Public Health Wales Annual Report 2012-2013 - Nphs.wales.nhs.uk

Public Health Wales Annual Report 2012-2013 Growth, development and responsiveness at a time of change

The year saw Public Health Wales grow, develop and respond to new challenges at a time of major change. Growth At the start of the year - 1 April 2012 thirteen health improvement programmes were transferred from the Welsh Government. Some of these are provided directly by staff who joined Public Health Wales. Others are commissioned from other agencies. One new screening programme Newborn Bloodspot Screening Wales – introduced testing for an additional medical condition in May 2012. Another the Wales Abdominal Aortic Aneurysm Screening Programme – was developed ready for launch in June 2013.

Bob Hudson, Chief Executive, said: “Public Health Wales is continuing to grow and adapt to the changing needs around us at a time of challenging financial pressures. This year, staff have been asked to do more work with less money and I am proud of how they have delivered. The challenge has not ended and we are again taking on more areas of work and welcoming new staff to our organisation.”

Development Bob Hudson said: “We have a clear ambition – to achieve a healthier, happier and fairer Wales. But we need to be clearer about the things we should do to make the most difference. “Three years since our establishment, we have reflected on what we have learned along the way. “The Minister and Chief Medical Officer,

both new appointments in the last year, have also required us to think more clearly in terms of outcomes and the impact we have. “The change in our role – where we increasingly commission others to provide services and where we need to work with others to achieve our aims – has also encouraged fresh thinking. “And, of course, we do not have the money to do everything the way we’ve done things in the past. So we have to be clearer about our priorities.” In response to this changing environment, Public Health Wales has been revising its strategy. There have been other developments too.

(continued on page 2)

Corporate News (continued from page 1)

Responsiveness

Meeting financial targets

A Health Improvement Review was initiated in 2012 to examine programmes in Wales. It engaged a wide range of stakeholders, including the public, and led to recommendations for the Minister to consider. Following a consultation process with staff the Public Health Development Directorate set up a project to guide the transition to new divisional structures and new ways of working. On a wider basis, a series of conversations with staff - “Have your say” – were held to have an open discussion about, amongst other issues, how to make Public Health Wales a great place to work. Ruth Davies, Director of Workforce and Organisational Development said: “I am determined that we make these conversations the way we work in future. We have added the Staff Survey feedback to what was said in the ‘Have your say’ workshops and that is informing our Organisational Development Plan.“

The largest measles outbreak in Wales started with a few cases in November 2012. Working with all health boards, Public Health Wales put into place an organisation-wide response to deal with the subsequent large number of cases and to encourage vaccination uptake. Dr Quentin Sandifer, Executive Director of Public Health Services, said: “The measles outbreak put us in the international spotlight. By pulling out all the stops, and by working with colleagues across the wider public health community, our staff showed that we can protect people’s health when needed and when under pressure.” Another issue requiring an unplanned and rapid response was the unscheduled care pressures that health boards faced over the winter of 2012/13. Working with Directors of Public Health, Public Health Wales provided analysis of the pressures to assist the NHS take action to manage unscheduled services in future.

Public Health Wales continued to achieve its financial targets in 2012/13, without the need for any assistance. With an income of £98.3 million, the organisation successfully broke even and recorded a small surplus of £10,000. Executive Director of Finance, Huw George, said: “We have had another challenging year when the organisation faced considerable financial pressures without any inflationary or growth funding. To meet our targets, we made financial savings of more than £2.3 million, which is over 2.5 per cent of budgets. This makes the continued progress of the organisation particularly rewarding.”

Foreword: achievement It’s that time of year again when we look back at our past achievements and look forward to what the next year has in store for Public Health Wales. It’s very easy to describe a year as challenging. When our role of improving and protecting the nation’s quality of life is set against a tough economic backdrop, it can hardly be anything other than challenging. However, I believe that we’ve not only risen to the challenge; we have far exceeded it! The past year has been one characterised by reprioritisation. In the face of the cost savings asked of all NHS bodies, we have been looking at how we can do more with less. This involves refocusing our attention on the areas of most need: those which have the biggest public health impacts such as tackling obesity and tobacco, preparing for a peoplecentred and community approach and addressing the life-course to reduce more effectively health inequalities and inequities in Wales. This is never an easy task and it’s one which we take very seriously. My colleagues and I share the view that it is essential that the financial situation of the NHS in Wales must not drive behaviour similar to that revealed in the Francis Report on care at the Mid Staffordshire NHS Foundation Trust. That is why to ensure transparency and full accountability we have been developing our priorities in full consultation with staff, stakeholders and the public as well as confirming that we have in place good governance and assurance frameworks at board level. The National Health Improvement Review has been the key driver in our reprioritisation

2|

Public Health Wales Annual Report 2012-2013

process. When I first looked into a selection of health improvement programmes in 2011, I recommended health improvement programmes in general were assessed and evaluated more thoroughly in order to be sure that public money was being invested wisely and contributing to an extensive improvement in population health. I’m delighted that the National Health Improvement Review, which did, indeed, look at the programmes in a much more thorough, in depth, and well-structured way, made sound recommendations to the Minister for Health and Social Services for potential disinvestment in some programmes and urgent prioritisation of others which would signal a step change in the way we deliver health improvement in Wales. The coming year will concentrate on the implementation of the recommendations. Reprioritisation has also been a recurring theme in our work with health boards during the last year. We have provided advice and evidence on the long term impact of reorientation, realigning and transforming services to move the NHS from a place of only treating people who are already ill, to helping and supporting people to choose healthier lifestyles. Prevention of illness and disability has been a major unifying concept underpinning our work and advocacy. I would like to thank members of the Public Health Wales Board for their dedication, support and hard work over the last year. I also extend my thanks to the executive team who have so expertly and successfully steered our

Professor Sir Mansel Aylward CB

organisation through the complex challenges, developments and demands which confronted us in the past year. Finally, and importantly, I would like to thank all colleagues in Public Health Wales without whose commitment and industry we would not have been able to respond as well as we have done to the many challenges we have faced in the current harsh financial climate. I hope you will enjoy reading about some of our achievements over the past year, which are featured in this Annual Report. There are many more examples of successful and demanding initiatives which have not been captured here but, I trust, the report provides a meaningful, if but a snapshot, of the many achievements we have gained during the last year. Professor Sir Mansel Aylward CB Chair: Public Health Wales

Corporate News

Public Health Wales Board As of 31 March 2013 membership of the Public Health Wales Board was as follows: Name

Position

Professor Sir Mansel Aylward CB

Chair

Mr John Spence

Vice Chair

Dr Carl Clowes OBE

Area of Expertise Representation Role

Board Committee Membership

Champion Roles

• (Chair) The Board • (Chair) Remuneration and Terms of Service Committee

Veterans

Independent member

• (Vice Chair) The Board • Quality and Safety Committee • Remuneration and Terms of Service Committee • (Chair) Information Governance Committee (from August 2012) • Audit Committee

Violence and Aggression

Non Executive Director

Third Sector

• Quality and Safety Committee • Audit Committee • Information Governance Committee • Remuneration and Terms of Service Committee

Professor Gareth Williams

Non Executive Director

University

• Quality and Safety Committee • Remuneration and Terms of Service Committee

Professor Simon Smail CBE

Non Executive Director

Independent Member

• (Chair) Quality and Safety Committee • Remuneration and Terms of Service Committee

Mr Terence Rose CBE

Non Executive Director

Independent Member

• (Chair) Audit Committee (from August 2012) • Information Governance Committee (from August 2012) • Remuneration and Terms of Service Committee

Dr Jo Farrar (to July 2012) Vacant (from August 2012)

Non Executive Director

Local Authority

• (Chair) Audit Committee (until July 2012) • (Chair) Information Governance Committee (until July 2012) • Remuneration and Terms of Service Committee

Equality (until July 2012)

Mr Bob Hudson

Chief Executive

• Audit Committee* • Quality and Safety Committee* • Information Governance Committee* • Remuneration and Terms of Service Committee*

N/A

Mr Huw George

Executive Director of Finance

• Audit Committee*

N/A

Professor Hilary Fielder (until September 2012) Dr Quentin Sandifer (from October 2012)

Executive Director of Public Health Services and Medical Director

• Quality and Safety Committee* • Information Governance Committee*

N/A

Dr Peter Bradley

Executive Director of Public Health Development

Mr Mark Dickinson

Executive Director of Planning and Performance

Safeguarding

N/A

• Quality and Safety Committee* • Information Governance Committee*

N/A

* Attend Committee meetings, but are not members of the Committee and therefore do not have voting rights. Further information on the Public Health Wales Board including the departures and arrivals of the Board is available in Section 3 of this report, Annual Governance Statement. Public Health Wales Annual Report 2012-2013

|3

Corporate News

Public Health Wales Board as of 31 March 2013. Top Row (L-R) Keith Cox, Dr Carl Clowes, Bob Hudson, Dr Peter Bradley, Dr Quentin Sandifer, Chris Lines, Mark Dickinson. Bottom Row (L-R) Professor Simon Smail, Ruth Davies, Professor Sir Mansel Aylward, John Spence, Terry Rose. (Huw George and Gareth Williams missing).

Concerns Public Health Wales takes all concerns seriously and views them as a way to learn how to improve the services it provides. The overall complaints and concerns performance for the period April 2012 to March 2013 is detailed as follows: Total number of complaints/concerns

45

Total number of formal complaints/concerns

43

Total number of informal complaints/concerns

2

Total number of complaints that reached the second stage*

2

Total number of complaints received from children

0

Total number of complaints received from MPs and AMs 0 *If the complaint went to the Ombudsman or independent secretariat review The complaints performance in relation to the formal complaints received is detailed below: Number of formal complaints

43

Acknowledged within 2 working days 93% Responded within 30 working days

82%

Concluded after 30 working days

18%

Complaints still ongoing Average time taken to respond

0 25 days

Three complaints were received via Community Health Councils. A complaint was received from the Information Commissioner Officer (ICO) but no action was taken against the organisation. A complaint was also received in relation to Public Health Wales adherence to the Welsh Language Scheme which was resolved locally.

4|

Public Health Wales Annual Report 2012-2013

One complaint was withdrawn and all remaining complaints were resolved via local resolution and involved:  Apology and explanation being provided within the response letter following complaints investigations  Complainant’s experiences discussed with relevant staff  Complainants invited to discuss concerns and queries with appropriate senior staff  Provision of appropriate information  Quarterly complaints reports are submitted to the Public Health Quality and Safety Committee The following service improvements arose from the complaints received and subsequent investigation:  Code usage between laboratories reviewed to ensure consistency  a Requests for Information Procedure, including Subject Access Request, has been developed and approved  Information Governance training has been updated to cover Subject Access Requests  Client handover documentation has been reviewed  Monitoring procedures established for extended General Anaesthetic times  Procedure introduced that includes the checking of images prior to sending

Annual Quality Statement This is the first year we have produced an Annual Quality Statement which provides an open and honest assessment of what we are doing to ensure all our services are meeting the needs of the population of Wales and reaching high standards. The Statement can be viewed at: www.publichealthwales.org/annualreport

Disability Public Health Wales has a range of policies including Dignity at Work and recruitment and selection policies which relate to disabled employees. These policies ensure that disabled employees are not substantially disadvantaged. This includes exploring with the employee any reasonable adjustments that may support their achieving and sustaining the required standards of performance.

IN BRIEF Population health: This document reports on Public Health Wales’ significant activities in making Wales healthier, happier and fairer. It does not report on population health. The Chief Medical Officer for Wales and Directors of Public Health produce annual reports on the health of the populations of Wales and each of the health boards respectively. The Directors of Public Health Annual Reports also provide more detail about the work carried out by the seven local public health teams. Public Health Wales monitors sickness absence target: In 2012/2013, overall sickness absence for Public Health Wales was 3.51 per cent. Public Health Wales continued to have the lowest sickness absence rate amongst NHS organisations in Wales. The current sickness target set by the Welsh Government is 3.25 per cent.

Improving health and wellbeing and reducing health inequalities

Health Improvement Review completed Public Health Wales has been conducting a review into a range of health improvement programmes supported by the Welsh Government’s Department of Health, Social Services and Children, and Public Health Wales itself. The national health improvement review considered whether health improvement programmes are sustainable, represent good value for money, and deliver priority outcomes consistent with national policy to those most in need. A Health Improvement Advisory Group was established by the Public Health Wales Board to undertake the review and make recommendations for the Welsh Government and the Minister through the Chief Medical Officer. A number of sub-groups were established to look at different aspects of the review including, evidence, links with primary care, and communication and engagement. A Programme Budgeting and Marginal Analysis (PBMA) Expert Reference Panel was set up to determine which initiatives were making a long lasting improvement to health and so should be maintained, those which needed to improve or needed further monitoring, and those where disinvestment was recommended. The review has now finished and a report has been written which makes recommendations on future investment and disinvestment in health improvement initiatives, as well as suggestions on ways in which public sector organisations, along with academia and the third sector, can work together to increase the impact of the initiatives.

The First Minister, Carwyn Jones AM and, right, Public Health Wales Vice Chair John Spence

Conference raises profile of public health in Wales The importance of public health in Wales was again illustrated when the First Minister for Wales, Carwyn Jones AM, and the then Minister for Health and Social Services, Lesley Griffiths AM, addressed 250 delegates at the second Welsh Public Health Conference in July 2012. Jointly run by Public Health Wales and Welsh Government, the theme of the conference was Together for Public Health and was based around Together for Health, the Welsh Government’s five year vision for the NHS in Wales. Building on the success of the first Welsh Public Health conference held in 2011, the second conference attracted stakeholders from

across public health in Wales with discussions focussed on the Public Health Bill for Wales, mental health, the proposed Housing Bill for Wales and taking forward health improvement in Wales. Professor Sir Mansel Aylward CB, Chair of Public Health Wales said: “I was delighted that the First Minister and Health Minister spoke to such a large number of conference attendees about the importance of public health and pleased to see the range of stakeholders represented. “The conference played an important role in facilitating discussions to see how we can help deliver a happier, healthier and fairer Wales.”

Work to give every child a healthy start continues Work by a multi disciplinary team within Public Health Wales is continuing to look at giving every child in Wales a healthy start in life. Rapid reviews of the evidence for interventions have been carried out. These looked at the epidemiology of different factors affecting a child’s health including the trends in Wales, the

evidence of effectiveness of interventions and the application of the evidence to the population in Wales to estimate what impacts can be anticipated. They also mapped current activity in the various health boards. Reviews have been carried out on substance misuse, alcohol, maternal mental health and obesity and nutrition in pregnancy. One of the rapid review topics – smoking in pregnancy – has now been taken forward as a pilot. The pilot aims to evaluate the extent to which improvements in the delivery of smoking cessation services to pregnant women can increase the proportion of pregnant treated smokers and reduce the number of women smoking during pregnancy. Four pilots are set up in Abertawe Bro Morgannwg University Health Board, Aneurin

Bevan Health Board, Cwm Taf Health Board and Betsi Cadwaladr University Health Board. Another aspect of the Early Years Programme is looking at the surveillance of agreed indicators to see whether the changes being suggested make a difference to the health of Welsh children. A project team was set up to extract data from maternity systems in Cwm Taf and Aneurin Bevan Health Boards; to appraise data from maternity systems to assess its suitability for reporting on the indicators; and to produce a mock surveillance report. The multi agency team brought together expertise from Public Health Wales’ Informatics and Observatory teams along with Welsh Government Health Statistics, Cwm Taf Health Board and Aneurin Bevan Health Board.

Public Health Wales Annual Report 2012-2013

|5

Improving health and wellbeing and reducing health inequalities

Local people become champions for health Local people in Gwent are being given the opportunity to become champions for health in their community thanks to a new scheme launched by Aneurin Bevan Public Health Team. The Community Health Champion Network aims to provide local people with the knowledge, skills and confidence necessary for them to become champions for health in their local community. Over 200 champions have already been recruited to the network and will be given training from public health professionals on issues such as smoking, alcohol and obesity. Dr Gill Richardson, Director of Public Health for Aneurin Bevan Health Board said, “This is a very exciting programme to be involved in. We are working with the voluntary sector, local

Welsh Public Health Bill

authorities and Communities First to empower our local communities to have control over their health by training and educating local people and community members to spread the word on key health issues.”

Public Health Wales welcomed the Welsh Government’s consultation on the need for a Public Health Bill in Wales. Staff provided support to the Welsh Government, running focus groups. Staff were also encouraged to provide individual responses to contribute to the response submitted by the Public Health Wales Board. The Board welcomed the Chief Medical Officer for Wales to talk about the proposals at a Board meeting and took the opportunity to feedback the views held by Board members.

Top results for Alcohol Intervention Programme The Alcohol Team of Public Health Wales was recognised internationally when it won first prize for its ‘outstanding poster’ at the 2012 International Network on Brief Interventions for Alcohol and Other Drugs conference in Barcelona. Launched in May 2012, the team provides the Alcohol Brief Intervention training programme. This gives guidance to staff working in oral and maxillofacial units, trauma clinics, social workers, midwives and other professionals or volunteers who are in regular contact with people who drink harmful amounts. The programme helps these people to offer support and advice to those drinking harmful amounts of alcohol in a bid to reduce their drinking levels. Since 2010, the Alcohol Team has been busy training GPs on the programme and has trained over 550 GPs in Wales in total. From March to August 2012, the team has trained over 650 individuals and 1,000 trainees signed up to participate in the programme before the end of September 2012. These individuals included nurses, health visitors, midwives, social workers, mental health practitioners and many others within the care sector. The winning poster

Support for community weight management groups Cwm Taf Public Health Team’s work to support self-help community weight management groups has recently been recognised as ‘Promising Practice’ through the Public Health Good Practice Scheme. The Public Health Wales Good Practice Scheme is in its second year and was established by the public health networks to provide a systematic approach to identifying, supporting and sharing good practice in health promotion practice. Cwm Taf Public Health Team has established a number of self-help community weight

6|

Public Health Wales Annual Report 2012-2013

management groups across both Rhondda Cynon Taf and Merthyr Tydfil following the expressed needs of communities for a low cost local alternative to commercial slimming groups. Led by community workers and volunteers, local groups provide members with an opportunity to learn about nutrition, participate in physical activity, and practice new recipes in a supportive environment. They aim to support group members to identify and make realistic lifestyle changes and manage their weight.

Programme to help obese patients lose weight wins NHS Wales Award A weight management programme that is helping obese patients in Bridgend to lose weight through diet and exercise, won an NHS Wales Award. The partnership approach from Public Health Wales, ABM University Health Board and Cwm Garw GP Practice in Bridgend scooped the Promoting Better Health and Avoiding Disease Award.

Improving health and wellbeing and reducing health inequalities

Champions for Health – an Olympic legacy

Dr Ruth Hussey OBE (right), joins Dr Sharon Hopkins, Director of Public Health for Cardiff & Vale University Health Board (second from right) and other NHS Wales staff to launch the action period of Champions for Health (October 2012).

More than eight in ten NHS staff who signed up for the Champions for Health campaign said they would maintain the changes made to improve their lifestyles. In an evaluation of the campaign to improve NHS staff’s health and to encourage their advocacy for healthy lifestyles 35 per cent of those who responded felt it had improved their general health. Overall, 67 per cent indicated that they would pass on what they had learnt from their involvement in the campaign to family and friends. More than 450 NHS Wales staff actively engaged in the Champions for Health campaign which was launched in August. The campaign aimed to build on the energy and excitement created by the London 2012 Olympic Games. The pilot campaign was run by Public Health Wales and encouraged NHS Wales staff to commit to two healthy lifestyle challenges and record their progress online over a six month period, enabling them to see improvements in their own health. There were five options to choose from: drinking safely, taking regular exercise, eating healthily, stopping smoking and working towards a healthy weight. Staff from every health board and trust in Wales took part, as well as individuals from the Welsh Government’s health and social services department. Plans for the next phase of the campaign are currently being developed.

Older people indicators published for health board areas A series of older people indicators for each of the seven health board areas were developed to support the monitoring and evaluation of the Healthy Ageing Action Plan and the development of the Joint Commissioning Strategy for Older People in their area.

Stop smoking graffiti at North Wales hospitals Colourful graffiti art has been placed on pavements around hospital grounds across North Wales to encourage people to quit in 2013. One year ago smoking was banned from hospital grounds across North Wales. Although there has been a decrease in patients’ visitors and staff smoking on the grounds and outside entrances to the hospitals many still ignore and defy the signs and requests. Smoking outside a health organisation creates an unhealthy environment and sends a message that it is acceptable to smoke. Graffiti that appeared at North Wales hospitals

27,700 hospital admissions caused by smoking each year in Wales The Public Health Wales Observatory and Welsh Government published a major report in June 2012 which examined the impact of smoking on the health of the population of Wales. The report highlighted how smoking continues to be the greatest single cause of mortality in Wales. In people aged 35 and over, smoking causes nearly one in five of all deaths and around one third of the inequality in mortality between the most and least deprived areas of Wales. The report, entitled ‘Tobacco and Health in Wales’ provides a range of information to support the implementation of the Welsh Government’s Tobacco Control Action Plan for Wales.

Dr Judith Greenacre, Director of Health Intelligence for Public Health Wales said, “The report is the most comprehensive of its kind in Wales, providing decision makers in the Welsh Government, local authorities, NHS and the wider public with a wide-ranging picture of the impact of smoking on the health of the population. “This important information should be used to assist stakeholders in taking action to prevent young people from starting to smoke, helping smokers to quit and reducing exposure to second hand smoke.”

National Oral Health Plan to improve dental health Practitioners in Public Health Wales’ Dental Public Health Team have worked with colleagues in Cardiff University and the Welsh Oral Health Information Unit to support the Welsh Government's development of a new National Oral Health Plan for Wales. Launched in March 2012, the plan sets the agenda for improving oral health and reducing oral health inequalities in Wales over the next five years.

Standards for Condom Card (C-Card) Schemes in Wales published Public Health Wales developed standards for the delivery of Condom Card (C-Card) schemes in Wales to support quality and consistency across Wales’ C-Card Scheme management; monitoring and evaluation delivery; publicity and promotion and training. The Standards introduce an accreditation system, by application, which if successful will lead to the Scheme receiving a number of additional benefits. To achieve accreditation,

providers of the scheme must demonstrate that they meet these standards in full. Dr Marion Lyons, Director of Health Protection and Programme Lead for Sexual Health, said: “I welcome the launch of these standards, which will encourage consistency in the delivery of C-Card Schemes across Wales and strengthen their role in providing good quality sexual health information to young people in Wales.”

Public Health Wales Annual Report 2012-2013

|7

Improving health and wellbeing and reducing health inequalities

Time to Change campaign raises awareness amongst staff

Talking with patients about healthy choices During 2012/13 Hywel Dda Local Public Health Team began work on a new training package and resources to support NHS staff in talking to patients about healthy choices. Training courses have been designed for different teams to help staff not only think about their own health but also in making ‘every contact count’ with patients across Carmarthenshire, Ceredigion and Pembrokeshire. This work is designed to support and complement existing training, including Brief Intervention Training linked to particular lifestyle topics and Motivation Interviewing skills training. All courses are now supported by new local resources – ‘Hywel’s Handbook for Health’ and the online health promotion resource centre ‘Hywel’s House’. Principal Public Health Officer, Ian Scale, said: “NHS staff have opportunities every day to chat to patients about their health and the changes they could think about to stay well. “Resources are important to provide the accurate information that staff tell us they need and training is essential to build the skills and confidence to raise a topic or start a conversation. “Staff also tell us they want to know how to make changes in their own lives so that they can more effectively help others.” This work forms part of the all-Wales work to ‘make every contact count’ and is a collaboration between the Local Public Health Team and Hywel Dda Health Board Communications Team and Workforce and Organisational Development Directorate.

Alcohol Awareness Week 2012: To promote Alcohol Awareness Week 2012, Cardiff and Vale University Health Board and Betsi Cadwaladr University Health Board developed a toolkit for organisations and workplaces to promote sensible drinking. The toolkit, developed in partnership with Alcohol Concern Cymru, was designed to support workplaces to run their own campaigns during the week. It featured information on recommended guidelines for consumption, encouraged people to talk openly about their drinking habits with friends, 8|

Public Health Wales Annual Report 2012-2013

Powys Health Board launched a local Time to Change campaign on World Mental Health day, October 2012, targeting staff. The campaign aims to raise awareness amongst all staff that mental health issues can affect any of us without it necessarily impacting on us as professionals. The Powys Public Health Team worked on the development and implementation of this campaign. They engaged with the Wellbeing at Work group and the Stress Management

subgroup to develop the key messages and promotional material of the campaign. As part of the campaign, an email strapline was adopted and promoted through the multiagency Mental Health Planning and Delivery partnership, and the Vice Chair of the Health Board fronted the first poster. In addition, key messages, information and signposting of support were placed on the intranet and in staff newsletters.

Child Measurement Programme starts second year

Over 1,100 deaths a year in Wales caused by injuries

The Child Measurement Programme for Wales continued to successfully deliver a national programme run by Public Health Wales which aims to collect information on the heights and weights of all reception age children in Wales. During the first year of the Programme, training events were held across Wales which aimed to train all staff involved. Three hundred and fifty five people attended 14 sessions across Wales to learn about why children are being measured and details of changes to national standards and guidelines.

colleagues and family members, and proposed people try to have at least two alcohol-free days each week. European conference hosted: The All Wales Physical Activity and Nutrition Network hosted the eighth annual meeting and symposium of the European Network for the Promotion of Health-Enhancing Physical Activity (HEPA Europe) on the 26 and 27 September 2012. The main theme of the event was: Getting to the grassroots: Using the ‘green’ environment to promote physical activity and featured a welcome address by the Chief Medical Officer

Public Health Wales and the Collaboration for Accident Prevention and Injury Control (CAPIC) at Swansea University published a report showing the burden injuries place upon the health of the Welsh population and the NHS in Wales. The report calls on more to be done around the prevention of falls: the leading cause of both deaths and hospital admissions due to injury. Researchers found that injuries result in three deaths, 115 hospital admissions and 1,200 A&E attendances every day in Wales. Dr Sarah Jones, consultant in public health for Public Health Wales and co-author of the report said: “This report has highlighted the scale of the burden of injuries in Wales. Many of these injuries, admissions and deaths are preventable and the bottom line is that more action is needed, at both a local and national level, to prevent them.”

for Wales, Dr Ruth Hussey and a key note lecture by Dr William Bird MBE. Hospital food: improvements on the menu: Public Health Wales worked with the Welsh Government and Health Boards across Wales to make hospital menus healthier. The All Wales Hospital Menu Framework was launched in Ysbyty Cwm Cynon in Mountain Ash in January 2012 by Health Minister Lesley Griffiths and Judith John, Consultant Dietitian for Public Health Wales.

Improving the quality, equity and effectiveness of healthcare services

Report and analyses published on unscheduled care in Wales Public Health Wales has concluded an initial review of unscheduled care, looking at the drivers of unscheduled care and trying to understand the changing patterns of presenting demand for unscheduled care in Wales. In support of this work, the Public Health Wales Observatory published a suite of analyses on unscheduled care for each of the six health boards which have emergency departments within their boundaries. The analyses included information from the Emergency Department Data Set (EDDS). This is its first use by the Observatory since submission of data to the EDDS only began on 1 April 2009.

Welsh Rugby Union assistant coach Robin McBryde launches the One in Ten Campaign

Successful pharmacy campaigns tackle key public health issues Public Health Wales has supported a number of public health pharmacy campaigns in 2012 and 2013. In September 2012, diabetes and stroke charities joined forces with Community Pharmacy Wales, Public Health Wales and the Welsh Government to deliver the One in Ten campaign. It aimed to find the ten per cent of the Welsh population at increased risk of getting diabetes or having a stroke. In November 2012 Public Health Wales worked with the seven health boards, Community Pharmacy Wales and the British Lung Foundation to run a month long campaign to raise awareness of respiratory disease. ‘Love Your Lungs’ saw people across Wales given the opportunity to visit their local chemist to take a simple test of their respiratory health and how they can improve it. Evaluation of the ‘Love Your Lungs’ campaign found that pharmacists in Wales completed a short breath test questionnaire with over 13,000 members of the public. Andrew Evans, Principal Pharmacist for Public Health Wales, said: “In Wales around 62,000 people have Chronic Obstructive Pulmonary Disease which is a major cause of emergency hospital admissions. This campaign was designed to raise public

awareness of the risk factors associated with respiratory disease – and especially the risks associated with smoking. “This evaluation is good news for health professionals, because it highlights the effectiveness of the pharmacy setting as a means of engaging with a large number of people face-to-face.”

Plans made for launch of Wales Abdominal Aortic Aneurysm Screening Programme In October 2012, the Welsh Government announced the introduction of a new screening programme for Wales, which could save more than 100 lives each year. Planning for the Wales Abdominal Aortic Aneurysm Screening Programme, part of Public Health Wales, was already well underway and the first screening invitations were issued from May 2013. The aorta is the main blood vessel which carries blood to the body. As people get older, the walls of this vessel may develop a weakness and expand to form an aneurysm. The condition is most common in men aged over 65. Rarely, the aneurysm becomes very large and there is a danger that the vessel walls will give way. This is a life threatening risk. Screening is offered to men aged 65 living in Wales who are invited for a one-off ultrasound test to check whether they have an abdominal aortic aneurysm (AAA). It is estimated that as many as four in 100 men in Wales will have an AAA, although the majority will have a small AAA that does not need treatment.

Public Health Wales Annual Report 2012-2013

|9

Improving the quality, equity and effectiveness of healthcare services

Wales top of the table in antenatal detection rates of major congenital heart disease Data published in March 2013 showed that in 2011/12, Wales had the highest rates of heart abnormalities detected antenatally in the UK. Wales is also the UK region that has seen the greatest increase in such detection rates since 2009/10. Evidence suggests that antenatal diagnosis of major congenital heart disease improves outcomes, particularly in relation to serious morbidity such as brain damage. The data, from the National Institute for Cardiovascular Outcomes Research, shows that in Wales over a half of the major cardiac heart disease in babies requiring surgery or therapeutic catheterisation during the first year of life was diagnosed antenatally. This is well above the UK average and compares to a rate of around a third in the other countries of the UK. Wales has also made the greatest improvements in these early detection rates – up from 34 per cent in 2009/10 to 52 per cent in 2011/12. Antenatal Screening Wales (ASW) is the Managed Clinical Network for antenatal screening in Wales and is hosted by Public Health Wales. ASW supports screening through development of policy, standards and performance management.

CARIS Annual Review published The Congenital Anomaly and Information Service (CARIS) published an annual review covering the years 1998 to 2011. The review included an overview of congenital anomalies in Wales, a summary of CARIS activity during 2011 and special reports focussing on chromosomal trisomies such as Down syndrome (trisomy 21), Edwards’s syndrome (trisomy 18) and Patau syndrome (trisomy 13). CARIS also held two meetings in North Wales which comprised presentations on the findings of the review report and guest speakers covering genetic, foetal medicine, paediatric and parental perspectives on chromosomal trisomies. About 170 people attended the meetings and feedback scores were excellent.

10 |

Public Health Wales Annual Report 2012-2013

International Health Coordination Centre established The International Health Coordination Centre (IHCC), funded by the Welsh Government, is being hosted by Public Health Wales. It has been established to act as a clearing house for knowledge, support and resources relating to international health engagement in Wales. It is seeking to work with partners across the wider Welsh health community to join up approaches, share learning and communicate

good practice. It follows the framework Health within and beyond Welsh borders: An enabling framework for international health engagement. The IHCC team has been working on the establishment tasks, including mapping international health activity across Wales, conducting a stock take of health boards’ commitment to international health and gathering case studies.

Staff from Aneurin Bevan Health Board get to grips with the National Early Warning Score (NEWS)

A national approach to improving services across NHS Wales 1000 Lives Plus had another busy year as the national improvement programme, supporting organisations and individuals in their aim to deliver the highest quality and safest healthcare for the people of Wales. This year saw the launch of Improving Quality Together, a standardised framework of core improvement skills for all NHS Wales’ staff and contractors which builds on the methodology behind 1000 Lives Plus. The framework will enable staff to understand systems, identify changes, set aims, test changes and spread improvements more effectively throughout the country. There are three levels of training: bronze, silver and gold

with a specific level for board members and identified senior management The STOP campaign was also launched to improve the safety of patient care through better use of urinary catheters and peripheral venous cannulas. The focus encourages frontline staff to stop and assess whether the patient they are caring for needs a device and, if one is in place, to question whether it’s still needed or could be removed. The programme has also led on the introduction of the National Early Warning Score (NEWS) which is a simple system that hospital staff can use to assess whether patients developing potentially life-threatening illnesses such as sepsis. It is now being used in all hospitals throughout Wales. Over 2,000 healthcare students have now joined the 1000 Lives Plus Student and Educator Community which links them up with educators in Welsh universities to focus on quality improvement. Students have led national campaigns on improving person centred care, supported the STOP campaign and piloted their own improvement projects. Improving Quality Together is enabling NHS staff across Wales to make improvements to the services they deliver

Improving the quality, equity and effectiveness of healthcare services

Increase in numbers of women attending for cervical screening Cervical Screening Wales published a report in September 2012 showing a slight increase in the number of women attending for smear tests in Wales. The latest statistical report published by the programme showed an overall 0.1 per cent increase in the number of women being screened, with a 0.8 per cent increase in women under the age of 30. Covering the period from April 2011 to March 2012, the report showed that Cervical Screening Wales screened nearly 230,800 women following a formal invitation from the screening programme, compared with around 213,100 in the previous year.

Screening coverage for women in the target age group of 20-64 years was 76.5 per cent, meaning that this percentage of women had received an adequate screening result at least once in the last five years.

Award winning evaluation of cervical screening technology A member of the Public Health Wales Screening Division won first prize at the Annual Scientific Meeting of the British Association for Cytopathology (BAC) for presenting an evaluation of computer assisted screening technology. Dave Nuttall, Head of Laboratory Services, presented his award winning work on the evaluation of the “Becton Dickinson FocalPoint™ No Further Review” technology at the two day conference at Keele University in September 2012. The work forms part of a series of studies, the Cervical Screening Wales CAESAR studies (Computer Assisted Screening, Reporting and Evaluation), which is validating and implementing Computer Assisted Screening technology for the Cervical Screening Programme in Wales. The results were very encouraging and the technology was demonstrated to be at least as good as the current manual test. New computer assisted technology became operational in Wales in October 2012. It means that around 20 per cent of cervical cytology samples will require a manual quality assurance check only prior to a negative report being issued. This development will help improve sample turnaround times within Cervical Screening Wales.

Conclusion of £10 million breast screening project

Newborn Bloodspot Screening Wales introduces new test Newborn Bloodspot Screening Wales began offering testing for an additional medical condition from 1 June 2012. Since that date, parents of babies who have their newborn bloodspot sample taken are being offered screening for Medium chain acyl-CoA dehydrogenase deficiency (MCADD). Babies with MCADD, a rare inherited condition, have problems breaking down fats to make energy for their body. This can lead to serious illness, or even death.

Newborn bloodspot screening means that babies who have MCADD can be identified early and parents can receive specialist advice. This allows special attention to be given to the baby’s diet, including making sure they feed regularly. Parents in Wales are now offered the opportunity to have their baby tested for MCADD along with the existing tests for congenital hypothyroidism, cystic fibrosis and phenylketonuria.

The year saw the successful conclusion of a £10 million project to upgrade the equipment used by Breast Test Wales. The awarding of the Welsh Government funding allowed the screening programme to replace analogue equipment at all four static screening centres and 10 mobile screening units in Wales with new state-of-the-art digital equipment. Building works to improve the static centres in Cardiff, Swansea, Wrexham and Llandudno were also completed. Breast Test Wales offers screening to women aged between 50 and 70 resident in Wales and has the highest cancer detection rate in the UK.

Public Health Wales Annual Report 2012-2013

| 11

Improving the quality, equity and effectiveness of healthcare services

Successful first two years for Bowel Screening Wales Bowel Screening Wales published a report in December 2012 highlighting a successful first two years for the programme. The report revealed that from the start of the programme in October 2008 to November 2010, there was a 55.2 per cent uptake rate and more than 400,000 people aged between 60 and 69 were invited to take part in the screening programme by completing a home testing kit sent in the post. The age range covered by the programme has now been extended to 74 years of age.

Cervical cancer incidence falls Cases of cervical cancer in Wales have fallen by almost a third in two years. In 2009, there were 11.4 cases of the disease per 100,000 women living in Wales, a figure that fell to 7.8 per 100,000 in 2011. The fall in cancer incidence was welcomed by Cervical Screening Wales, which offers smear tests to women in Wales to check for changes in the cervix that could cause cancer.

Members of the Health Protection Team collecting their award

Staff win national award Members of the Public Health Wales Health Protection team, headed by Dr Marion Lyons, have won a prestigious UK health award. In October 2012 Josie Smith was presented with the E-Health Insider Award for ‘Best use of IT to promote patient safety’ at an award ceremony in London. The award recognises the team’s work on the development and implementation of the Harm Reduction Database (HRD) Wales. HRD Wales is a unique web-based national database providing a patient management system with reporting functionality for people who inject drugs and access Needle and

Cancer incidence in Wales 2007-11 report published The Welsh Cancer Intelligence and Surveillance Unit (WCISU) has published cancer incidence figures in Wales for the diagnosis period from 2007-2011. The annual report on cancer incidences in Wales for the calendar year 2011 is published to support the larger triennial report ‘Cancer in Wales 19952009: a Comprehensive Report’. The report shows a slight increase (0.1 per cent) in the total number of malignancies excluding melanoma skin cancer (NMSC) in Wales in 2011 compared to 2010 for males and a 2.1 per cent increase in 2007. 12 |

Public Health Wales Annual Report 2012-2013

Syringe Programme (NSP) services across Wales. Following the introduction of the HRD, there has been a 47.5 per cent increase in the total number of individuals accessing NSP services. There has also been a substantial increase in recorded onward referrals to specialist health and social care services. Josie Smith, Research Scientist with Public Health Wales, said: “We are delighted to have won this very special award, which recognises a lot of hard work in implementing a comprehensive, user-friendly and accessible system designed to improve patient safety.”

Wider determinants of health reports produced at small area level The Public Health Wales Observatory has published small area reports for each of the seven health board areas which map a number of indicators relating to the wider determinants of health. The reports have been produced to show variation in the wider determinants of health at small area level and are intended to support local partnership work and the development of local single integrated plans.

Protecting people from infectious and environmental hazards

HIV awareness raising campaign launched A new campaign to remind people that HIV infection is still a health risk launched in Wales on World Aids Day in December 2012. The campaign was funded by the Welsh Government and delivered by Public Health Wales. Every year new cases of HIV infection are diagnosed in Wales. There were 169 new cases diagnosed in 2011, compared to 152 in 2010. Advertisements with the strapline; “Thinking about sex? You are now!” appeared across the country on buses, inside buses and trains, on billboards and at nightclubs, sports clubs, colleges and universities. These advertisements, as well as Bluetooth messaging at train stations in Cardiff, directed people to a dedicated website where they could assess their risk of infection. They could also find out how to protect themselves in future, and where to go for testing.

Response to measles outbreak

Senior Response Team

In November 2012, Public Health Wales was notified of the first measles cases in a measles outbreak centred on the Swansea area that lasted for eight months. The outbreak affected the Powys and Hywel Dda health board areas as well as the Abertawe Bro Morgannwg area, but cases were reported in all areas of Wales. A Senior Response Team was convened in February 2013 and met weekly to co-ordinate action to bring the outbreak to an end. By the time the outbreak was declared over in July 2013, there had been 1,455 reported cases of measles across Wales. One person died from the infection. Public Health Wales worked with health boards to deliver more than 75,000 unscheduled MMR vaccinations through GP surgeries, schools vaccination sessions and weekend drop-in clinics. Modelling undertaken by Warwick University suggested that efforts to increase vaccination uptake levels shortened the outbreak by at least four months.

Extra MMR vaccination clinics ran across Wales

The hardest hit age group in the outbreak was children and young people aged 10 to 18 who missed out on routine MMR vaccination in the late 1990s due to fears about the safety of the vaccine. Throughout the outbreak, Public Health Wales worked to remind young people and their parents that the vaccine is proved to be safe and effective and that two doses of MMR is the only protection against measles, mumps and rubella.

Prepared for London 2012 Public Health Wales’s Health Protection Division worked hard to prepare for the challenge posed by the 2012 London Olympic Games, which saw some events and training camps taking place in Wales. The games presented a major challenge to health services and public protection services, with the possibility of disease outbreaks, extreme weather events or environmental hazards taking place at a time when there were more people than usual in Wales. The Health Protection Division worked extra hours throughout the Olympic period, and

provided a daily SitRep report to senior staff, the Health Protection Agency, the Welsh Government and partner agencies on public health threats and incidence of communicable disease in Wales. Additional staff joined the on-call rota to ensure an enhanced emergency response was available out of normal working hours. New plans were revised and rehearsed to ensure the response to chemical releases, fires, radiation releases and the release of biological agents. The Public Health Wales Microbiology Division also provided an enhanced service

during the Olympic Games, implementing new testing techniques ensuring that results of patients with diarrhoeal illness could be made available within 24 hours instead of the usual two to three days.

Public Health Wales Annual Report 2012-2013

| 13

Protecting people from infectious and environmental hazards

Wales achieves most registrations in clean hands campaign Plan for liver health in prisons launched Public Health Wales launched a service delivery plan to support Welsh prisons in improving liver health in prisoners in May 2012. Representatives from all five prisons in Wales and from across the Welsh health service were present at a launch event that included a presentation by the then Minister for Health and Social Services, Lesley Griffiths AM. The event, held at the Temple of Peace in Cardiff, heard how the “Delivery plan for providing seamless services for the provision of liver health care in Welsh prisons” aims to make testing and vaccination for hepatitis available to all prisoners in Wales. It is estimated that around 10 per cent of prisoners are hepatitis C positive. The plan aims to reduce this figure by raising awareness of liver health issues in prisons, reducing the transmission of hepatitis infection in prisons and diagnosing hepatitis in all prisoners who have the infection.

14 |

Public Health Wales Annual Report 2012-2013

In May 2012, The World Health Organization (WHO) commended Wales for signing up more hospitals and healthcare facilities in the run up to the annual SAVE LIVES: Clean Your Hands event than any other country or area in the world. WHO reported that 31 new healthcare facilities in Wales had signed up– more than any other country or area.

The international campaign encourages healthcare professionals to register to show their commitment to raising awareness of the part hand hygiene can play in reducing rates of healthcare associated infections. Public Health Wales was thanked for its work in encouraging healthcare organisations to sign up for the campaign, then in its fourth year.

Antimicrobial resistance materials produced To mark European Antimicrobial Awareness Day on 18 November 2012, Public Health Wales, in partnership with the Welsh Government, developed a pack of educational resources to support the responsible use of antibiotics in Wales. European Antimicrobial Awareness Day (EAAD) aims to improve both public and professional awareness of the need to use antibiotics responsibly to help to control the increase of antibiotic resistance. The number of infections due to antibioticresistant bacteria is growing, but there is a lack

of new antibiotics. Education in the responsible use of antibiotics is of paramount importance to help control resistance. The pack contained educational resources to support antimicrobial stewardship and were delivered to GP practices in November 2012. These resources included adult antibiotic information sheets, booklets providing a guide to coughs, cold, earache and sore throats in children and a bulletin highlighting an increase in E. coli bacteraemias in the elderly in Wales.

Sustainability Report

Sustainability Report 2012/13 Overview

Key achievements during 2012/13

Public Health Wales is committed to embedding sustainable development as a central organising principle and supports Welsh Government policy for this to be adopted across the public sector. During 2013/14, this approach will be taken forward by Public Health Wales through the implementation of revised planning arrangements, particularly the development of three year delivery plans and a Public Health Outcomes Framework for Wales.

Q Response to Sustainable Development Bill White Paper Q Sustainability embedded as key element of Health Improvement Review Q Development of revised Lease Car Policy (to be approved in 2013/14) Q Local training and use of technology, such as videoconferencing

Overview of performance The purpose of this section is to provide a summary of Public Health Wales’ performance during 2012/13. The information provided aims to conform to the requirements for public sector bodies in reporting on sustainability, which are set out in the Financial Reporting Manual (FReM). As an all Wales organisation, Public Health Wales has a presence in over 40 locations, which includes accommodation that is owned, leased or provided by/shared with other NHS organisations. Financial and non-financial information is not currently available for all of these premises.

Summary of 2012/13 performance Area

Financial Indicator 2011/2012 2012/2013

Official business travel

£663,487

£696,256

1,560,254 business miles

1,600,453 business miles

489

490

Estate Energy - electricity

£125,240

£174,8151

371,067kWh

682,684kWh2

171

3043

Estate Energy - gas

£43,169

£69,1344

576,551kWh

717,396kWh5

107

1326

Estate Water

£10,131

£16,3737

2,628Cu.metres

3,318Cu.metres8

N/A

N/A

Estate Waste

£45,386

£7,0219

N/A

1,331,390 Litres10

N/A

N/A

£887,414.99

£963,599

N/A

N/A

767

926

Total 1

2

3

Information included on the following sites - 14 Cathedral Rd; 18 Cathedral Rd; 24 Alexandra Rd; 4th Floor, Churchill House; Charnwood Court, Nantgarw; Temple of Peace; Oldway Centre, Orchard Street; Unit 4, 5 and 6 Magden Park; North East Wales Breast Screening Centre Wrexham; North Wales Breast Screening Centre Llandudno; St David’s Park, St Davids Parkway; Preswylfa; Mamhilad, Llys Castan/Chesnut Court Information included on the following sites - 14 Cathedral Rd; St David’s Park, St Davids Parkway; Temple of Peace; North East Wales Breast Screening Centre Wrexham; North Wales Breast Screening Centre Llandudno; 24 Alexandra Rd; 18 Cathedral Rd; 4th Floor, Churchill House. Calculated using the Department for Environment Food and Rural Affairs Greenhouse Gas Conversion Factor Repository

4

5

6

Consumption 2011/2012 2012/2013

Information included on the following sites - 18 Cathedral Rd; 24 Alexandra Rd; Charnwood Court, Nantgarw; Temple of Peace; Oldway Centre, Orchard Street; North East Wales Breast Screening Centre Wrexham; North Wales Breast Screening Centre Llandudno; St David’s Park; St Davids Parkway; 14 Cathedral Rd; Mamhilad; Preswylfa Information included on the following sites - 18 Cathedral Rd; 14 Cathedral Rd; St David’s Park, St Davids Parkway; Temple of Peace; Alexandra house; North East Wales Breast Screening Centre Wrexham; North Wales Breast Screening Centre Llandudno Calculated using the Department for Environment Food and Rural Affairs Greenhouse Gas Conversion Factor Repository

Commentary on Performance The figures detailed in the performance table show, in some cases, significant increases on those reported for 2011/12. This is a result of additional accommodation being included in the assessment for 2012/13 and further information, such as consumption, being available. Further analysis of both sets of figures is required during 2013/14 to establish an accurate baseline. The CO2e emissions have been calculated using the Department for Environment, Food and Rural Affairs Greenhouse Gas Conversion Factor Repository. The emissions figures included within the report for 2011/12 have also been updated using this tool to support comparisons in future years. This has resulted in changes in the emissions reporting within the previous year’s annual report. Following a reconciliation of mileage reports, there has been a minor change to the 2011/12 official business travel financial indicator.

Emissions (tonnes of CO2e 2011/2012 2012/2013

7

Information included on the following sites - 18 Cathedral Rd; 14 Cathedral Rd; 24 Alexandra Rd; Charnwood Court, Nantgarw; Clwydian House; Temple of Peace; Oldway Centre ,Orchard St; North East Wales Breast Screening Centre Wrexham; North Wales Breast Screening Centre Llandudno; St David’s Park, St Davids Parkway; Unit 4, 5 and 6 Magden Park; Llys Castan; Mamhilad; Preswylfa 8 Information included on the following sites - 14 Cathedral Rd; St David’s Park, St Davids Parkway; Temple of Peace; 24 Alexandra Rd; North East Wales Breast Screening Centre Wrexham; North Wales Breast Screening Centre Llandudno 9 Information included on the following sites - 14 Cathedral Rd; Temple of Peace 10 Information included on the following sites - 14 Cathedral Rd; Temple of Peace

Key deliverables for 2013/14 Q Work to embed sustainable

development within Public Health Wales in line with emerging legislation and Welsh Government policy Q Development of governance

arrangements and establishment of KPI’s Q Quarterly reporting of key figures, such

as consumption, through revised performance reporting arrangements

Environmental Management Governance

Q South East Wales Accommodation

The lead for key areas of sustainability/environmental management within Public Health Wales is currently split between the Executive Director of Planning and Performance and Board Secretary respectively. Environmental/facilities issues are reported by the Board Secretary to the Executive Team and Board through a monthly report. The Executive Director of Planning and Performance has facilitated Executive Team and Board discussions during the reporting period in relation to Public Health Wales’ strategic approach to sustainability, which is reflected in the organisation’s response to various Welsh Government consultations. Further work is required to develop and strengthen the organisation’s Environmental Management Governance during 2013/14. As part of this process, work is also being undertaken to incorporate sustainability reporting into Public Health Wales’ revised performance arrangement. It is anticipated this will be reported on a quarterly basis and will support the monitoring and completion of the annual sustainability report.

Q Development of Public Health Outcomes

Review Framework for Wales Q Working towards ISO 14001

Public Health Wales Annual Report 2012-2013

| 15

Operating and Financial Review

Section 2

Operating and Financial Review All financial targets achieved Public Health Wales has once again achieved all its financial targets in 2012/13, without the need for any assistance. With an income of £98.3 million, the organisation successfully broke even and recorded a small surplus of £10,000. Executive Director of Finance, Huw George said: “This was another challenging year when the organisation faced considerable financial pressures without any inflationary or growth funding. In order to achieve this we made financial savings of more than £2.3 million, which is over 2.5 per cent of budgets. This makes the continued success of the organisation particularly rewarding.

“We are aware that we will be facing financial pressures for several years to come and we are grateful to staff across the organisation who continue to rise to the challenge.” The successful delivery of a capital programme of £2.6 million ensured that Public Health Wales met its target to achieve its external financing limit. The organisation also achieved its target of creditor payment compliance with 96.2 per cent of non NHS invoices being paid within 30 days, which was a further improvement in performance. The Public Health Wales Board has agreed

that in the medium term it would establish a budget principle that it needed to ‘invest for change’ and ‘save to invest’. Over the next three years the organisation has agreed that it will aim for investment each year of 0.8 – 1 per cent and that it would expect, as a matter of course budget holders to produce housekeeping savings of 1.5 per cent. This agreement has been taken forward in the 2013/14 budget strategy. For 2013/14 a funding gap was identified, which was closed in order to balance the budget through the identification of £1.4 million savings. Investment in service delivery of £0.8 million has also been made.

Summary of Financial Statements for 2012-13 The following tables set out the financial statements for Public Health Wales for the period 1 April 2012 to 31 March 2013. The Summary Financial Statements (SFSs) are a

summary of and consistent with the full financial accounts for Public Health Wales on which an unqualified opinion has been issued. For a full understanding of Public

Health Wales’ financial position and performance, the full annual accounts for 2012/13 can be provided on request.

Statement of changes in taxpayers’ equity

2012-13

Public Dividend Capital £000

Retained earnings £000

Revaluation reserve £000

Other reserves £000

Total £000

15,596

458

187

0

16,241

Balance at 1 April 2012 Changes in taxpayers' equity for 2012-13 Retained surplus/(deficit) for the year Net gain on revaluation of property, plant and equipment Net gain on revaluation of intangible assets Net gain on revaluation of financial assets Net gain on revaluation of assets held for sale Impairments and reversals Movements in other reserves Receipt of donated/government granted assets Disposal of donated/government granted assets Transfers between reserves Net gain/loss on other reserve (specify) Reclassification adjustment on disposal of available for sale financial assets Reserves eliminated on dissolution New Public Dividend Capital received Public Dividend Capital repaid in year Public Dividend Capital extinguished/written off Other movements in Public Dividend Capital in year

0 0 (1,812) 0 62

Balance at 31 March 2013

13,846

16 |

Public Health Wales Annual Report 2012-2013

10 0 0

0 0

0 0

10 0 0

0 0 0 0 0 0 0

0 (187) 0 0 0 0 0

0 0 0 0 0 0 0

0 (187) 0 0 0 0 0

0

0

0

0 0 0 (1,812) 0 62

468

0

0

14,314

Operating and Financial Review

Statement of comprehensive income for the year ended 31 March 2013

Revenue from patient care activities Other operating revenue Operating expenses Operating surplus/(deficit) Investment revenue Other gains and losses Finance costs Retained surplus/(deficit)

Statement of financial position as at 31 March 2013

2012-13 £000s

2011-12 £000s

79,098 19,299 (98,314)

66,008 19,502 (85,491)

83

19

55 (86) (42)

25 (20) (12)

10

12

Statement of cash flows for the year ended March 31 2013 2012-13 £000s Cash flows from operating activities Operating surplus/(deficit) 83 Depreciation and amortisation 2,438 Impairments and reversals 1,783 Interest paid (42) (Increase)/decrease in inventories 25 (Increase)/decrease in trade and other receivables (1,984) (Increase)/decrease in other current assets 0 Increase/(decrease) in trade and other payables 418 Increase/(decrease) in other current liabilities 223 Increase/(decrease) in provisions 20 Net cash inflow/(outflow) from operating activities Cash flows from investing activities Interest received (Payments) for property, plant and equipment Proceeds from disposal of property, plant and equipment (Payments) for financial assets Net cash inflow/(outflow) from investing activities Net cash inflow/(outflow) before financing Cash flows from financing activities Public Dividend Capital received Public Dividend Capital repaid Capital elements of finance leases and on-SORP PFI

2,964

2011-12 £000s

19 1,599 85 (12) 311 (1,741) 0 920 2,113 1,521 4,815

55

25

(1,924)

( 4,811)

0 (780)

(4) 0

(2,649)

( 4,790)

315

25

0 (1,812)

1,455 0

30

0

31 March 2013 £000s

31 March 2012 £000s

Non-current assets Property, plant and equipment Intangible assets Trade and other receivables Other financial assets Other assets Total non-current assets

15,684 0 0 0 0 15,684

17,590 0 0 0 0 17,590

Current assets Inventories Trade and other receivables Other financial assets Other assets Cash and cash equivalents Total current assets

86 7,539 0 0 2,501 10,126

111 5,493 0 0 3,968 9,572

Total assets

25,810

27,162

Current liabilities Trade and other payables Borrowings Other financial liabilities Provisions Other liabilities Total current liabilities

(5,745) 0 (623) (2,365) 0 (8,733)

( 5,413) 0 (450) ( 2,268) 0 ( 8,131)

1,393

1,441

Total assets less current liabilities

17,077

19,031

Non-current liabilities Trade and other payables Borrowings Other financial liabilities Provisions Other liabilities Total non-current liabilities

0 0 (1,713) (1,050) 0 (2,763)

0 0 (1,663) (1,127) 0 (2,790)

Total assets employed

14,314

16,241

13,846 468 0

15,596 458 187

0

0

14,314

16,241

Net current assets/(liabilities)

Financed by taxpayers' equity: Public dividend capital Retained earnings Revaluation reserve Donated asset reserve Government grant reserve Other reserves Total taxpayers' equity

Net cash inflow/(outflow) from financing activities

(1,782)

1,455

Net increase/(decrease) in cash and cash equivalents

(1,467)

1,480

Cash [and] cash equivalents [and bank overdrafts] at the beginning of the financial year

3,968

2,488

Cash [and] cash equivalents [and bank overdrafts] at the end of the financial year

2,501

3,968

Public Health Wales Annual Report 2012-2013

| 17

Annual Governance Statement

Section 3

Annual Governance Statement of the Chief Executive Scope of Responsibility The Board is accountable for governance and internal control. As Chief Executive and Accountable Officer of Public Health Wales, I have responsibility for maintaining appropriate governance structures and procedures as well as a sound system of internal control that supports the achievement of the organisation’s policies, aims and objectives, whilst safeguarding the public funds and the organisation’s assets, for which I am personally responsible. These are carried out in accordance with the responsibilities assigned by the Accounting Officer of NHS Wales. As Chief Executive and Accountable Officer, I have personal overall responsibility for the management and staffing of the organisation. I am required to assure myself, and therefore the Board, that the organisation’s executive management arrangements are fit for purpose and enable effective leadership.

Overview In October 2010, the Board approved Public Health Wales’ five-year strategy. The strategy details seven key objectives and this has driven our work and priorities during 2012/13. The Board also reviewed the strategy during the year and confirmed that the seven key strategic objectives were still relevant and appropriate. The seven strategic objectives are:  To improve health and reduce health

inequalities by addressing the social, economic and environmental factors which determine people’s health  To promote healthy behaviour  To improve the quality and effectiveness of healthcare services  To protect people from infectious disease and environmental hazards  To respond effectively to the public health aspects of emergencies  To reduce illness and death by delivering evidence based screening programmes  To establish Public Health Wales as a cohesive, effective and sustainable organisation which leads by example. At just over three years old, Public Health Wales is still a relatively young organisation but it nevertheless continues to grow and evolve and has made considerable progress in a number of areas during 2012/13. Investment in front line services has continued again this year. For example, we have completed the digital upgrade of the

18 |

Public Health Wales Annual Report 2012-2013

mammography screening equipment on target and the planned introduction of the two new screening programmes, Abdominal Aortic Aneurysm and Newborn Bloodspot. This, together with the investment in new microbiology analysing equipment, are major steps forward in improving the quality and safety of our services. We have also recently appointed a Director of Nursing. Unlike for health boards, this is not a Board position but it nevertheless represents a very important appointment for us and ensures that the views and advice from this key section of the nursing and clinical profession is properly represented, as well as bringing a new dimension to quality and governance issues within the organisation. We will also seek, going forward, to strengthen engagement with other nursing and clinical professional sectors represented within the organisation. As the services and functions of Public Health Wales evolve and grow, so must the organisation grow and evolve with it. We have, for example, undertaken a major review of the future direction of the health improvement programmes in Wales. This will potentially result in changes to the existing programmes and cause some reorganisation of the Health Improvement Division to ensure it is fit for purpose, but this will help us to focus on those health improvement interventions that will have the greatest impact. Public Health Wales has developed a Public and Stakeholder Engagement Strategy designed to put those who benefit from the services in a position where they can influence and help shape policy and service development. There have been a number of examples during the year of engagement with service users, most notably in breast screening, Stop Smoking Wales and the Health Improvement Review. As part of the development of our Workforce and Organisational Development Strategy, we have been seeking the views and opinions of our staff. During the year a number of workshops were held with staff across Wales. Their views, thoughts and contributions on a variety of issues will help shape our future plans, strategies and priorities. The Board and its Committees continue to guide, scrutinize and, where necessary, challenge the work and progress of the organisation. For example, the Board noted that some delays had occurred in inviting women for breast screening, as a result of the move to digital, and that statutory and

mandatory training in the organisation was below target levels. The Board and its Committees have ensured every effort has been made to rectify this and no user of our services or staff member is placed at unnecessary risk. The Board has also placed great emphasis on ensuring that our microbiology services renew their four yearly Clinical Pathology Accreditation (CPA). This is a stringent review which ensures the microbiology systems and processes meet the very high expected standards. The review highlighted some areas for improvement which have subsequently been rectified and we are currently awaiting confirmation of accreditation. The Board is also keen to ensure that our screening programmes also apply for the appropriate CPA accreditation and this process is currently underway. Looking forward to 2013/14, there are a number of planned developments which will again see Public Health Wales grow and evolve. A number of staff and functions from the National Leadership and Innovation Agency for Healthcare (NLIAH) will be transferred to Public Health Wales, bringing together key NHS service improvement functions. The proposed Public Health Bill for Wales will no doubt bring additional and welcomed measures as well as our own internal organisational development and accommodation programmes which all contribute to improving public health services in Wales. We are very aware of the recently published report on the independent inquiry into the care provided by the mid-Staffordshire NHS Foundation Trust (commonly referred to as the Francis report). Along with the NHS in Wales we will be paying particular attention to this report and learning from the findings and recommendations as well as supporting others. Evaluating the recommendations and preparing a response will be a priority for us in the early part of 2013/14. Public Health Wales has a number of third party agreements with a variety of organisations and institutions. These agreements play an important role in ensuring that Public Health Wales receives and has access to the most up to date advice and research. We have in place processes which ensure that we receive value for money from these agreements but we want to strengthen these processes and this will be reviewed during 2013/14.

Annual Governance Statement Governance Framework The Welsh Government requires that NHS Trusts operate within the wider governance framework set for the NHS in Wales and incorporate the standards of good governance set for the NHS in Wales (as defined within the Citizen Centred Governance principles and Standards for Health Services in Wales), together with its planning and performance management frameworks. The principles of the Code of Conduct and Accountability for the NHS in Wales are fully endorsed by the Trust. Its governance policies have been reviewed in line with both the specific guidance and the spirit of the codes of practice applying to its delivery of healthcare services. NHS Trusts in Wales must agree Standing Orders for the regulation of proceedings and business. They are designed to translate the statutory requirements set out in the Public Health Wales NHS Trust (Membership and Procedures) Regulations 2009 into day to day operating practice. Together with the adoption of a scheme of decisions reserved for the Board, a scheme of delegations to officers and others, and Standing Financial Instructions, they provide the regulatory framework for the business conduct of the Trust. These documents, together with the range of corporate policies set by the Board and the adoption of the Values and Standards of Behaviour framework, make up the Governance Framework. The Board functions as a corporate decision-making body, with Executive Directors and Non-Executive Directors being full and equal members and sharing corporate responsibility for all the decisions of the Board. In particular, the Board has responsibility for the strategic direction, governance framework, organisational culture and development, developing strong relationships with key stakeholders and partners and delivery of Public Health Wales’ aims and objectives. In addition, Executive Directors have Board level responsibility for discharging Public Health Wales’ corporate and public health functions. The Board is supported by the Board Secretary, who acts as principal advisor on all aspects of governance within Public Health Wales. The Board has established a standing committee structure, which, it has determined, best meets the needs of the organisation whilst taking account of any regulatory or Welsh Government requirements. The Committees established include:  Audit  Quality and Safety  Information Governance  Remuneration and Terms of Service In addition, Public Health Wales has established a Charitable Funds Committee. This Committee has not met, as charitable funds are currently administered by Velindre NHS Trust on Public Health Wales’ behalf. In the interest of cost effectiveness, discussions are ongoing with Velindre NHS Trust on how

charitable funds can continue to be jointly managed by both trusts. Board Committees are chaired by Non Executive Directors and Committee Chairs provide reports of each meeting directly to the Board. Public Health Wales also established Board level groups to take forward specific pieces of work during 2012/13. For example, the Health Improvement Advisor Group, chaired by a Non Executive Director, was established by the Board to take forward and advise the Board on the Health Improvement Review. The Wales Audit Office completed its Structured Assessment for 2012/13 and whilst it made some recommendations for improvement, overall it concluded that the organisation continues to make good progress in putting in place key governance arrangements. The Wales Audit Office highlighted the need for a coherent and comprehensive framework document which described and brought together all the key governance components.

Board and Committee membership The Board has been constituted to comply with the Public Health Wales National Health Service Trust (Membership and Procedure) Regulations 2009. In addition to responsibilities and accountabilities set out in terms and conditions of appointment, Board members also fulfil a number of Champion roles where they act as ambassadors for these matters. We are pleased to be able to confirm that the Minister for Health and Social Services has approved the reappointments of four of our Non-Executive Directors, including the Chair. Public Health Wales will benefit considerably from the wealth of experience and expertise that these members bring to the Board. Dr Jo Farrar left her post as local government representative on the Public Health Wales Board in July 2012. For a large part of the year this post has been vacant. Local government is a key partner in tackling public health issues in Wales and it is therefore a distinct disadvantage for the organisation not to have this link in place. We are working with the Welsh Government and Welsh Local Government Association to fill this vacancy as soon as possible. Professor Hilary Fielder, Executive Director of Public Health Services, retired in September 2012. Professor Fielder was subsequently replaced by Dr Quentin Sandifer. This transition went smoothly and without any interruption to services. It is pleasing to report that we were able to find someone who is able to carry forward the considerable and valuable work that Professor Fielder initiated during her time with Public Health Wales. We should also note that the Board member changes noted above resulted in the loss of two female Board members. As a consequence, we are very mindful of the fact that we do not currently have any female Board members, something which we would like to rectify as soon as possible.

The following table outlines dates of Board and Committee meetings held during 2012/13, highlighting any meetings that were inquorate: Board/ Committee

2012-13

Board

26 Apr, 28 Jun, 5 Sept, 25 Oct, 20 Dec, 21 Feb, 21 Mar

Audit

10 May, 6 Jun, 13 Sept, 19 Dec, 20 Mar

Quality & Safety

17 Apr, 17 July, 18 Oct, 31 Jan

Information Governance

6 Jun, 13 Sept, 19 Dec, 20 Mar

Remuneration & Terms of Service Committee

5 Sept, 25 Oct, 21 Mar

Quorate

Inquorate

Where meetings were inquorate, escalation arrangements were in place to ensure that any matters of significant concern that could not be brought to the attention of the Committee could be raised with the Public Health Wales Chair. In support of the Board, Public Health Wales has an established Local Staff Partnership Forum. The Board has established four standing Board Committees which are detailed below. Committee papers and minutes for each meeting are published on the Public Health Wales website. The chairs of the committees provide verbal reports to the board meeting following each committee meeting. Minutes of committee meetings are also presented to the Board once approved by the relevant Committee. Each Committee also produces an Annual Report of business, copies of which are available on the Public Health Wales website.

The Audit Committee The Audit Committee comprises three Non Executive Directors, including the Chair, and meets on a quarterly basis. The Audit Committee's Terms of Reference state that it is responsible for providing advice and assurance to the Board and the Accountable Officer on whether effective arrangements are in place through the design and operation of the Trust’s assurance framework and to support the Board in its decision making and in discharging its accountabilities for securing the achievement of the Trust’s objectives, in accordance with the standards of good governance determined for the NHS in Wales. The Audit Committee is authorised by the Board to investigate or have investigated any activity (clinical or non clinical) within its terms of reference. In doing so, the Committee has the right to inspect any books, records or documents of the Trust relevant to the Committee’s remit, ensuring patient/client and staff confidentiality, as appropriate. The Audit Committee met five times during 2012/13 and was quorate on each occasion.

Public Health Wales Annual Report 2012-2013

| 19

Annual Governance Statement The Quality and Safety Committee The Quality and Safety Committee comprises four Non Executive Directors, including the Chair, and meets quarterly. The Quality and Safety Committee is responsible for seeking assurances that governance (including risk management) arrangements are appropriately designed and operating effectively to ensure the provision of high quality, safe healthcare, public health provision and services across the whole of the Trust’s activities. The Committee is authorised by the Board to investigate or have investigated any activity within its terms of reference. In doing so, the Committee has the right to inspect any books, records or documents of the Trust relevant to the Committee’s remit, ensuring patient/client and staff confidentiality, as appropriate. The Committee is also responsible for reviewing and considering claims under the NHS Wales redress scheme. No settlements under this scheme were made during 2012/13. The Quality and Safety Committee met four times during 2012/13 and was quorate on three occasions.

The Information Governance Committee The Information Governance Committee comprises three Non Executive Directors, including the Chair, and meets on a quarterly basis. Public Health Wales has well established arrangements for Information Governance to ensure that information is managed in line with the relevant Information Governance law, regulations and Information Commissioners Office guidance. The arrangements include a Trust wide Information Governance Committee, Trust and Divisional Caldicott Guardians, a Caldicott Guardian for the National Databases and Divisional Information Governance leads. The Information Governance Committee is responsible for ensuring these arrangements are maintained and adhered to. The Information Governance Committee receives summaries and reports on all Information Governance incidents and near misses reported through the Trust’s incident management system. All serious incidents are reported fully to the Committee and Welsh Government and full Root Cause Analysis investigations are undertaken. During 2012/13, Public Health Wales reported two significant data security lapses; one involving missing patient information the other involving disclosure of information. The missing patient information was reported to the Information Commissioner. The Information Commissioner found that Public Health Wales had taken the appropriate action and decided that no further action was needed. The second significant data security lapse was a complaint from the Information Commissioner concerning non-compliance with a Subject Access Request under the Data Protection Act. Following a full investigation, the Information Commissioner decided to take no further action.

20 |

Public Health Wales Annual Report 2012-2013

The Information Governance Committee met four times during 2012/13 and was quorate on each occasion.

The Remuneration and Terms of Service Committee The Remuneration and Terms of Service Committee comprises all five Non Executive Directors, including the Board Chair, and meets on a regular basis. The committee considers the pay and terms and conditions of service for Executive Directors and other senior members of staff and considers other pay costs related matters such as applications under the voluntary early release scheme. The Remuneration and Terms of Service Committee met twice during 2012/13 and was quorate on each occasion. As a result of the national pay freeze which has been observed in Public Health Wales, the Committee mostly considered applications in respect of the voluntary early release scheme. The Remuneration and Terms of Service Committee produced an Annual Report of business, which was presented to the Board in September 2012. A copy of the report is available on the Public Health Wales website.

System of Internal Control The system of internal control is designed to manage risk to a reasonable level rather than to eliminate all risks. It can therefore only provide reasonable and not absolute assurance of its effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the risks to the achievement of organisational policies, aims and objectives, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control has been in place in the Trust for the year ended 31 March 2013, and up to the date of approval of the Annual Report and Accounts.

Risk Management The current risk management system is designed to identify and prioritise the risks of the organisation, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The Board Secretary leads on risk management and on developing and maintaining a sound system for risk management processes. Directors of Divisions manage risk within their respective areas and identified senior staff within each service area who will have a remit for risk management. A Risk Management Group, chaired by the Board Secretary, was established in 2010 to oversee risk management matters within the organisation. The Group consists of representatives from all parts of Public Health Wales and meets regularly to discuss and assess all aspects of risk within the organisation. These include the risk register, incidents, complaints and claims. The Group is able to escalate risks to the Executive Team and to the various Board Committees, as

appropriate, and is able to make recommendations on new and existing risks. The Group also develops and implements risk related policies and procedures. The reporting of risks is encouraged and the Risk Management Group has a key role in communicating emerging significant team/departmental risks. Risk management is a standard element within all Public Health Wales job descriptions and states that all staff have a responsibility to fulfil a proactive role towards the management of risk in all their actions. This entails the risk assessment of all situations and taking appropriate actions. This will be further strengthened with the implementation of the Public Health Wales Datix risk management system as the web risk assessment form will be made available to all staff as the identification and reporting of risk is the responsibility of all employees. The web based risk assessment form will also allow for the risk to be escalated to the relevant Executive Director, Divisional Director and/or Board Committee. Public Health Wales has developed a Corporate Risk Register, which summarises both operational and management level risks for the organisation. Risks are scored and mitigating actions detailed. Risks are allocated to Executive leads and are reviewed at each meeting of the Risk Management Group. The Risk Register, including new, revised and deleted risks are regularly reviewed by the Executive Team and at each meeting of the Quality and Safety Committee, and will be reported at least annually to the Audit Committee and Board. The organisation will be looking to strengthen the way it monitors risks, for instance each risk will in future be allocated to a Board Committee so that Committee is responsible for monitoring their own risks. The Corporate Risk Register contains thirteen high level risks. Examples of the risks included on the register range from ensuring that the organisation reaches financial balance to divisional restructure. These risks are monitored closely and the level of risk is amended as things develop. The Corporate Risk Register is supported by an operational risk profile. The risks on the operational risk profile arise from activities and processes undertaken within Divisions to achieve the organisation’s objectives. The risks are identified during the normal course of work and are considered as they arise. They are managed at the time that they arise and reported by staff locally. However, if necessary the risk can be escalated as appropriate. All serious incidents are reported fully to the Quality and Safety Committee and Welsh Government and full Root Cause Analysis investigations are undertaken. The Committee is also responsible for the monitoring progress against actions identified to ensure that they are completed within the timescales set. In 2012/13 a total of six Serious Incidents were reported to the Welsh Government. The Quality and Safety Committee is also responsible for ensuring that lessons are learnt from serious incidents and that these lessons are embedded in future practices.

Annual Governance Statement The NHS Wales Shared Services Partnership, Audit and Assurance Services provide an internal audit function to Public Health Wales. Their programme of reviews provides an independent and objective opinion on the adequacy of the systems of risk management, control and governance by measuring and evaluating effectiveness.

Doing Well, Doing Better: Standards for Health Services in Wales Public Health Wales uses the Doing Well, Doing Better: Standards for Health Services in Wales as its framework for gaining assurance on its ability to fulfil its aims and objectives for the delivery of safe, high quality health services. This involves self assessment of performance against the standards across all activities and at all levels throughout the organisation. An evaluation of this self assessment is undertaken by the Audit and Assurance Service and a plan for improvement is developed, which is considered by the Quality and Safety Committee.

As part of this process, the organisation has completed the Governance & Accountability assessment module and has:  Openly assessed its performance using the

maturity matrix  Responded, where received to feedback from Healthcare Inspectorate Wales  Put plans in place to achieve the improvement actions identified within clearly defined timescales proportionate to the risk, although it was noted that we need to improve the monitoring of these plans The organisation achieved the following level of performance for 2013:

Public Health Wales NHS Trust Governance and Accountability Module

Do not yet have a clear, agreed understanding of where they are (or how they are doing) and what / where they need to improve.

Are aware of the improvements that need to be made and have prioritised them, but are not yet able to demonstrate meaningful action.

Are developing plans and processes and can demonstrate progress with some of their key areas for improvement.

Setting the Direction

X

Enabling Delivery

X

Delivering results achieving excellence

X

Overall Maturity Level

X

This process has been subject to independent internal assurance by the organisation’s Head of Internal Audit. The Quality and Safety Committee will be responsible for the monitoring of progress against the Corporate Standards for Health Services Improvement Plan. Public Health Wales is represented at the Healthcare Standards Self Assessment Tool User Group. Public Health Wales embeds the Standards for Health Services within its activities and structures as they develop. Each of the Corporate Standards for Health Services had an Executive Lead and nominated Corporate Lead, along with a responsible Board Committee. In addition, the revised Healthcare Standards are built into relevant Public Health Policies and Procedures as appropriate. Divisional Directors are also required to develop and lead arrangements to cascade and embed the standards that are relevant to their work. To assist with this a protocol has been developed to provide staff with details of their roles and responsibilities in relation to the management of the Standards for Health Services.

UK Corporate Governance Code Public Health Wales Board has complied with the main principles of the UK Corporate Governance Code as they relate to an NHS public sector organisation in Wales. This assessment has been informed by the organisation’s assessment against the Governance and Accountability Module

Have well developed plans and processes and can demonstrate sustainable improvement throughout the organisation / business.

Can demonstrate sustained good practice and innovation that is shared throughout the organisation/ business, and which others can learn from.

undertaken by the Board and also evidenced by internal and external audits. Public Health Wales is following the spirit of the Code to good effect and is conducting its business openly and in line with the Code. The Board recognises that not all reporting elements of the Code are outlined in this Governance Statement but are reported more fully in the Trust’s wider Annual Report. There have been no reported departures from the Corporate Governance Code.

as a group and individually. The Board needs to consider how to further evaluate its own performance.

Strategic and Corporate Performance

Publication of risk register The Minister for Health and Social Services required that all NHS organisations publish their risk registers on a regular basis. Public Health Wales publishes the risk register as part of the Board papers and Committee papers.

Board Performance/Assessment The Public Health Wales has robust arrangements in place to assess the performance of the Board and individual Board members. During 2012/13, the Chair undertook a series of mid and end of year appraisals with Board members, which assessed their performance against a series of national, organisational and personal objectives. These discussions informed a series of informal Board meetings and away days, which provided an opportunity to address development needs and to reflect on the Board and organisation’s strategic direction and performance since it was established in 2009. The Board has also participated in a workshop where it discussed the recommendations from the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis report). During the session the Board was able to reflect on its performance and effectiveness

Ministerial Directives Whilst Ministerial Directives are received by health boards, these are not always applicable to Public Health Wales. However, Public Health Wales did receive directives/direction from the Minister for Health and Social Services via Ministerial letters received by the Chair.

Annual Quality Statement The Minister has required that each NHS organisation produces an Annual Quality Statement. Public Health Wales will produce this in line with the guidance issued by the Welsh Government. The Statement will complement the Annual Governance Statement and form part of the Annual Accounts and Report. We aim to complete the first Annual Quality Statement by September 2013. Safe Care, Compassionate Care The Minister has issued Safe Care, Compassionate Care, which is a national governance framework to enable high quality care in NHS Wales. This has been disseminated widely around the organisation. Public Health Wales Annual Report 2012-2013

| 21

Annual Governance Statement Increasing the number of women and under-represented groups in public appointments in Wales: The Minister has requested that the NHS in Wales makes every effort to increase the number of women and under-represented groups as Board members. Since the departure of Dr Jo Farrar and Professor Hilary Fielder, Public Health Wales does not have any female Board members. We are working with the Public Appointment Unit in the Welsh Government to ensure every opportunity is maximised to increase the number of women and under-represented groups.

Revised Planning Framework As part of Public Health Wales’ ongoing development, discussions have taken place at Board level and with the Executive Team in relation to revising the organisation’s current planning framework. A number of issues were identified during these discussions, including:  Simplifying current arrangements  Reflecting changes within the organisation and wider system  Better alignment of challenges, outcomes and action and  Greater focus on data led performance information Following these discussions, a revised Framework has been developed that will consist of the following key elements:  Revised strategy  Public Health Outcomes Framework for Wales  Prioritisation  Three year delivery plans and  Annual plans These elements will be underpinned by developments in Public Health Wales’ accountability arrangements with the Welsh Government, improvements in performance reporting and the development of a Public Health Quality Framework. The revised proposals aim to create an enabling framework to support the delivery of the aims and commitments within our strategy. They have been informed by a number of strategic developments that have taken place in 2012/13, such as the Health Improvement Review, transfer of defined NLIAH functions, and current discussions with Welsh Government in relation to changes in accountability arrangements. The revised planning and performance arrangements were approved by the Board in March 2013. A key aspect in the further development and implementation of the arrangements will be engagement with staff and key stakeholders.

1,000 Lives Plus The 1000 Lives Plus Programme continues to play a significant role in supporting organisations and individuals to deliver the highest quality and safest healthcare for the people of Wales. The programme is focused on building capacity and sustaining and spreading improvements. It supports frontline staff across Wales through evidence-based

22 |

Public Health Wales Annual Report 2012-2013

‘programme areas’ and provides clinical leadership through its Faculty. It is committed to engaging patients and students in improvement work and promotes an internationally recognised quality improvement methodology. Public Health Wales’ Chair is co-chair of the 1000 Lives Plus Programme Board, which also includes Public Health Wales representatives. It is a formal undertaking by Public Health Wales to lead on two of the programme’s work streams - ensure care is based on best evidence and ensure a focus on improved outcomes. Public Health Wales has led the coordination of the Champions for Health project, which is an all-Wales project to equip NHS Wales staff to become more healthy and effective role models and advocates of public health messages. Intended to include 25 per cent of all NHS staff in Wales, the project draws on the methodologies used in 1000 Lives Plus for improvements. Staff in Public Health Wales are also being trained as part of ‘Improving Quality Together’, a new framework which will provide a national approach to improving standards and delivering care, which has been launched by the 1000 Lives Plus Team.

Hosted Bodies During 2012/13, following a request by the Welsh Government, Public Health Wales agreed to host the Health and Wellbeing, Best Practice and Innovation Board. Consisting of the Chair and two staff members, the Board has been established to enable the evaluation of the potential impact of innovations and developments and to facilitate their adoption across the NHS, local government and the third sector in Wales. The Welsh Government funds the Board and sets its work plan, priorities and targets. Public Health Wales provides corporate governance and managerial support. A hosting agreement will be put in place detailing the working arrangements.

Civil Contingencies/Business Continuity Public Health Wales’ Emergency Response Plan details the organisation’s response to a wide range of incidents and threats. The plan provides an overarching framework for the organisation’s response to incidents and outbreaks, including the mobilisation of additional resources. The organisation has undertaken risk assessments in accordance with emergency preparedness and civil contingency requirements as based on UKCIP 2009 weather projections to ensure that the organisation’s obligation under the climate change Act and the Adaptation Reporting requirements are complied with. We monitor our Carbon footprint using 2011/12 as a baseline figure and we have adopted the Welsh Government initiative of ensuring sustainability is embedded in everything we do. Public Health Wales has also adopted an Accommodation Strategy that embeds sustainable development as key principles.

Key divisions within Public Health Wales, such as Screening, Health Protection and Microbiology, have established business continuity arrangements in place. As part of these arrangements, relevant staff are aware of their duties as outlined within the plans. The Information management and technology installed infrastructure has been tested to ensure the network is available across multiple sites in the event of local emergencies or one or more buildings suffering unforeseen problems. Public Health Wales’ business continuity arrangements were reviewed by Internal Audit in November 2011 and the arrangements were given adequate assurance.

Sustainability Public Health Wales fully supports proposals detailed in various Welsh Government consultation documents to embed sustainable development as the central organising principle of selected public sector bodies in Wales through ensuring a clear focus on outcomes and that strategic decisions are informed by consideration of the wider determinants of health and wellbeing. Public Health Wales recognises that sustainable development and public health are intrinsically linked and that complementary actions are necessary to address the key challenges facing Wales in relation to both.

Equality A Strategic Equality Plan was adopted by the Trust Board in April 2012, with a further progress report provided to the Board in December 2013. The plan details the actions we are taking to address and improve equality related issues in all parts of the organisations. The Strategic Equality Plan also laid out an additional objective to ‘embed Equalities into organisational performance and Executive and Board Decision Making’. As part of the Strategic Equality Plan, all new and revised policies and strategies are subject to an equality impact assessment (EQIA).

Staff Public Health Wales engages staff systematically in a number of ways. We have a consultation process for all new and revised organisational policies: a staff conference, a senior management forum and a national forum which are all used to engage in conversations with staff in person. These are used in parallel with an open blog, a web forum and other virtual ways for staff to share their work and opinions. On a project by project and issue by issue basis, Public Health Wales engages staff using workshops, briefings, the web, email and increasingly, social media. In particular, a number of workshops were held with staff across Wales as part of the organisational development programme, obtaining feedback from staff on future direction and what does or does not work well. More emphasis has been placed on the training and development function, particularly in respect of the health and safety compliance mentioned earlier.

Annual Governance Statement As an employer with staff entitled to membership of the NHS Pension Scheme, control measures are in place to ensure all employer obligations contained within the Scheme regulations are complied with. This includes ensuring that deductions from salary, employer’s contributions and payments in to the Scheme are in accordance with the Scheme rules, and that member Pension Scheme records are accurately updated in accordance with the timescales detailed in the Regulations. Note 12 to the accounts provides details of the scheme, how it operates and the entitlement of employees.

Review of effectiveness As Accounting Officer, I have responsibility for reviewing the effectiveness of the systems of internal control. My review of the system of internal control is informed by the work of the internal auditors and the executive officers within the organisation who have responsibility for the development and maintenance of the internal control framework. My review will also consider comments made by external auditors in their audit letter and other reports. The remit of the Audit and Assurance Service is to:  Provide an overview of the establishment of risk management and control and governance arrangements for the organisation  Review of the Standards for Health Services arrangements for Public Health Wales, particularly those that underpin the Annual Governance Statement and  Review processes for monitoring and managing the financial systems and the financial information, including those provided by Velindre NHS Trust The Internal Audit Assurance Statement and Annual Report for 2012/13 concludes that ‘The Board can take reasonable assurance that the arrangements upon which the organisation relies to manage risk, control and governance within those areas under review, and the organisational compliance

noted, are suitably designed and applied effectively. However, some issues have been identified that, if not addressed, increase the likelihood of risks materialising’. Cardiff and Vale Counter Fraud Service provides a service to Public Health Wales and its work plan for 2012/13 was fulfilled and covered all the requirements under Welsh Government Directions. It provides regular reports and updates to members of the Executive Team and directly to the Audit Committee. The Executive Team also has a robust governance structure ensuring monitoring and control of the efficient and effective use of the Trust’s resources. Financial monitoring, service performance, quality and workforce information is scrutinised at meetings of the Trust Board, and at various operational team meetings. Public Health Wales has a well developed annual planning process, including a revised planning framework, which consists of a revised strategy; the Public Health Outcomes Framework for Wales; prioritisation; three year delivery plans; and annual plans. These annual plans detail the workforce and financial resources required to deliver the service objectives and include the identification of cost improvements and areas for savings. The achievement of the Trust’s financial plan is dependent upon the delivery of these cost improvement and savings measures. The Financial Plan ensures that statutory financial duties are fulfilled, but also strives to generate funds for the further development of services. As part of the annual accounts review, the Trust’s efficiency and effectiveness of its use of resources in delivering its objectives is assessed by the Wales Audit Office. During 2012/13, Public Health Wales reported two significant data security lapses; one involving missing patient information the other involving disclosure of information. The missing patient information was reported to the Information Commissioner. The Information Commissioner found that Public Health Wales had taken the appropriate action

and decided that no further action was needed. The second significant data security lapse was a complaint from the Information Commissioner concerning non-compliance with a Subject Access Request under the Data Protection Act. Following a full investigation, the Information Commissioner decided to take no further action.

Conclusion The overall opinion is that no significant governance issues have been identified. There were two data security lapses about which the Information Commissioner deemed no further action necessary. Therefore, reasonable assurance can be given that there is a sound governance framework, designed to meet the organisation’s objectives and that the framework is generally being applied consistently.

Bob Hudson Chief Executive, Public Health Wales

Public Health Wales Annual Report 2012-2013

| 23

Remuneration Report

Section 4

Remuneration Report The pay and terms and conditions of employment for the Executive Team have been, and will be, determined by the Public Health Wales Remuneration and Terms of Service Committee within the Framework set by the Welsh Government. The Executive Team consists of the Executive Directors plus the Director of Workforce and Organisational Development, the Director of Communications and the Board Secretary. The Remuneration and Terms of Service Committee also considered and approved applications relating to the voluntary early release scheme. The Public Health Wales Remuneration and Terms of Service Committee consist of the following Members: Chair of Remuneration Committee: Professor Sir Mansel Aylward CB Members: Dr Carl Clowes OBE Dr Jo Farrar* Mr John Spence Professor Simon Smail CBE Professor Gareth Williams Mr Terry Rose CBE *Dr Jo Farrar ceased to be a member with effect from 1 July 2012

24 |

Public Health Wales Annual Report 2012-2013

Existing public sector pay arrangements apply to all staff including the Executive Team. On that basis, in 2012/2013, no “cost of living” increases for Executive Team members were approved by the Remuneration Committee. During 2012/13, the Remuneration and Terms of Service Committee approved the starting salary and terms and conditions of employment for the Executive Director for Public Health Services. The Committee also approved an increase in salary for Dr Peter Bradley, Executive Director of Public Health Development, of one additional session per week. This was to reflect the substantial additional workload that the Director has been undertaking since taking up post. The increase is equivalent to £11,937 per annum. This will be backdated to 1 November 2011. No other increases to salary for members of the Executive Team were considered or approved by the Remuneration Committee during 2012/13. Additionally, all of the Executive Team are on pay points and not pay scales and therefore no member of the Executive Team was entitled to or received any incremental increase in salary during 2012/13. Performance of the Executive Team is assessed against personal objectives and the overall performance of Public Health Wales. Public Health Wales does not make bonus payments. All and any pay awards are subject to performance. All payments are against the pay envelope in the annual letter from the Chief Executive of NHS Wales letter on this matter. Due to the implementation of Agenda for Change, there were no local pay bargaining initiatives during the year and none are planned in the future. Details of salaries and pension benefits for senior employees are shown at Annex 1 to the Remuneration Report.

NHS Bodies in Wales are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director in Public Health Wales in the financial year 2012-13 was £150k-155k (2011-12, £140k-£145k). This was 5.17 times (2011-12, 4.75) the median remuneration of the workforce, which was £29,464 (2011-12, £30,459). The remuneration of the Chief Executive was £140,000 (2011-12 £140,000) which is 4.75 times (2011-12, 4.60) the median remuneration of the workforce. In 2012-13, one employee received remuneration in excess of the highest-paid director compared to four employees in 2011-12. Remuneration ranged from £10,029 to £155,477 (2010-11, £9,360 to £155,477). Total remuneration includes salary, benefitsin-kind as well as severance payments. It does not include employer pension contributions and the cash equivalent transfer value of pensions. The salary includes medical commitment awards, planned additional sessions and clinical excellence awards. There was an increase in the banded remuneration of the highest paid director as a result of a new appointment made in 2012/13. This, along with the fact that the workforce within Public Health Wales has changed to comprise more lower banded staff in total, has resulted in an increase in the multiplier factor of the median salary to the highest paid director from 4.75 in 2011/12 to 5.17 in 2012/13. During 2012/13, five staff received compensation totalling £102,000 under the early release scheme. Full details of this are shown under note 11.4 to the Annual Accounts.

Remuneration Report Salary and pension entitlements of senior employees 2012/13 Annex 1 - Salary and Pension disclosure tables

Salaries and Allowances 2012-2013 Other Annual Salary Remuneration (bands of (bands of £5,000) £5,000) Name and Title

£'000

£'000

2011-2012

Bonus Payments (bands of £5,000)

Benefits in kind (rounded to the nearest £00)

Salary (bands of £5,000)

Other Remuneration (bands of £5,000)

Bonus Payments (bands of £5,000)

Benefits in kind (rounded to the nearest £00)

£'000

£00

£'000

£'000

£'000

£00

Mr Bob Hudson, Chief Executive

140-145

0

140-145

7

Dr Peter Bradley, Executive Director of Public Health Development

140-145

0

60-65

0

Dr Hilary Fielder, Executive Director of Public Health Services 1

70-75

0

140-145

0

Dr Quentin Sandifer 2

75-80

1

0

0

Mr Huw George, Executive Director of Finance

100-105

3

100 - 105

3

Mrs Ruth Davies, Executive Director of Workforce & Organisational Development

95-100

0

95-100

2

Mr Mark Dickinson, Executive Director of Planning & Performance

90-95

3

90-95

9

Mr Keith Cox, Board Secretary/ Director of Corporate Services

85-90

1

85-90

3

Mr Chris Lines, Director of Communications

85-90

0

85-90

0

Professor Sir Mansel Aylward CB

40-45

0

40-45

0

Dr Carl Clowes OBE

5-10

0

5-10

1

0

0

0

0

Professor Simon Smail CBE

5-10

1

5-10

2

Mr Jonathan Spence

5-10

3

5-10

3

0

0

0

0

5-10

0

5-10

0

Non Executive Directors:

Dr Jo Farrar

Professor Gareth Williams Mr Terence Rose CBE

1. Professor Hilary Fielder retired on 30 September 2012 2. Dr Quentin Sandifer was appointed as Executive Director of Public Health on 8th October 2012

Remuneration Ratio

Band of highest paid director's total remuneration £000s Median total remuneration £000s Ratio

2012-2013

2011-2012

140-145

140-145

29

30

5.17

4.75

Public Health Wales Annual Report 2012-2013

| 25

Remuneration Report

Pension Benefits

Name and Title

Real increase in pension at age 60 (bands of £2,500) £000

Lump sum at Real increase Total accrued age 60 related in pension pension at to accrued Cash Cash lump sum age 60 at pension at 31 equivalent equivalent Real increase/ Employer’s at age 60 31 March 2013 March 2013 transfer value transfer value in cash contribution to (bands of (bands of (bands of at 31 March at 31 March equivalent stakeholder £2,500) £5,000) £5,000) 2013 2012 transfer value pension £000 £000 £000 £000 £000 £000 £000

Mr Bob Hudson, Chief Executive

0 - 2.5

0 - 2.5

5 - 10

0

114

83

30

0

Dr Peter Bradley, Executive Director of Public Health Development

0 - 2.5

2.5 - 5

30 -35

95 - 100

535

499

36

0

Dr Hilary Fielder, Executive Director of Public Health Services 1

0 - 2.5

0 - 2.5

30 - 35

95 - 100

716

732

-16

0

Dr Quentin Sandifer, Executive Director of Public Health Services 2

(2.5) - 0

(5) - (2.5)

40 - 45

130 - 135

824

833

-9

0

Mr Huw George, Executive Director of Finance

0 - 2.5

0 - 2.5

20 - 25

70 - 75

404

391

12

0

Mrs Ruth Davies, Director of Workforce & Organisational Development

2.5 - 5

0

15 - 20

0

216

165

51

0

Mr Mark Dickinson, Executive Director of Planning & Performance

(2.5) - 0

(2.5) - 0

25 - 30

75 - 80

426

418

8

0

Mr Keith Cox, Board Secretary/ Director of Corporate Services

(2.5) - 0

(5) - (2.5)

35 - 40

115 - 120

798

792

5

0

0 - 2.5

0 - 2.5

5 - 10

25 - 30

158

142

16

0

Mr Chris Lines, Director of Communications

1. Professor Hilary Fielder retired on 30 September 2012 2. Dr Quentin Sandifer joined the Organisation on October 1 st 2012

Declaration of significant interests Professor Sir Mansel Aylward  Member: National Advisory Board to Minister for Health and Social Services, Welsh Government  Member: Industrial Injuries Advisory Council, London  Scientific Advisor: Health Claims Bureau  Chair: Merthyr Tydfil County Borough Council Standards Committee  Independent Member: ATOS Healthcare Clinical Governance Board  Chair: Faculty of Occupational Medicine Academic Forum  Vice President: Shaw Trust  Patron: Vocational Rehabilitation Association  Patron: TREAT Trust  Medical Advisor: US Preventative Medicine, Nashville, TN, USA  Member: Council of College of Medicine, UK  Member: Academic Advisory Board for the Centre for Health Services Innovation at the Counties Manukau District Health Board, New Zealand  Vice President: College of Occupational Therapists  Patron: Lles Cymru Wellbeing Wales  Director: Centre for Psychosocial and Disability Research, Cardiff University  Member: Supporting People National Advisory Board, Welsh Government 26 |

Public Health Wales Annual Report 2012-2013

During 2012-13 the significant interests of the Public Health Board were as follows:

 Vice President: The College of Occupational Therapists  Chair: Expert Review Panel: Growing Up in New Zealand Longitudinal Study  Special Advisor: Work and Income, Ministry of Social Development, New Zealand  Member: Specialist Advisory Panel – Bovine Tuberculosis  Chair: Steering Group for the Guided eLearning Programme for Managers (GEM Study). St Bartholomew’s and The Royal London School of Medicine  Chair: Organising Committee for International Forum on Disability Medicine 2012, The Royal Society of Medicine, London Dr Carl Clowes  Director and President Ymddiriedolaeth Nant Gwrthyrn (Charitable Company)  Director of the Board: Dolen Cymru (Charitable Company)  Hon: Lesotho Consul in Wales  Life President: Dolen Cymru Mr Terence Rose  Employed part time as Health and Safety Consultant. Formerly Director of Wales Health and Safety Directorate  Spouse employed by NHS Professor Simon Smail  Trustee: Leonard Cheshire Disability

Mr John Spence  Non Executive Director UK Standards Agency until 2013  Chair of the Welsh Food Advisory Committee Professor Gareth Williams  Chair: Board of Trustees and Management Group, Treganna Family Centre, Cardiff  Chair: NIHR Doctoral Fellowship Programme, National Institutes for Health Research, Trainee Co-ordinating Committee, Leeds  Co-Director: Wales Health Impact Assessment Support Unit (WHIASU, a Cardiff University-Public Health Wales Partnership)  Spouse: Co-Director of WHIASU Mr Bob Hudson  Advisor: Consultancy firm Groundswell Dr Peter Bradley  Advisor/sponsor: Healthy Ambitions Suffolk, a social enterprise promoting health based in Suffolk  Member: CASP International promoting appraisal skills (internationally)  Honorary professor at Swansea University Dr Quentin Sandifer  Honorary Senior Lecturer, Division of Infection and Population Health, University College London

Statement of Assurance I confirm that there is no relevant audit information in the Annual Report of which the Wales Audit Office is unaware. As Chief Executive, I have taken all the steps in order to make myself aware of any relevant information and ensure the Wales Audit Office is aware of that information.

Bob Hudson

Statement of the Chief Executive’s responsibilities as accountable officer of the Trust The Welsh Ministers have directed that the Chief Executive should be the Accountable Officer to the Trust. The relevant responsibilities of Accountable Officers, including their responsibility for the property and regularity of the public finances for which they are answerable and for the keeping of proper records, are set out in the Accountable Officer’s Memorandum issued by the Welsh Government. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an Accountable Officer.

Accountable Officer, Public Health Wales

Bob Hudson Chief Executive 6 June 2013

Report of the Auditor General for Wales to the National Assembly for Wales on the Summary Financial Statements I have examined the summary financial statements contained in the Annual Report of Public Health Wales NHS Trust as set out on pages 11 to 22.

Respective responsibilities of the Accounting Officer and auditor The Accounting Officer is responsible for preparing the Annual Report. My responsibility is to report my opinion on the consistency of the summary financial statements with the statutory financial statements and the remuneration report. I also read the other information contained in the Annual Report and consider the implications for my report if I

become aware of any misstatements or material inconsistencies with the summary financial statements.

Basis of opinion I conducted my work in accordance with Bulletin 2008/3 ‘The auditor’s statement on the summary financial statements’ issued by the Auditing Practices Board for use in the United Kingdom.

year ended 31 March 2013 on which I have issued an unqualified opinion. I have not considered the effects of any events between the dates on which I signed my report on the full financial statements, 20 June 2013 and the date of this statement.

Opinion

Huw Vaughan Thomas

In my opinion the summary financial statements are consistent with the statutory financial statements and the remuneration report of Public Health Wales NHS Trust for the

Auditor General for Wales Wales Audit Office 24 Cathedral Road Cardiff CF11 9LJ 23 September 2013

Public Health Wales Annual Report 2012-2013

| 27