The Annual Quality Statement for NHS Wales 2014: Delivering high quality health services to the people of Wales

1 The Annual Quality Statement for NHS Wales 2014
xxxxxxx
Delivering high quality health
services to the people of Wales
The Annual Quality Statement
for NHS Wales 2014

Contents
Introduction from Andrew Goodall, Chief Executive, NHS Wales 3
1. Helping you to stay safe and healthy 4
2. Keeping you safe while you are in our care 8
3. Treating you with dignity and respect 12
4. Working with you to make sure you receive the right care 16
5. Making sure you receive care quickly and effectively 20
6. Treating you as an individual 24
7. A big thank you to everyone who works for NHS Wales 28
Our focus for the year ahead 32
More information about NHS services, and the Annual Quality Statement 35
Introducing NHS Wales
There are ten organisations in NHS Wales – seven health boards covering
the whole of Wales, and three national trusts, the Welsh Ambulance
Service, Public Health Wales, and Velindre NHS Trust, which provides
expert cancer services to people across the country and also includes the
Welsh Blood Service.
NHS Wales is funded by the Welsh Government, which sets the
priorities and targets for health services in Wales.
Welcome
I am pleased
to introduce
the first NHS
Wales Annual
Quality
Statement,
which gives
an overview
of the excellent work being
taken forward by all NHS
organisations in Wales to
improve the quality of care for
people living in Wales.
All of us will be touched by the
NHS at some point in our lives and
it remains a service at the heart
of public expectations with public
service values at its heart. It is also
a service with millions of contacts
with people every year in hospitals,
community, mental health and
primary care services. However,
high-volume services must deliver
high-quality care and good patient
experiences. This is why quality of
care and patient safety are at the

Introduction
core of the day-to-day business for
the NHS in Wales.
Overall, the NHS in Wales can be
proud of that fact that more than
90% of people in the latest national
survey were very satisfied with the
care they received.
This statement sets out those areas
where we have seen improvements,
including preventing infections and
how we care for people with cancer;
following a stroke or at the end of
their lives. Our vaccination levels are
at the highest we have seen; we have
good population screening in place;
cancer survival rates are improving
as is life expectancy for the Welsh
population.
However, there is still more that we
can do to improve care. Meeting
patient needs with dignity and respect
is very important to the NHS. When
this does not happen, we have taken
action.
The Trusted to Care report was
published last year after concerns
were raised about standards of care in
some wards in two hospitals. We have
acted on its findings at a local and a
national level.
We have reviewed the way the
NHS handles complaints and
concerns and are implementing its
many recommendations. We have
introduced new ways of keeping
track of how we are doing and where
we need to improve. Our underlying
principle is that we must learn from
our mistakes.
NHS Wales must continue to improve
so it can provide you and your family
with high-quality care when you need
it most. There are a number of key
areas we will focus on over the next
year, including:
• We want to work with you
to help you take care and
responsibility for your own
health. We know that leading a
healthy lifestyle can help prevent
us from becoming ill;
• We will continue to develop
joined-up services with others
so care can be provided closer
to people’s homes, while also
working to prevent delays in
treatment when you do have to
go to hospital;
• We will continue to act on the
Trusted to Care recommendations
and the findings from the
subsequent spot checks of
hospital and mental health
wards;
• We will make sure we identify
people affected by dementia as
early as possible so they receive
the best possible care.
Above all, we want to provide safe,
compassionate, person-centred care.
We are committed to putting things
right if we get them wrong. We will
act on people’s feedback and work
with you to continue to ensure we
have a truly National Health Service
we can all take pride in.
Andrew Goodall
Chief Executive, NHS Wales

Helping you to stay safe and healthy
Good health is a partnership between you as an individual and
NHS Wales. We will do everything we can to keep you healthy,
but there are many things that you can do to keep yourself
healthy too. For example, we can support you to give up
smoking, but it depends on your decision to live smoke-free.
When it comes to health we know that small steps can result in big changes.
We also know that staff in the NHS can find living healthily a struggle too.
We are supporting staff to improve their health through the Champions
for Health programme. We also want to develop stronger partnerships
with organisations outside the NHS so we can support more people in
our communities to make healthier choices and avoid becoming ill.
Here are some of the ways we are helping people to
make healthy choices and live healthy lives.
1

1.Helpingyoutostaysafeandhealthy
Champions for Health
helped healthcare staff
across Wales make positive
changes to their health.
It has encouraged staff to
lead fitter, healthier lives
and become advocates
for healthy lifestyles
with their patients and
wider communities.
Staff reported significant
improvements around
exercise, working towards a
healthy weight and reduced
consumption of alcohol.
The campaign has given
people more confidence
to talk to their patients,
and also their friends and
families about healthy
lifestyle choices.
Helping our staff to help you
This has given me a real
insight into what it’s like for
my patients.The good news
is I can now talk to them
honestly about what I’ve
been trying to do and how I
know it’s not always easy.
– Dr Glyn Jones, participant
in Champions for HealthWatch Liam talk about how he gave
up smoking thanks to Champions
for Health here www.bit.ly/liamc4h
Beating flu!
Influenza, known as
flu, is a highly infectious
disease that can be
deadly.
We especially want to protect
the elderly, people with long-term health conditions,
pregnant women and young children, as they are most
at risk of being killed by ‘flu. The best way to protect
people is through an annual flu vaccine. The national
flu vaccination programme is co-ordinated by Public
Health Wales and has helped protect thousands of
children and adults. We encourage all
NHS Wales staff to be Flu Fighters
and get vaccinated.
www.bit.ly/flufightercymru
Over two thirds of eligible
children have been vaccinated
against flu, and we’d like you to
help us raise this number
next year.
DID YOU KNOW?

Cardiff Vale University
Health Board’s qualified
dieticians run short
courses for small
groups called ‘Eating
For Life’. The courses
help people change
what they eat so
they can be healthier.
The health board
has also developed
Foodwise, a weight
management programme
run in communities by partner
organisations like Communities First and leisure services.
The health board has supported people to change their
lifestyle before having non-urgent surgery. Smoking
and being overweight both
increase the risk of surgical
complications, such as
developing life-threatening
blood clots or infections. The
programme helps people
to stop smoking and lose
weight, reducing the risk
of harm or complications
as a result of surgery.
Helping people lose weight
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.
– Karen, helped by the
‘Eating For Life’programme
DESIGNED TO SMILE SUCCESSES
• The latest Designed to Smile report shows a drop of
about 6% in the number of 5 year olds with tooth decay.
• Parents tell us their children enjoy the lessons, and are
more likely to brush their teeth at home.
• Tooth decay is still common in children in Wales.
Parents can help their children by making sure children
in Wales brush their teeth twice a day with fluoride
toothpaste and keeping sugary foods and drinks to
mealtimes only.
Read more at www.designedtosmile.co.uk
Designed to Smile - improving
children's dental health
Designed to Smile is a national
programme to improve the
dental health of young
children in Wales. Last year
93,000 children took part in
supervised daily tooth brushing
with fluoride toothpaste in
school or nursery. Children
have lessons on how to keep
their teeth and mouth healthy,
including making healthy food
choices. Children are given home dental packs so they
can keep up the good habits in the school holidays.

the introduction of the
MMR vaccine. In total 1,202
notifications of measles
were received. Measles can
be fatal, and unfortunately
one person did die in
this outbreak. More than
77,000 doses of MMR
were given to people across
Wales during the outbreak.
We also saw a record
uptake of MMR vaccines
for children aged two
(95.9%) and five (92.9%).
People are four times more
likely to quit smoking when
they get support rather than
by going it alone.
DID YOU KNOW?
SUPPORTING PEOPLE
TO QUIT SMOKING
All health
boards are
working
with Public
Health Wales
to provide sessions for
people to give up smoking.
Some of these are provided
by Stop Smoking Wales.
Stoptober was another
high profile campaign that
encouraged people to
try to quit in October.
Expectant mums are
also encouraged to stop
smoking and are offered
quick referrals to sessions
to enable them to stop.
www.stopsmokingwales.com
The importance of
vaccination against
diseases was shown
by the recent measles
outbreak in Wales.
Not being vaccinated
means you are at a much
greater risk of catching
a disease, which
could even be fatal.
We know that vaccinating
children against measles,
mumps and rubella
(MMR) is the best way to
protect them from these
damaging and potentially
deadly diseases. The MMR
vaccine has been proven
to be safe, despite media
scare stories in the past.
Low levels of vaccination
make it more likely that
an outbreak of one of
the diseases will occur.
Between November 2012
and July 2013 Wales
experienced the largest
measles outbreak since
Vaccinating children
against deadly diseases
Teenagers at risk
received MMR
vaccinations

8 The Annual Quality Statement for NHS Wales 20148 All Wales Annual Quality Statement 2014
2
Keeping you safe while you are in our care
We have made patient safety a priority in NHS Wales. We aim to avoid all
possible harm when we care for people, whether that’s in hospital, in
community services, or in your home.
We have targeted particular areas where we know people can suffer harm. For
example, we are addressing issues around infections and also sepsis. We want to
make sure medicines are used safely, for example, warfarin, which is used to thin the
blood. We know that moving people who are elderly and frail from their home into
hospital can also put them at risk so we are working hard to provide more care in
the community.
We monitor how safe your care is through staff reporting patient safety incidents,
such as falls, pressure ulcers, infections or medication errors. We encourage
reporting so we can ensure everyone learns and improves when things go wrong.
When we see themes and trends we issue a patient safety alert setting out clear
actions for staff to take. Find out more at www.patientsafety.wales.nhs.uk
We know we need to do more, despite our successes so far. We have set clear
priorities for all NHS organisations to make care safer and we are keeping a
close watch on what happens. You can help us to help you keep safe – by
telling us if you are concerned if we missed something or may have done
something wrong.

2.Keepingyousafewhileyouareinourcare
Ask about Clots
One patient risk that we
work hard to prevent is that
from blood clots (thrombosis)
that may develop when
you are in hospital.
A simple assessment can
identify people at risk from
blood clots. For those at
risk there are drugs that
can help prevent blood
clots and save lives.
To help promote the use
of assessments and anti-
thrombosis drugs, the
national ‘Ask about Clots’
campaign was developed
by 1000 Lives Improvement
and supported by Lifeblood,
the thrombosis charity. The
campaign is helping members
of the public to understand
the risk, so they can ask
for an assessment and be
given the appropriate treatment. It is also raising
awareness among staff to remind them to carry out
the assessments and give the necessary drugs.
Find out more at www.askaboutclots.co.uk
All health boards in Wales
review the care of patients who
have died in hospital – this is
called a ‘mortality review’.
The notes are checked to ensure
patients received the right care and
treatment. By looking at patient notes in this way and
asking questions we can identify ways to improve care.
In the 6 months to March 2014 NHS Wales completed over
4,000 mortality reviews to see if there were improvements
in care that were needed. An independent review during
2014 commended this approach and it is now routine
practice in NHS Wales. Through this process we identified
the need to improve how to care for very ill people nearing
the end of their life and instructions for staff about whether
to attempt
to resuscitate
people. We have
developed a
new approach
to be used
across Wales.
Implementing this
in 2015 is a key
priority for us.
Reviewing the care of every
person who has died in hospital
Ask About Clots' PULL UP BANNER English PRINT.pdf 1 03/10/2014 12:25

Driving down infections
Infections can be
very harmful. Many
infections that people
get in healthcare settings
are preventable.
Staff across Wales are
working hard to prevent
patients getting infections
while they are in hospital.
This work includes improved
cleaning and sterilising
techniques, focusing on
the importance of hand-
washing and quick responses
if infections do occur.
We also want to prevent
the over-use of antibiotics
to try and maintain their
effectiveness. This means
not prescribing antibiotics
when they won’t do any
good. We are working
closely with GPs to make
sure antibiotics are not given
out if they aren’t needed.
C.difficile is one of the most
well known infections that
affect people in hospitals and
in the community. Concerted
efforts by NHS Wales staff
across Wales have reduced
infection rates, which is
very important in providing
safer care and enabling
people to return home more
quickly. We have learned
several lessons from an
outbreak in Betsi Cadwaladr
University Health Board.
Even though we have made
progress, levels of infection
remain too high so there is
still some way to go to meet
target figures for preventing
infections. This remains a
priority focus for NHS Wales.
Identifying and
treating sepsis
Sepsis can be a life
threatening condition
when the body’s response
to an infection goes into
overdrive and starts to
attack its own organs.
It can be caused by
something as simple as a
cut or insect bite, or an
infection like pneumonia.
It is also a risk following
surgery, or for women who
have just given birth. Sepsis
is often a contributory
factor when people
suddenly get ill and die.
Every health board and
trust is actively involved in
tackling sepsis. We have
issued specific guidance
to organisations that
they must use if they
identify sepsis. These
patient safety notices are
important to make sure
care is given quickly.
34%
Deaths from
MRSAreduced by
18%
*2013 statistics

Falls are a major cause of
disability and death in older
people in the UK, and cause
significant problems for
people in terms of pain,
loss of confidence and
independence. Preventing
falls has been a major
focus for all NHS Wales
health boards and trusts.
For example, Hywel Dda
University Health Board
has worked in partnership
with the leisure department
of Carmarthenshire Local
Authority to develop exercise
programmes for frail adults
to improve stability and
encourage people who have
had strokes to find ways to
exercise. The programmes are
delivered in community venues
across Carmarthenshire.
A care pathway has been
introduced, in partnership
with the Welsh Ambulance
Service to enable older adults
who have suffered a fall to
remain at home, following
assessment from paramedics.
These people are followed up
by the Community Resource
Team who do a falls risk
assessment and identify ways to
reduce the risk of further falls.
GPs can also refer people who
are frail or at risk of falling
to the Community Resource
Teams for assessment. For those
older adults who continue
to fall despite receiving help,
there is also rapid access to
a frailty assessment service
with a specialist in caring
for elderly people and a
multi-disciplinary team.
Preventing injuries from falls
• All NHS Wales organisations take part in World Sepsis
Day each year; a global event promoting the best ways
of preventing sepsis through raising awareness of the
symptoms and action needed.
• Staff in all health boards have had rapid response training
to use the six key elements of sepsis prevention – known
as the ‘Sepsis Six’.
• We use the National Early Warning Score (NEWS) to
monitor the health of patients in hospital.
• Many hospital wards keep kits of anti-sepsis equipment to
enable quick treatment as soon as sepsis is identified.
Watch a video filmed in Wales for World Sepsis Day
here www.bit.ly/wsd13vid
ACTIONS TO TACKLE SEPSIS

3
Treating you with dignity and respect
Everyone has a right to be treated with dignity and respect and we believe this is
very important. It means treating people with kindness and compassion. This is
something that we must always get right. We are pleased that most people tell
us that they are very happy with the care they receive, but we know there are
occasions when the quality of the care we provide does not meet the standards
we expect. When this happens we take action so that we can learn and put
things right. We have ensured all of NHS Wales learnt from the findings of a
review called Trusted to Care into standards of care in two of our hospitals.
There are many other ways in which we monitor how well we are doing and where
we need to improve. We have set clear standards and we check these regularly. A
report is published each year to show progress against these fundamental
standards. We have also been working hard to make the improvements identified
by the Older People’s Commissioner for Wales following her review.
We have inspectors who visit all NHS Wales hospitals throughout the year to
check people are receiving safe and compassionate care. The inspectors publish
their reports so everyone can see how well hospitals are meeting expectations.
Vist the Healthcare Inspectorate Wales website here: www.hiw.org.uk

We needed to make sure the issues raised in Trusted
to Care were not widespread in Wales so we made
unannounced spot checks of 70 adult acute wards
across 20 hospitals in Wales and nearly half of all
mental health in-patient wards for older people.
These visits observed care to ensure that patients were
receiving medication correctly, including the use of sedation
and also that individual drinking and toileting needs were
being met. They also provided an opportunity to speak to
patients, families, carers and staff about the care provided.
These visits identified lots of good practice as well as
areas that we can improve. These areas of improvement
include things like improving the storage of medicines on
the ward and reviewing the amount of documentation
recorded by staff. We are also going to launch an awareness
raising campaign across Wales to highlight the importance
of drinking more fluids and avoiding dehydration.
3.Treatingyouwithdignityandrespect
Spot Checks for Quality
Trusted to care: www.bit.ly/TrustedtoCare
Spot checks: www.bit.ly/NHSWspotchecks
Fundamentals of Care: www.bit.ly/fdmtlcare
We know that continence
is a major concern for
people who go into
hospital, particularly
if they are older.
Continence was looked
at very closely in the spot
checks. We want people
to receive help to go to the
bathroom if they need it.
We also want to make sure
that catheters are fitted
safely if they are needed,
to reduce the risk of people
getting urine infections.
For three years NHS Wales
organisations have taken
part in a programme to
promote the safer use
of catheters. We have
introduced a ‘care bundle’
(a combination of the
safest ways of working)
for catheters, which has
reduced the number
of infections. In Powys
Teaching Health Board
the programme has been
extended from hospitals into
the community and is being
used by community nurses.
A national continence tool
is used to assess the needs
of patients and assist them
if they are incontinent.
These measures are checked
through the fundamentals
of care reporting system.
Whilst the spot check visits
identified many areas of
good practice, we also found
areas where improvements
were needed. These wards
have been asked to make
improvements. Continence
care will be checked by our
inspectors during their visits.
Continence care

The number of people
with dementia in Wales
is increasing because
people are living longer.
This means that many
patients in hospital have
dementia, even though
they are often being
treated for other things.
It is really important that
people who are living
with dementia receive
appropriate care and are
made to feel safe and
secure. We are prioritising
this in the coming year.
Hywel Dda University
Health Board was the first
health board in Wales
to embed the Butterfly
Scheme to identify and
provide tailored care for
dementia patients in
hospitals. More than 1,000
staff have been trained
and the health board
is planning to appoint
‘Butterfly Champions’ on
each ward. The scheme
has also been translated into
Welsh.
In Cwm Taf University Health
Board a ‘forget-me-not’
is used to identify
patients who have
dementia or other
memory problems.
The forget-me-not
reminds healthcare
professionals to
provide extra levels of
support if necessary. Patients
with dementia complete a
‘This is me’ leaflet with the
help of family members,
which contains information
about their preferences and
life to help staff provide
personalised care.
Making sure we are a
dementia friendly service

We are determined that people receive compassionate
and safe care as they approach the end of their lives.
The individual’s needs and wishes must be at the centre of
all services and families need to be supported as well. Many
people would prefer to die at home rather than in hospital and
we would like as many as possible to have their wishes met.
We are proud that Wales is the only UK country to offer 24/7
access to palliative care services. Families of people who have
died tell us that overall their experience was positive. We
measure this using a rating called iWantGreatCare, and the
average score for end-of-life care is 9.5 out of 10.
One of the ways we have improved care is through the
introduction of ‘Just in Case’ boxes to ensure that specialist
medication can be easily accessed from a number of facilities
such as pharmacies and hospitals to ensure that teams are
able to give effective drugs to patients outside normal opening
hours.
Visit iWantGreatCare Wales www.bit.ly/iwgcwales
Ensuring dignity at the end of life Dying at home
We know that most
people would be prefer
to die at home, rather
than in hospital. And this
was certainly the case for
Mr T, who was diagnosed
with an advanced and
untreatable primary
cancer which had spread to his liver.
With only his son living nearby, he was keen to be able to
die at home and a discharge was planned to enable this to
happen. Mr T was a very private man and didn’t want to be
seen by lots of different healthcare professionals. He also
had specific requests for how he wanted his personal care to
be provided.
A clinical nurse specialist from St David’s Hospice Care met
with Mr T and was able to explain to him and reassure him
about his end of life care. A small team of home nurses
were allocated to respond to his request for a minimum
number of professionals to be involved. They were also
able to support Mr T’s son, who was finding the sudden
deterioration in his father’s health difficult to cope with.
Mr T spent the last two weeks of his life at home and died
with his son present. The hospice nurse was able to wash
Mr T and dress him in the clothes he had wanted to wear
and stayed with his son until the funeral director arrived.

4
Working with you to make sure
you receive the right care
We want to work with you to make sure that the care and treatment you
receive is appropriate. We do this by ensuring that any treatment has been
proven to work based on the best available research. Sometimes we may be
the ones finding the evidence, which is why we are committed to taking part
in research to find new ways of working and trying out new treatments.
We also want to make sure that everyone in Wales receives effective treatment,
wherever they live and whichever organisation is delivering the care. This is our
commitment to equity – making sure everybody can be sure they are receiving high
quality healthcare. We are finding new ways of delivering services so that people
don’t have to travel long distances to hospitals, or even not have to go to hospital
at all. We are committed to providing high quality services in different places, not
necessarily in every hospital, and as close to peoples’ homes as possible.
To help us achieve these aims we produce delivery plans which provide guidance
and direction to NHS Wales on specific areas including: stroke, heart disease,
cancer, end of life, respiratory health, critically ill, diabetes and eye care.
All the Delivery plans can be found here: www.bit.ly/delivplans

4.Workingwithyoutomakesureyoureceivetherightcare
MAKING SURE CANCER TREATMENTS
ARE THE BEST THEY CAN BE
There are many aspects to providing high
quality cancer care, including encouraging
people to live lifestyles that can help prevent
cancer occurring. If people do develop cancer,
it is important that it is diagnosed quickly.
Surgery, radiotherapy and chemotherapy
options need to be decided quickly so people
receive treatment as soon as possible.
NHS Wales conducts ‘peer reviews’ of cancer
services to make sure that all organisations
are delivering the best possible care for
people with cancer. The peer reviews are a
mix of self-assessments and inspections by
experts. Reports have been published on
treatments for lung cancer and an all-Wales
review of lung cancer services is available. It
is essential that we meet the high standards
that we want to achieve, so taking part
in national reviews and audits are very
important. It also means that any problems
can be identified and addressed.
Read the Lung Cancer 2013
Peer Review All Wales Report
at www.bit.ly/lcwales
The renal team from Abertawe Bro
Morgannwg University Health Board has
successfully introduced a night-time home
renal dialysis service for patients with
chronic kidney disease. This has made a big difference to
patients’ quality of life, for
example, they are able to spend
more time with their families
doing the things they enjoy,
they don’t have to travel to
hospital as often, and they are
experiencing much better health.
Improved care for patients with kidney disease
It has improved all
aspects of my life and
my family’s life.
– Hayleigh, SwanseaWatch the video at
www.bit.ly/nightdialysis
award winner
Improved health
outcomes from
'Leg Clubs'
In Powys Teaching Health
Board the district nursing
team has established a
number of specialist ‘Leg
Clubs’ which enable patients
to receive treatment in a
local community venue
rather than hospital.
The new way of delivering
care has resulted in much
better treatment for people.
It has improved the healing
of ulcers and patients say
the social aspect of the clubs
is really valuable to them. It
has also reduced the number
of times
people have
to go into
hospital. award winner

Our vision for maternity
services in NHS Wales is a
service where pregnancy
and childbirth are
recognised as an event
of social and emotional
significance. We want
women and their families
to be treated with dignity
and respect.
We want pregnancy and
childbirth to be a safe and
positive experience for
every mother, wherever
they live and whatever their
circumstances. To achieve this
Health Boards are:
• Asking women and
their partners about their
experience of maternity
services and using feedback
to improve services.
• Supporting women to live
healthy lifestyles.
• Improving direct access to
a midwife by 10 completed
weeks of pregnancy.
• Increasing normal
birth rates and reducing
caesarean sections.
• Encouraging mothers to
breastfeed their babies.
A range of support is
provided to parents and
their children through the
Welsh Government’s Flying
Start, early years programme.
Parents living in Flying Start
areas are provided with
an enhanced health visitor
service alongside parenting
support, part time quality
childcare and help for early
language development.
Keeping you safe at home
Staff in the Welsh Ambulance Services Trust are working to
organise care for people in their homes through the alternative
care pathways project. Ambulance staff use community
services for patients who have fallen or had epileptic or
hypoglycaemic episodes. Instead of
taking them to hospital, paramedics
can refer patients to their GP or an
identified community team.
This work is ensuring
patients receive the most
appropriate care, from the
right clinician, at the right
time and in the right place.
– Grayham McLean, Welsh
Ambulance Services NHS Trust.
Better care for mums and babies

The Welsh
Blood Service
The Welsh Blood Service is
part of Velindre NHS Trust and
relies on strong relationships with
the public to ensure supplies of blood and plasma
are available for healthcare organisations in Wales. They
have particularly targeted increasing the number of people
on the bone marrow donations register to ensure people
with very serious diseases can receive vital transplants.
NHS Wales is grateful to everyone who has donated to the
Welsh Blood Service. The number of bone marrow donors has
exceeded all targets, and many patients have benefited from
vital treatment. Thank you.
Helping patients with long-standing
'wounds' to heal
People with wounds like pressure
ulcers and other damage to skin
will be helped by the world’s first
centre of excellence in wound
prevention and treatment that
has opened in Wales.
The Welsh Wound Innovation Centre
(WWIC) is a partnership between NHS Wales, Welsh
universities, companies and the Welsh Government.
Wounds and skin damage can often occur in patients in
hospital or people in the community who have reduced
mobility. The new centre will help develop new treatment
methods to help people who are suffering with wounds. It
will also identify the ways to prevent wounds from developing
or getting worse.
RESEARCH IN WALES
NHS Wales is taking part in research
to improve several areas in
healthcare. These include: HPV-
related cancer, rehabilitation for
Parkinson’s disease, early detection
of type 1 diabetes in young people,
treating thyroid eye disease, kidney
disease in babies and toddlers. We
can only do this with so many of our
patients helping and taking part. In
2014 the Welsh Government, via
NISCHR, distributed £40.5 million to
support research in health and social
are in Wales.
THE DIFFERENCE YOU CAN HELP MAKE
Velindre NHS Trust has opened a new Clinical Research
Treatment Unit in the Velindre Cancer Centre.
This means patients will be able to
take part in ‘cutting edge’ early
phase trials of new drugs for the
first time in Wales. Patients have
already been recruited to more
than 70 research studies.
DID YOU KNOW?
Male donors can donate
blood every 12 weeks and
female donors every
16 weeks.
... To meet the need
for blood in hospitals in
south, west and mid Wales.

5
Making sure you receive care
quickly and effectively
NHS Wales is committed to making sure you receive the care you need, when you need it.
Many healthcare issues are best resolved quickly so people get back to normal life, or as
near as they can get to it quickly. We know that in some areas people are waiting too long
to be treated. We are working hard to improve this. We are prioritising services where it
really matters so people are being seen and treated on time. We have looked particularly at
making sure people can see their GP when they need to.
Our ambulance service and hospital emergency departments have been under pressure.
We are acting to ensure that our emergency services can respond to local needs. This also
means providing more services in our communities to prevent the need to go to hospital if
there are more appropriate alternatives. We are working closely with our partners in social
care and other agencies to provide integrated services which best meet your needs.
But this is not just an issue for emergency care. There are thousands of operations,
tests and treatments scheduled every day in NHS Wales. Finding the balance between
providing emergency care and ensuring all the planned operations and other
procedures can take place is a challenge. We need to provide all our services in a
timely way and we are working hard to ensure that people have the care they need
without having to wait too long for it.
You can help us achieve this. Please Choose Well when using NHS Wales services.
We know many people already do – thank you!

5.Makingsureyoureceivecarequicklyandeffectively
Dr Olivia's Guide to AE
You can watch it here:
www.bit.ly/drolivia
Many of the people who come to AE would find it
more useful to use other services, such as the emergency
dentist or local pharmacy. Aneurin Bevan University
Health Board is explaining that important message in a
film featuring Wales’ youngest AE consultant, Dr Olivia.
Dr Olivia’s Guide to AE: ‘Is it really an Emergency?’
has already been watched by thousands of people
and has featured on the BBC News. It’s a fun way of
communicating a very important message.
It’s important for everybody in
Wales to Choose Well. Phone NHS
Direct Wales on 0845 46 47 to find
out where it’s best to seek help.
IMPROVING
PATIENT FLOW
Staff at Cwm Taf
have improved ‘patient
flow’ in their hospitals,
reduced delays and made
sure patients receive
treatment more quickly.
The ‘Focus on Flow’
project has seen a
reduction in levels of
demand on accident and
emergency services and
increased the number
of patients handed over
into hospital from an
ambulance
within the
15 minute
target. award winner
The Alcohol Treatment Centre (ATC)
in Cardiff city centre helps reduce the
number of people going to the Accident
Emergency department at the
University Hospital of Wales because of alcohol related
injuries. 70% of Accident Emergency admissions at
peak times are due to alcohol, increasing the potential
for anti-social behaviour and violence, as well as meaning
people have to wait longer to be seen.
Avoiding unnecessary pressure on
our emergency services
award winner
Less than 25%
of people treated
in the ATC were
sent to hospital.
Many patients
said the care they
received had
helped them to
stop drinking to
excess again.
Less than
25%

• We are funding
5000 Eye Health
Examination Wales
(EHEW) appointments
across Wales. This has
meant that 5000 patients
who would have had
their appointment in
a hospital eye service
are able to access
eye care at their local
accredited optometrist.
• Your local high street
optometrist can give
you expert advice on
eye problems that
need urgent attention
and the best way to
treat them. They have
better equipment
than GP surgeries for
examining eyes.
• Tackling delays
and backlogs in
ophthalmology clinics.
• New ‘e-referral’ system
to make sure people
are seen more quickly.
• Upgrading equipment
across Wales to improve
scans and tests.
• We are undertaking
school projects helping
children understand the
importance of eye health.
We are committed to improving services for people
with poor eye health and sight loss. We know
some serious eye conditions can need very quick
treatment and we know that sometimes treatment
has unfortunately not been given quickly enough to
prevent people from losing their sight.
We have published a plan which explains what NHS Wales
is doing to improve eye-care services to ensure people
receive the care they need. We are moving more services
out of hospitals to make them easier to access, nearer to
where people live.
Prioritising eye care STEPS WE ARE
TAKING IN WALES
Eye Health
Examination
Wales5000

Improving access to
surgery for heart patients
Heart surgery is a
serious matter, and
only performed when
absolutely necessary. Once
the decision to proceed
with heart surgery has
been made it is very
important that people
do not wait too long
for their operation.
Cardiff Vale University
Health Board has acted on
concerns over waiting times
for heart surgery patients.
While the recovery rates for
people who had the surgery
were very good, some
people were not receiving
their operation in time
and died while waiting.
To deal with this we
increased the number of
open heart operations
to ensure people get the
surgery they need. We
are committed to ensuring
people who need this
important surgery will
receive it safely and
sooner than before.
Much faster access to expert
advice for heart patients
We want to ensure that when patients need expert
advice they can access it quickly.
One example of this is Betsi Cadwaladr University Health
Board needing to ensure people with heart problems
can access expert cardiology advice when they need it.
A new programme of rapid testing in community venues
combined with ‘virtual’ links with cardiology consultants
has achieved faster, safer care for people by providing
services nearer to their homes. There is still some work
needed to ensure all treatments are available, but there
have been some notable successes.
• Rapid access to expert advice and management
dropped from over 30 days waiting to less than
2 days on average.
• 80% of people are safely discharged with the
right treatment,
without having
to go to attend a
hospital clinic.
• High patient and
GP satisfaction rates
with the service.
Find out more in
this video:
www.bit.ly/bcucardio

6
Treating you as an individual
The things that matter to you also matter to us. We want to work with you to
get your care right ensuring it meets your individual need, involving your family
or carers when needed.
We are developing new ways of listening to what people are telling us about our
services as we want to know what really matters to people. We also want people
to tell us about any concerns they have about their care if they feel they have been
let down. We use a process called ‘Putting Things Right’ to deal with issues and
complaints raised by patients. We have reviewed this recently so we know we
need to make it easier for people to have concerns dealt with. We need your
help with this – please take any opportunities to tell us what you think about the
care we provide and how we can improve things quickly.
We have found it very helpful to hear stories from patients. Health boards
often include a patient story in their meetings. This provides real human
context for discussions about quality issues. We would like to thank every
person who has told their story. It is incredibly valuable to us as we seek to
continuously improve.

6.Treatingyouasanindividual
We want everyone to
have the best quality
healthcare on offer. We
know that some people
can only express their
needs for care effectively
by speaking Welsh,
and that especially
when people are ill or
vulnerable, they can
feel more comfortable
speaking to a member
of staff in Welsh.
We also know that we
need to make an ‘active
offer’ – people might not
ask for healthcare staff
to speak Welsh; we need
to make sure people are
asked what language they
would prefer us to use.
There are several
examples of how we
are extending language
choice in all areas of health
services. Betsi Cadwaladr
Language matters
has launched a bilingual
text message reminder
service which is helping
people keep outpatient
appointments. Patients
are given a language
choice from their very first
appointment. Speech and
language therapists in
Abertawe Bro Morgannwg
have started using new
Welsh-language tools to
help children under three
years old who speak Welsh.
Over the coming year we
need to focus on delivering
actions in our national
strategy ‘More Than Just
Words’ and the upcoming
Welsh Language Standards.
More than Just Words:
www.bit.ly/mtjwfbl
Welsh Language
Commissioner:
www.bit.ly/comgymg
A VALUABLE
TWO MINUTES
2 Minutes of your
Time is a survey
developed by Cardiff
Vale University Health
Board. It is based on
issues which have been
shown to tell us whether
patients feel they have
been treated with dignity
and respect. In response
to the surveys, the health
board has prioritised
improving patients’
comfort on wards and
discharge processes.

award winner
Hywel Dda
University
Health Board
has worked
with people who use their
services to develop better
hospital way-finding and
signage.
The health board worked
closely with adults with
learning disabilities, staff, the
local community health council
and patients to design signs
that use symbols and colours.
Using colour zones and
easily recognisable symbols
is an effective way of
communicating clear
directions, particularly
for adults with learning
disabilities. Feedback from
users, particularly people
with literacy issues, has been
positive. People have found
it easier to identify which
department they need and
how to get there.
Find out more in
this video:
www.bit.ly/hdsignage
Service users help develop better directions
Carers play an incredibly important role so we want
to support them as best we can. For example, GP
practices in Aneurin Bevan University Health Board
are working to identify and proactively support
people who act as carers for family members in
a Local Enhanced Service using the Royal College
of GPs Carers Toolkit. GPs are also encouraged
to identify and offer particular support to young
people who are acting as carers.
In Hywel Dda University Health Board, GP practices,
hospitals and pharmacies are taking part in the Investors in
Carers scheme, which offers more support to carers. The
health board is also developing a Young Carer version to use
in partnership with secondary schools to support teenagers
who care for a disabled or ill parent or family member.
Investing in carers

Caring for the mind
Improving general hospital care for people with
learning difficulties is being rolled out across Wales.
This means taking key steps to ensure:
• Early recognition of patients with learning disabilities
• Effective communication with patients, carers, family
members and clinicians
• Dignified, person centred care and treatment
• Effective review and discharge planning
Abertawe Bro Morgannwg University Health Board
piloted the work and now report 100% compliance,
other health boards are now at different stages of the roll
out, which includes training for all staff.
Velindre NHS Trust has developed ‘Top tips’ to help
people cope with common difficulties when receiving
treatment for cancer. These include fatigue and low
mood. Children also need support through a family
member’s illness. Staff are being equipped to direct
families and carers of patients to information and support
from clinical services.
‘ACT-ion for Living’ provided by Cardiff and Vale
University Health Board consists of weekly sessions of
mindfulness-based therapy. It has two main messages,
accept what is out of your personal control and commit to
action that improves and enriches your life. It helps people
clarify what is important and meaningful to them then uses
that knowledge to guide, inspire and motivate them to
make changes that will make life better.
In Powys Teaching Health Board, children and young
people are offered ‘blended counselling services’ that
includes online therapy services and face-to-face school
based counselling. Young people can access face-to-face
counselling and benefit from online support without
being referred by a doctor.
Mental health is a major
area of investment for NHS
Wales. There are a number
of programmes running
throughout Wales that
emphasise the importance
of mental health in everyday
life, for example in our
schools.
This year we have developed a strategy to reduce rates of
suicide and self-harm in a programme called Talk to Me 2. We
are working with several other organisations to prioritise people
who are at risk of suicide or self-harm. We are also seeking
to learn from incidents in mental health services to help us
improve.
We have also started a major programme to ensure children and
young people with mental health problems and their families
receive the advice and support they need in a timely manner.

28 The Annual Quality Statement for NHS Wales 201428 The Annual Quality Statement for NHS Wales 2014
A big thank you to everyone
who works for NHS Wales
The people who work for NHS Wales make the difference in everything
we do. Their passion and commitment shines through the services we
deliver. We want to recognise and reward this where we can, which is
why we run the NHS Wales Awards annually. The innovation and hard
work showcased in the Awards is inspiring.
It would be impossible for us to provide so many services and treatments
day in day out throughout Wales without the commitment and passion
of our staff and primary care contractors. This also extends to the many
volunteers and third sector organisations who also provide care, support
and practical help to people who need it. I want to take this opportunity
to offer a sincere thank you to everyone who works for the NHS and our
partner organisations.
7

7.AbigthankyoutoeveryonewhoworksforNHSWales
Our staff
We know staff wellbeing
is hugely important. When
staff aren’t cared for then
the quality of the care
they provide can drop.
We are taking steps to
ensure staff receive the
support they need to carry
on providing care to others.
We also want to ensure
staff can raise concerns
that they may have.
Although we have increased
the number of staff overall
working in NHS Wales by
nearly 10 per cent since
2004, we are seeing issues
recruiting to certain roles.
We are increasing our efforts
to recruit doctors at all
levels as we realise we need
more medical staff. There
are also opportunities for us
to explore more innovative
working models to make
sure we are delivering the
care that is needed.
We also want an empowered
workforce, recognising there
are many people who work
for us who are not directly
employed by NHS Wales, but
work on a contract basis.
We also value the huge
input from volunteers and
people working in the Third
Sector who contribute to
providing support and care
for people across the country.
Recruiting
more nurses
One of the main
issues identified
in recent reports
published about poor
care across the UK is
the need to ensure
there are enough
nurses working on
hospital wards.
NHS Wales has committed to ensuring there are enough
nurses to provide everyone with safe, effective care. We
have invested an extra £10m every year since 2013 for
health boards to use to ensure the right levels of nursing
staff are employed to provide quality services in the future.
We have been increasing the numbers of training places for
nurses each year. There are also ‘return to practise’ courses
for people who have trained but are not currently working
as nurses, and who would like to come back.
The number of
GPs in Wales
has increased by
more than 10%
since 2004.

Improving Quality Together
(IQT) is the national learning
programme for all NHS Wales
staff and contractors. It provides
a common and consistent
approach to improving the
quality of services in NHS
organisations across Wales.
IQT will help all staff improve the
way they work to ensure you
receive even better care. It is also
helping create better working
environments, to make your care
safer, reduce the number of delays
if you need treatment, and help
you return to your normal life as
quickly as possible after receiving
treatment.
You can find out more about
Improving Quality Together online:
www.iqt.wales.nhs.uk
Watch Julia explain the difference
IQT makes:
www.bit.ly/iqtjulia
DELIVERING EXCELLENT CARE BEYOND
OUR BORDERS
55 members of NHS Wales staff were deployed
as part of the army reserve unit 203 (Welsh) Field
Hospital to Helmand province in Afghanistan in
2013. The six month tour of duty has provided
staff with valuable experience that is leading to
new approaches to work back here in Wales.
Over 12,000
NHS Wales staff have
completed the first level of
Improving Quality Together.
just gives the whole team
a different dimension and
a different perspective
and it really paid off.
– Julia, Business Manager,
Powys Teaching Health Board

NHS Wales values the many
people who give up their free
time to help provide additional
support to those that need it.
For example, the Care Home
Ask and Talk (CHAaT) volunteer
service was developed in Aneurin
Bevan University Health Board
in partnership with the NHS
Retirement Fellowship. It is a
unique volunteer service made up
of retired NHS professionals who
support older people living in care
homes.
The ChAaT offer ‘face to
face’ meetings, providing an
opportunity to talk in private or
groups about the experiences of
individuals living in a nursing care
home. The focus is on quality of
life, making sure people living in
nursing care homes are safe, well
cared for and enjoy living in the
home.
There are many other examples
of volunteers making important
contributions to the ongoing
work of NHS Wales – on behalf
of everyone who works in NHS
Wales, thank you!
Watch the video:
www.bit.ly/abchaat
We are investing an additional
£40 million as part of a plan
to improve access to primary
care services across Wales.
Our aim is to allow people to be cared
for closer to their homes, helping
people look after themselves and avoid
unnecessary hospital appointments.
We want to:
• Plan and deliver health services
locally within the community.
• Provide skilled healthcare
professionals in your local area.
• Give patients access to GPs, nurses
and pharmacists on the day they
need it, either face to face, on
the phone, by email or video call.
• Have teams of health and
social care professionals
working around a patient to
give them the treatment they need.
BRINGING SERVICES CLOSER TO YOU
award winner
Volunteer team supports older people

Our focus for the year ahead
We have given you a summary of the things that we have been doing within NHS Wales to keep improving
the services we provide for you. We also want to reassure you that when we identify things that cause
concern we will take action. It is also important for us to look forward and ensure that we are clear about
what we need to do in the year ahead to make further improvements where we know we need to.
Ourfocusfortheyearahead
We want to work with you to help you
take as much care and responsibility
that you can for your own health or
that of your family. We know that
leading a healthy lifestyle can help
prevent us from becoming ill.
We will develop integrated health and
social care services with our partners
that can be provided as close to peoples
homes as possible. To do this we will
be investing in our primary care and
community services. What we call our
‘primary care clusters’ will be coming
up with local solutions to meet local
challenges and needs. We want to work
towards providing as much care as we
can within your local community and
prevent unnecessary trips to hospital.
More timely care
We want to ensure that we prevent
delays in treatments. In some cases,
this will take time but we have a
number of programmes in place to
introduce new ways of working to help
achieve this, building on the examples
we’ve described in this document.
We will continue to turn the
recommendations of the ‘Trusted
to Care’ report and our spot checks
into action. For example during the
summer we will introduce a campaign
around preventing dehydration to
ensure people are not affected by
this easily avoidable condition.
We will continue to prioritise making
sure that we identify people affected

Ourfocusfortheyearahead
by dementia as early as possible so
they can receive the care that is best
for them, especially when they are in
hospital. This year we will be taking a
range of actions to ensure that Wales
becomes a dementia friendly nation.
Respecting people’s wishes
We want to ensure we provide dignified
care for people at the end of their
lives. We want to have conversations
with people about whether or not
to attempt to resuscitate if they are
very ill and close to death. We want
to have these conversations well
before decisions need to be made
so that when people are dying they
can have their wishes respected.
We are committed to improving the
way that we respond to any feedback
and complaints about the care we
provide. We want everyone to feel
able to let us know immediately if
they are concerned about their care
so that we can put things right.
We are taking a number of actions.
This includes making sure that
we have good systems to share
and act on any learning from
when things may go wrong.
A prudent approach
The principles of prudent healthcare will
be very helpful as we look to develop
our services. We want to prevent
harm, use treatments that we know
work, and make sure our services are
sustainable. We especially want to work
with the people who use our services
to find better ways of caring for people
to meet their need and preventing
people from getting ill in the first place.
Healthcare is ever changing with
new treatments and equipment, so
we know that we can never stand
still. We also need to contribute to
this new knowledge so all of our
organisations will be taking part in
research so that we can continue to
introduce innovative ways of working.
Above all, we want to ensure that we
provide safe, compassionate, person-
centred care. We are committed
to putting things right if we get
them wrong. We want to act on
people’s feedback and work with
the people of Wales to continue to
ensure we have a National Health
Service we can all take pride in.
Thank you for reading this
Annual Quality Statement. Our
mission is to deliver high quality
health services to you. If you
would like to comment on this
publication or any other aspects
of care in NHS Wales please email
YourHealth@Wales.GSI.Gov.UK

MoreinformationaboutNHSServices
If you would like to read about
health services in your area, here
are the links to the Annual Quality
Statements published by the health
boards in Wales for 2013-14.
1. Abertawe Bro Morgannwg
www.bit.ly/abmuaqs
2. Aneurin Bevan University
Health Board
www.bit.ly/anbevaqs
3. Betsi Cadwaladr University
Health Board
www.bit.ly/bcuhbaqs
4. Cardiff Vale University
Health Board
www.bit.ly/cavaqs
5. Cwm Taf University Health
Board
www.bit.ly/ctafaqs
6. Hywel Dda University
Health Board
www.bit.ly/hddaaqs
7. Powys Teaching Health Board
www.bit.ly/powysaqs
The three NHS Trusts in Wales
also produce Annual Quality
Statements – here are the links
to the publications for 2013-14
Public Health Wales NHS Trust
www.bit.ly/phwaqs14
Velindre NHS Trust
www.bit.ly/velindreaqs
Welsh Ambulance Services
NHS Trust
www.bit.ly/wastaqs
Additional links
My Local Health Service
mylocalhealthservice.wales.gov.uk
iWantGreatCare Wales
www.bit.ly/iwgcwales
Where you can find more information about services near you
5
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6
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NotesaboutthisAnnualQualityStatement
Delivering high quality health services to the people of Wales – The Annual Quality
Statement for NHS Wales 2014 was published by NHS Wales. Much of this material
was drawn from the 2013-2014 Annual Quality Statements produced by NHS Wales
organisations.
Every effort has been made to check the information contained in this statement are
accurate and reflect current working practice in NHS Wales at the time of publication.
Delivering high quality health services to the people of Wales – The Annual Quality
Statement for NHS Wales 2014 was written and produced by 1000 Lives Improvement
and the ‘Working With Not To’ Co-Production project on behalf of The Welsh
Government and NHS Wales.
User-experience accessibility: This report has been checked by Barod CIC to help us
make it is easier to use. (www.barod.org).
©2015, NHS Wales.
Notes about this Annual Quality Statement

It covers the following topics:
• Helping you stay safe and healthy
• Keeping you safe while you are in our care
• Treating you with dignity and respect
• Working with you to make sure you receive the right care
• Making sure you receive care quickly and effectively
• Treating you as an individual
• Our focus for the year ahead
Delivering high quality health
services to the people of Wales
The Annual Quality Statement
for NHS Wales 2014
This Annual Quality Statement is a review of NHS
Wales services, published by the Welsh Government.

The Annual Quality Statement for NHS Wales 2014: Delivering high quality health services to the people of Wales

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The Annual Quality Statement for NHS Wales 2014: Delivering high quality health services to the people of Wales