caring for people - Cardiff & Vale University Health Board

CARING FOR PEOPLE KEEPING PEOPLE WELL Annual Quality Statement

2013 - 2014

Contents Welcome from the Chair and Chief Executive ......................................................2 Introduction ...............................................................................................................................................3 Your Health Board ...........................................................................................................................3 Who uses our services? ...............................................................................................................4 Who helps us to provide healthcare services? ..........................................................4

Treating you with dignity and respect – meeting your individual needs ..........................................................................................22 Access to services ............................................................................................................................27 Our staff and volunteers ..........................................................................................................28

How did we do in 2013/2014? ..............................................................................................5 What went well in 2013/2014? ...........................................................................................6 What could have gone better in 2013/2014? ..........................................................6

Looking forward to 2014/2015 .........................................................................................30

Who monitors the quality of our services? What have we learned about ourselves this year? .........................................8

Acknowledgements .......................................................................................................................33

How to give us your comments ........................................................................................32

Helping you stay as healthy and independent as possible ....................9 How safe is the care we give? ...........................................................................................14 How good is the standard of care? ..............................................................................20

A more detailed technical version of this document can be found on our website at http://www.cardiffandvaleuhb.wales.nhs.uk/opendoc/247913 Links to other websites and useful contact details are also provided.

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Welcome from the Chair and Chief Executive Welcome to the second Annual Quality Statement for Cardiff and Vale University Health Board. The statement tells you about quality and safety in the Health Board from April 2013 – March 2014. Last year we told you of the steps we had taken to develop a three year plan for our services. We called it Organising for Excellence (20132016).The number one purpose is:

“Caring For People, Keeping People Well” In this second Quality Statement we look back on 2013/14. We want to tell you what went well, what did not go so well and where there is a need to improve. The world around us is changing and we know that the way we deliver healthcare will change as technology and services change to meet needs. In order to plan which services you need, we really want to understand what it is like for you as patients, families and carers. We want to understand what worries you about healthcare. We also want to know what has gone well and why. What made the difference for you?

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The NHS across the UK has been the subject of some shocking reports during 2013/2014 which, without a doubt, will play a major part in the way we plan care for the future. We need to make sure that our services are of the highest quality and that they are safe. We need to know that every person who makes use of our services is treated with respect, with dignity kindness and compassion.

While we continue to focus on improving quality, safety, outcomes and experiences for patients, there is still a great deal more that we need to do. These are our priorities in 2014/15. The information provided in this Quality Statement is drawn from our data management systems and our quality improvement systems. To the best of our knowledge it is accurate, and provides a true reflection of our organisation.

In January 2014, the Health Minister, Mark Drakeford, set out his own plan to introduce ‘Prudent Healthcare’. Put simply this means that we should: • Do no avoidable harm • Carry out the minimum appropriate treatment on patients • Put relationships between patients and professionals on an equal footing We know that the only way we can achieve this is to work with you and with our partner organisations. By working together we can develop services that are suitable for your needs now and in the future.

Maria Battle Chair

Adam Cairns Chief Executive

Introduction Your Health Board Cardiff and Vale University Health Board (the Health Board) is one of the largest NHS organisations in the UK. We look after the health and well being of around 475,000 people living in Cardiff and the Vale of Glamorgan. We provide local primary care services, health centres, community health teams and hospitals. The Health Board has nine hospitals and 17 health centres. It also provides services in health centres run by our NHS partner organisations within Cardiff and the Vale and beyond. The Health Board’s 9 hospitals are; Barry Hospital, Cardiff Royal Infirmary West Wing, Children’s Hospital for Wales, University Hospital Llandough, Rookwood Hospital, St. David’s Hospital, University Dental Hospital, University Hospital of Wales and Whitchurch Hospital. There are also 66 GP, 90 Dental and 68 Optometry practices as well as 107 community pharmacies.

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When many people think of the NHS they think of doctors and nurses, but it is important to remember the many varied roles that make all the care we provide possible. Allied healthcare professionals and health scientists comprise more than 40 different professions including dieticians, physiotherapists, radiographers, audiologists and laboratory scientists to name but a few. Healthcare Support Workers play a key role in supporting staff to deliver direct clinical care. We must also remember all of the non-clinical people who make such a difference in the care delivered. These include our portering staff, cleaning and catering staff, electricians and engineers and many others.

optometrists, dentists and community based therapists and pharmacists.

The majority of services are provided to people in a community or primary care setting. Secondary care: this is care provided in a district general hospital setting e.g. you may be referred to a consultant in an out-patient clinic in relation to a heart problem, you may deliver your baby in hospital or you may be admitted as an emergency with a surgical problem requiring an operation.

Services across the Health Board are delivered in a number of different settings and you may hear them referred to as:

Tertiary care: these are specialist services such as paediatric intensive care, specialist children's services, renal services, cardiac services, neurology, bone marrow transplantation and medical genetics.

Primary and Community Care: these are services provided in a community setting by GPs, practice nurses, district nurses,

The Health Board is a recognised specialist centre

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The Community We Serve • the population of Cardiff and the Vale is growing twice as fast as the rest of Wales. • our childbirth rate is three times higher than the rest of Wales • babies being breastfed is much more than in other areas of Wales which is very good news • the number of people aged 0-24 in Cardiff is much higher than other places in Wales, averaging 35.5% (122,600 people) compared with 30.3% nationally. • over a quarter of our children live in poverty • about 300 teenagers (under 18) get pregnant each year • the number of people who are over the age of 85 is increasing. This means there will be more than 17,000 people over the age of 85 living in Cardiff and the Vale of Glamorgan by 2017. • the number of people with dementia will increase. • chronic conditions such as heart disease, diabetes and stroke are becoming more common.

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• the number of people from Black and other Minority Ethnic (BME) families is much higher than other areas in Wales • the 2011 census recorded 50,580 carers in Cardiff and the Vale of Glamorgan (a 12% rise in the last 10 years). • approximately 1,579 people identified themselves as young carers for Cardiff and the Vale of Glamorgan – we think there are more • 20% of the total population served by the Health Board suffer from problems with hearing, sight and general communication problems • More than 4,000 people suffer with a serious mental health illness. • there has been a gradual overall increase in the number of new asylum seekers moving into Cardiff over the past two years.

All of these facts are important because we need to plan our services to meet the needs of the people we serve.

Who helps us to provide healthcare services? We work closely with our colleagues in the Local Authorities in Cardiff and the Vale of Glamorgan (the Councils), other University Health Boards, Universities and Third Sector (Voluntary) organisations, to deliver a wide range of services. Please see the larger technical document for more information on some of the exciting work we are doing together currently to improve health and provide better care for people living in our communities. One example is the joint development of a 10 year plan to meet the needs of our increasingly older population. Older people are helping us to develop this.

How did we do in 2013/2014? In last year’s Annual Quality Statement we talked about some really important work that we wanted to do in 2013-2014.

What did we say we wanted to do?

We did it

We did a lot of work and things are improving

✓

improve care for people with cancer

✓ ✓

improve care for people who have strokes cut down waiting times for treatments

✓

improve general health and well being through health promotion set up a course to train our staff to deliver safer care for patients

We did not manage to do this but it is still an important piece of work that is planned

✓

improve emergency care

finish our review of liver surgery in the health board

We did a lot of work but need to do more

✓ ✓

look at more ways of improving care after the Francis report was published

✓

get better at ‘Putting things Right’ when people complain to us or raise concerns with us about someone’s care

✓

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Two minutes of your time

‘This is my third visit to this ward in 3 months. The staff have always been excellent and very attentive. Full of practical advice and reassurance. Being diagnosed with pre- invasive breast cancer it has been a difficult time for myself and my family and the dedicated staff on x ward are exceptional in their care and advice. No question goes unanswered-pain relief was always available, together with compassionate practical advice. I cannot praise the staff highly enough, from the receptionist to the nursing staff right through to the catering staff-all are caring and attentive.’

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What went well in 2013-2014 ? There are many things that we are proud of: • the number of adults smoking is coming down • there was a very big increase in the number of our staff who had flu jabs • we started a project to help people get fit before surgery and another project to give people advice on staying healthy • we are responding to less serious complaints about care in 2 days – 92% of the time • our Board members do Safety Walkrounds to speak to staff and patients and families over 10 times every month • the number of stroke patients who get care in the right place in the first 24 hours is one of the best in Wales • more than 90% of patients who completed our ‘Two Minutes of your Time survey’ told us that they were happy with the way we look after their privacy, dignity, help them to eat, call for help, get drinks and help to go to the toilet and with their pain control.

• we have done a lot of work with carers (see more in Section 8) • 95% of patients told an independent organisation that they are happy with their GP practice • many of our staff and volunteers have been recognised and received awards for their efforts in caring for people

What could have gone better in 2013 -2014 ? The health service has continued to experience many challenges. Some of these you will have heard discussed in the national and local media. Pressures on services during the winter months – again there was very high demand on our emergency services and hospital beds. The year before many of our beds filled up and a lot of patients who were waiting to come in for surgery were delayed because there were no beds available for them. This year we did much better. The number of cancelled operations was

much lower with 1570 fewer cancelled operations; a 36% reduction. We continue to work together to improve this position. Liver surgery – last year while reviewing our normal safety arrangements, we became very concerned about a number of patients dying following liver surgery. We asked the Royal College of Surgeons to undertake a review for us which helped us to understand if the number of patients dying was in the normal limits for such complex surgery. It was necessary for us to take appropriate action. We met with all 10 families where we had concerns and shared the outcome of the report with the families. We do not have any concerns about the service now but will continue monitoring it. Waiting times for cardiac surgery – in 2012 we became aware that our patients were having problems in being seen by specialist cardiac surgeons in South Wales. It became clear that a small number of patients had died while waiting for treatment. Patients having treatment, were doing very well. Our Cardiac Surgeons were very frustrated with this

situation, knowing that any patient with cardiac disease can die suddenly, so quick treatment is important. We have worked with Welsh Health Specialised Services Committee to find a solution and have now got agreement to increase the number of open heart operations being undertaken. We are planning to do 900 operations a year instead of 800 and we and other local Health Boards are investing £1.7m to improve. Treating people with dignity and respect – a member of parliament raised concerns about the care her husband received while a patient in the University Hospital of Wales in Cardiff. We undertook an independent internal investigation to look in to the issues raised which was scrutinised by the Community Health Council, Health Inspectorate Wales and the Chair of our Quality and Safety Committee. We are currently seeking external expert advice in line with the process for “Putting Things Right” (complaints process). As part of this review the ward in question was visited and inspected by HIW. A recent follow-

up Dignity and Essential Care inspection by Health Inspectorate Wales (HIW) has been undertaken along with a visit to the Emergency Unit and the vast majority of recommendations for the ward which followed their last visit have been fully implemented. HIW made some very positive comments about the way that patients were being treated. The state of our buildings, computer systems and medical equipment - Some of our buildings and departments are in a poor state of repair and more concerns are being raised with us on these issues from patients and carers. The cost of the replacement of this equipment and estate in our current financial position is a challenge. We are therefore working closely with Welsh Government to find a solution. Welsh Government has funded some of our big building projects such as the replacement of the Mental Health Unit and Stroke Unit at Llandough Hospital and Children’s Hospital for Wales.

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Who Monitors The Quality Of Our Services? What Have We Learned From Our Monitoring? There are a number of ways in which the Health Board is monitored on the safety and quality of its services; by external organisations and we monitor our services ourselves. Who monitors us? Welsh Government (WG) The Community Health Council (CHC) Health Inspectorate Wales (HIW) Auditor General for Wales (AGW) Welsh Risk Pool (WRP) The Royal Colleges – e.g. of Surgeons, Physicians etc

How do we monitor ourselves? Standards for Health Services in Wales Taking part in National Audits of our practice Local clinical audits of people’s care Leadership safety walkrounds Unannounced visits and inspections of wards and departments Performance reviews The internal audit department Professional Performance Reviews for Nursing and Midwifery Therapists and Health Scientists

What have we learned this year? CHC - raised concerns about the Out Of Hours GP services. This is now being monitored very closely as part of internal performance reviews. HIW - reported some very positive visits. Areas we have improved include new seating in the Emergency Unit, better signposts, better supply of pillows, redesign of nursing documentation and more training on Dementia. AGW/Auditor General for Wales - recognised our commitment to listening to patients and the public. We need to improve the way we respond to complaints. WRP - an improved score on the Surgical Pathways Standard (a WRP Standard). Some areas to improve include waiting times for treatment, better auditing of the quality of record keeping and staff knowledge in relation to the level of complaints and patient safety incidents. More detail can be found in Section 3.3 of the larger technical document

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Helping you stay as healthy and independent as possible Smoking Key Messages • In Cardiff and Vale of Glamorgan, just over one in five adults (21%) smoke • Smoking is the UK's number one cause of avoidable premature death, linked to a range of serious and often fatal conditions • People who breathe second-hand smoke are at risk of many of the same diseases as smokers, including cancer and heart disease • Smoking during pregnancy increases the risk of still born babies and Sudden Infant Death Syndrome (cot death), low birth weight and miscarriage • Smoking prevalence is higher in more deprived areas What are we doing about it? • A Hospital Smoking Cessation Service is in place • Introduced a policy to help patients who are facing surgery to address lifestyle risk factors such as smoking

• 218 staff have been trained to help people quit smoking, • 22 GP Practices are involved in work to help patients quit smoking • ‘Dragodil’ wallscape has been put in place at UHW • Introduced a Smoke-Free Health Board policy and E Cigarette guidelines • We will soon have a No Smoking Enforcement Officer patrolling the grounds of our hospital sites What can you do? We believe that two out of three smokers would like to quit. You are four times more likely to quit with a support programme than in any other way. If you’d like to give up, get in touch for support: Call the Hospital Smoking Cessation Service: • in University Hospital Wales on 029 2074 3582 • in Llandough: on 029 2071 5420 Call Stop Smoking Wales on 0800 085 2219

Key messages Uptake of: • scheduled immunisations in children at one year of age for 5:1 is 93.6%, below the target of 95%

• the completed HPV vaccination course in girls in the 2012-13 is 82.2%. The target is 90% • MMR1 vaccine in 16 year olds is 93.6%; MMR2 is 88.1% • seasonal flu vaccination for at risk individuals aged 6 months to 65 years is 51.1%. The target is 75%

• all immunisation at four years of is 84.6%. The Welsh average is 87% • the second dose of MMR vaccine at 5 years of age is 90.5%, below the target of 95%

What are we doing? • establishing link GP in each practice • established quarterly distribution of immunisation uptake data from Public Health Wales to each practice • regular training is provided to practice staff to encourage them to reconsider current Immunisation clinic delivery • together with Flying Start colleagues we are increasing access to vaccination in areas of deprivation • encouraging all staff attending Immunisation training to Make Every Contact Count (MECC) • ensuring those requiring immunisation for Seasonal Flu are reminded of their need for vaccination though a variety of media sources

Immunisation

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What can you do? • contact your GP Surgery to find out if you (and any family members) are up to date and/or to arrange any immunisations • if you have a chronic health condition or are over 65 years make an appointment with your GP for a seasonal flu vaccination in October of each year • look at the NHS Direct Wales website for information on what immunisations are needed and when: http://www.nhsdirect.wales.nhs.uk/Encyclopa edia/v/article/vaccinations/

Alcohol

Key messages • nearly half the population (44%) drinks above the recommended limits on at least one day a week • more than a quarter (26%) report binge drinking • drinking during pregnancy can harm the developing baby • children whose parents drink heavily are at risk of serious emotional and behavioural problems • alcohol is linked to accidents, injuries and poisoning. Social problems related to alcohol include crime, domestic violence and lost working days

What are we doing? • Public Health Wales has been rolling out an Alcohol Brief Intervention (ABI) training programme across Wales. 718 staff from a variety of primary and secondary care settings, substance misuse services and allied organisations in Cardiff and Vale have been trained, with further sessions booked • local trainers have been identified to deliver courses across Cardiff and Vale, with a range of organisations and partners, including GP practice staff, to support them to undertake ABIs and to implement a range of alcohol education interventions • discussions are being held with staff to improve both hospital and Emergency Unit data to improve local knowledge re alcohol misuse. • the Substance Misuse Area Planning Board has set up an Alcohol Group to plan and deliver comprehensive action on alcohol ranging from prevention and education, to environmental control and treatment services

What can you do? • swap your usual for a smaller drink e.g. a smaller glass of wine or a bottle of beer • drink a lower strength drink e.g. one with less units or lower alcohol content • drink a soft drink or a glass of water between alcohol drinks • drink alcohol only with meals, not before or after you’ve eaten • have at a least two alcohol free days a week • follow the lower-risk guidelines around alcohol consumption: men should not regularly (most days or every day) drink more than 3 to 4 units a day. Women should not regularly drink more than 2 to 3 units a day. Binge drinking is defined as drinking eight or more units of alcohol in one session for men, and more than six units in one session for women See http://change4lifewales.org.uk/adults/alcohol/?l ang=en for more tips

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Obesity Key messages • our population is too obese • obesity is a risk factor for chronic diseases which reduce quality of life and life expectancy • our population is getting more obese over time • boys are more obese than girls, but in adulthood this switches. • obesity is linked to deprivation What are we doing? • we offer dietetic-led structured group education programmes ‘Eating For Life’ to support people in making and sustaining lifestyle changes • we have developed Foodwise, a community weight management programme delivered by Communities First and leisure services • we deliver MEND childhood weight management programme to families • we work closely with partners including

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National Exercise Referral Scheme to promote physical activity • we work closely with schools and other community settings promoting healthy options through the network of healthy schools • the corporate health standard supports healthy options for staff • we work with schools and other community settings promoting healthy options What can you do? • eat healthier foods and drinks, with less sugar and saturated fat • try cooking from scratch rather than using processed foods • eat 5 portions of fruit and vegetables a day • reduce portion sizes • sit less and move more • individuals and organisations can pledge to make a positive food change by visiting www.foodcardiff.org.uk or following us on Twitter www.twitter.com/fairfoodcardiff or Facebook www.facebook.com/foodcardiff

Karen Tiltman told us: I lost six stone. I was so out of breath I couldn’t go up the stairs unless I was on my hands and knees. But I go to town now, to Splott market – to be honest without the programme I’d still be a couch potato. There’s quite a lot I’m doing.” Karen says she’s a stress eater and the help from course leaders has given her a better understanding of food. Advice on portion size, food types and help understanding food labels have all helped to reduce her weight. She said: “It helped me to stop being a couch potato, I go to the shops, I read the labels for low fats. I’ve done a lot of things that I wouldn’t have done without the help.”

Physical activity • Key messages • around three quarters of our population are not meeting the physical activity guidelines • advancing technology, motorised transport and less manual work has contributed to us being less active and more sedentary • inactivity and sedentary behaviour are risk factors for overweight and obesity and other chronic health conditions • sedentary behaviour increases with age • boys and men are more active than girls and women • areas of deprivation have low levels of physical activity What are we doing? • partnership plans focus on increasing the number of pupils walking and cycling to school • Implementing Sustainable Travel Plans, supporting staff, patients and visitors to

• • •

walk or cycle and also the Cycle to Work Purchase Scheme a pilot scheme with primary care teams is supporting staff to raise the issue of physical activity with patients and to signpost them to appropriate local activities being active is a component of the ‘Making Every Contact Count’ Programme supporting the local authorities to implement the Active Travel (Wales) Bill Land use plans and large housing developments are being influenced to incorporate walking and cycling

in your living room, ballroom in a local hall or joining a street dancing club • why not challenge a friend to a game of squash or golf. Or join a local football or netball team? • try something new. Your local Leisure Centre has a wide variety of activities for people to try for beginners to intermediate level (Leisure Centres in Cardiff and the Vale)

What can you do? • use the car less and walk when you can • make it sociable – get your family or friends involved • move more while doing the housework • save money by making the most of the outdoors; walking, jogging, running or gardening - they’re all free • bike it, to school or work or just for fun • dance like nobody is watching. From dancing

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How Safe Is The Care We Give? Providing safe, high quality care is our number one priority. The majority of patients we survey report a positive experience of their care but, unfortunately, there are occasions when things have not gone as well as we would like and sometimes patients come to harm. There are a number of processes in place within the Health Board to help us establish and monitor how safe our care is

Key Patient Safety Issues There are a number of key patient safety issues that we are working very hard to address and these include:

Infection control and prevention of sepsis

Healthcare associated infections (HCAI) are infections that develop as a direct result of medical or surgical treatment or contact in a healthcare setting • They can affect both patients and healthcare workers • Cause people to feel very unwell and stay longer in hospital • Cause death in a small number of cases • Increase costs in the NHS – over £50 million a year Infection Control and prevention is a key Welsh Government target, this year the Health Board have reduced the total number of patients with C difficile for people aged over 66 years of age. In the last reporting year, the Health Board missed this target of reducing C.difficile cases by 20% by just three cases. Across Wales, just two Health Boards achieved a 20% reduction in C.difficile. In terms of Methicillin Resistant Staphylococcus Aureus (MRSA), our performance was good for the first half of the year but by the end of the year, the Health Board had not achieved any

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improvement with thirty cases and the number of Methicillin Sensitive Staphylococcus Aureus (MSSA) cases had also risen. We publish regular data on infection control rates on our health board webpages : http://www.cardiffandvaleuhb.wales.nhs.uk/infe ction-prevention-and-control

What is your risk of getting an infection when you are admitted to hospital? It is likely that on any one day in our Health Board, 1 in 25 of our patients will have a HCAI – in line with health care average.

What are we doing to reduce the risk? • Providing clean environments • Ensuring hand washing is performed by healthcare workers. • Improving the use of antibiotics • Reducing our use of catheters and intravenous devices

Providing safe, high quality care is our number What can The you do to help us? one priority. majority of patients we survey • Tell your doctor or nurse if you’ve been report a positive experience of their care but, taking antibiotics prior to your admission to hospital • Clean your hands before eating and after using the toilet • Always ask healthcare staff if they have washed their hands Visitors can help by: • Cleaning hands before and after providing personal care, such as bathing, washing, dressing, helping to feed and toileting for the patient. • Not sitting on hospital beds

What is Sepsis? Sepsis is a life-threatening condition that occurs when the body's response to an infection damages its own tissues and organs. In the UK, severe sepsis is a condition with high prevalence – about 2.3% of hospital patients and about 27% of intensive care patients. It is serious because death rates are very high – around 30 – 50%. Can it be treated successfully? Yes. The first hours of treatment are the most important. Patients must receive appropriate antibiotic therapy as soon as possible. What are we doing about this? We know that we need to recognise at a very early stage that someone is developing sepsis and then treat it very quickly. We have been working hard to introduce the New Early Warning Score system (NEWS) and Rapid Response to the Acutely Ill Patient (RRAILLS ) system. What can you do? • Take your antibiotics as prescribed • Finish the whole course of antibiotics • Don’t take antibiotics unless you need them; this helps reduce the chances of developing

infections that do not respond to antibiotics • Don’t take someone else’s antibiotics Do we need to do more? We know we are improving, we need to do better. It is one of our priority areas for 2014-2015 To find out more visit www.world-sepsis-day.org and www.sepsistrust.org

Falls prevention Falls are a major cause of ill-health within the older population and may lead to injuries, hospital admissions and death. The rise in the number of older people will impact on the number of falls. Public Health Wales predict that, in Cardiff and the Vale of Glamorgan, the number of people aged 65 years and over admitted to hospital because of a fall will rise: • from 1,460 in 2010 to approximately 1,780 in 2020 • by over half to 2,345 in 2030

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We know that there has been an increase in attendances at the Emergency Unit (EU) for falls for people aged 65 years and over, increasing by 4% each year since 2007. What is the risk of falling? In 2013-2014 there were 3939 reported incidents of patients having slips, trips and falls. 58 patients received more serious injuries such as fractures of long bones or head injuries following a fall in one of our hospitals. You are much more likely to fall if you are a frail and elderly person, or have sensory loss or impairment.

• Talk to your GP or the hospital doctor about your medication especially if it makes you feel dizzy or drowsy • Bring well fitting shoes or slippers in to hospital • Care and Repair Cymru will offer advice and can put grab rails in your home. Removing loose rugs, trailing wires and other hazards can also make your home safer • Use a walking aid if you have been given one • If you come in to hospital please let us know if you have a history of falling

Drug errors

What are we doing about this? • Every in-patient is assessed for their risk of falls • A plan of care is put in place to prevent you falling • We are developing a strategy for the prevention of falls and how to keep your bones healthy What can you do to help us? • Talk to your GP if you are worried about falling • Exercise reduces your risk and keeps your bones strong

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We know that minor drug errors happen on a daily basis. There were 972 reported drug errors in 2013/2014. Of these, 964 caused no harm

to the patients but eight were serious. In two cases, patients had severe reactions to intravenous drugs, in two other cases the wrong dose was administered to the patient. One patient was given the wrong medication and one had another patient’s medication included on their chart and administered to them. Tragically, two patients died this year as a result of post–operative clots in the lungs. In both cases, clot busting drugs had not been prescribed and this was a serious contributory fact to their deaths. Both cases have been fully investigated and a number of actions taken to ensure these tragic events do not happen again: • The way in which we work out your risk of developing a clot when you come in to hospital has been changed • consultants now complete the prescription chart prior to admission for surgery and if clot busting drugs are not required, the reason for this is also recorded • all paperwork is now checked by wards and theatres and this is not delegated to junior doctors

What is the risk? We know that serious drug errors are very rare but minor errors, which cause no harm, occur on a daily basis. What are we doing about it? • Educating nurses, doctors and pharmacists • Carrying out regular audits • Newsletters • Safe Medication Practice Groups • March on Medicines campaign – March 2014 How can you help us? • Letting Nurse/Pharmacist know early on in your admission if you have been having problems taking your medicines prior to admission. • Don’t ask nurses to leave your medicines out for you to take later. • Nurses should ask you for your name, date of birth and address before giving medicines – if they don’t, challenge them • Remember to tell the Doctor/Nurse/Pharmacist if you or your relative has any allergies.

Pressure damage Pressure ulcers (sometimes referred to as 'bedsores', or 'pressure sores') are caused when an area of skin and the tissues below are damaged as a result of being placed under enough pressure to affect the blood supply. Usually they occur in a person confined to bed or a chair by illness. What is your risk of developing pressure damage? Anyone can get a pressure ulcer, but some people are more likely to develop them than others. People may be at risk of developing a pressure ulcer if, for example, they: • Have problems moving and cannot change position by themselves without help • Cannot feel pain over part or all of their body • Are seriously ill or undergoing surgery • Had a pressure ulcer in the past • Are incontinent • Have a poor diet and don’t drink enough water

• Are very old or very young • Have damaged their spinal cord and cannot move or feel their bottom or legs • Are older people who are ill or suffered an injury, for example a broken hip. What are we doing about it? Introduced a SKIN BUNDLE – this is a list of things that must be followed for every patient, every time. Surface - attend to the surface on which the patients lie or sit Keep patients moving and turn patients Incontinence and increased moisture management Nutrition - optimise nutrition and hydration • Your risk of developing a pressure ulcer is assessed within 6 hours of admission to hospital • There is a full investigation of all serious pressure ulcers to try and see why they happened How can you help us? • Make sure that if you are able to, you move in bed or the chair at least every hour

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Hospital Acquired Thrombosis A venous thrombosis is a blood clot which develops in the veins of the body. These occur most commonly in the leg, when they are called deep vein thrombosis (DVT). Sometimes a clot can break off and travel to the lungs, and this is known as a pulmonary embolism (PE). A hospital acquired thrombosis is one that develops as a result of being treated in hospital What is the risk of developing a Hospital Acquired Thrombosis? • Blood clots can happen to anyone. • 1250 people in Wales are at risk of dying every year from a blood clot. • 6/10 of people in Wales believe that they are more likely to develop a thrombosis on an aeroplane than in hospital • However 2/3 blood clots occur in hospital or in the 3 months after people leave hospital. • A person is 10 times more at risk of developing a blood clot when being treated for a serious illness in hospital.

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The Health Board monitors the number of hospital acquired thrombosis on a monthly basis. It is not always easy to identify a HAT. These have reduced over the last year: Month HAT

For more information on blood clots : http://www.cardiffandvaleuhb.wales.nhs.uk/hos pital-acquired-thrombosis or at www.askaboutclots.co.uk

04/13 05/13 06/13 07/13 08/13 09/13 10/13 11/13 12/13 1/14 48 47 26 33 47 31 35 30 34 34

What are we doing about it? • We calculate your risk of developing a clot when you are admitted to hospital • We have produced a patient information leaflet • The Medical Director has set up the Thrombosis and Anticoagulation Group to make sure all patients receive appropriate thromboprophylaxis What can you do? Clots can be avoided!! • Lead a healthy and active lifestyle • Stop smoking • Keep hydrated • Ask staff about the risk of clots if you are admitted to hospital

2/14 31

3/14 35

4/14 29

5/14 35

H AT (HOSPITAL ACQUIRED THROMBOSIS)

Make sure your doctor checks your risk of VTE so you get the best care in hospital. For more information go to: www.thrombosis-charity.org.uk

Reporting patient safety incidents 15,000 patient safety incidents reported – most are minor. Common issues include: Patient slips, trips and falls while in hospital Drug errors Lack of staff Pressure ulcer Communication problems Problems with medical equipment 97 incidents were serious enough to report to Welsh Government. We are working on processes for improving patient identification, preventing falls and drug errors and reinforcing infection control procedures.

Regulation 28 reports

Complaints about care

We received 2 of these reports from the Coroner because he felt the deaths could have been prevented. We are undertaking work training for staff on substance misuse and the way in which we record resuscitation status on patient boards has changed.

692 compliments 297 enquiries 640 informal concerns 1134 formal concerns 127 comments 3 suggestions 100 cases referred to the Ombudsman – 29 investigated

Patient Safety Walkrounds Over 10 walkrounds every month by Board members talking to staff, patients and families about the quality and safety of services. Our main concerns have been the quality of the environment in some areas.

Mortality data We have reviewed over 300 deaths of patients in hospital and only 2.3% of cases raised a concern requiring further review. All are being investigated under our governance arrangements. There are no key trends. For more information http://www.cardiffandvaleuhb.wales.nhs.uk/rami

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How Good Is The Standard Of Care? It is vital that the Health Board continually monitors the standard of care that is being delivered. Standards are set for us as outlined below. Our compliance with these Standards is measured and monitored through our internal quality and safety systems at Clinical Board level and through standard reporting mechanisms to the Quality, Safety and Experience Committee and regular performance reporting to the Board.

You can see our plans and annual reports on the internet site: www.cardiffandvaleuhb.wales.nhs.uk/ publications-strategies-and-plans

Who sets the Standards?

National Institute for Health and Care Excellence (NICE) publishes a range of standards on clinical care, www.nice.org.uk

Welsh Government Delivery plans - there are a wide range of plans for different services which have been designed to: • Improve health • Improve access to treatment and improve peoples’ experiences of care • Improve safety and quality of services There are identified lead Board members, Clinical Leads and Managers responsible for developing, implementing and monitoring the plans.

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National Evidence Based Guidance

Royal Colleges set standards and guidance for their members. The following websites may be of interest to you: www.rcplondon.ac.uk www.rcgp.org.uk www.rcseng.ac.uk www.rcoa.ac.uk Doing well, Doing Better - Standards for Health - a set of 26 Welsh Government Standards designed to improve care across a range of healthcare settings

Fundamentals of Care - a set of 12 nationally agreed Welsh Government Standards which provides guidance on the quality of care you should expect from health and social care providers. Welsh Risk Pool – our insurer – sets Standards for Maternity, Accident and Emergency and Surgical Services as well as for the management of complaints and claims How do we monitor ourselves against them? • Participation in 40 National Clinical Audits as well as a big programme of local audits carried out by healthcare professionals across the Health Board • Annual self assessment against the Standards for Health and Fundamentals of Care Standards • Annual external assessment by Welsh Risk Pool on selected Standards • Standards for Health Services in Wales • Taking part in National Audits of our practice

• Local clinical audits of peoples care • Leadership safety walkrounds • Unannounced visits and inspections of wards and departments • Performance reviews • The internal audit department • Professional Performance Reviews for Nursing and Midwifery How are we doing? National Clinical Audits – we are doing well in many areas but there are areas for improvement which we are addressing. Information on 5 of the big audits are published on the ‘My Local health Service’ website http://mylocalhealthservice.wales.gov.uk/#/en.

Fundamentals of Care – we are doing well but need to do more to help patients get more rest and sleep better and to make sure that mouth care is of a high standard for our most poorly patients Welsh Risk Pool – we scored 80% on the Surgical Pathways Standard this year. This was a big improvement on last year’s score of 65% but we want to do more to meet the Standard in 2014-2015 More detail on how we are doing can be found in Section 3.6 of the larger technical document

Standards for Health - we are happy with our progress but need to do more. The Standards will be changing next year and we will be working with clinical staff to make sure we are meeting the new standards.

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Treating You With Dignity And Respect Meeting Your Individual Needs We want everyone using our services to feel that they have been treated with dignity, respect and kindness every time.

Dignity and Essential Care Inspections During 2013 – 2014 there have been a number of announced and unannounced HIW monitoring visits to different wards and departments in the Health Board including the Emergency Unit at UHW. These visits are known as Dignity and Essential care (DECI inspections). In general findings are positive. A number of improvements in care have been made in relation to the findings of reviews during 20132014. The following are some examples. • New seating has been ordered and has been included in the Emergency Unit (EU) redesign scheme • Directional signage has been improved in the new Emergency Unit • A toy cleaning rota has been introduced in the Emergency Unit on a daily basis • Further work on communication with those with sensory loss is underway

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• Supply of pillows in the EU has been reviewed • 3 members of staff in the EU are undertaking the achieving excellence in the care of older people module • Supplies of ‘Dignity pegs’ in one ward have been increased to ensure curtains remain closed when patients are undergoing washes or treatments • A Health Board Wayfinding group is undertaking a review of all signage based on recurring themes in many DECI inspections, including equality related aspects such as sensory loss issues • An increase in the number of staff undertaking dementia training • Identification of dedicated rooms in departments for sensitive conversations with patients and families

Two Minutes of your Time - our unique survey is based on issues which have been shown to tell us whether patients feel they have been treated with dignity and respect. In Section 3.1 we told you the positive things people have told us. The two questions which continue to score less well are: • Were you always warm enough? • Were you or your carer involved in planning your discharge? We have checked our heating systems, carried out an audit of ward temperatures and reviewed the amount of bed linen and blankets available. We have also designed a new discharge leaflet. Two minutes of your time

HIW publish all of their reports on their website: www.hiw.org.uk. During 2014-2015 we will also be making these available on our website.

What have you told us? Fundamentals of Care – after speaking with patients we scored 83% in the Standards about dignity and respect

‘Sometimes I was left waiting an hour or more for pain relief, it felt like I was forgotten. This was during the night only however I have felt safe and have had help with anything I have struggled with and the staff have made me feel at ease with all the new things I’ve had to deal with.’

Two minutes of your time

‘ I am filling in form on behalf of my 92 year old mother. All staff have been wonderfully kind and also so professional. My mother is profoundly deaf, this has in the past frustrated some members of the public she has had contact with. However at this hospital everyone has been so patient and caring towards mum. She absolutely adores everyone here. In fact she has just commented to her nurse ‘I wish I could take you home with me’. From all the family we are so grateful for the care shown to mum.’

• 206 staff attended our range of Communicating with Dignity and Respect training programmes • This is now a mandatory component of the Health Board’s Clinical Leadership and Senior Clinical Leadership programmes. A new one day workshop designed to help Health Care Support Workers to respond respectfully and effectively to patients in emotional distress, called the HELP programme was developed early in 2013

Patient Stories Complaints about care 9% of our complaints last year related to the attitude of staff. This is not good enough. • Every complaint is taken seriously and fully investigated. Action is taken where appropriate.

The Health Board continues to collect stories from a wide range of service users which identify areas for improvement. Each Board meeting starts with a patient story and a separate Patient Experience report is also presented and discussed. Patient Stories are also presented in Clinical Board Quality and Safety Groups and in the Quality, Safety and Experience Committee.

In November 2013 the Board was told the story of a 68 year old man who had suffered from lymphoma and been given the all clear. Unfortunately his cancer returned and he had multiple acute admissions to various hospitals. His story was told from his niece’s perspective who became his main advocate with regard to emotional and practical support. The gentleman died at the Marie Curie Hospice, not at home as he had wanted, and his niece considered the whole experience too bureaucratic. An End of Life education module has now been introduced. So far 170 district nurses had been trained. In addition, the continuing healthcare process was being examined to fast-track discharge and it has improved from 30 to 8 days). This will enable us to care for more people at home We have found this approach to be a very powerful method of obtaining individuals' views on their care.

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Equality, Diversity & Human Rights

You can see our Strategic Equality Plan and Annual report at: http://www.cardiffandvaleuhb.wales.nhs.uk/ strategic-equality-plan-annual-report

Equality, Diversity & Human Rights (EDHR) are core Health Board values and we are very pleased to demonstrate year on year improvement in our Stonewall Diversity Champions national rating. Stonewall Diversity Champions is an annual benchmarking exercise that ranks employers against an equality index and we will continue to use this as a benchmark for our improvement.

Sensory loss • ‘Sensory impairment’ or ‘sensory loss’ are terms used to describe loss of sight and hearing and communication difficulty • over 20% of the total population of Wales suffers from some degree of sensory impairment • we know this can have adverse consequences for health and wellbeing, and it is increasing, especially among older people • up to 40% of people with learning disabilities also have sight and hearing problems • there is a higher sensory impairment in people from a Black and Minority Ethnic (BME) background • recently the Board received representatives from the Royal National Institute for the Blind and Action on Hearing Loss together with

During 2013-14 we have continued to promote the importance of EDHR to ensure patientcentered service provision based on individual need, through for example our work with Asylum seekers/refugees. We will continue to work in partnership with the Third Sector to build upon positive employment initiatives such as Positive about Disabled People and the Mindful Employer Charter

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two NHS users with sensory loss who shared their patient experiences with the Board. They informed us that there are 76,000 hard of hearing people in the Cardiff and Vale area and around 70% of people over 70 years of age experienced hearing difficulties. It follows that good communication is vital. Their stories were very powerful and are being used to inform the work we are doing to improve care • we know from inspections by HIW and from feedback for patients that we are not doing enough to improve communication with people who have sensory loss. It is another priority area for us

Taking care of our carers • we have worked with the Vale of Glamorgan Council, Cardiff Council, voluntary organisations and carers themselves to develop a local Carers Information and Consultation Strategy • in June and November 2013, 98 carers attending a Carers Week event where a

range of health checks were offered together with provision of relevant advice. • The health needs of carers in the minority ethnic communities were also recognised as part of the annual Minority Ethnic Communities Health Fair in March 2014, which resulted in 52 carers being identified and supported. In early 2014 we undertook a further carers survey to assist in shaping our plans for 2014 – 15. We had some interesting feedback.

You said: We did As a result of an end-oflife carer’s story, we were able to write to the carer advising her of the changes made in a number of ways to palliative care. These were particularly pertinent to her and the relative she was caring for. She has since given consent for her story to be used as a case study for staff training.

‘The number of carers contacting the Patient Experience Facilitator (Carers) has significantly increased since our carers’ leaflet racks have been in place providing contact details for information and advice. An elderly woman who called recently had just become a carer following her husband’s diagnosis of Parkinson’s Disease. She shared her concerns about managing financially and we were able to send her the Citizens Advice Bureau Benefit and Advice Factsheet and talk to her about their drop- in service where she could receive personalised advice’

If you are a carer there is a lot of information available on our website www.cardiffandvaleuhb.wales.nhs.uk/ information-for-carers. You can email us on [email protected] Ring us: Sue Barrow, Patient Experience Facilitator on 029 2033 5468, or Nigel Hughes, Patient Experience Facilitator Carers - Training and Support, on 029 2074 5359 or e mail [email protected]

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Welsh Language • The last census showed that Cardiff is one of the areas of growth for the Welsh language. The Health Board serves 50,000 Welsh speakers across the City and the Vale. It is the second largest used language in the area. • Older people, particularly those with dementia need to be able to communicate in a language of their choice, in many cases this is Welsh. • Children and young people: the increase in Welsh medium education means that we must also provide services for children in Welsh when required - for example for school visits • New Welsh Language Standards will replace the Welsh language Scheme in 2015. • Plans and changes for services actively consider how bilingual services will be provided. • When recruiting staff we include Welsh language skills as part of the assessment process.

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This year the Health Board has been implementing the first 12 months of the More than Just Words Strategy, which is the Welsh Government strategy on improving bilingual services offered by NHS Wales While progress has been achieved in some areas we recognise that little progress has been achieved against some actions particularly in sharing good practice and implementing the ‘active offer’ to patients and service users. We have more to do.

Dementia Care The Health Board in partnership with Cardiff County Council, Vale of Glamorgan Council and a number of voluntary organisations undertook a considerable amount of work during 2013-2014 to develop the Cardiff and Vale Dementia Plan 2014-2017. This has been recently launched. The vision for the strategy can be summarised as to prevent, to delay, to help cope:

More information on the Dementia Plan can be found at: http://www.cardiffandvaleuhb. wales.nhs.uk/ news/33291 The Health Board Younger Onset Dementia Service is a specialist and dedicated service for people who receive a diagnosis of dementia under the age of 65, and for their carers and families. If you would like to know more about this Service, please contact us: Younger Onset Dementia Service c/o MHSOP Admin (off East 18) University Hospital Llandough Penlan Road, Penarth CF64 2XX Tel: 029 2071 5779 - Fax: 029 2071 5814 Email: [email protected] Alternatively, if you need to talk to someone about your situation as a client or carer, you can contact the Wales Dementia Helpline on 0808 808 2235. http://www.cardiffandvaleuhb.wales.nhs.uk/you nger-onset-dementia-service

Access To Services Improving access to services is one of our key priorities. We need to ensure that you get the right care at the right time in the right place by the right person. All of our plans for services focus on getting this right.

23% of our complaints last year related to cancelled appointments or long waiting times for treatment so we know this is an important issue to you. Some of the key areas we are trying to improve are: • Emergency and urgent care • Better use of technology to help us to meet our waiting times targets e.g. how we book and schedule appointments; • Cancer care • Providing more care in primary care and the community • Cardiac services particularly cardiac surgery • Doing more day case surgery

Some examples of work we have undertaken in 2013-2014 include: • The Patient flow Programme – to improve the care of patients emergency and urgent care needs • Work to improve availability of GP services both in the daytime and out of hours • FOPAL (Frail Older Persons Assessment and Liaison Service) • Rapid access chest pain clinics • Dental services – In December 2013, the Health Board allocated an increase in dental activity of approx £320,000 to five existing General Dental Practices in the Cardiff and Vale area in order to provide some additional capacity to ease access pressures on primary care dentistry • Optometry services (eye checks) we are looking at ways in which hospital ophthalmology services can be supported by primary care optometrists

• Cardiff Health Access Practice (CHAP) - provides services for people who are vulnerable, in terms of their health and wellbeing. Such groups include asylum seekers and refugees, illegal migrants, homeless people, sex workers and violent patients. The focus of the service is primarily public health. • Prison Health Service - HMP (Her Majesty's Prison) Cardiff - One of the major developments during 2013 was the transfer of the Prison healthcare team to the Health Boards employment. • Improved Access to services for Children with Speech, Language and Communication Difficulties (SLCD) • Cardiff’s Alcohol Treatment Centre – has won a national award this year. It provides care for those with alcohol related injuries in the city centre at weekends and prevents unnecessary visits to the Emergency Unit

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Our Staff And Volunteers We know that we can only give high quality, safe services if we employ staff who have the right skills and training to do their jobs. Facts • We employ more than 14,000 staff. • Although recruitment to general nursing posts is good, we still have difficulty in recruiting nurses to a small number of areas including Specialist Theatres and Mental Health for Older People • We still have a number of medical recruitment shortages most notably within the Emergency Unit and Psychiatry . This remains a recognised UK wide issue. Working in different ways • We know that our workforce is changing • Recruitment problems mean that there will be shortages in some specialties • Increasing numbers of women in the workforce • Increasingly flexible approaches to working • Changes in professional roles • In future we will see increasing numbers of non-medical staff carry out roles that were traditionally carried out by medical staff

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Leading Improvement in Patient Safety Programme ( LIPS)

Improving Quality Together (IQT) This is part of Welsh Government’s Delivering Excellence Framework and requires Health Board’s to train their staff to build skills and knowledge and change attitude and behaviours. This helps us focus on quality improvement. Almost 1200 staff have completed bronze/silver IQT.

The Health Board has developed this programme so that senior clinical leaders can work together to improve patient safety at a team/organisational level. 22 teams (110 staff) took part in the first programme of LIPS in March 2014, some 110 clinical staff and a further 100 staff are scheduled to participate in the second programme which begins in September. Projects include: Outpatient Prescribing Medicines reconciliation Preparation for Radiological Interventions: Getting it right and on time. Reducing wound infections Improving care of the agitated, confused, delirious patient Reducing medication errors

Staff awards It is so important that our staff are recognised for the excellent work that they carry out and we actively encourage line managers to put their staff forward for awards whether these are internal staff recognition awards or national awards. A number of staff were honoured in the annual staff recognition awards. Some of the winners included: • Mike Williams, a volunteer who supports the weekly arts and craft classes for patients with dementia and their carers • Nicky Palmer a research nurse working in critical care is involved in a national intensive care research trial • Dr Peter Mullaney, a Consultant radiologist was recognised for his work in developing and delivering a musculoskeletal sonography service yielding significant benefits for patients and the department. • Andrea Clarke and Amanda Spellacey have implemented SONAS TM an evidence based therapeutic activity for older people who have significant communication impairment specifically as a result of dementia

• Edward Daw goes the extra mile in supporting people with mental health and complex needs including supporting them with court appearances For more information on our award winning staff please visit: http://www.cardiffandvaleuhb. wales.nhs.uk/searchresults/?q=staff+recognition +awards&site=orgid*864&requiredfields=DC% 252Elanguage%3Aeng&orgid=864

Our volunteers Volunteers are individuals who, on an unpaid basis, contribute their time, energy and skills to play a vital role in supporting a good patient experience in the Health Board. They enrich and extend the care provided to service users, and supports carers and families through practical help. Volunteers undertake their role alongside paid staff complementing, not replacing their work, and adding value to it. The number of volunteers has increased from 11 known volunteers in 2009, to currently more than 500 active Health Board and Third Sector volunteers (this number includes Mental Health volunteers).

What have our volunteers told us during 2013-2014? Positive • Enjoyment from o chatting and spending time with patients o Meeting and helping people o Gratitude of staff and patients for the support Not so positive • The corporate induction being too long; (to which the Health Board listened and this has now been reviewed) • When a patient is known to have died • Wards can be unwelcoming and sometimes we are not being kept busy enough Work will be taken forward to address the issues identified in the coming year. For more information on Volunteering in the Health Board please visit http://www.cardiffandvaleuhb.wales.nhs.uk/ volunteering Email: [email protected] or Telephone: 029 20335467

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Post Year Events and Looking Forward to 2014 - 2015 Trusted to Care – following publication of this report in June 2014, Board members carried out a series of unannounced visits and inspections to a large number of wards and departments. Although some areas for improvement have been identified, Board members were pleased and reassured by the largely positive comments from patients and carers about the kindness and compassion being shown by our staff. We can reassure you that the failings identified in the Trusted to Care report have not been identified in our Health Board. We of course, will never be complacent on this issue and will continue with unannounced visits and inspections. The Chair and Vice Chair of the Board will continue unannounced visits to listen to patients, families and carers.

• Increase capacity in Diabetes and Obesity programmes • Deliver the Healthy Weight Framework in order to achieve improved levels of healthy weight for adults and children • Deliver Alcohol Brief Intervention training for primary care and other key professionals, • Further strengthen implementation of the Optimising Outcomes Policy • Deliver the prevention elements of Cardiff and Vale’s 10-year Older People’s Strategy

To read our full response to the Minister please visit:www.cardiffandvaleuhb.wales.nhs.uk/news/32899

Safe care

A number of key priorities have been agreed and these are set out in more detail in the larger technical document. Quality targets to achieve them will be outlined in the Quality and Safety Framework 2014 -2017 which is currently being developed and will be published in Autumn 2014. Some include:

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Staying Healthy

• Continue to reduce the incidence of Healthcare Acquired Infection • Continue work on the recognition and management of sepsis (RRAILS,NEWS)

• Develop and implement the three year Quality and Safety Framework • Introduce an electronic incident reporting system • Develop and deliver a regular programme of Root Cause Analysis and Being Open training to support staff in the investigation of serious patient safety incidents

High Standards of care • Improve systems in place for the delivery and implementation of data from national audits • Improve the systems for the distribution and monitoring of compliance with national guidance • Being Open – increasing the availability of information to the public on the effectiveness of services • To continue work on improving the care of patients with cancer.

Timely care • To continue to improve patient ‘flow’ through the system and to reduce the demand on hospital services by improving access to services in the community and primary care setting • Improve capacity and access to specialist hospital services e.g. cardiac services • Increase the number of patients undergoing day surgery, the way in which we currently use theatres and increase the number of patients who are admitted on the day of surgery • Continue to improve access to GP practices

Treating people as individuals • Continue to look at ways in which patient feedback and experience is used to drive service improvement

• await ministerial response to the Keith Evans All Wales Review of Putting Things Right process and implement any recommendations • Continue implementation of the 1000 lives Learning Disabilities Interventions • Continue work to support people receiving care in their Language of choice • Developing sensory loss as the Health Board’s first ever equality theme.

• Address the findings of the 2013 FOC audit and roll out the child friendly survey in Childrens’ wards and departments, during 2014 -15. • Increase numbers of staff attending the Cardiff University End of Life Care Module throughout 2014 to achieve target of 10% ward staff trained

Our staff and volunteers

Dignity and respect • Continue to respond to the findings of the Andrews review –Trusted to Care – and provide assurance that the Health Board has considered the report’s findings and recommendations and has built this in to its improvement work for 2014-2015.

• Deliver September 2014 LIPS programme • Continue to roll out a coaching approach supported by the OSCAR Coaching Model – Coaching for Performance, to create a coaching culture through the Clinical Board’s performance arrangements. • Address areas for improvement identified in our volunteer programme survey

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How to give us your comments We really need your feedback! Your feedback good and bad - helps us to improve our services. There are a range of ways that you can do this:

Complete a survey If you are an inpatient you may be asked to complete a survey asking a range of questions about your overall experience. We send a more detailed questionnaire to some patients when they return home or after a clinic appointment. Leave your comments on the website. Please click on the following link or use the QR code: www.cardiffandvaleuhb.wales.nhs.uk

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Join a patient group We listen to views passed on to us by a wide range of patient support groups. A list of groups can be found at: www.nhsdirect.wales.nhs.uk The Patient Experience team can also help on 02920 335468

Tell us your story Your stories provide us with helpful feedback about good and not so good care. If you would like to tell us your story please ring 02920 745294 Raise a concern If you want to raise a formal concern please contact our Concerns team on 029 2074 4095, If you wish to submit your complaint via e mail, please send it to [email protected] or write to : Adam Cairns, Chief Executive Cardiff and Vale University Health Board, Headquarters, University Hospital of Wales, Heath Park, Cardiff CF14 4XW The Advocacy and Concerns Team, comprising members of the Health Board Concerns Team and Cardiff and Vale Community Health Council, will be available on Tuesdays and Thursdays at the Information Centre in University Hospital Llandough. Their role is to listen, advise and support

Acknowledgements We would like to thank all of our staff who continue to work hard to deliver high quality care to our patients. Also a huge thank you to our wonderful team of volunteers. We would also like to express our thanks to the Cardiff and Vale of Glamorgan Community Health Council and the Cardiff and Vale University Health Board Stakeholder reference Group in developing this Annual Quality Statement. Most importantly, thank you to all our patients, families and carers who have given us their comments and invaluable feedback on their experiences. We rely on this information to improve our services and look forward to hearing your views in the future.

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