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Eich cyf

Yr Adran Iechyd a Gwasanaethau Cymdeithasol
Cyfarwyddwr Cyffredinol • Prif Weithredwr, GIG Cymru

Department for Health and Social Services
Director General • Chief Executive, NHS Wales

Darren Millar AMChairPublic Accounts CommitteeNational Assembly for WalesCardiff BayCardiff GOVERNANCE ARRANGEMENTS AT BETSI CADWALADR UNIVERSITY LOCAL

During my appearance before the Public Accounts Committee on 18 July. I agreed to send you several pieces of additional information.
Cost of Chris Hurst’s Work for the Health Board
Chris Hurst undertook two days work for Betsi Cadwaladr at a total cost, including VAT, of £2,800 plus expenses (paid at Welsh Government rates). I understand that the rate agreed for Mr Hurst’s work was recommended by Welsh Government’s recruitment consultants Odgers Berndtson.
Date of Chris Hurst’s Departure from Welsh Government
Chris Hurst resigned and left his role in Welsh Government as Finance Director for the Department of Health and Social Services on 31 December 2011.
Details of the escalation process for concerns about Local Health board
I attach at Doc 1 a copy of the Escalation Process as set out in the Delivery Framework.
Terms of Reference for the report prepared by Allegra
The formal Terms of Reference for the Allegra Report are attached at Doc 2.
Expenditure by Betsi Cadwaladr University Health Board on Salary Protection
We are currently seeking the most update information on expenditure on salary protection for the Local Health Board. I will arrange for this to be sent you as soon as possible.
Definition of “Core Capacity” and Impact of unscheduled care on Core Capacity.
I was asked to provide information regarding `core capacity’. In relation to surgical operations this comprises the theatres and beds which are generally designated or assumed to be available for planned activity. Clearly the theatres and beds are supported by budgeted staff and non-pay resources. Health Board will plan activity levels with reference to the capacity and will schedule admissions and operations accordingly. The core capacity will not take account of potential ‘additional activity’ which is secured either within the organisation through waiting times initiatives or externally by, for example, the use of other NHS providers or the independent sector. Such activity normally incurs additional, premium costs above those included in planned budgets.
I was also asked to clarify the impact of unscheduled care on core capacity. During the Winter and early Spring of 2012/13 there was a high level of demand for unscheduled care. This occurred across the UK. Our Health Boards opened additional beds but also usedsome of the core elective capacity for patients admitted as emergencies. This led to cancellations of planned activity. Health Boards did reinstate some of the cancelled activity and took decisions in this regard which were guided by clinical priority.
As stated above this additional activity was more costly and required the application of additional funding. The ability of Health Board to fund such activity was determined by the amount of money available to them in the context of their statutory financial duties.
David Sissling
2. Escalation within the Delivery Framework
Escalation Action
None required – earned autonomy (including potential for reducing all targets and/ or the frequency of Q&DM) and minimal monitoring beyond that required within trajectory.
for national returns.
Proactive assurance mechanisms.
Boards/Trusts fail responsible for remedial action in response to areas DSU (or other of failure. WG indicates the intervention the position with immediate implementation of plans and effectiveness of solutions.
Executive highlight report.
Support from other agencies if required.
other intervention. WG and to join regular involved in determining the response with DSU required outcomes through mechanisms.
regular meetings/calls.
and/or a failure to Executive NHS Wales. Actions to be determined by NHS Chief Executive which may include Meeting required with Chair, Vice Chair, CEO, Board Secretary Introduction of `special measure’ arrangements.
Removal of appropriate funding streams.


Name of treatment regimen

University Hospitals/Ireland Cancer Center Sickle Cell Inpatient Treatment Guidelines Supportive Care Sickle Cell Guidelines • If patient is hypovolemic on admission, hydrate with Normal Saline @ 300 - 500 • If patient is euvolemic on admission or becomes euvolemic after hydration, hydrate with D5W1/2NS at 75-125 ml/hr continuously. Laboratory/Radiology All patient


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