Transformation of services across NHS Wales
Introduction
The Covid-19 pandemic has exacerbated the challenges faced by the health and social care system in Wales, prompting the transformation of services and promoting new ways of working to rise and meet those challenges. Health and care staff have been working at the forefront of these developments as they continue to meet the needs of patients in a rapidly changing landscape.
In this briefing, we highlight examples of innovative practice across NHS Wales from recent months and some of the new ways in which staff are caring for their patients, whether through community outreach initiatives or the use of digital technology. It showcases the ways in which the system is addressing the scale of the challenge left in the wake of the pandemic, while also embracing the transformation in services brought about by the pandemic by improving access, efficiency, and treating more people in the community.
Some examples illustrate how opportunities have been seized to work across the health, care and voluntary sectors in a collaborative effort to provide patient-centred care and sustain improved ways of working. The partnership response to the pandemic has been exemplary and these case studies demonstrate just some of the opportunities as we move forwards with recovery.
Innovations shown in this briefing are not only in response to the pandemic but include other examples of advances in the system, such as the use of an operative robot in the Royal Gwent Hospital and a new emergency service in Cardiff and Vale University Health Board. These demonstrate a willingness within the system to embrace new technologies outside of the pandemic response which will have long-term benefits in the future.
Other examples highlight preventative action taking place, including the use of virtual wards and volunteers in mental health, which show a system working to care for patients within their communities, adopting a partnership approach to help patients avoid serious harm and hospital admission. As society continues to come to terms with the impact of the pandemic, these practices indicate a healthcare system that is working to minimise harm and provide patient-centred care.
These transformations have led to a significant increase in the number of people accessing non-COVID services across Wales. We want to see this trend continue and provide further assurance to the public that the NHS will do all it can to be here for those who need it.
Nobody can deny the scale of the challenge the NHS in Wales is facing, and we recognise the importance of building on innovative care models not only to support safe access to services, but to be better prepared for what lies ahead.
It is hoped that the work highlighted here will inspire others to think about providing care differently and share learning across the health and care sectors.
Case studies
Aneurin Bevan University Health Board
Theatre teams test state-of-the-art operating robot at Royal Gwent Hospital
Surgeons and theatre staff at the Royal Gwent Hospital were fortunate to have the opportunity to test-drive a state-of-the-art operative robot.
The robotic system enhances precision, flexibility and control during operations, improving visibility for surgeons. In contrast with traditional open and laparoscopic (keyhole) surgery techniques, the operative robot uses 3D vision technology. As a result, robotic surgery allows surgeons to perform delicate and complex procedures that may have otherwise been difficult with other methods.
As a minimally invasive surgical technique, robotic surgery allows benefits such as reduced post-operative pain and quicker recovery. This approach can be used across all specialities, including urology, colorectal, gynaecology and ear nose and throat.
After gaining an insight into the robot’s capabilities and benefits, surgeons and theatre staff are now looking forward to the future arrival of their very own surgical robot, which will improve surgical services for patients in the Health Board area.
Betsi Cadwaladr University Health Board
Drive-through service for heart patients at Llanfairfechan
People with pacemakers need to have their device checked regularly but because of COVID-19 restrictions, it has been difficult for the team in the Health Board to see patients face-to-face. Over the last year the Cardiology Investigations Department at Ysbyty Gwynedd have been operating a drive-through clinic at Bryn y Neuadd in Llanfairfechan. Patients can park under a sheltered area and then have one of the cardiac physiologists download information from their pacemaker through their car window.
A wireless header is handed to the patient through the car window to hold over the implanted device. Information is downloaded from the device on to an iPad and sent to a pacing database to be reviewed. While the information is downloading, staff can have a consultation with the patient.
The team have had positive feedback from patients, but are currently only able to offer appointments to those with devices made by the company Medtronic. Other manufacturers are working on a monitor which will allow other devices to be checked.
Cardiff and Vale University Health Board
New Emergency Service brought to the homes of Cardiff and Vale residents
Patients experiencing medical emergencies in Cardiff and the Vale of Glamorgan can be treated in the community, thanks to a new joint service from the Cardiff and Vale University Health Board (CAVUHB) and Welsh Ambulance Services NHS Trust (WAST). The new Physician Response Unit (PRU) went live on April 19 2021 for a trial period of six months, operating from 10am-7pm on weekdays (except Wednesdays).
The service works when a member of the public calls 999, at which point the call handler may choose to dispatch PRU to treat the patient at the scene. PRU has the advantage of senior decision making at the first point of patient access as responders have direct contact with specialists and senior physicians within the hospital. Responders from PRU can also carry out diagnostic tests at the scene, including COVID-19 screening, ultrasound and blood tests.
By piloting this consultant-lead service, some of the community’s most vulnerable groups, including the frail, elderly, those who are shielding and people experiencing mental health crisis, could avoid attendance to the emergency unit completely.
Cwm Taf Morgannwg University Health Board
Digital counselling service set to support young people's mental health
Online counselling and self-help resources are available for 11–18-year-olds across the Health Board, following a new partnership with an award-winning digital mental health and wellbeing service, Kooth.
Kooth were commissioned by the Health Board to provide free emotional wellbeing and early intervention support for children and young people. Kooth is a self-referral service that has no waiting lists and/or specific access criteria and comes with the full accreditation of the British Association of Psychotherapy and Counselling. Services include one-to-one, anonymous counselling sessions and 24/7 access to self-help resources. Anyone aged 11-18 can join by visiting the website and signing up.
Kooth members have access to one-to-one counselling sessions with fully trained and qualified counsellors and emotional wellbeing practitioners, 365 days a year. Sessions are available between midday and 10pm on weekdays and between 6pm and 10pm at weekends. They can be booked in advance or accessed via an instant text-based chat. In addition, peer-to-peer support is available at pre-moderated discussion forums offering a safe space for members to share their experiences and ask questions.
Digital Health and Care Wales
Welsh nursing undergoes digital revolution
A new system, the Welsh Nursing Care Record (WNCR), is transforming nursing documentation by standardising forms, and turning them from paper to digital. For the first time ever, nurses will be able to complete assessments at a patient’s bedside on a mobile tablet, or other handheld device.
Data from the WNCR will be used to drive developments in learning across organisations in health and care to improve patient outcomes and experiences. The new system will enhance efficiency, value, and timeliness of care with the aim of improving patient safety.
Patients and staff will be able to move across services in Wales using the single WNCR system, ensuring consistency and accuracy. When a patient is discharged from hospital, digital assessments taken by nurses involved in their care will be made available to the national, digital patient record, the Welsh Clinical Portal (WCP).
The project has involved nurses and multidisciplinary team members from every NHS Health Board and Trust in Wales, working together for over three years to standardise the forms and create the new digital process. A Clinical Nursing Lead is now employed in each Health Board and NHS Trust to lead the introduction of the new documents.
Health Education and Improvement Wales
Over £730K invested in nursing placements
Health Education and Improvement Wales is to lead on a £730k project which will promote and widen access for a career in social care nursing. Funding provided by Welsh Government will create three regional Care Home Education Facilitators (CHEFs) who will work within the care home sector in Wales.
Similar roles are already firmly embedded within nursing and midwifery services to support nursing students through their training and placements. They will help to enhance the quality of student clinical education whilst directly supporting health provider staff. It is anticipated the new CHEF roles will provide similar support within the care home sector and will span the whole student journey. They will also support staff to help students meet their proficiencies, through to the point of registration and support of new registrant preceptorship.
Care homes are centres of excellence for teaching and learning and there are significant benefits of recruiting students to train in care homes local to them and considering the sector for future employment. CHEFs will significantly strengthen student support arrangements between individual care homes and Universities.
Hywel Dda University Health Board
Introducing the new Community Outreach team
Hywel Dda University Health Board is leading the way with a new project which sees a team of experienced community workers reach out to ethnic minority people living in Carmarthenshire, Ceredigion and Pembrokeshire to help them during the COVID-19 pandemic.
A three-strong outreach team led by Stepheni Kays, Community Development Outreach Manager, has started engaging with communities and will be reaching out to the 10,000+ people from minority ethnic communities. The community development outreach workers will develop close links with Local Authorities, third sector organisations and community groups to raise awareness and understanding of the Test Trace Protect process and the vaccination roll-out programme.
The community development outreach workers are the link between the Health Board and communities and support community cohesion actions, aiming to remove any barriers to accessing services.
The project has been developed drawing on the recent evidence base and publications about the impact of COVID-19 on ethnic minority communities in Wales, as well as the wider UK.
Powys Teaching Health Board
Volunteers to take on more mental health support roles in Powys
In the future volunteers are going to play a bigger role in supporting patients with poor mental health in Powys. The Health Board has trialled the use of Anchor Buddies with its community mental health team in Brecon and is looking to expand the scheme further.
Anchor Buddies are used to provide additional support to patients who need help with their mental health, either on a one-to-one basis or through group activities such as walking or gardening; and could also be used to help patients experiencing anxiety to visit places like restaurants or cinemas. Patients could also be asked to become volunteers themselves as part of the scheme, once they have made progress, as a further aid to their own recovery.
The Health Board is also working on plans to use volunteers as Tech Buddies to help mental health patients with limited digital skills to access appointments, or further information about their condition or hobbies online. Tech Buddies have been helping patients across a range of services to access virtual clinics via Attend Anywhere appointments during the pandemic. These have allowed them to connect with healthcare staff via a video call using a computer, tablet or smartphone, instead of meeting face-to-face.
Public Health Wales NHS Trust
New Resource Platform for Care Home Domiciliary Staff
Improvement Cymru’s Care Home Cymru team recently launched a new online resource platform for Care Home and Domiciliary Staff.
The team recognised staff from the sectors need to regularly access information from several different online sources which can be time-consuming and practically difficult in various settings. As the pandemic has added huge pressures on staff time, crucial time savings could be made if staff could access the information in one place, on either a mobile phone or computer.
The resource platform was produced in partnership by Improvement Cymru, Public Health Wales, Welsh Government and other partners in the care and domiciliary sector. Working together, they were able to identify the information staff need to access and developed a one-stop resource platform to host all the links to those websites.
The platform is available on an app (English only) and a website (bilingual), is easy to access (via phone or desktop) in various settings where staff might be during their shift.
Links include information on infection control, recognition of deterioration, mental health and wellbeing, COVID-19, training, guidance and useful contacts.
Swansea Bay University Health Board
Innovative approach to warding off hospital admissions
Cwmtawe Medical Group and Strawberry Place Surgery in Swansea are employing a virtual ward approach to match health care services to individual patients. The move is in line with the Cwmtawe Primary Care Cluster’s mission of treating people within their own community and helping take the strain off hospitals.
A virtual ward is a weekly multidisciplinary team meeting involving primary care, secondary care, community and voluntary services who combine their expertise to discuss how to manage and support patients who may be deemed frail, have complex conditions, have recently been discharged from hospital or are potentially at risk of having to go into hospital. Patients can be referred into the virtual ward by any professional across all sectors using a simple referral form.
Feedback on the concept, which was first introduced in March 2020, has been positive. The virtual ward is an excellent example of health care professionals and services combining their skills and expertise to safeguard the health and wellbeing of individuals and help them live a long and fulfilling life, wherever possible in their own communities, without the need to go to a hospital.
Velindre University NHS Trust
Neuro Oncology Team announced joint winners of the Advancing Healthcare Award
The Neuro Oncology Team have been awarded joint winners of the Advancing Healthcare Award in innovation in neurorehabilitation for their development of the Neuro-Oncology AHP Clinic. The Clinic was launched in Autumn last year to ensure patients with brain tumours and their families could access holistic care quickly and at different stages of their illness. The Clinic consists of a Neuro Oncology Clinical Nurse Specialist, Speech and Language Therapist, Dietitian, Physiotherapist and Occupational Therapist.
English for Speakers of Other Languages (ESOL) Project for Black, Asian and Minority Ethnic (BAME) Communities
The Trust, in partnership with Cardiff and Vale College, has been running English for Speakers of Other Languages (ESOL) Health and Cancer Awareness Projects in BAME Communities for the last 5 years.
This year, given the current COVID-19 situation, the project focused on educating the community about the risk of COVID-19, steps and precautions to prevent infection and reinforcing the message of staying safe and healthy. This information will be shared by the College at the ESOL Forum (UK wide stakeholder group for ESOL), Adult Learning Wales and Reach (ESOL provision in the community across key centres in Wales). The information will also be sent to community-based organisations as well as to the Public Health Wales-BAME sub-group.
Welsh Ambulance Service NHS Trust
New initiative to improve care for terminally ill patients
The Welsh Ambulance Services NHS Trust (WAST) has joined forces with Macmillan Cancer Support in Wales to launch a new initiative to improve the care delivered to terminally ill patients.
The collaboration is designed to improve the training delivered to ambulance crews so they can provide the very best care for patients at the end of life. The training will support clinicians to better recognise when a patient is nearing end of life and improve communication and symptom management skills to prevent avoidable hospital admissions.
The network of support being developed as part of the project in conjunction with Palliative Care Wales is invaluable, such as the ability for an ambulance clinician anywhere in Wales to be able to contact a palliative medicine doctor 24/7 from the patient’s home to seek their advice and guidance to achieve the best outcome for the patient.
The two-year project will also help to identify why, where and when patients at the end of life are needing to access the ambulance service, so they can identify areas for further development across the health and care sector in Wales.
