ARCH A Regional Collaboration for Health Prospectus: A World-Class Health and Wellbeing Economy for the South West Wales Region June 2015 A Regional Collaboration for Health (ARCH) Prospectus Contents Executive Summary 1 1. Vision 3 2. National and Regional Context 4 3. Partners and Stakeholders 6 4. Aims 8 5. The Collaborative Construct 9 6. Health Service Provision 10 6.1 ARCH – The Whole System 10 6.2 ABM & Hywel Dda University Health Boards 11 6.3 Health Service Need 13 6.4 Health and Wellbeing 14 6.5 Primary and Community Care 15 6.6 Singleton Health Campus 16 6.7 Morriston Health Campus 19 6.8 Precision and Personalised Medicine 22 6.9 Public Health Wales 23 6.10 South West Wales Cancer Service 24 6.11 Welsh Ambulance Services Trust 25 6.12 Centre of Excellence for Cardiovascular, Bariatric, Thoracic & Reconstructive Surgery 26 6.13 Collaborative Healthcare Management 27 7. Economic Developm ent: ILS Medi-Park 28 7.1 ILS Medi-Park Concept Across the Health Campuses 28 7.2 International Partnerships of Excellence 29 7.3 Healthcare Technology Centre (HTC) and Joint Clinical Research Facility (J-CRF) 29 7.4 Guest@ILS 30 7.5 Health & Wellbeing Centre 31 7.6 Healthcare and Life Science Skills Centre 32 8. The Skilled Workforce 33 8.1 Context 33 8.2 The Changes Required 34 8.3 Education and Talent Development 35 ARCH: A Regional Collaboration for Health A Regional Collaboration for Health (ARCH) Prospectus Contents (Continued) 9. Rural Health 36 9.1 Wales Centre for Rural Health 36 10. Bevan Academy for Leadership & Innovation 37 10.1 Context 37 10.2 Wales Prudent Health Centre 38 11. The ARCH Programme 39 11.1 Site Developments and Planning 39 11.1.1 Morriston Health Campus 39 11.1.2 Singleton Health Campus 40 11.1.3 Hywel Dda Health Campus 41 11.2 Finance 42 11.2.1 Financing Principles 42 11.2.2 Maximising Component and Collaborative Benefits 42 11.2.3 Managing Successful Programmes (MSP) 43 11.2.4 Financial Arrangements 43 11.2.5 Estimated Capital costs 43 11.2.6 Disposal Strategy 43 11.3 Governance and Leadership 44 11.4 Programme Management 45 11.5 Risk Management 46 11.5.1 Risk Management Policy 46 11.5.2 Risk Appetite 46 11.5.3 Risk Management Cycle 46 11.5.4 Risk, Assumptions, Issues, Decisions Log 46 11.6 Benefits and Impact 47 11.6.1 Healthcare 48 11.6.2 People and Communities 48 11.6.3 Health Economy 48 11.6.4 Workforce 48 11.6.5 Research and Science 48 11.6.6 Regional Economy 48 11.6.7 Wales’ Reputation 48 ARCH: A Regional Collaboration for Health Executive Summary ARCH: A Regional Collaboration for Health An integrated, open, collaborative medical and life sciences regional ecosystem, delivering high quality patient care, developing doctors, healthcare professionals and life scientists working locally with a global perspective to drive excellence for the sustainable benefit of the health, wellbeing and wealth of South West Wales and beyond. 1. Abertawe Bro Morgannwg University Health Board (ABMU) and Hywel Dda Benefits of ARCH University Health Board (Hywel Dda UHB) have been invited by Welsh - More Care provided closer to Government to propose a transformative plan for an integrated healthcare people’s home service that reflects the current and future demands of the region. - Keeping People Well longer 2. The NHS in Wales faces challenges of population and workforce demography, - More care being delivered in chronic disease, expectation and technological advance which demand a the appropriate setting bold “paradigm shift” in service provision with an urgent need for primary and - Preventing people from dying community based care and service reconfiguration for sustainability and prematurely, excellence. - Improved quality of life for 3. “Prudent healthcare has to be more than an idea and more than a set of people with long-term principles. It has to change the way health services are used and provided. It conditions, has to make a real practical difference to the broad sweep of those millions of - Improved outcomes for encounters which take place every year between Welsh people and their people recovering from health service.” Prof. Mark Drakeford, Minster for Health and Social Services, episodes of ill health or injury, Welsh Government. - Appropriate care provided in 4. Reducing health inequality, improved quality of care and access to services, specialist centre greater efficiencies and patient focus through prudent healthcare and the - Improved patient /carer attraction and retention of leading professionals will represent key healthcare experience of care, benefits. The expanded science base will produce economic outputs that will - Improved environments for result in long-term, sustainable impact. the safe care and treatment 5. Collaborative investment strategies including the use of Innovative Finance will of people protecting them lever investment into the region making the programme a sustainable health, from avoidable harm education, science, innovation and translation endeavour. - Increased efficiencies 6. ABMU, Hywel Dda UHB and Swansea University (SU), through ARCH will further - Improved access to services enhance the reputation of the region and Wales as a centre of excellence in - Long term sustainable multi service delivery, research, education and innovation in Healthcare and Life professional workforce Sciences, through a carefully planned and managed brand strategy for the - Increase in high skill jobs, long-term benefit of the communities they serve. - Increase in new companies, 7. The Welsh Government’s Department of Economy, Science and Transport has - Increase % of growing identified Life Sciences as a key economic sector. Building on this the Ministers, companies, Mrs. Edwina Hart and Prof. Mark Drakeford have stressed the need to develop - Increase intellectual the positive dynamic between the economy and health. property, 8. The ABMU and SU Partnership Board, established in 2012, has already delivered - Improved investment, a Joint Clinical Research Facility, a common Intellectual Property and - Improved market Commercialisation Policy and collaborative education and skills development. capitalisation Building on this, the parties are now embarking upon A Regional Collaboration - Increase in research income, for Health (ARCH). - International centres of 9. Swansea University’s Colleges of Medicine and Human & Health Science jointly excellence, are developing the concept of ILS Medi-Park to build upon the successes of the - Increase in academic first decade of the ILS initiative. The recent Research Excellence Framework publications, confirmed the world-class nature of the research and translation undertaken in - Increased research impact, the two Colleges with, for example, the College of Medicine being rated - international collaborations second of ninety five throughout the UK in its unit of assessment. - Increased percentage of 10. Through a vertically-integrated skills and education strategy across clinical and qualified workforce, non-clinical professions, ARCH will focus on the development and retention of a - Increase number of talented and dynamic workforce for both ABMU and Hywel Dda UHB and the multidisciplinary employees, wider Life Sciences and Health regional ecosystem that recognises the - Increase the number of challenges of rural healthcare as well as urban. qualification pathways ARCH: A Regional Collaboration for Health P a ge 1 o f 49 Executive Summary ARCH: A Regional Collaboration for Health ARCH A unique collaboration across the region which will transform the health economy and drive sustained improvement in health outcomes for our citizens 11. ARCH will see the creation of health campuses: the Singleton Health Campus which will integrate a number of strategic initiatives enabling significantly more care to be provided outside an acute hospital and developing seamless care pathways with primary care and the Morriston Health Campus: a major acute health and science centre for the South West Wales region. Additionally, there will be the development of facilities and services across Hywel Dda to support both existing and innovative healthcare delivery for their population including the creation of ILS@Hywel Dda 12. Underpinned by research excellence in the partner SU Colleges and broader networks, ARCH will develop and translate leading healthcare innovation to the benefit of the population of the region and beyond 13. Working in partnership with key stakeholders across the Swansea Bay City Region, ARCH will deliver an integrated regional approach to addressing its economic and health needs. 14. The intention is for ARCH to become active from 2015 onwards, delivering a combined impact which is far greater than the sum of its parts. 15. ARCH has been designed to act as an umbrella - individual elements can be taken forward independently as funding becomes available. ARCH organises, enables and enhances the health and wellbeing economy. Regional Collaborative Health, Social Care & Wellbeing Model ARCH will deliver a holistic regional model for health built on the principles of cooperation and collaboration across Hywel Dda UHB, ABMU HB and Swansea University. The core of this model is based upon establishing a relationship with our citizens, working together to develop local values, focused on the health and wellbeing of our communities. Working with the wider public, third and private sectors, ARCH will develop and implement in new service models based on the principle of care being provided closer to home. Expanding access through the development of new infrastructure and redeveloping and redefining the use of existing infrastructure will radically transform patient pathways across the region. Within this new model our Hospitals will be dedicated to those who are acutely unwell and require specialist care. When required, this will be delivered in environments which are comparable with the best in the world delivering improved patient outcomes within this holistic model, always supporting improved health and enabling care closer to home. ARCH is fully aligned to the Integrated Medium Terms Plans for both ABMU and Hywel Dda Health Boards. ARCH is the vehicle that develops and enables the regional collaboration to deliver for the populations of South West Wales. ARCH: A Regional Collaboration for Health P a ge 2 o f 49 1. Vision A Regional Collaboration for Health V ision Statement A n integrated, open, collaborative health and life sciences regional ecosystem, delivering high quality patient care, developing healthcare and life science professionals, working locally with a global perspective for the sustainable benefit of the health, well-being and wealth of South West Wales a nd beyond. We will improve population health by reducing variation and equalising access t o excellent care, and promote a vibrant economy through investment, innovation and sustainability of employment. Radical and innovative solutions for challenges insurmountable with traditional approaches. Regional ARCH covers six Local Authority Boundaries, Ceredigion, Pembrokeshire, Carmarthenshire, Bridgend, Neath Port Talbot and Swansea. There is a complex set of boundaries across the different sectors of the Economy but ARCH will deliver benefits across all six Local Authority areas. Welsh Government has established the Swansea Bay City Region to offer a new approach to economic regeneration; - Larger and more efficient labour markets; - Scope for better planning; - Better prospects for attracting investment, innovation and value added economic activity. The Swansea Bay City Region brings together business, local government and a range of other partners, working to a common goal of creating economic prosperity for the people who live and work in our City Region. ARCH interprets and applies the vision and aims of the City Region for the wider Health Economy including service delivery, education, and the Life Sciences and Health economic sectors. Collaboration The WG Minister for Health and Social Services has made Prudent Healthcare embracing the approach of co- production a key principle of healthcare strategy. ARCH takes this philosophy a step further, embracing service delivery, education, skills and talent development, research, innovation, translation and economic development within one integrated health ecosystem. Such a radical innovation would truly break the mould allowing new solutions to challenges that are proving insurmountable with traditional approaches. ARCH seeks to capture the opportunity to radically re-engineer disparate activities into one integrated innovative strategy to enable co-production in a much broader domain. ABMU, Hywel Dda UHB and SU are all significant actors, innovators, employers and influencers over the health, well- being and wealth of the region, which is manifested in a number of ways. There is already collaborative work delivering measurable benefits in terms of service delivery, education, research, innovation, and enterprise. It is natural therefore that these partners lead the development and delivery of the ARCH strategy. Clearly, this cannot be achieved without embracing all entities currently active in the health economy, within an inclusive dynamic strategy. Health In line with the Welsh Government Public Health Strategy, ‘Our Healthy Future’, improving the Health of the Communities in South West Wales is at the heart of the ARCH Programme. ARCH recognises that fundamental to excellence in health for the individual and our communities is ensuring the provision of: - Excellent health services, focused on keeping people well and caring for them as close to home as possible, with in-patient care delivered from high quality hospitals where necessary; - Education and skill development for the population, recognizing distinctive rural and urban need; and - Meaningful employment. ARCH delivers solutions to the main commitments set out in Together for Health, Prudent Healthcare, the Primary Care Delivery Plan, the emerging e-health strategy, the South Wales Programme, the Mid Wales Healthcare Collaborative and the Future Hospitals Commission: - Service modernisation, including providing care closer to home and developing specialist ‘centres of excellence’; - Addressing health inequalities; - Better IT systems and an information strategy ensuring improved information, access and care for patients; - Improving quality of care; - Developing the workforce of the future; - Coproduction with the our citizens; - A changed financial regime. ARCH addresses each of these commitments in an innovative way that extends the interface between health service provision and the knowledge economy of the region to drive improvement in our population’s health. There is also an undoubted reciprocity in that innovation offers solutions to the challenges of health service provision and actors in the health service are a largely untapped source of innovation for economic and commercial benefit. ARCH: A Regional Collaboration for Health P a ge 3 o f 49 2. National and Regional Context A Regional Collaboration for Health National Context The Welsh Government’s priorities are clear: - better IT systems and an information strategy - growth and jobs ensuring improved care for patients - educational attainment - workforce development - improving health and well-being for all of our - A changed financial regime – comments as before. citizens The South Wales Programme (now the NHS Wales - support children, families and deprived Collaborative) created three Acute Care Alliances, communities. based around three “major acute” centres. One, at Morriston Hospital (Morriston Health Campus), for the ARCH – A Regional Centre for Health will directly support citizens of ABMU and the Hywel Dda and South Powys Welsh Government in the delivery of these priorities. Health Board areas. The work of the South Wales Health The Innovation Wales Strategy (2014) confirms the vital and Pathology Collaboratives will place even greater role that the life sciences and health sector has for importance on Morriston as centre for care. business growth, but also in delivering significant social The Andrews Report “Trusted to Care” emphasised the and economic benefits, which offers a dual gain. It notes need to eliminate variable standards of care, improve that changing demographics of the country are creating the culture of care, involve and empower patients and a different demand for care – which in itself drives carers in all aspects of their care and service innovation through technology, new treatments and new development, improve the level of suitably qualified ways of delivering care. Organisations in Wales need to motivated staff day and night and Improve leadership identify these opportunities and identify ways of and accountability as part of joining up the strategies exploiting these areas of advantage. on workforce and capacity development, patient safety and quality. Innovation has been at the heart of the NHS since its creation. The NHS “works at the limits of science – Mid Wales Healthcare Collaborative seeks to ensure that accessible and high-quality healthcare are bringing the highest levels of human knowledge and skill provided for the population of Hywel Dda given its to save lives and improve health. It touches our lives at geography in terms of rurality and demographics. times of basic human need, when care and compassion are what matter most.” But whilst NHS staff are good at The Primary Care Delivery Plan challenges organisations identifying innovations and new treatment methods that to develop a more “social” model of health, which lead to better outcomes and improve the health of the promotes physical, mental and social wellbeing, rather than just the absence of ill health and draws in all population, wide implementation can sometimes be relevant organisations, services and people to ensure frustratingly slow. The NHS is identified in Innovation Wales as “a sleeping giant” in these developments – this the root causes of poor health are addressed. ARCH will support the principles of this plan by enabling a partnership, provides just such an opportunity for focus on exploiting these opportunities. - Prevention, early intervention and improving health, not just treatment Strategic Health Context - Co-ordinated care where generalists work closely The strategic drivers below describe a transformed Health with specialists and wider support in the community Economy. This prospectus will demonstrate how ARCH to prevent ill-health, reduce dependency and will enable this transformation to become reality at pace. effectively treat illness - Active involvement of the public, patients and their Together for Health commits the NHS in Wales to: carers in decisions about their care and wellbeing. - addressing health inequalities Our Healthy Future sets the Public Health agenda for - instigating a ‘compact with the public’ Wales. It calls for a commitment to improve the quality - service modernisation, including provided care and length of a healthy life for all people in Wales. It closer to home and developing specialist ‘centres of makes recommendations across the life course excellence’ with improved quality of care. emphasising prevention and early intervention with a focus on our most deprived communities; all based on a foundation of research and evidence. ARCH: A Regional Collaboration for Health P a ge 4 o f 49 N ational and Regional Context A Regional Collaboration for Health Health Economy The Social Services and Wellbeing Act ensures that all The Minister of Economy Science and Transport has defined Public Authorities play their role in improving the outcome 9 Key Sectors for the Welsh economy and they are: for people and the carers who need care and support Advanced Materials and Manufacturing; Construction; and focuses the public organisations on the prevention Creative Industries; Energy and Environment; Financial and agenda in order to promote wellbeing. Professional Services; Food and Farming; Information and The Future Generations and Well Being Bill sets an Communication Technology; Tourism; and Life Sciences. ambitious, long-term goals to reflect the Wales we want to see, both now and in the future. These are for a Each Key Sector is led by a Sector Panel charged with prosperous; resilient; healthier; more equal Wales; with advising the minister regarding strategic priority. This national cohesive communities; and a vibrant culture and thriving strategy has seen the creation of the Life Sciences Hub Welsh language. ARCH has, as a primary aim, the goal of Wales, the Arthurian Life Science Fund, The Life Science delivering a more equal and healthy society. It will use Bridging Fund, The Sêr Cymru Research Network, in all of research, service provision and education to improve which the ARCH partners have a governance and strategic prosperity and reduce inequality. role. Prudent Healthcare: It is accepted that the challenges of The life science and health sector in Wales employs 11,000 rising costs and increasing demand, while continuing to high-value people in more than 350 companies. improve the quality of care requires transformed methods Overwhelmingly, these companies are SMEs with a modest of service delivery. number of large global enterprises creating significant employment. The majority of economic activity is in a sub- The Bevan Commission, with others around the world, has set of Life science called Medical Technology (often referred challenged the NHS in Wales to adopt the principles of to as Medtech or Healthcare Technology). Life science, and prudent healthcare. Prudent healthcare puts NHS Wales at particularly Medtech, is also characterised by the fact that it the front of a growing international effort to get greater integrates with other key sectors, particularly ICT, advanced value from healthcare systems for patients. manufacturing and tourism. As this prospectus will show Prudent health principles are at the heart of the ARCH Programme. Not least through the ARCH builds upon and embeds the Institute of Life Science Wales Centre for Prudent Health Care being an integral which in the first 10 years of its existence has supported the part of the collaboration. creation 800 new high-value jobs within the sector, as well as supporting the creation of 50 new enterprises, actively Rural Healthcare Plan and the Mid Wales Healthcare assisting 425 enterprises and attracted more than £50m of Collaborative: Many of the factors and conditions incremental inward investment. ARCH therefore has a affecting health and well-being in rural South West Wales proven track record of innovation, translation and are also common to urban communities. Yet there are entrepreneurship within the life science sector. many factors and conditions whose effect in the rural The ILS has also created a research and translation community is harsher than in the urban setting. The environment which houses the UK Centre for Mass circumstances of the individual are compounded by the Spectrometry, the MRC Farr Institute, the ESRC Administrative reduced capacity of the rural community to alleviate that Data Research Centre, the MRC CLIMB Centre, the Centre person’s hardship. Later in this document, ARCH explores for NanoHealth, the SAIL Databank, and other Centres of how some of these issues can be transformed through a Excellence which were acknowledged in REF2014 as being different approach to managing health in rural settings. 100% world-leading. Skills Much has been written about lack of integration in the education and skills development system across the UK and in Wales. ARCH seeks to address this identified need for change. The region has 3 universities, a number of Further Education colleges, provision within the NHS and provision within the private sector. The life science sector requires a specialist multidisciplinary, interdisciplinary, skilled, motivated and inspired workforce. The region, therefore, represents a unique environment to design a collaborative, integrated skills development strategy to support and sustain the vision. The Minister for the Economy, Science and Transport has approved the establishment of the All Wales Life Science Skills Group with the region playing a major role, recognising the emergence of a stakeholder-informed strategy to respond to the identified need for change. Hywel Dda UHB has strong historical links with all three Universities in the region. As well as the links built upon the professional education delivered through Swansea University, the UHB has forged partnership working with Aberystwyth University and University of Wales Trinity St David’s, through partnership arrangements around rural health and wellbeing developments, and through formal membership of Universities, along with Swansea, onto their R&D committee. A RCH: A Regional Collaboration for Health P a ge 5 o f 49 3. Partners and Stakeholders A Regional Collaboration for Health ARCH This scoping prospectus has been developed as a truly joint venture between ABMU and Hywel Dda UHB Health Boards and Swansea University who see themselves as equal partners in this development. The partners see their role as developing and delivering the initiative by serving the needs of the citizens of Wales placing them at the heart of the vision. The outcomes and impact of ARCH will be sustained through a co-production ethos delivered in collaboration with a range of stakeholders. ARCH has consciously adopted the following definition of Partner and Stakeholder for this prospectus. Partner: organisations with which a department works to deliver their objectives, with a formal agreement of roles which may often be a long-term relationship (HM Treasury 2004) Stakeholder: A stakeholder is a person or group having an investment or interest in an enterprise. They may share in some risk or reward, particularly if their investment is monetary, but what they stand to gain may not be tied directly to their contribution in the same way as that of the project partners. Stakeholders are often those who are vested in how a project is designed and whether it is successful, but they may not have direct responsibilities and tasks that influence project completion. (US DOJ 2014) A world-class health and wellbeing Economy for the region ARCH: A Regional Collaboration for Health P a ge 6 o f 49