Improving quality, outcomes and experience

The Fourth Objective 

Covers a large thematic area where improvements are required to improve clinical performance across a number of key areas. We wish to build further upon good work commenced that takes a pathway focused approach to this. 

Patient experience

If collected robustly and consistently, Patient Experience feedback provides an opportunity to identify areas of practice that are good (and can be emulated across the Health Board) as well as areas that require improvement, in close to real time. This means we can learn from trends before they result in significant harm, but it also means that the patient voice can more greatly influence the development of our services. In summary, the experience and satisfaction of patients using our services would improve.

Prevention

Prevention and reduction of avoidable ill-health are key priority areas and we will continue to engage with partners across the North Wales region to meet these challenges and improve the health and wellbeing of our population.

Primary care and early intervention

The vast majority of patient contacts in the NHS occur in Primary Care. We recognise the importance of stable, resilient primary care services in ensuring that the residents of North Wales have care at the right time and in the right place, medicalised only when necessary.

Community care and clusters

A cluster is a grouping of GPs working with other health and care professionals to plan and provide services locally. Cluster priorities include a range of interventions that are identified to improve public health outcomes. Supporting primary care providers to work collaboratively within their clusters is expected to improve primary care sustainability and resilience.

Pharmaceutical services

Improved patient outcomes by providing innovative and specialist medicine in a faster way, adhering to clinical evidence when doing so, and ensuring that the administration of every medicine used adds value to the patient receiving it.

We recognise the need to make urgent improvements in operational performance, but is also continued focus is required in parallel to redesign services to place a greater emphasis upon prevention and primary care.

Planned care

We firmly recognise the need to improve planned care performance. While progress has been made in particular for those with the very longest waits, there are still too many patients waiting long periods for planned care interventions. We also needs to change the approach in some areas of planned care to be better prepared for current and future demand.

The plan sets out a range of activities that will lead to reductions in overall waiting list sizes and lengths of wait, with particular focus upon the longest waiting patients. These activities will result in improved patient experience and less unnecessary travel. Our resources will be better used, allowing more care to be delivered.

Some of this work will require the reconfiguration of services to improve the effective and timely delivery of care. We will undertake work to identify the potential for different service configurations and the impact they would have for people living with multiple long-term conditions, seeking to deliver more coordinated care resulting in less hospital visits.

Unlike other organisations, we do not have dedicated ‘cold surgery’ sites at present. These are sites where surgical activity can be protected from the impact of urgent and emergency care pressures. This will be partially addressed when the additional theatres and ward space in Llandudno become available. We will continue to explore the potential of cold-site surgical and diagnostics capacity.

Alongside this, improvements will be made to the way appointments and procedures are booked to make this more efficient and more convenient and accessible for patients.

We need to change the approach in some areas of planned care to be better prepared for current and future demand.

Urgent and emergency care

It is important to make it easier for people access urgent and emergency care in the right place when they need it. Better availability and use of alternative appropriate services for those who need urgent, but not life-threatening care will lead to better experience and outcome for those using those services. By reducing pressure on Emergency Departments it will also lead to better experience and outcome for those who need the highest level of care and support.

Many people still attend Emergency Departments when they could have been treated within other health care settings, such as a minor injury unit, by primary care out-of-hours services (including NHS 111 Wales) or in many cases by planned care services in less urgent settings. Signposting, alongside ensuring adequate timely access within planned care services, continue to be important in reducing avoidable demand upon urgent and emergency care services.

Plans to improve Same Day Emergency Care Services and expand the use of community pharmacy services as an alternative to urgent care GP and hospital services are among the steps being taken to help get the care and support they need without avoidable delays.

Cancer care

During 2023-24 we developed a cancer care road map for the coming five year. The plan sets out a range of actions to develop a more resilient service for the people of North Wales, enabling us to maintain referral to diagnosis waiting times. The activities will also lead to more care being delivered in North Wales, resulting in less long journeys for individuals with cancer.

This work will build upon comparatively good historic cancer referral to diagnosis waits and improving outcomes by addressing those areas of cancer care that remain challenging across primary and secondary care and in cancer diagnostics.

The recruitment and retention of specialist staff has presented difficulties in recent years, but there have been recent improvements and it is a key priority to now embed this.

Diagnostics

There are performance and sustainability challenges in a number of diagnostic areas that adversely impact upon waiting times and patient experience. These require a mixed approach to address current demand alongside resolving sustainability issues for the longer term. Addressing the priorities in the plan will allow us to better balance demand and capacity in diagnostics, which in turn will result in shorter planned care waits, and faster diagnoses.

Adult mental health, learning disability, CAMHS and neurodevelopment

Implementing the actions set out in the plan will lead to more consistent mental health service delivery in North Wales, with greater alignment with national best practice and guidelines. This will improve access to services and user experience.

Currently challenged services

Addressing the challenges that these services are experiencing will lead to more consistent, reliable services, able to better meet the needs of the population of North Wales.

Women’s services

We are awaiting the National ‘Women’s Health Plan for Wales’ and remains committed to transforming and improving quality services for women. We will continue to engage with both Gynaecology, Maternity and Neonatal Voices and local Public Health Colleagues to understand our population needs, to inform and co-produce service development plans.

Children

The plan aims to provide more consistent availability of children’s services closer to home, increased child safety arising from high quality decision making in children safeguarding cases and better longer-term outcomes through consistent focus upon the first 1000 days of life.