Improving Care - NHS Wales Awards 2011 Winners

07 July 2011, National Leadership & Innovation Agency For Healthcare

Helping patients to cope with bowel cancer, preventing pressure ulcers and providing specialist treatment to help people lose weight is just some of the work which has been recognised in this year’s NHS Wales Awards, announced today.

Six awards were given to NHS organisations across Wales for their innovative work and best practice that is improving patient care. 

Cardiff and Vale University Health Board led the way with two awards for its work to improve services for patients with foot care problems and skin conditions. 

Cwm Taf Health BoardHywel Dda Health BoardBetsi Cadwaladr University Health Board and ABM University Health Board are also celebrating after winning one award each.

The improvements to care which have been recognised include work being done through 1000 Lives Plus, the five year programme which seeks to improve the quality of patient care by reducing avoidable harm, waste and variation across NHS Wales.

NHS Wales Chief Executive David Sissling, who presented the awards in a ceremony at the All Nations Centre, Cardiff this afternoon, said, “The NHS Awards recognise the innovative work that is being done by our healthcare staff every day to ensure we provide the best possible care for patients.

"The high quality of the entries is an impressive reflection of the professionalism of our staff and their commitment to safe, efficient and compassionate care. 

“These are excellent examples of best practice which will be shared across Wales. They are a tribute to all staff involved."

The winners of the NHS Wales Awards 2011 are:

Citizens at the Centre of Service Re-Design and Delivery

Cwm Taf Health Board for its interactive DVD to guide patients through diagnosis and treatment of bowel cancer.
 
Developing a Flexible and Sustainable Workforce

Cardiff and Vale University Health Board for its work to improve foot care services for community patients and in-patients.

Improving Quality Through Better Use of Resources

Betsi Cadwaladr University Health Board for the introduction of enhanced recovery after surgery which is helping orthopaedic patients recover from surgery quicker and return home sooner. The work is a key part of the 1000 Lives Plus programme.

Working Seamlessly Across Organisations

Cardiff and Vale University Health Board for its project to improve care for patients with skin conditions by improving GP training and using telemedicine.

Promoting Better Health and Avoiding Disease

Hywel Dda Health Board for the establishment of a unique clinic in Carmarthenshire to help patients lose weight by receiving medical, dietary and psychological support.

Improving Patient Safety

ABM University Health Board for its work to eliminate pressure ulcers (commonly known as bed sores) as part of the 1000 Lives Plus programme to improve patient safety.


More than 130 projects entered into this year’s NHS Awards, which showcase good practice and achievement in healthcare.

National Leadership and Innovation Agency for Healthcare (NLIAH) Director Dr Alan Willson, who leads the NHS Wales Awards, said that the standard of the winning work demonstrates world class ambitions and achievements.

He said, “The NHS Wales Awards are a great opportunity to acknowledge and celebrate good practice that has helped to transform health care.

“The high standard of winning work from across Wales demonstrates that patients are benefiting from well designed and successful improvements to give them the best possible experience and outcome.

“This is the fourth year that we have held these important Awards and it is inspiring to hear about yet more examples of excellent healthcare continuing to be developed and delivered right here in Wales.”

The NHS Wales Awards were launched in 2008 to celebrate the 60th anniversary of the NHS.

The Awards are jointly organised by the National Leadership and Innovation Agency for Healthcare (NLIAH) and the Welsh Assembly Government.
 
View all the NHS Wales Awards 2011 storyboards at http://www.nliah.com/compendiums/NHSAwards2011.
 
Citizens at the Centre of Service Re-design and Delivery 
Winner: Cwm Taf Health Board - Colorectal Cancer Pathway:  An interactive journey to de-mystify the process for patients, families and friends
 
Being diagnosed with cancer is a stressful experience for patients who often find it impossible to retain any detailed information about their care.
 
To try and make the process easier, staff at Cwm Taf Health Board produced an interactive DVD to guide patients through diagnosis and treatment.
 
The innovative video is aimed at patients with colorectal (bowel) cancer which affects in one in 25 people in the UK, with over 30,000 new cases each year.
 
It provides guidance and information in a reassuring manner which can be viewed in the patient’s home with family and friends.
 
The DVD takes the viewer through the journey from diagnosis to treatment. It was filmed in the local hospital (Prince Charles) and introduces patients to many of the staff they are likely to come in contact with and the environments they will visit.
 
Viewers can also opt to view a continuous film depicting the patient pathway from consultation to various tests and care options.
 
Judging the award, Maria Battle, Senior Director, Consumer Focus Wales, said, “This project was particularly inspiring as it enabled patients to become familiar with the care they would receive in hospital from the comfort of their own home.
 
“Being diagnosed with cancer is such a stressful time and this simple, easy to use DVD can help to demystify the different tests and treatments that are needed, enabling the patient to feel more informed and confident to cope with their condition.”
 
 
Developing a Flexible and Sustainable Workforce
Winner: Cardiff and Vale University Health Board - Improving Foot Care Services
 
Neglected toe-nails are an all too common problem that can lead to foot pain, infection, ulceration and mobility problems.
 
Many people struggle to care for their feet due to sight impairment, arthritis or an inability to reach, yet there is no nail trimming service available as part of NHS podiatry services.
 
Cardiff and Vale University Health Board, in partnership with Age Concern and the Society of Chiropodists and Podiatrists, decided to develop a training course for people to deliver foot care for patients at low risk of developing complications.
 
A new accredited programme was developed including the creation of a checklist to be used with the patient to ensure the most appropriate course of action is taken.
 
Around 168 people have attended the training programme from nursing departments, residential care homes and special schools.
 
Age Concern has provided 222 appointments over nine months in three clinic sites across Cardiff & Vale.
 
Judging the award, Rhian Huws Williams, Chief Executive Care Council for Wales said, “This transformational model is really about partnership working. It has the potential to be rolled out across Wales as a partnership between all sectors.
 
“The approach ensures patients are receiving an effective service as soon as they need it, improving their quality of life, helping them maintain their independence and dignity and of course also preventing more costly treatment at a more acute stage.”
 
Improving Quality Through Better Use Of Resources
Winner: Betsi Cadwaladr University Health Board – Enhanced Recovery Orthopaedics
 
Orthopaedic patients in North Wales are recovering from surgery quicker and returning home sooner, thanks to the introduction of enhanced recovery after surgery in Betsi Cadwaladr University Health Board.
 
The new way of working was introduced in Wrexham Maelor Hospital to help knee and hip surgery patients and is a key part of the 1000 Lives Plus programme to improve quality and reduce harm, waste and variation.
 
It’s designed to better prepare patients for surgery, which can lead to quicker recovery rates and patients being able to return home earlier with reduced complications.
 
The work brings together a range of improvements designed to improve the patient experience and clinical results, including better checks and assessments before surgery.
 
It also includes improved nutrition before, and after, surgery and encourages early movement post-surgery, as well as involving patients more closely in their care and treatment.
 
Staff at Wrexham Maelor underpinned the work with the development of a school for patients which taught them the principles of enhanced recovery.
 
The consistent message that the patient is not ill was delivered and patients were encouraged to expect a discharge of between one and three days.
 
The implementation of enhanced recovery has led to a reduction in the length of stay with patients leaving hospital after three days rather than six.
 
Evidence suggests rolling out the knee programme to all Consultants across BCULHB would save 2610 bed days alone.
 
Judging the award, Donna Mead, Dean of the Faculty of Health, Sport and Science at the University of Glamorgan, said, “This is an excellent example of a new way of working which is making a real difference to patient care.
 
“The programme has positively influenced patient care before, during and after joint replacement surgery with a view to being discharged in the shortest possible time.
 
“It has enabled patients to become actively engaged in their own care and is improving their experience.”
 
Working Seamlessly Across Organisations
Winner: Cardiff and Vale University Health Board – Teledermatology – Improving GP education in dermatology and, through triage and waiting list management, improving patient experience
 
A project to improve GP knowledge and understanding of dermatology using telemedicine has improved care for patients with skins conditions in Cardiff and the Vale.
 
Between 15% and 20% of all GP visits are patients with skin conditions yet very few GPs receive any dermatology training either in, or after, medical school.
 
With large numbers of patients in primary care, and few specialist dermatologists in secondary care, many patients have endured long waiting times for specialist treatment or been placed on a waiting list when they could be managed by the GP.
 
Cardiff and Vale Health Board decided to develop a project that would link local patients and GPs with specialist dermatologists at the Welsh Institute of Dermatology.
 
Telemedicine is used to provide rapid access to a consultant who, after reviewing digital photographs with a brief history, reports back to the GP, advising on treatment and management, and allowing them to continue to manage the patient in the community.
 
The consultant also identifies patients needing a hospital visit and links with coordinators to organise an appropriate out-patient appointment, based on the severity of the case.
 
The first year of the pilot received 250 referrals from 11 practices and in 2009/10, received nearly 1000 referrals from 40 practices.
 
Consistently, each year, 70% of replies offer advice for the GP to continue managing the patient in primary care, thereby saving 700 out-patient appointments in 2009/10.
 
Judging the award, Jo Farrar, Chief Executive Bridgend County Council, said, “This is a fantastic project which has involved primary and secondary care working together to improve efficiency, effectiveness and most importantly the patient’s health and experience.
 
“It has resulted in fewer referrals to hospital, reduced waiting times and rapid access for urgent cases.”
 
Promoting Better Health And Avoiding Disease
Winner: Hywel Dda Health Board – Carmarthenshire Multi-Disciplinary Weight Management Clinic
 
The establishment of a unique clinic in Carmarthenshire to tackle obesity is helping patients to lose weight and reduce their risk of chronic conditions such as diabetes and heart disease.
 
The new service enables obese patients to receive not only medical and dietary support but also psychological treatment.
 
It was developed by Hywel Dda Health Board following recognition that there was a lack of effective, evidence-based services for patients with obesity.
 
More than 60% of people in Carmarthenshire are classed as overweight with 21% obese.
 
Previous dietary care offered to patients had not always been successful with a high level of people dropping out and appointments often infrequent.
 
A survey of patients who had accessed the dietetic service showed that the majority of those questioned wanted more frequent follow-up and support.
 
In response to this, staff decided to develop a clinic that would offer the support of a medical consultant, specialist obesity dietician and a consultant clinical psychologist.
 
Patients were given an initial assessment with all three specialists, a treatment plan agreed and fortnightly follow-up appointments put in place.
 
In the first six months of the new clinic, 13 patients attended with no drop out compared to a previous 50% drop out rate with the usual care.
 
Ten out of the 13 patients lost weight, with six of these patients managing a clinically significant weight loss.
 
Around 62% of patients required intensive psychological support which helped them to improve the control of their eating patterns, reduce levels of emotional stress and improve their self-perception of their shape and size.
 
Judging the award, Kate Watkins, Director of the Welsh NHS Employers’ Unit, said, “This exciting project developed from the recognition by a group of staff that there was a significant health problem in their locality.
 
“Very impressively, they have sought the evidence for a solution, taken that evidence and used it to create the effective outcome of enabling patients to lose weight and reduce their risk of chronic conditions such as diabetes and heart disease.
 
“This is the only clinic of its type in Wales and the work should be applauded.”
 
Improving Patient Safety
Winner: ABM University Health Board – Getting to Zero: A Health Board Approach to eliminating hospital acquired pressure ulcers
 
Pressure ulcers are now a thing of the past for patients in ABM University Health Board thanks to the introduction of new ways of working developed as part of the 1000 Lives Plus programme to improve patient safety.
 
The Health Board has led pilot work to develop and implement the SKIN bundle which looks at four key areas to improve patient care; the surface of the skin, keeping the patient moving, incontinence and nutrition.
 
Patients are regularly assessed for risk of developing a pressure ulcer and their results clearly recorded on a chart at the bottom of their bed.
 
The new measures were initially implemented on Anglesey Ward in Morriston Hospital before being rolled out to wards across the health board.
 
In the three years that Anglesey ward has been using the bundle only one pressure ulcer has developed and the annual incident rate has dropped from 4% to zero.
 
Some wards across ABM have gone more than 600 days without a pressure ulcer and a high percentage have gone more than 400 days without an incident.
 
All patients within the trolley and resuscitation bays of A&E are being assessed and the SKIN bundle implemented.
 
Prior to these changes, wards were reporting around 4-6 patients a month arriving on their wards from A&E with skin damage. There have been no such incidents reported since the implementation.
 
The work is being spread across Wales through the 1000 Lives Plus programme and internationally including Scotland, England and Denmark.
 
Judging the award, Jan Davies, Director of 1000 Lives Plus, said, “This is an excellent example of an organisational cultural shift which is making a real difference to patient care.
 
“There used to a belief that pressure ulcers were an inevitable outcome for some hospitalised patients but now we know that they can and should be avoided and staff are dedicated to ensuring this happens.
 
“This work, which is an integral part of 1000 Lives Plus through the transforming care programme, has delivered fantastic results and the best practice is being shared not only across NHS Wales but further afield to ensure pressure ulcers become a thing of the past.”