When trauma and orthopaedic patients in Cardiff faced long waits and poor experiences, Consultant Trauma and Orthopaedic Surgeon Oliver Blocker saw a better way. Drawing inspiration from successful medical models of Ambulatory Emergency Care (AEC), he developed a new approach to deliver same-day trauma and orthopaedic care — improving outcomes for patients while reducing system pressure.

Supported by the Bevan Exemplar Programme, Oliver’s project established Wales’s first dedicated Trauma Ambulatory Care Unit at the University Hospital of Wales, creating a blueprint that has since been adopted and adapted across multiple health boards.

The Challenge

Before the project began, trauma and orthopaedic patients — particularly those with hand injuries — often faced inefficient pathways and unsuitable environments. External factors further accelerated the need for change: public attention following social media posts about poor patient experiences and a Health Inspectorate Wales review that confirmed the need for urgent change.

Oliver recognised that these patients did not always require full admission but did need timely, specialist assessment and treatment. Inspired by the medical AEC model, he proposed a dedicated trauma ambulatory care pathway where patients could receive rapid evaluation, minor procedures, and follow-up within a single, purpose-designed space.

The Innovation

The project aimed to redefine how trauma care was delivered, creating a safe, efficient system for same-day assessment and treatment. With the support of hospital management, an appropriate space was identified within the newly redeveloped area of University Hospital of Wales.

The proposal coincided with national momentum around the Same Day Emergency Care (SDEC) agenda — a national policy shift to manage more urgent cases without admission.

Supported by the Bevan Commission and with external factors driving the change, the new unit opened its doors within a year— a remarkable turnaround for a service redesign of this scale. The speed and success of the launch exceeded expectations, but the real test came when the world changed.

Lasting Impact

When the COVID-19 pandemic struck, the unit’s flexibility and focus on safe, same-day care became invaluable. It played a pivotal role in maintaining trauma services safely when hospitals across Wales faced significant disruption. The model proved so successful that it was later showcased in the Journal of Trauma and Orthopaedics.

When Oliver moved to Betsi Cadwaladr University Health Board (BCUHB) as a consultant, he took the model north as part of the Bevan Commission’s Adopt and Spread Programme, securing £45,000 of funding to support implementation. There he quickly became SDEC project lead. He established a new SDEC service in Bangor, expanded a surgical SDEC in Glan Clwyd, and helped develop similar models in Wrexham.

The results were transformative, reshaping how urgent orthopaedic care was delivered and experienced. Patients benefited from faster access to treatment and fewer unnecessary admissions. Staff reported better workflow, improved teamwork, and increased job satisfaction. The trauma ambulatory care model also demonstrated measurable improvements against national benchmarks and significantly enhanced the patient experience — a testament to the power of clinician-led innovation.

Enablers and Lessons Learned

Oliver credits the Bevan Exemplar Programme as a crucial enabler. The structured support, coaching, and networking opportunities provided the confidence and practical tools to turn an idea into reality.

“The Bevan Commission gave me everything I needed — the skill set, support, and problem-solving expertise to build the original project,” he reflected. “That same project document is now being used by other health boards to develop their own services.”

The £45,000 of Bevan funding also allowed protected time for engagement, planning, and evaluation — an essential factor in proving the model’s value. As the approach became established within routine practice, not all of the planned funding was needed, demonstrating excellent value and sustainable transformation.

He notes that timing and national alignment were key. “It almost perfectly fitted with the ideas I already had,” he said. “When you’re in the right place at the right time, with the right support, you can move mountains.”

Reflections on the Bevan Exemplar Experience

Oliver describes his time as a Bevan Exemplar as “transformational” — shaping not only his project but his professional identity.

“It’s changed me completely,” he said. “I wouldn’t be the same consultant without it. It’s given me the insight into how the NHS really works and the tools to make change happen.”

He explains that the programme offered far more than project support — it provided a deep understanding of systems, strategy, and the art of navigating complex structures. “It gives you that insight into how the system really works and how to work around the barriers that usually drive people to frustration,” he reflected.

He likens the experience to gaining an elite skill set. “It’s like moving from being a soldier to a Navy SEAL,” he said. “Everyone can do their job well, but this gives you that extra level of understanding that lets you do things differently. People ask how I’ve managed to make things happen — it’s because I know how, because I was trained.”

That ability to see the system clearly, anticipate challenges, and navigate them strategically, he believes, is what makes Bevan Exemplars stand out as leaders of change across health and care in Wales.

He also highlights the value of the Bevan family — a continuing network of innovators who share challenges, solutions, and encouragement across Wales. “It’s that community of people who’ve been through it before — people who get it,” he explained. “We still support each other, years later.”

Those lessons and connections have continued to shape Oliver’s approach to change, influencing new models well beyond Cardiff.

Wider Adoption and Influence

Since its inception, the trauma ambulatory care model has attracted interest from other Welsh health boards and even colleagues in England. The original project documentation has been shared with Hywel Dda University Health Board to inform the development of their own service, and national orthopaedic networks continue to reference the work as an example of good practice.

Oliver’s experience also informed his leadership of high-volume, low-complexity surgical pathways in Abergele, establishing cross-site collaboration that now enables around 20 surgeons from across North Wales to deliver elective procedures more efficiently. This model is now informing broader transformation plans within the health board.

What’s Next

While Oliver has since stepped back from his formal SDEC leadership role, the impact of his work endures. The units he helped to establish continue to deliver faster, more efficient care for trauma patients, and the infrastructure remains in place for future growth.

He is now focusing on innovation in theatre productivity, exploring new surgical techniques and workflow redesigns to increase capacity and reduce waiting times for joint replacement surgery — building once again on the skills and mindset developed through the Bevan Exemplar experience.

A Lasting Legacy

From a single idea in Cardiff to implementation in North Wales, Oliver Blocker’s journey exemplifies the power of clinical innovation, strategic alignment, and perseverance. His work continues to inspire others to reimagine care — proving that with the Bevan Commission behind you, there really are no limits to what can be achieved.

When long referral processes and growing waiting lists left patients and staff struggling, Clinical Lead Occupational Therapist at Betsi Cadwaladr University Health Board (BCUHB), Heather McNaught, set out to find a better way. Supported through the Bevan Exemplar Programme, Heather and her team developed a project to align Occupational Therapists (OTs) directly within GP practices — delivering timely, person-centred care closer to home. The result was shorter waits, stronger relationships, and better outcomes for both patients and professionals.

Tackling Long Waits and Frustration

Community OT services across North Wales were facing long delays caused by complex referral systems. Referrals were initially handled through a Single Point of Access (SPOA), where they were triaged between health and social care before being passed to community teams. This multi-step process meant patients often waited up to six weeks before even being added to the waiting list, with routine waits averaging 13–14 weeks in total.

While urgent cases were prioritised, many patients with routine needs deteriorated during the wait or tried to manage independently. Staff were frustrated and morale was low. It became clear that the process needed to be redesigned to provide faster, fairer access to occupational therapy support.

A New Model: Embedding OTs in Primary Care

The disruption caused by the COVID-19 pandemic offered an opportunity to rethink how care was delivered. Heather and her team piloted a model aligning OTs directly within primary care clusters, creating a more visible and accessible presence for both GPs and patients.

Working with a supportive Clinical Director who was also a practising GP, the team introduced a dedicated email mailbox for direct health-to-health referrals, simplifying the process and removing the reliance on paper-based systems. Referral forms were streamlined, criteria refined, and OTs began attending practice meetings to offer advice and early input.

Being embedded within GP practices helped build strong working relationships and raised awareness of the OT role in supporting patient independence. Following the success of the pilot, the model was scaled up across Wrexham and parts of Flintshire, supported by the Bevan Exemplar Programme.

“It wasn’t about new money or resources,” Heather explains. “It was about working smarter — changing the pathway, strengthening relationships, and bringing care to where it was needed most.”

Improving Access, Experience, and Wellbeing

The redesign led to significant improvements in access and efficiency.

• Average waiting times reduced by nine weeks, with the longest waits now around four weeks.
• Time from referral to receipt improved from 10 days to 1.5 days.
• Assessment-to-discharge times shortened from 17 weeks to nine weeks.
• Urgent referral rates fell from 6.5 per week to 2.5 per week.

 For patients, faster access meant earlier intervention and greater independence:

• 52% reported a major improvement in their main complaint, with a further 33% reporting moderate improvement.
• 63% said the service had a major impact on their ability to bathe independently.
• 64% regained confidence leaving and entering their homes.
• 72% were able to access toilet facilities independently.
• 75% reported overall improvements in wellbeing and reduced dependence on others.

Behind these figures are people regaining the confidence to live independently — from showering safely to leaving their homes without support.

For staff, morale rose significantly. Working within GP practices gave OTs greater autonomy and more direct collaboration with other health professionals. The ability to communicate through systems like EMIS and attend cluster meetings helped break down silos and improved multidisciplinary working. The service remained cost-neutral to GP practices — achieved by reallocating existing resources rather than increasing staffing or expenditure.

Reflections on the Bevan Exemplar Experience

Participation in the Bevan Exemplar Programme provided the team with the structure and momentum they needed to move from local pilot to sustainable service change. The programme helped them to measure impact systematically, share results effectively, and showcase their learning across Wales.

The project was subsequently showcased at several events, inspiring other teams to rethink their referral pathways and consider the benefits of embedding allied health professionals within primary care. The experience also encouraged Heather to take on a national role as Co-Chair of the All Wales Primary Care OT Network, helping to share good practice and connect services across health boards.

Next Steps and Future Ambitions

Building on the success of the Bevan Exemplar project, BCUHB has since secured Welsh Government funding for early-intervention OTs to work with people living with heart failure and other long-term conditions in primary care. These posts focus on prevention and condition management — keeping people well for longer and reducing hospital admissions.

At the same time, the community OT team continues to evolve. With shorter waiting lists and more efficient pathways, they now have the capacity to focus on proactive and preventative interventions rather than reacting to crises. Heather’s goal is to strengthen the role of occupational therapy in addressing gaps in community provision, aligning closely with Wales’ commitment to prudent and value-based healthcare.

Sustainability remains high, with staff fully engaged and motivated to maintain the improved model.

A Lasting Legacy

From long waiting lists and frustrated staff to a proactive, responsive, and patient-centred service, this project exemplifies the power of innovation from within. By embedding OTs into primary care, Heather and her team have shown how small, intelligent changes can transform the way services are delivered and experienced. The skills and knowledge from the Bevan Exemplar programme have continued to support ongoing service change, improving patient outcomes and staff experience.

This work reflects the very essence of the Bevan Exemplar ethos — empowering frontline professionals to identify challenges, test solutions, and deliver prudent, sustainable change. Its success stands as a model for how innovation rooted in everyday practice can strengthen the health and care system across Wales.

Transforming health and care sometimes begins by asking whether the current system truly meets people’s needs. For Natasha Bold, Highly Specialist Speech and Language Therapist at Cwm Taf Morgannwg University Health Board (CTMUHB), the answer to that question led to a complete rethink of how to support children with social communication differences.

The project, Building Blocks for Communication, developed through the Bevan Commission’s Planned Care Innovation Programme, introduced a new pathway focused on empowering families, adapting environments, and strengthening early years support.

Rethinking the Pathway

Speech and language therapy is often one of the first services children are referred to when concerns about social communication difficulties or early signs of Autism arise. However, a significant proportion of referrals were for children at a pre-intentional stage of development—before they were able to communicate purposefully. For these children, direct therapy was unlikely to deliver the outcomes families hoped for.

Natasha and her team set out to design an alternative approach. Building Blocks for Communication replaced early one-to-one therapy with parent workshops, where families could learn practical strategies, share experiences, and build confidence. Alongside this, early years practitioners received training to create supportive environments and embed consistent strategies in everyday settings.

This shift in focus—from providing therapy to the child, to equipping the people around them—ensured children were supported holistically, while managing demand on overstretched services.

Impact for Families, Staff and Services

The outcomes of the project have been significant:

• Families empowered – Parents consistently reported greater understanding of their child’s needs, reduced stress, and increased confidence in supporting communication. Many valued the peer support that group sessions provided.
• Better prepared referrals – Families arriving for later therapy stages came with clearer expectations and stronger foundations for direct work, enabling more effective interventions.
• Service efficiencies – Caseloads reduced as families were supported earlier and more appropriately. Time savings allowed staff to focus on children most likely to benefit from direct therapy.
• Skilled workforce – Early years practitioners reported increased confidence and knowledge, extending the benefits beyond individual families to wider community settings.

The model has been recognised by colleagues across CTMUHB as one of the service’s most impactful initiatives, with staff noting improved outcomes and renewed professional satisfaction.

Wider Adoption and Influence

The success of Building Blocks for Communication has extended beyond its initial pilot; it is delivered as part of the core service. Flying Start services across CTMUHB have adopted and adapted the model, offering support even earlier in children’s journeys. Families now benefit from more consistent, joined-up provision, reducing pressure on core services.

At a national level, Natasha was invited to co-chair the All-Wales Social Communication Pathway Group, where the project has informed wider strategic work. The approach has also attracted interest from other health boards and even colleagues in England, reflecting its potential to be scaled and spread more widely.

The Bevan Exemplar Experience

Natasha credits the Programme with providing the platform and momentum to drive her project forward. The structured support, mentoring, and peer network not only helped shape the project, but also gave her the confidence to share it more broadly.

“It was like you were part of a family. You were all in it together. You wanted everyone to do well, and were excited for them. Even when it was a bit stressful, you had a cohort of people that were experiencing similar things that were difficult. The Programme kept me on track, opened doors across Wales, and gave me the confidence to share what we were doing,” she explains. “It also sparked a lasting interest in quality improvement and leadership, which I’ve continued to develop in my career.”

Looking Ahead

The next step for Building Blocks is embedding it further upstream, ensuring families can access support as early as possible. Strengthening collaboration with Flying Start services is a key focus, alongside influencing the development of national pathways that recognise and support children with social communication differences more effectively.

Natasha’s long-term ambition is for this approach to become part of standard practice across Wales, so that every child is supported in a way that reflects their individual communication needs.

Conclusion

The Building Blocks for Communication project demonstrates how innovation can transform services by focusing on prevention, empowerment, and partnership. By shifting the model of care towards families and practitioners, Natasha Bold and her team have created a pathway that not only improves outcomes for children but also builds resilience in services.

It is a clear example of the Bevan Innovator ethos in action: tackling persistent challenges with new thinking, and shaping a health and care system that is both person-centred and sustainable.

Further information on the project, including resources can be found here: Building Blocks for Communication Course – Cwm Taf Morgannwg University Health Board