Download PtHB Heart Disease Delivery Plan Update Feb 2015

The Heart Disease Delivery Plan of Powys Teaching Health Board
2013 – 2016: 2014/15 update
1.
Background
“Together for Health – a Heart Disease Delivery Plan” was published by the
Welsh Government in 2013 and provides a framework for action by Local
Health Boards and NHS Trusts working together with their partners. It sets
out the Welsh Government’s expectations of the NHS in Wales to prevent
avoidable heart disease and plan, secure and deliver high quality personcentred care for anyone affected by heart disease. It focuses on meeting
population need, tackling variation in access to services and reducing
inequalities in health outcomes across 6 themes.
For each theme it sets out:
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Delivery aspirations for the prevention and treatment of heart disease
Specific priorities for 2013-2016
Responsibility to develop and deliver actions to achieve the specific
priorities
Population outcome indicators and NHS assurance measures
Following the publication of the National Heart Disease Delivery Plan (HDDP),
all Health Boards were required to develop and agree local HDDPs for
submission to Welsh Government by 31 December 2013. The HDDP for
Powys was submitted to Welsh Government in advance of the deadline and
was approved by Board on 19th February 2014.
In October 2014, Welsh Government requested that Health Boards update
their current plans and submit a refresh reflecting the current position by the
end of December 2014, following Board approval. In order to inform this
update a midyear review was carried out in August/September 2014. The
PtHB Director of Planning is currently reviewing local leadership and delivery
arrangements for the national delivery plans, many of which are drafted from a
“provider” rather than “commissioner” perspective.
2.
Powys Health Board Delivery Plan
The Powys Health Board produced its first delivery plan in 2013. In our
delivery plan we set the following priorities for 2014:
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The promotion of healthy hearts
The timely detection of heart disease
Fast and effective care
Living with heart disease
Improving information
Targeting research
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In delivering heart disease services, there are a number of service
improvements that we have implemented locally that have had a real impact
on both patient care and outcomes. An example of this is the ongoing
development of smoking cessation pathways for pre-operative patients.
3.
The Vision:
Our vision for heart care is for:
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People of all ages to have as low as possible a risk of developing heart
diseases and, where they do occur, an excellent chance of living a long
and healthy life, wherever they live in Wales.
Wales to have incidence, mortality and survival rates for heart disease
which are comparable with the best in Europe
We will use a range of indicators to measure success. These are being
developed and will be refined over time and will include indicators such as:
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Coronary disease prevalence rates: % patients under 75 living with
coronary heart disease
Circulatory disease mortality rates under 75 per 100,000 population.
Survival following out of hospital cardiac arrest
Cardiovascular death in relation to average life expectancy - potential
years of life lost.
The Drivers:
There are good reasons for heart disease to be a key priority area for Powys
Health Board
According to the latest figures available from the Welsh Health Survey, 19% of
adults are being treated for high blood pressure and 8% for any heart
condition, excluding high blood pressure.
The most significant1 cause of heart-related ill health and death in Powys is
coronary heart disease. Although death rates in Wales have been falling over
the last 3 decades, they remain around 15% higher than in England 2. In
addition, death rates vary significantly across Wales; the death rate in the
most deprived fifth of wards is almost a third higher than in the least deprived
fifth3 - showing the pronounced impact of poverty and the socio-economic
determinants of health. While coronary heart disease is a largely preventable
cause of ill health and death, the latest figures for Powys show that major risk
factors remain high4:
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19% of adults report smoking (compared with 21% across Wales).
1 Public Health Wales Observatory, using ADDE (ONS) 2014
2 Trends in Coronary Heart Disease 1961-2011, British Heart Foundation, 2011
3 The Cardiac Disease National Service Framework for Wales, Welsh Government, 2009
4 Welsh Health Survey 2013, Welsh Government statistics released September 2013
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14% of adult non-smokers report regular exposure to other people’s
tobacco smoke indoors
57% of adults were classed as overweight or obese; amongst children
the figure was 23.2% (of whom 9.9% were obese)5
40% of adults reported drinking above guidelines on at least one day in
the past week
Only 35% of adults reported being physically active on 5 or more days
in the past week
These risk factors highlight the focus on coronary heart disease and
promotion of healthy hearts as a theme. Coronary heart disease is, however,
just one part of the picture and this Delivery Plan, covers heart conditions
more broadly. It highlights the importance of providing high quality detection
and treatment of all major heart diseases, including:
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5.
Heart failure (predominantly caused by coronary heart disease)
Arrhythmia management, including management of atrial fibrillation
(frequently a consequence of coronary disease)
Congenital heart disease (in children and adults)
Inherited or idiopathic cardiac conditions, including cardiomyopathies
What do we want to achieve?
In line with national expectations, the Powys Heart Disease Delivery Plan sets
out action to improve outcomes from heart disease in the following key areas,
up to 2016:
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The promotion of healthy hearts
The timely detection of heart disease
Fast and effective care
Living with heart disease
Improving information
Targeting research
Organisational Profile and summary of current service provision
Powys teaching Health Board is one of seven integrated Health Boards in
Wales and is responsible for both commissioning and providing health care
services to the Powys population of around 132,000 people. In fulfilling its
responsibilities, Powys teaching Health Board faces a number of challenges:
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A relatively small population (~4% of the Welsh total) living in a large
county of >5,000km2 (~25% of the landmass of Wales). Powys is
around 140 miles long, with a travel time by car of around three hours
5 Childhood Measurement Programme Annual Report 2012/2013
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north to south. 88% of the Powys landmass is classified as agricultural
land and the population is sparse (<2 people/hectare on average); only
one town has more than 10,000 people. 50% of the population live in a
hamlet or village; 23% of the population report that their nearest family
member lives at least 50 miles away
Population projections show that by 2033, the Powys population aged
over 75 years will have increased significantly (Figure 1)
Although much of Powys is a beautiful rural environment, many parts
are hilly or mountainous. Coupled with slow travel times on some
roads, the situation presents obvious challenges to the timely delivery
of health care, including access to life-savings interventions for
cardiovascular disease
Powys teaching Health Board directly provides non-specialist
healthcare services, through its network of community services and
community hospitals. The organisation commissions acute hospitalbased services from a complex range of secondary and tertiary care
providers in both England and Wales. Taken together, in this regard,
the Health Board is unique within Wales
Figure 1: Powys: > 75 Years Population Projections
In addition, there are significant health inequities and inequalities within
Powys. Further, evidence from the Welsh Health Survey that Powys adults
are often relatively low users of health care services compared to the rest of
the Welsh population. (Table 1)
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Table 1: Health Service Use in Powys and Wales
Health service use
GP in the past 2 weeks
Attended casualty in the past twelve months
In hospital as an inpatient in the past twelve months
Attended outpatients in the past twelve months
Saw a pharmacist in the past twelve months
Attended a dentist in the past twelve months
Attended an optician in the past twelve months
Source: Welsh Health Survey, 2013 (Welsh Government)
Powys
15%
14%
7%
31%
65%
77%
49%
Wales
17%
17%
9%
32%
70%
70%
50%
Improving Health and Wellbeing
Health improvement priorities are articulated in the Powys Integrated Medium
Term Plan 2014-2017, which has determined the local delivery of actions to
improve health and wellbeing through a partnership approach.
This
framework sets out the Powys response to the ten challenges identified in
Welsh Government’s public health strategy “Our Healthy Future”:
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Stopping the growth in health inequities
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Reducing smoking rates
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Increasing physical activity rates
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Reducing unhealthy eating
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Stopping the growth in harm from alcohol and drugs
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Reducing teenage pregnancy rates
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Reducing accident and injury rates
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Improving mental well being
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Improving health at work
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Increasing immunisation rates to recommended levels
More recently, the primary prevention transformation programme for Powys
further prioritises five key deliverables, each of which will potentially have
direct or indirect impact on heart disease: to reduce smoking prevalence; to
reduce alcohol misuse; to reduce childhood obesity; to increase the resilience
of young people (in line with Friedli and Parsonage); and to increase rates of
immunisation. There has already been significant stakeholder engagement
on the development and further roll-out of these priorities, in the context of the
Powys teaching Health Board Integrated Medium Term Plan 2014/17. In this
context, it should be noted that a range of actions are in hand to improve local
performance of Smoking Cessation Services, which are currently failing to
deliver the Welsh Tier 1 smoking cessation target in Powys.
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Overview: The Delivery of Services for Heart Disease
Primary and Secondary Care
Primary care based heart disease treatment services in Powys are provided
from 17 general practices across the north, mid and south localities. Delivery
is in line with the requirements of the national General Medical Services
contract and the Quality and Outcomes Framework (as confirmed by the
Powys Heart Disease Delivery Plan Needs Assessment). Powys teaching
Health Board has also implemented a number of Local Enhanced Service
agreements with Powys general practices, to further improve the local
prevention and management of cardiovascular disease, including for heart
failure and diabetes, which all practices in Powys have now signed up to. Out
of hours GP care is provided by Shropdoc, whose main organisational HQ is
in Shrewsbury, Shropshire.
The Health Board has also supported the implementation of the MSDi tool
across general practice in Powys. Although not specific to heart disease, this
tool will improve the identification and management of patients with
complex/multiple health care needs going forward. Although there are open
access arrangements for primary care to some diagnostic interventions for
heart disease in Powys (including for BNP testing for heart failure and
echocardiography), these arrangements are not yet uniform.
Primary care provision is in turn supported by a range of community services
directly provided by Powys teaching Health Board, including community
nursing teams (with cardiac nurse specialists), community hospitals and other
services. The cardiac rehabilitation programme is delivered by specialist
nurses working from a range of community hospital and leisure centre venues
across Powys, supported by physio- and occupational therapists and BACR
instructors.
Powys teaching Health Board commissions heart disease services at
secondary care level through its clinically-led locality-based approach. In- and
out-patient based cardiology services are provided to the populations of north
and mid Powys in Shrewsbury and Hereford, by the Shrewsbury and Telford
Hospitals NHS Trust and the Wye Valley NHS Trust respectively. The
population of south Powys receives its services from the Nevill Hall and Royal
Gwent Hospitals (Aneurin Bevan University Health Board) and Morriston
Hospital (Abertawe Bro Morgannwg University Health Board). In relation to
consultant-led outreach provision into Powys, cardiology clinics are held twice
a week at Brecon Hospital, provided by Aneurin Bevan Health Board and a
new service will commence in Newtown in early 2015, provided from the
Shrewsbury and Telford Hospitals NHS Trust. 24 hour tape ECG and
echocardiography are available.
Specialist Services
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The Welsh Health Specialised Services Committee (WHSSC) commissions
ambulance and specialist heart services (including services for patients with
congenital heart disease) for the Powys population, on behalf of Powys
teaching Health Board. In discharging this responsibility, WHSSC reports to
the Board of the Health Board. Powys patients requiring tertiary level
intervention for cardiovascular/heart disease may be treated in a number of
specialist centres, including Stoke/Wolverhampton (north Powys), Birmingham
(mid Powys) and Cardiff (south Powys).
With reference to ambulance services provided by the Welsh Ambulance
Services Trust, Powys teaching Health Board is working alongside other
Welsh Health Boards in Wales to implement joint unscheduled care plans,
through its Unscheduled Care Board. The performance of the ambulance
service is reported at Board level in Powys teaching Health Board through its
integrated performance report.
Patient Support Groups
There are no heart disease-specific patient support groups in Powys. The
local strategy is to move away from disease-specific expert groups, as such
an approach would not be sustainable or effective in Powys. Further work will
be taken forwards under the Powys Long Term Conditions programme,
recognising that patients often have multiple and complex needs which are
more efficiently and effectively managed through an integrated approach.
Summary of the Powys Heart Disease Needs Assessment
The Heart Disease Delivery Plan requires each Local Health Board to carry
out local population needs assessments to promote healthy hearts and treat
heart disease, review their services in the light of that assessment, identify
gaps between need and current provision and identify where service provision
needs to change to meet demand.
Background
The Powys heart disease epidemiological needs assessment was completed
to support development and delivery of the Powys Heart Disease Delivery
Plan in December 2013. Led by Public Health Wales, the Powys needs
assessment does not yet completely reflect the anticipated scope of the plan
(for example, congenital and inherited cardiac conditions; arrhythmias). In line
with other Health Boards, it is anticipated that this may be addressed in the
future. In the meantime, the needs assessment has underpinned the local
priorities articulated in the Heart Disease Delivery Plan for Powys. The full
needs assessment is available as an accompanying document to the plan.
In the needs assessment, the term “significant” is used to signify a difference
which is statistically significant; likewise, terms such as “higher” and “lower”
are only used when a difference is statistically significant.
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Key Messages
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There is some evidence from the Welsh Health Survey that Powys is
“healthier” than the rest of the population of Wales – but the %
differences are small and based on self-reporting
There is some evidence from the Welsh Health Survey that Powys
adults have healthier lifestyles than other Welsh adults. However, this
effect tends to become diluted with increasing age. Further, the
absolute positions within Powys in relation to lifestyle behaviours leave
very considerable room for improvement
Levels of smoking in Powys are not significantly different from the rest
of Wales; rates are improving only slowly, in line with the rest of Wales.
Smoking Cessation Services are currently failing to achieve target
performance in Powys
There is significant, socioeconomically-determined variation in the
levels of harm being caused by smoking in Powys. For example,
smoking-attributable mortality rates in the adult population > 35 years
are around 1.5x higher in the most deprived populations in Powys,
compared to the most affluent
Based on GP registrations, the crude prevalence of coronary heart
disease in Powys is not significantly different to the rest of Wales.
Given the age structure of the Powys population, this is perhaps
surprising – a higher prevalence could have been expected. Adjusting
for age, the prevalence of coronary heart disease in Powys becomes
significantly lower than the rest of Wales. Taken together with the
findings of the Welsh Health Survey, there may be under-recording of
coronary heart disease in Powys GP practices (for both males and
females). There is evidence that similar concerns may exist for
hypertension and diabetes
Based on QOF analysis, there are opportunities to improve the primary
care management of hypertension and diabetes in Powys. For
example, there is evidence that 1 in 10 patients with coronary heart
disease do not have a blood pressure below 150/90, 1 in 5 patients
have a cholesterol level greater than 5 mmol/L and 1 in 12 patients did
not receive ‘flu immunisation in the previous season. In addition, the
there is considerable variation between practices in relation to the
management of coronary heart disease and its main risk factors
In Powys, premature mortality rates from overall cardiovascular and
coronary heart disease are both currently better than the Wales
average. However, this comparative approach is undermined by the
fact that Wales performs relatively poorly on these measures compared
to other European countries
Expert advice from Public Health Wales supported the use of
premature mortality from coronary heart disease as a proxy for need.
Using this approach, there is some high level evidence that the
relatively low emergency admission and intervention (angiography;
revascularisation) rates for coronary heart disease in the Powys
population are in line with local need. However, there is also significant
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anecdotal evidence within Powys that patients with coronary heart
disease present late to primary care (including after acute events). In
addition, the relationship within Wales between “rurality” and patterns
of service utilisation for coronary heart disease appears not to be clear
cut. The position requires further investigation to define levels of
potentially undiagnosed and unmet need in relation to coronary heart
disease in Powys
Population Health Profile
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Powys is the most rural area in England and Wales and has a resident
population of 132,976. There are a greater proportion of residents
aged over 50 years in Powys compared with Wales. The projected
population pyramid for Powys for 2033 shows a substantial growth in
the number of people aged over 60 years, who will form a large
proportion of the Powys population
Ystradgynlais is the most deprived area in Powys and is among the
worst 10% areas in Wales. St John (Brecon), Newtown South,
Welshpool Castle, Newtown Central and Llandrindod East /
Llandrindod West are in the worst 30%
There are three localities in Powys, each with their own GP clusters,
with 47% of the Powys population living in North Powys
Whilst the population of Powys experiences better life expectancy at
birth and tends to experience better health outcomes than the rest of
Wales, local inequities remain. There are persistent differences in life
expectancy, healthy life expectancy and disability free life expectancy
between the most and the least deprived fifths of the population
An important feature is that Powys adults report using health services
less than adults across Wales for both primary and secondary care.
Possible reasons for this include cultural issues, less “need” for
services and/or that poor access to services deters uptake
7% of the Powys population (age standardised) reports having a heart
condition, lower than any other health board area and lower than the
Wales average (9%)
Mortality from cardiovascular disease is higher in Wales than many
other European countries. Mortality rates are higher in males and are
strongly related to deprivation. In Powys, mortality rates for those aged
under 75 years are significantly lower than Wales average rates
Mortality from circulatory disease for all persons of all ages as well as
for those aged under 75 years is also lower in Powys than Wales. In
Powys there is a persistent difference in premature mortality from
circulatory disease between those who are in the most and least
deprived populations
Premature mortality rates in Powys from coronary heart disease are
significantly lower than for Wales
The Promotion of Healthy Hearts
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The prevalence of smoking in Powys is not significantly different to the
rest of Wales. Smoking attributable mortality in Powys in those aged
over 35 years has been declining since 2001/03 and has remained
significantly below Wales.
There are differences in smoking
attributable mortality between the most and least deprived communities
in Powys
A higher proportion of Powys adults report eating five portions of fruit
and vegetables a day compared with Wales. However, survey results
for 11 to 16 year olds shows that a lower proportion of boys in Powys
eat fruit or vegetables daily
In Powys, self reported physical activity rates amongst adults and
children are higher than Wales
Obesity is a risk factor for coronary heart disease, as well as other
significant diseases such as diabetes and hypertension. Self reported
obesity rates amongst adults in Powys are significantly lower than
Wales
Results of the National Childhood Measurement Programme show that
obesity rates in reception year pupils in Powys are higher than Wales
A lower proportion of Powys adults report drinking above guidelines or
binge drinking compared with Wales average. A higher proportion of
boys aged 11-16 years in Powys report drinking alcohol at least once a
week compared with Wales. Hospital admissions linked to alcohol are
lower than other Health Boards
The Role of Primary Care in the Management of Coronary Heart Disease
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The age standardised prevalence of coronary heart disease on GP
registers is significantly lower in Powys than Wales. This could be an
indication of a healthier population in Powys or under recording in GP
practices. This is also the case for hypertension prevalence and
diabetes prevalence
A lower proportion of Powys residents with hypertension are given
lifestyle advice when compared to the rest of Wales
Diabetes management in GP practices is similar in Powys to the rest of
Wales, except for one indicator relating to blood pressure management
in patient with diabetes
QOF data relating to the management of coronary heart disease shows
that Powys is performing to similar levels as Wales
There needs to be close working with GP practices to better
understand where there is significant variation in QOF data between
practices and to address areas where optimal clinical management is
not being undertaken
Fast and Effective Care
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For both angiography and revascularisation interventions, Powys has
lower intervention rates than other Health Boards, with rates
significantly below that of Wales. It is not yet possible to determine
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whether these interventions rates are appropriate for the Powys
population
The limited nature of this data makes it difficult to draw further
conclusions. Recommendations have been made for areas requiring
further investigation
Improving Information and Targeting Research
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The needs assessment does not yet provide a comprehensive picture
of potentially unmet need in Powys. This section of the needs
assessment highlights where further information and research would
help to provide a more robust understanding of heart health needs in
Powys
Local Prevention Priorities
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Powys is more likely to have a higher burden of coronary heart disease
in future due to its aging population, highlighting the need to have a
focus on healthy aging
To reduce smoking prevalence and reduce health inequalities there is a
need to:
o Target groups with highest smoking prevalence and target
children and young people
o Ensure smoking cessation services are accessible and effective
o Optimise the work of GP practices through QOF to increase the
proportion of patients with long term conditions who are given
smoking cessation advice and referred to smoking cessation
services
o All contacts with healthcare staff should be an opportunity to
prevent smoking and increase smoking cessation rates
o Advocate for interventions that will have an impact at a
population level e.g. smoke-free cars, tobacco plain packaging
Increase fruit and vegetable consumption in adults and more
specifically in children. This will be taken forward as part of the Powys
Healthy Weights Strategy, based on a strong partnership approach
Increase physical activity levels for people of all ages in Powys, again
through the Powys Healthy Weight Strategy
Through the work of the Childhood Obesity Group (currently
established on a task and finish basis as a subgroup of the Powys
Healthy Weights Steering Group) there should be focused partnership
work to reduce levels of childhood overweight and obesity in Powys
Reduce excess alcohol consumption by:
o Better understanding the reasons for alcohol consumption in
children, particularly boys
o Having a partnership approach to tackling underage drinking
o Advocating interventions that will have an impact at population
level e.g. minimum unit pricing
Optimise the promotion of healthy behaviours in the primary care
setting e.g. increase the proportion of patients with long term conditions
given lifestyle advice by GP practices as part of QOF
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Work with communities to develop local engagement and ownership of
health issues. Potential vehicles for achieving this in Powys include the
development of Community Champions and improving local delivery
through the neighbourhood management approach
Local Delivery Priorities
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7.
Mapping of community service utilisation and effectiveness is needed
to better understand pathways of care and obtain a more complete
picture of heart health need in Powys. Early detection is a key
component in the management of coronary heart disease. Further
investigation is needed into rates of diagnosis of coronary heart
disease in GP practices in Powys, as part of QOF
Work with GP practices to optimise opportunities for secondary
prevention e.g. optimising blood pressure or reducing cholesterol levels
in patients with coronary heart disease
Further work to explore the relatively low rates of angiography and
revascularisation is needed, including through stakeholder discussion
At present, intervention rates are compared with Wales’ average.
However, this approach should be reviewed to explore the utility of
comparisons with other countries which experience better
cardiovascular disease outcomes than Wales
Participation in Clinical Audit
At present Powys teaching Health Board does not routinely undertake audit in
relation to the implementation of the HDDP as this is undertaken by service
provider organisations. However, work is underway within the Health Board to
look at audit measures to support the implementation of the Powys HDDP and
Powys teaching Health Board’s contribution to National Clinical Audit.
As no audits were undertaken in the previous 12 months there are no
priorities to report. However, as stated above this in being reviewed locally.
8.
Development of Powys Health Board Local Delivery Plan for
Heart Disease
In order to refresh the Powys HDDP, a 6 months interim assessment of
progress against the plan was undertaken. This is to be presented to the
Executive Team within Powys teaching Health Board in January 2015, along
with a draft refresh of the Powys HDDP and recommendations for further
ensuring delivery of the plan. Powys teaching Health Board will then agree
actions to be undertaken during the period 2014-2016 and expected
outcomes.
In addition to this the HDDP was updated to reflect the National priorities as
agreed by the Heart Disease Implementation Group.
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9.
Our Priorities
Following the completion of our review of progress made over the last 12
months we have now reviewed and assessed our delivery plan priorities and
actions for the coming 12 months. Our action plan for heart disease includes
actions against each of the priorities within the Welsh Government’s Heart
Disease Delivery Plan (2013) and actions to implement the Cardiac Disease
NSF and the Welsh Health Specialised Services Committee Review of
Cardiac Services.
Promotion of healthy hearts
The priorities for 2013 – 16 are:
1. Work with a broad range of partners (including Local Service Boards and
the third sector) to:
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Raise awareness of healthy living
Signpost existing sources of information, advice and support
relating to lifestyle change6
Develop and deliver local strategies and services to tackle
underlying determinants of health inequality and risk factors for
coronary heart disease
Target resources in population areas of high risk (such as areas of
deprivation) and areas of high impact (including early intervention
actions with children to tackle prevention from outset of life)
2. Support and facilitate GPs, practice nurses and community pharmacists to
proactively:
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Use every opportunity in primary care to promote healthy lifestyle
choices and smoking cessation
Ensure consistent provision of testing and treatment for risk factors
such as high blood pressure and cholesterol
Locally determined priorities are detailed in the Plan
Timely detection of heart disease
The priorities for 2013 – 16 are:
1. Identify and implement ways of raising public awareness of the symptoms
of heart disease and the importance of seeking urgent medical advice and
raise awareness of when to ring 999, seek advice from NHS Direct and
when to contact their GP
6 Including, for example, Stop Smoking Wales, Fresh Start Wales, Change 4 Wales
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2. Provide GPs with timely access to diagnostic testing and procedures for
heart disease, increasing direct access to testing (at the point of care or
from a central laboratory), without need for secondary referral, where
appropriate
3. Provide rapid access services to meet GP and patient need
4. Provide GPs with timely access to specialist cardiology advice through
telephone and email, speeding diagnosis for people who may not need
referral to a clinic
5. Ensure adequate access to cardiac catheter laboratories, matched to
population need
6. Raise symptom awareness of GPs and ensure through audit that people
are referred to secondary and tertiary care in line with national guidance
and referral protocols and pathways agreed by the cardiac networks
7. Provide specialist cardiology advice within 24 hours for those admitted to
hospital with suspected heart disease - reorganising delivery of services to
achieve this where necessary
8. Ensure effective collaboration between the All Wales Medical Genetics
Service, Cardiac Networks, Hospital Lipid Clinics and GPs to use the
Familial Hypercholesterolaemia Cascade Testing service to identify and
treat individuals with Familial Hypercholesterolaemia and reduce the high
risk of this group developing early onset heart disease
9. Ensure effective use of arrhythmia specialists and the All Wales Medical
Genetics Service to ensure patients with inherited heart conditions have
appropriate advice and testing and that specialist advice is provided to
interpret the results
Locally determined priorities are detailed in the Plan
Fast and effective care
The priorities for 2013 – 16 are:
1. Organise services to ensure people admitted because of diagnosis with a
heart disease are assessed by a consultant cardiologist7, within 24 hours
of admission to hospital
2. Start definitive treatment in a timely manner, with a focus on driving down
waiting times and meeting clinical need. As a minimum treatment must
start in line with the 26 week Referral to Treatment waiting times target for
cardiac disease
3. Deliver prompt and equitable access to appropriate interventions, including
new diagnostic procedures, technologies, treatment and techniques, in
line with the latest evidence and guidance and with evidence based
policies and priorities agreed by NHS Wales
7 A consultant cardiologist is someone on the General Medic register with a Certificate of
Completion of Training (CCT) or Certificate of Completion of Specialist Training (CCST) in
cardiovascular medicine or cardiology, who is employed as a consultant, spends the majority
of their direct clinical care programmed activities caring for patients with heart disease and
who undertakes regular continuing professional development of relevance to the care of
patients with heart disease.
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4. Ensure all complex surgery is undertaken with peri-operative care
standards as in the ERAS project
5. Use the 1000 Lives Plus Programme to implement improvements to
services for people with acute coronary syndrome, heart failure, atrial
fibrillation and in need of anti-coagulation
6. Manage effective transition to quaternary services in England where
needed
7. Coordinate effective discharge and timely repatriation of patients to local
hospitals as soon as clinically appropriate following treatment in line with
discharge plans and the All Wales Repatriation Policy
8. For patients who need it, ensure effective transition to appropriate
palliative and end of life care, in line with the Delivering End of Life Care
Plan
9. Develop an NHS Wales policy on Do Not Attempt Cardiopulmonary
Resuscitation (DNACPR) decisions, ensuring that this always respects
individual patient wishes
10. Review provision of defibrillators in public places and community first
responders, within LHB areas, ensuring - in liaison with the WAST and the
British Heart Foundation - that there is adequate provision and training and
an effective first responder in place
Locally determined priorities are detailed in the Plan
Living with heart disease
The priorities for 2013 – 16 are:
1. Plan and deliver services to meet the on-going needs of people with heart
disease as locally as possible to their home and in a manner designed to
support self management and independent living. This should include as
appropriate:
 Evidence based follow-up in the community where possible
 Drug and device management
 Cardiac rehabilitation (including psychological management and
exercise)
 Exercise programmes (such as the National Exercise Referral
Programme)
 Guidance on healthy lifestyle and self-care to minimise further ill
health
2. Assess the clinical and relevant non-clinical needs of people with a
diagnosis of a long term heart disease and – in liaison with patients (and
where appropriate family/carers) - record relevant clinical and non-clinical
needs and wishes as the basis of implementing care in a care plan. This
should include adults with congenital heart disease. The care plan should
include information on what the diagnosis means for the patient, what to
look out for and which service to access should problems occur; it should
be reviewed at appropriate points along the pathway
3. Make arrangements to ensure that information in the care plan or GP letter
is available both to the patient and recorded on clinical information
Page 15 of 32
systems - and is accessible to others who have clinical responsibility for
the patient, including out-of-hours GP services, on a 24/7 basis
4. Provide access to expert patient and carer programmes when required
5. Work proactively with third sector services and provide effective
signposting to information and support, enabling patients to easily access
support services
Locally determined priorities are detailed in the Plan
Improving Information
The priorities for 2013 – 16 are:
1. Ensure IT infrastructure supports effective sharing of clinical records/care
plans
2. Put effective mechanisms in place for seeking and using patients’ views
about their experience of heart services
3. Monitor and record performance against the Cardiac Disease National
Service Framework and through annual self-assessment against the
Quality Requirements and use the results to inform and improve service
planning and delivery
4. Ensure full (100%) participation in mandatory national clinical audits,
delivering significant improvements on current low participation rates - to
support service improvement and support medical revalidation of clinicians
– and ensure that findings are acted on
5. Participate in and act on the outcome of peer review
6. Publish regular and easy to understand information about the
effectiveness of heart services
Locally determined priorities are detailed in the Plan
Targeting Research
The priorities for 2013 – 16 are:
1. Support and encourage protected research time for clinically active staff (in
primary as well as secondary and tertiary care)
2. Build on and extend academic training schemes to develop a highly skilled
workforce
3. Promote collaboration with key research initiatives such as CVRG-C and
HBRU
4. Promote public health research, for example to identify the best ways of
working with those who are most disadvantaged or to demonstrate how
services meet individual and population needs
5. Invest in accurate collection of key clinical data in a format that can be
incorporated into the SAIL (Secure Anonymised Information Linkage)
database for population-level health and social care research including
focus on epidemiology, impact of interventions on outcomes, clinical trial
scoping and service delivery modelling and assessment
Page 16 of 32
6. Collaborate effectively with universities and businesses in Wales to enable
a speedier introduction of new evidence-based and cost-effective
technology into the NHS
Locally determined priorities are detailed in the Plan
The Heart Disease Implementation Group has agreed a small number of
priorities for the 12 months that will be addressed at a national level.
These are:
1. Developing a consistent model for the delivery of cardiovascular risk
assessment
2. Delivering the cardiac waiting time target through more effective
pathways
3. Developing and piloting component or differential waiting time targets
4. Consider new workforce models of delivery that release capacity
5. Improving participation and case ascertainment in National Clinical
Audit
A paper outlining the current position of the HDDP and the requirement to
focus on the above priorities is due to be presented to the Board in February
2015 when PtHB will report on how it plans to address the agreed priorities
going forward.
10.
Performance Measures/Management
The Welsh Government’s Heart Disease Delivery Plan (2013) contained an
outline description of the national metrics that LHBs and other organisations
will publish:


Outcome indicators which will demonstrate success in delivering
positive changes in outcome for the population of Wales.
NHS assurance measures which will quantify an organisation’s
progress with implementing key areas of the delivery plan.
Progress with these outcome indicators will form the basis of our annual
report on heart disease.
Page 17 of 32
Powys Heart Disease Delivery Plan
Action Plan: 2013 - 2016
Theme 1: The Promotion of Healthy Hearts
Priority
Actions
To further consolidate
local partnership
working to deliver the
series of specific
priorities in the
national plan
Raise awareness of
healthy living, including
through rollout of the One
Powys Plan with Powys
County Council
Signposting of
information, advice and
support for lifestyle
change
Expected outcome
Risks to Delivery
Increase in referrals to
lifestyle support services
and Stop Smoking Wales
Lack of public health
specialist capacity in
the Powys PH team
Development of a health
inequalities action plan for
Powys
Levels of unmet need,
coupled with financial
position of the Health
Board
Timescales /
Milestones
Lead
By April 2015
DPH
Promotion of smoking
cessation services
(Pharmacy, SSW).
Smoking cessation pathways
for maternity and pre-op
being developed.
SSW currently reviewing the
service across Wales.
Rolling out MECC within the
HB from April 2015.
Health Inequalities Action
Plan is being developed.
As above
DPH
Smoking cessation services
are being promoted to
GPs/Pharmacy.
Rolling out MECC within the
HB from April 2015.
Working with SSW nationally
to develop an action plan to
increase accessibility and
referrals to SSW.
Powys Tobacco Action Plan
has been developed
More effective targeting of
resources according to
need
Develop local action plans
for health inequalities and
risk factors for coronary
heart disease
To support and
facilitate GPs, practice
nurses and
community
pharmacists to deliver
a proactive approach
Target resources at areas
of high risk and high
impact (including CYP)
Healthy lifestyle choices
including smoking
cessation to be actively
promoted in primary care
Roll out and further
development of Making
Every Contact Count in
Powys, in line with the
PtHB 3 Year Plan
transformation
programme
As above plus
Improved rates of smoking
cessation
Powys THB staff trained in
and delivering brief
intervention
As above
Additional Information
Page 23 of 32
Improve the delivery of
Stop Smoking Wales in
Powys
LOCAL
To support
development of the
50+ Health Checks
Programme approach
in Powys
Address the other
primary
preventive
opportunities
identified in the PtHB
HDDP
Needs
Assessment
Await evaluation of pilot
phase (elsewhere in
Wales) and localise to
Powys, in preparation for
national rollout
Implement locally as part
of national rollout of “Add
to Your Life” from 4/14
Target groups with
highest smoking
prevalence and target
children and young
people
Ensure smoking cessation
services are accessible
and effective
Optimise the work of GP
practices through QOF to
increase the proportion of
patients with long term
conditions who are
supported through healthy
lifestyle advice (including
smoking cessation) an
onward referral where
appropriate
All contacts with
healthcare staff to be
used as an opportunity to
prevent smoking and
increase smoking
cessation rates
Advocate interventions
that will have an impact at
Roll out of “Add to Your
Life” in Powys
Lack of senior
specialist public health
capacity in Powys
By April 2015
(subject to national
timetable)
DPH
By April 2015 then
ongoing
DPH
Implications of a rural
IT infrastructure and
rural population for an
on-line programme
Improved position and trend
across a range of
population health outcome
measures (through Three
Year Plan process)
Local performance of
Stop Smoking Wales
Lack
of
senior
specialist public health
capacity in Powys
Competing
priorities
faced by frontline staff
Targeted work on maternity,
smoke free homes, focus on
Stoptober for the most
deprived areas of Powys.
Healthy Lifestyle LES linked
to MECC.
Making Every Contact Count
roll out from April 2015.
Targeted approach to ABI is
being delivered and links to
MECC made.
Neighbourhood management
- community research
undertaken to support the
needs assessment and
develop action plan
(Newtown) CEON Community Engagement
Officers Network.
Healthy Weights action plan
in place and reviewed
quarterly by Healthy Weights
Steering group (chaired by
DPH).
Fruit and vegetable
consumption covered in all
AC courses delivered by the
Public Health Dietitians.
Page 24 of 32
a population level (e.g.
smokefree cars, tobacco
plain packaging)
Through the Powys
Healthy Weights Strategy:
increase fruit and
vegetable consumption
and levels of physical
activity (all ages)
Reduce excess alcohol
consumption through a
targeted approach
To realise the
opportunities
identified in the PtHB
HDDP Needs
Assessment for
enhanced
identification and
management of CHD
and its risk factors in
primary care
(including variation
between practices)
Work with communities to
develop local
engagement and
ownership of health
issues
Findings of the PtHB
HDDP Needs
Assessment to be
addressed through the
annual planning and
performance review
mechanisms for primary
care
Improved performance on a
specified range of QOF
measures
Lack of capacity in
primary care team
As per current
primary care
assurance and
review processes
Medical
Director
Page 25 of 32
Theme 2: Timely Detection of Heart Disease
Priority
Actions
To identify and implement
ways of raising public
awareness of the
symptoms of heart disease
and the importance of
seeking urgent medical
advice and raise
awareness of when to ring
999, seek advice from
NHS Direct and when to
contact their GP
Development of local
communication and
engagement plan to
support delivery of the
HDDP in Powys,
encompassing a
public education
campaign about the
symptoms of heart
disease (as part of
wider approach to
USC)
Development of PtHB
locality commissioning
plans
To provide GPs with timely
access to diagnostic
testing and procedures for
heart disease, increasing
direct access to testing (at
the point of care or from a
central laboratory), without
need for secondary
referral, where appropriate
To provide rapid access
services to meet GP and
patient need
To provide GPs with timely
access to specialist
cardiology advice through
telephone and email,
speeding diagnosis for
people who may not need
referral to a clinic
To ensure adequate
access to cardiac catheter
laboratories, matched to
Expected
outcome
Risks to Delivery
Timescales /
Milestones
Lead
Improved levels of
understanding and
awareness of
symptoms of heart
disease in local
communities
Lack of local comms
capacity to design,
and implement and
evaluate an ongoing
proactive scheme of
this nature
Revised timescale
to be agreed
PtHB Urgent Care
lead
Services
commissioned
Organisational
capacity
System to be in
place for 2015/16
contract year
PtHB locality lead
commissioners
Additional
Information
Complexity of provider
arrangements
Financial position of
PtHB
As above
As above
As above
As above
PtHB locality lead
commissioners
As above
As above
As above
As above
PtHB locality lead
commissioners
Development of PtHB
locality commissioning
plans (through
Services
commissioned
Organisational
capacity
System to be in
place for 2015/16
contract year
PtHB locality lead
commissioners
Page 26 of 32
population need
To raise symptom
awareness of GPs and
ensure through audit that
people are referred to
secondary and tertiary
care in line with national
guidance and referral
protocols and pathways
agreed by the cardiac
networks
To provide specialist
cardiology advice within 24
hours for those admitted to
hospital with suspected
heart disease reorganising delivery of
services to achieve this
where necessary
To ensure effective
collaboration between the
All Wales Medical
Genetics Service, Cardiac
Networks, Hospital Lipid
Clinics and GPs to use the
Familial
Hypercholesterolaemia
Cascade Testing service to
identify and treat
individuals with Familial
Hypercholesterolaemia
and reduce the high risk of
this group developing early
onset heart disease
To ensure effective use of
arrhythmia specialists and
the All Wales Medical
WHSSC)
Complexity of provider
arrangements
Establish appropriate
educational and
clinical audit
programmes
Improved levels of
knowledge and
referral practice
amongst Powys GPs
Development of PtHB
locality commissioning
plans
Services
commissioned
Financial position of
PtHB
Organisational
capacity
As above
Medical Director
As above
PtHB locality lead
commissioners
Financial position of
PtHB
Any requirement for
additional investment
to repatriate the
activity to Powys
Revised timescale
to be agreed
DPH (with locality
general manager
mid-Powys)
Via WHSSC
Via WHSSC
Via WHSSC
Competing demands
on GP time
Organisational
capacity
Complexity of provider
arrangements
Complete work in
hand to deliver an
outreach OP FH
service for Powys in
Llandrindod, as part of
the wider Powys
repatriation
programme
Model implemented
and pathways
established
Via WHSSC (all
Wales action plan)
Via WHSSC
Page 27 of 32
Genetics Service to ensure
patients with inherited
heart conditions have
appropriate advice and
testing and that specialist
advice is provided to
interpret the results
LOCAL
Powys tHB to be an active
participant in the
programme of work
(agreed at the SW Cardiac
Network HDDP
Implementation Group) to
examine access, waiting
time variation and service
configuration issues (the
Network and LHBs, though
WHSSC)
To ensure Powys
participation in the South
Wales Cardiac Network
Task and Finish Group
established to
develop/recommend a
cardiovascular risk
assessment tool for Wales,
to ensure that local
opportunities are realised
To be confirmed by
SWCN
To be confirmed by
SWCN
Initially via CEO
then PtHB locality
lead
commissioners
Timescale to be
confirmed
DPH
Action plan and T&F to be
established at national
level
Page 28 of 32
Theme 3: Fast and Effective Care
Priority
To organise services to
ensure people admitted
because of diagnosis
with a heart disease are
assessed by a
consultant cardiologist8,
within 24 hours of
admission to hospital
To start definitive
treatment in a timely
manner, with a focus on
driving down waiting
times and meeting
clinical need. As a
minimum treatment
must start in line with
the 26 week Referral to
Treatment waiting times
target for cardiac
disease
To deliver prompt and
equitable access to
appropriate
interventions, including
new diagnostic
procedures,
technologies, treatment
and techniques, in line
with the latest evidence
and guidance and with
Actions
Development of PtHB
locality commissioning
plans
Expected outcome
Risks to Delivery
Services commissioned
Organisational capacity
Complexity of provider
arrangements
Timescales /
Milestones
Lead
System to be in place
for 2015/16 contract
year
PtHB locality
lead
commissioners
Additional
Information
Financial position of
PtHB
As above
As above
As above
As above
PtHB locality
lead
commissioners
As above
As above
As above
As above
PtHB locality
lead
commissioners
A consultant cardiologist is someone on the General Medical Council’s specialist register with a Certificate of Completion of Training (CCT) or Certificate of Completion of
Specialist Training (CCST) in cardiovascular medicine or cardiology, who is employed as a consultant, spends the majority of their direct clinical care programmed activities
caring for patients with heart disease and who undertakes regular continuing professional development of relevance to the care of patients with heart disease.
Page 29 of 32
8
evidence based policies
and priorities agreed by
NHS Wales
To ensure all complex
surgery is undertaken
with peri-operative care
standards as in the
ERAS project
To use the 1000 Lives
Plus Programme to
implement
improvements to
services for people with
acute coronary
syndrome, heart failure,
atrial fibrillation and in
need of anti-coagulation
To manage effective
transition to quaternary
services in England
where needed
To coordinate effective
discharge and timely
repatriation of patients
to local hospitals as
soon as clinically
appropriate following
treatment in line with
discharge plans and the
All Wales Repatriation
Policy
For patients who need
it, to ensure effective
transition to appropriate
palliative and end of life
care, in line with the
Delivering End of Life
Care Plan
To review provision of
defibrillators in public
places and community
Via WHSSC
Via WHSSC
Via WHSSC
Via WHSSC
Via WHSSC
Development of PtHB
locality commissioning
plans
Services commissioned
Organisational capacity
System to be in place
for 2015/16 contract
year
PtHB locality
lead
commissioners
Complexity of provider
arrangements
Financial position of
PtHB
Via WHSSC
Via WHSSC
Via WHSSC
Via WHSSC
Via WHSSC
Development of PtHB
locality commissioning
plans
Services commissioned
Organisational capacity
System to be in place
for 2015/16 contract
year
PtHB locality
lead
commissioners
System to be in place
for 2015/16 contract
year
PtHB locality
lead
commissioners
Revised timescale to be
agreed
TBD from
2014/15
Complexity of provider
arrangements
Financial position of
PtHB
Development of PtHB
locality commissioning
plans
For review in Powys in
collaboration with
WAST and in light of
Services commissioned
Organisational capacity
Complexity of provider
arrangements
TBD from 2014/15
Financial position of
PtHB
TBD from 2014/15
Page 30 of 32
first responders, within
LHB areas, ensuring in liaison with the
WAST and the British
Heart Foundation - that
there is adequate
provision and training
and an effective first
responder in place
LOCAL
To improve reporting
arrangements from
WHSSC to PtHB
including in relation to
the impact and outcome
of the Cardiac Services
Review for the Powys
population
the 2014 WAST
“Cardiac Arrest Survival
Plan” (through revised
commissioning
arrangements from
2014/15)
Establish improved
accountability and
reporting arrangements
from WHSSC to Board
of PtHB on cardiac
issues
Local progress to be
reported through the
HDDP Annual Review
Additional investment
required to implement
the recommendations of
the Review
Revised timescale to be
agreed
Director of
Planning
Issue likely to be
included in report of
PtHB review of its
commissioning
arrangements
Workforce and OD
issues
Page 31 of 32
Theme 4: Living with Heart Disease
Priority
To plan and deliver services to
meet the on-going needs of
people with heart disease as
locally as possible to their
home and in a manner
designed to support self
management and independent
living. This should include as
appropriate:
Evidence based followup in the community
where possible
Drug and device
management
Cardiac rehabilitation
(including
psychological
management and
exercise)
Exercise programmes
(such as the National
Exercise Referral
Programme)
Guidance on healthy
lifestyle and self-care to
minimise further ill
health
To assess the clinical and
relevant non-clinical needs of
people with a diagnosis of a
long term heart disease and –
in liaison with patients (and
where appropriate
family/carers) - record relevant
Actions
Expected
outcome
Ensure the needs of
patients with chronic
heart disease
(including secondary
prevention) are
adequately reflected
in the Powys long
term conditions and
carers programmes
Ongoing needs of
patients with heart
disease are met
through the Powys
long term conditions
programme
As above: through the
long term conditions
programme (care
plans already in the
draft model)
Ensure Powys
engagement in the
As above
Risks to Delivery
Inability to shift the
pattern of financial
investment in Powys
to primary and
community-based
services
Timescales /
Milestones
Lead
System to be in place
for 2015/16 contract
year
PtHB locality
lead
commissioners
As above
PtHB locality
lead
commissioners
Additional
Information
Financial position of
PtHB
As above
Page 32 of 32
clinical and non-clinical needs
and wishes as the basis of
implementing care in a care
plan. This should include
adults with congenital heart
disease. The care plan should
include information on what the
diagnosis means for the
patient, what to look out for and
which service to access should
problems occur; it should be
reviewed at appropriate points
along the pathway
Make arrangements to ensure
that information in the care plan
or GP letter is available both to
the patient and recorded on
clinical information systems and is accessible to others who
have clinical responsibility for
the patient, including out-ofhours GP services, on a 24/7
basis
To provide access to expert
patient and carer programmes
when required
To work proactively with third
sector services and provide
effective signposting to
information and support,
enabling patients to easily
access support services
LOCAL
Nurse-led cardiac rehabilitation
programme of work
established by the
National HDDP
Implementation Group
to develop the care
plan approach across
Wales
Design and implement
the IS and IT solutions
Information available
and accessible
Poor IT infrastructure
in some community
services
System to be in place
for 2015/16 contract
year
PtHB
information
and IT leads
PtHB locality
lead
commissioners
PtHB locality
lead
commissioners
Organisational
capacity
Establish work
programme
As above
To develop a local
response to the
findings of the Review
of Cardiac
Rehabilitation in
South Wales
Programme
established as part of
LTC programme
As above
Organisational
capacity
As above
As above
As above
Findings of review
addressed as part of
local priority setting
Any additional
investment
requirements
Revised timescale to
be agreed
Organisational
capacity
PtHB locality
lead nurse(s)
Each locality
continuing to
support nurse led
cardiac
rehabilitation.
Demand for the
programme has
remained and there
Page 33 of 32
Nurse-led management of heart
failure
To develop a local
response to the
findings of the Review
of Heart Failure Nurse
Specialist Services in
South Wales
Findings of review
addressed as part of
local priority setting
Any additional
investment
requirements
Organisational
capacity
Revised timescale to
be agreed
PtHB locality
lead nurses(s)
has been an
observed increase
in the demand for
clinics. This has
manifested
differently for each
locality and the
team are
responsive and
flexible in their
approach, focusing
on what is required
at any particular
time for their
locality.
For the South
Locality the Care
Planning Group is
to establish a Task
& Finish Group to
look at specialist
nurse staffing and
current services to
Brecon Hospital.
GPs have marked it
as a priority in their
cluster plan.
Work is underway
with one particular
GP who is using
risk stratification
software in
highlighting heart
failure patients.
This information is
being used to
develop a nurse led
clinic which will
assist in seeing the
right patient at the
right time.
Page 34 of 32
Theme 5: Improving Information
Priority
To ensure IT
infrastructure supports
effective sharing of
clinical records/care
plans
To put effective
mechanisms in place
for seeking and using
patients’ views about
their experience of
heart services
To monitor and record
performance against
the Cardiac Disease
National Service
Framework and through
annual self-assessment
against the quality
requirements and use
the results to inform and
improve service
planning and delivery
To ensure full (100%)
participation in
mandatory national
clinical audits,
delivering significant
improvements on
current low participation
rates - to support
Actions
Expected outcome
Local engagement in
the task and finish
group being established
through the SWCN to
produce, with NWIS, a
vision for integrating IT
systems (linking in with
research data)
Establish mechanisms
through existing patient
engagement
arrangements at PtHB
locality level
Integrated information
system across primary
care and community
services
Agree the role of SWCN
in supporting PtHB in its
assurance
responsibilities as a
commissioner of heart
services
Assurance completed
(encompassing all
provider organisations)
Improved coordination
of care
Patient
views/experience are
more influential in the
commissioning process
Risks to Delivery
Availability of capital
and revenue
Timescales /
Milestones
Lead
Implementation from
2015 at Wales level
PtHB
information
lead
Revised timescale to be
confirmed
PtHB patient
engagement
lead
As above
PtHB
performance
and quality
leads
By April 2015
PtHB clinical
audit lead
Additional
Information
No IT system for
community nursing
services
Competing priorities for
patient engagement
work
Lack of organisational
capacity
Complexity of provider
arrangements
Establish internal
processes
Await SWCN review of
Health Board input to
the national clinical
audits
As above
As above
Page 35 of 32
service improvement
and support medical
revalidation of clinicians
– and ensure that
findings are acted on
To participate in and act
on the outcome of peer
review
To publish regular and
easy to understand
information about the
effectiveness of heart
services
LOCAL
To investigate and
address the current
gaps in information and
analysis relating to
current services, as
identified in the PtHB
HDDP Needs
Assessment (including
registration rates for
coronary heart disease
in GP practices in
Powys)
Peer review to be
established for PtHB
To be established as
part of the annual report
To agree and
implement a
programme of work with
PHW
More
effective
identification
and
sharing of good practice
Information published
Comparable peer for
Powys
not
realistic
within Wales
Availability of Powysspecific
effectiveness
intelligence from all
provider organisations
By April 2015
Intelligence issues/gaps
identified in the HDDP
needs assessment fully
identified and
addressed for Powys
Lack of local PH
intelligence capacity
Revised timescale to be
confirmed
Revised timescale
be confirmed
SWCN
to
PtHB
performance
lead
DPH
Competing priorities in
PHW
Page 36 of 32
Theme 6: Targeting Research
Priority
LOCAL
PtHB heart research:
establish baseline
position
Progress and complete
current research
Identify public health
research opportunities
Actions
Expected outcome
Risks to Delivery
Timescales /
Milestones
Lead
Additional
Information
SWCN audit of
current research
complete. SWCN in
the process of setting
up a group to look at
next steps
The BAFTA study
has now closed; no
Powys patients were
recruited
To participate in the
SWCN audit of current
HB research activity,
budgets and funding
Baseline established
Lack of local capacity to
contribute to the audit
Revised timescale to be
agreed
Medical Director
(through PtHB
research lead)
Complete local
participation in the
Birmingham Atrial
Fibrillation Treatment of
the Aged (BAFTA)
follow-up study (a longterm follow-up study of
an earlier RCT
examining warfarin
versus aspirin for stroke
prevention in the
management of atrial
fibrillation in an elderly
(> 75) primary care
population
Develop links with PHW
research leads
Powys participation in
the BAFTA study
successfully concluded
Inadequate local links
established with the
research lead in
Birmingham
Closed
Medical Director
(through PtHB
research lead)
Local research
opportunities better
understood and realised
Organisational capacity
Revised timescale to be
agreed
DPH
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