maen nhw wedi datrys y broblem trwy deilwra metadata’r gwybodaeth maen nhw’n casglu. Bydd hyn yn arwain at newid y ffiniau ar y map yn unol â ffynhonnell y wybodaeth wreiddiol. Mae hyd yn oed y posibilrwydd o arddangos y wybodaeth i lefel Ardal Gynnyrch Ehangach Haen Is.

Mae fe wedi bod yn drawiadol i weld sut mae pobl yn trafod materion sydd yn aml wedi bod yn rhwystrau wrth i ni edrych i wella gwasanaethau cyhoeddus. Mae heddiw yn brawf bod gweithio mewn ffyrdd newydd a gwahanol yn gallu arwain at atebion diddorol i hen broblemau.


GovCamp Cymru

GovCamp Cymru

This year the Good Practice Exchange is supporting GovCamp Cymru, which is an unconference for people working in or with public services in Wales. The event aims to bring people together to discuss and improve public service development and delivery.

As the Good Practice Exchange exists to share public service knowledge and practice, this is an ideal event for us to get behind.

Having supported the NHS Hack Day in Cardiff, we’ve seen what happens first hand when you give people who are passionate about what they do the time and space to improve their work. There were lots of fantastic ideas developed during the weekend, including the use of iPads to chart eye movement, and better learning from quality improvement audits.

There have been some inspiring unconferences this year, with lots of useful resources coming from LocalGovCamp in particular. GovCamp Cymru is in a good position to build on some of the learning from this, as LocalGovCamp was sponsored by the Satori Lab, who are running the event. This Guardian article from Sarah Lay is fascinating reading – will the same key themes crop up in Wales?

Photo issued under a Creative Commons licence by Official BlackBerry Images (https://www.flickr.com/photos/blackberryimages/8032817785/)

Photo issued under a Creative Commons licence by Official BlackBerry Images

On the GovCamp Cymru explained webpage there’s a bit about how people might pitch sessions. I’ll get my thinking cap on and start thinking about issues that I’ve come across that may need tackling. I wonder whether anyone will put forward sessions on collaboration (as Glen Ockso blogged about for We Love Local Government) or digital tips for councillors (from Swansea’s own Dave McKenna) like in LocalGovCamp?

There are also some great blogs reflecting on the event, with a healthy debate going on as to how the event met the sector’s needs, from Phil Jewitt’s post on how central digital is to LocalGovCamp to Kate Bentham’s post on whether she should have attended. It’s great to see such an open, transparent and respectful approach to feedback and learning.

With austerity and numerous graphs of doom being bandied around, we’re constantly reminded that public services face challenges that they have never faced before. If public services have changing needs, then we can’t expect supporting events to stay the same either. This event comes at an important time then, and we’re really looking forward to working with you all to improve public services at GovCamp Cymru.