CORPORATE PLANNING AND POLICY FRAMEWORKS

Transcription

1 CORPORATE PLANNING AND POLICY FRAMEWORKS FEBRUARY 2010

2 CORPORATE PLANNING AND POLICY FRAMEWORKS FEBRUARY 2010 INDEX Introduction... 3 Planning Frameworks Acute Services Planning Framework Adult Mental Health Planning Framework Alcohol and Drugs Planning Framework Cancer Planning Framework Disability Planning Framework Long Term Conditions Planning Framework Maternity Planning Framework Older People Planning Framework Primary Care Planning Framework Sexual Health Planning Framework Unplanned Care Planning Framework Policy Frameworks Introduction Employability, Financial Inclusion and Responding to the Recession Policy Framework Health Improvement Policy Framework Quality - Creating a Person Centred and Mutual NHS Policy Framework Sustainability Policy Framework Tackling Inequality Policy Framework Unpaid Care Policy Framework Appendices Appendix 1: Three Year Outcomes Approach Appendix 2: Lead Directors for Planning Frameworks Appendix 3: Standard Structure for Plans Appendix 4: Cost Savings Proposals Appendix 5: Equalities Template for Cost Savings

3 INTRODUCTION INTRODUCTION 1. INTRODUCTION AND STATEMENT OF PURPOSE 1.1 This document provides detailed guidance for planning round and brings together the Corporate Planning and Policy Frameworks which have been developed as a primary output of our collective review of the planning system. There is significant further work to do to implement all of the conclusions of the review but this paper provides the basis to progress planning across the organisation. 1.2 It is important to state the purpose of planning and its context. The primary purpose of our organisation is to enable us to deliver effective and high quality health services, to act to improve the health of our population and to do everything we can to address the wider social determinants of health which cause health inequalities. 1.3 The clear focus for planning is to make us more effective in achieving this primary purpose and the related priorities and objectives. Planning should enable us to identity the critical problems and to define and implement the change required to address those problems. Planning is about driving change, including the change required to ensure stability and address the challenges which we face. 1.4 Effective planning matters because it provides the means for us to deliver the transformational change to which we are committed and to ensure we: - address the substantial financial, health improvement and inequalities challenges which we face; - ensure that we do the right things in the most effective way; - create coherence across a complex organisational delivering millions of individual transactions in a vast range of settings; - have a credible and clear narrative for our population, partners and government on how we are intending to deliver our organisational purpose; - engage staff in the development of that narrative to ensure that they can contribute to the direction of the organisation and the services in which they work. 1.5 An effective, transparent and coherent system of planning which relates our organisational imperatives and commitments to financial decision making is particularly important as we enter a prolonged period of highly challenging resource constraints. 1.6 The principles which underpin the current planning process are not changed by the reframing of the planning system. They remain that: - the primary focus for planning lies within the Partnerships and the Acute Division which produce three year plans, updated annually; - Partnerships and the Division are not just about service delivery but also have critical responsibility for their own planning and contributing to whole system planning; - the planning resource is distributed and devolved to reflect that focus; - Heads of Planning and their teams primary function is to provide support and specialist advice to senior management teams and to manage the process of developing plans, ensuring the plan is a continual point of reference and is underpinned by appropriate performance management and reporting routines; - senior management teams in each part of the organisation, led by Directors have the primary leadership role for planning; Directors also have cross system leadership roles; 3

4 INTRODUCTION - performance management should operate within each part of the organisation and corporate performance management should ensure that there are clear lines of accountability for delivery of our headline commitments; - key performance indicators will reflect the objectives and outcomes established in the planning process and performance on those indicators will also inform the continual cycle of planning and review; - CHCPs and CHPs lead joint planning with Local Authorities and provide the NHS input to community planning and single outcome agreements. 1.7 While we continue to have a devolved model of planning and leadership of planning the Corporate Planning and Policy Frameworks which are embedded within this document set out commitments which bind and are to be delivered by the whole of our organisation. 2. THE FRAMEWORKS AND THEIR PURPOSE 2.1 The Framework based approach to planning and policy is intended to address the lack of collective and clear direction in a number of critical areas of activity. The approach also signals a shift to outcome based planning where we establish clear outcomes we will deliver the three year planning cycle, signal the changes and actions which are required to deliver those outcomes and report through performance management routines our progress in delivering on those outcomes. Appendix 1 describes the outcomes based approach in more detail. 2.2 The Frameworks developed under each of these headings bring together service, care group, disease and delivery system issues. Alongside the Planning Frameworks we have established a number of Policy Frameworks - in essence these develop and articulate our approach to issues or areas of activity which require to be read across into all of the corporate and local planning processes. The Policy Frameworks establish outcomes which need to be achieved across the organisation in all of our plans. 2.3 These Frameworks coverage is based on national requirements, where there is a need for whole system planning and as covering primary priorities for NHSGGC. Planning Frameworks - Acute Services - Adult Mental Health - Alcohol and Drugs - Cancer - Children and Young People s Services - Disability - Long Term Conditions - Maternity - Older People - Primary Care - Sexual Health - Unplanned Care Policy Frameworks - Employability, Financial Inclusion and Responding to the Recession - Health Improvement - Quality - Creating a Person Centred and Mutual NHS - Sustainability - Tackling Inequality - Unpaid Care 2.4 The Frameworks are not plans but set the context and direction within which each part of the organisation will develop its plan. They require input and commitment from the whole organisation and reflect other key corporate documents including the DPH report. 2.5 We also see a two-way flow of influence and direction between the planning and Policy Frameworks and the plans, strategies and policies developed with each Local Authority. 4

5 INTRODUCTION The planning and Policy Frameworks will also provide a basis for NHS input to community planning and SOAs. 2.6 A range of Directors led development of the Frameworks - Appendix 2 lists the lead Directors. 2.7 These Frameworks will provide sufficient direction for the 2010/11 planning round and will be updated and developed during the first year of that planning round. They are primarily a consolidation and articulation of known and existing material and provide clarity of corporate direction on key areas of activity. 2.8 It has not be possible to have a full consultation exercise in this initial development round and it will be important to ensure that: - key stakeholders are aware of this first Framework process and the extent to which it will draw on and consolidate existing material which has been informed by wide engagement; - each part of the organisation uses this preparatory part of the planning cycle to engage their key stakeholders so that their views can be reflected, to a degree in the first Framework round; - wider consultation will be built into the review and updating of Frameworks. 2.9 A number of further key points should be made: - the Frameworks are primarily focused on the responsibilities of the NHS but they are an important part of the basis of each part of our system engaging in the critical business of joint service planning with each Local Authority and with wider community planning partners to tackle inequalities and improve health; - the Frameworks have been developed to standard structures; - The expectation is not that local plans will include the totality of the Planning Frameworks but the plans will need to explicitly demonstrate the action that part of the organisation will be taking to deliver the outcomes in each Policy and Planning Framework. 3. DEVELOPING PLANS 3.1 Directors and management teams will run a planning process which will bring together the products of the locally focused work, with the corporate planning and Policy Frameworks to produce a plan which delivers on these new requirements. 3.2 Plans need to: - the primary purpose of the plans is to enable us to run our NHS business but they need to provide a basis to inform and communicate with of a number of different audiences, staff, interest groups and the public on what outcomes NHSGGC will achieve in this planning cycle; - clearly be about change and addressing challenges not describing routine business; - the full plans need to be a primary vehicle to direct and deliver change; - be defined within a clearer set of planning disciplines, the analysis of where we are now, the defined description through analysis and evidence of where we need to be and the how do we get there as a comprehensive and linked set of actions; - set out the contributions to be made to delivering the outcomes expressed in the Corporate Planning and Policy Frameworks; 5

6 INTRODUCTION - be based on an explicit analysis of local services, priorities and needs set out additional outcomes to be achieved over the three year planning period; - describe for the coming year the actions which will be taken to progress towards those outcomes and the intermediate measures of progress which will be delivered during that year. These outcomes will related to service change, reducing inequalities and improving health; - consider the relationship between the Frameworks and how to take a coordinated approach to achieving the outcomes. For example, approaches to long term conditions and primary care and other common changes required across the Policy Frameworks; - in the second and third annual updates, progress against those actions and anticipated intermediate measures will be reported for the previous year; - each plan will set out the key performance indicators which will enable the Partnership or Division to measure their performance and provide the basis of the corporate performance management system; - the Acute Division will produce a short consolidated plan which brings together key cross-division issues and challenges and summarises the outcomes to be achieved across the Division. The individual Acute Directorate plans should set out the contribution to the requirements and outcomes of the planning and Policy Frameworks; - the plans will clearly indicate how financial and workforce resource deployment will change over the period of the plan, directly related to the actions and outcomes identified; - where a Partnership hosts a service the same requirements to lead planning and develop an explicit plan will apply. 3.3 The standard structure for plans is Appendix 3 of this document. 4. RESOURCE PLANNING 4.1 The period from 2010/13 will see significant pressure on public finances and therefore on NHS funding. We are moving from a period of unprecedented growth to a period where substantial reductions in costs will be required across NHSGGC. 4.2 The Frameworks begin to highlight at headline level the changes in workforce and finance which will be required to enable us to deliver the outcomes which are set out for the next three years. We need to integrate this work into the development of a three year strategic financial Framework for the whole organisation and we are working to get to that position. 4.3 The integration of service, workforce and financial planning has been established as a critical objective for planning in each part of the organisation and the Frameworks provide a clearer basis for that work as do the savings templates which have been issued for financial planning, included at Appendices 4 and 5. The key challenge is to target savings as part of the planning process rather than apply a blanket methodology which does not reflect service priorities, relative efficiency and effectiveness or population needs. 4.4 Set out in the rest of this section is an overview of financial challenge we are facing in 2010/ SGHD has recently announced the level of indicative minimum funding uplift which Health Boards can anticipate for 2010/11. For NHSGGC, this is 2.15%. This remains draft budget uplift at this stage which remains to be confirmed following the outcome of the Parliamentary approval process. 6

7 INTRODUCTION 4.6 This is lower than the anticipated rate of growth for almost all the Board s main cost drivers in 2010/11requiring the development of yet another significant cost savings response in order to balance the books in 2010/11. SGHD has already recognised this in making their budget announcement for 2010/11, confirming that they expect Health Boards to generate 2% recurrent cash savings in 2010/11 to secure the achievement of a breakeven financial outturn. As the analysis within section 3 shows, the level of cost savings response required of the Board is 2010/11 is nearer to 3%. 4.7 The likely opening financial position going into 2010/11 has the following elements: Recurring M Non- Recurring M Total M Notes Deficit c/fwd from 2009/10 (24.9) (24.9) Potential funding growth General Expenditure growth (i) Pays (30.8) (30.8) 3. (ii) Supplies and Services (5.6) (5.6) 4. (iii) Prescribing (18) (18) 5. (iv) Capital Charges (7.9) (7.9) 6. (v) Other Providers (4.1) (4.1) 7. (66.4) (66.4) 3. Currently approved service (10.1) (7.0) (17.1) 8. commitments 4. Cost savings plans (i) 2009/10 slippage (ii) 2009/10 FYE Notes: Initial projection of 2010/11 financial challenge (48.4) (7.0) (55.4) 1. This is the total of the original anticipated deficit of 14.9m and additional recurring financial pressure of 10m identified within section 2(ii) above. (Note: The recovery of slippage on the 2009/10 cost savings plans is reflected within section 4 in the table above.after taking account of this; the net additional cost pressure carried forward into 2010/11 is 6m) % general funding uplift. 3. Assume 2.25% general pay increase for staff on A4C terms and conditions together with agreed changes for bands 1-3 and band 5 pay scales, giving an overall rate of cost increase of 2.5%; assume 1.5% increase for all other staff groups. 4. Provision for price inflation on existing contractual commitments and 1% uplift for general inflation/growth. 5. Provision for overall growth of 5.7%, 5% for primary care, 8% for acute based on initial horizon scan of likely prescribing cost growth areas in 2010/11. At this stage, limited account has been taken of potential cost savings opportunities. 7

8 INTRODUCTION 6. Indicative provision for 2010/11 cost growth, relates in the main to 2009/10 capital programme. 7. Assumes payments to other providers are uplifted by 2.15% 8. (i) Listing of currently approved service commitments (recurring costs) Individual Item M Notes 1. C/fwd from 2009/10 (includes Cochlear implants of 0.5m as the largest individual item) 2.8 Sundry prior year commitments, where expenditure commitments not yet underway require to be reviewed, could potentially be restricted by 50%. 2. ACH s 2.0 FYE 3. Bowel Cancer Screening 0.8 FYE 4. Acute Emergency Services 0.4 VOL- FYE 5. Compliance with food/fluid/nutrition policy 6. Agreed changes to R&D funding 1.5 arrangements 7. Renfrew/Barrhead Health 0.9 Centres 8. Other Costs Savings Approach 2010/ FYE A wide ranging programme of reviews is already underway to consider the scope for cost savings across all services and how these might be generated within 2010/11. We are exploring the areas below: - Organisational structures to identify posts which could be declared redundant and where costs could be reduced through redeployment/voluntary severance and the scope for reducing working hours of selected posts within non-frontline areas, including identifying scope for advertising future vacancies on marginally reduced working hours. - The scope for reducing management posts and costs, focusing primarily on corporate services and support structures. - Changing skill mix by replacing higher grade posts with healthcare support workers, with targets to be established and agreed for each service area. - Review of overtime and agency usage is being carried out with the objective of establishing cost savings targets for each service area. - The following areas of service are currently being reviewed to identify the scope for productivity improvement with a view to releasing costs and/or limiting the amount of additional new resource which requires to be provided for within the Board s financial plan. The use of nurse bank will also be reviewed in this context: 8

9 INTRODUCTION - Acute Services; - District Nursing; - AHPs; - Medical Workforce; - Administration support to managers - The scope for accelerating planned savings from the implementation of the Acute Services Review is being explored. - Within Corporate Services, further opportunities for cost reduction are being explored within the following functions: - health and safety; - staff recruitment; - public health; - communications; - research; - clinical governance; - financial services and payroll; - health improvement; - community engagement; - inequalities; - human resources. - The scope for reducing costs related to existing and planned information technology developments is currently being reviewed. - The potential for securing further cost reduction/limiting expenditure growth on acute and primary care prescribing is currently being explored - A further review of the potential for legitimately increasing income received from other NHS Boards in respect of services provided to their patients is being carried out. - Continuing review of Resource Transfer to ensure efficient and transparent use of resources. - The development of a primary care financial strategy which is focussed on agreed priorities and confirmation of scope for release of consequential cost savings. - Review of the potential for release of cost savings within Adult Mental Health Inpatient Services, based on up to date benchmark data. - A review of the potential for the release of cost savings within Elderly Mental Health and Continuing Care beds, and Day Hospital services. - A review of the potential for further procurement related cost savings in 2010/11. - A review of the scope for cost savings within office accommodation including project to relocate corporate HQ to internal NHS accommodation. - A review of the potential for reducing expenditure on transport costs, including potential for shared services within other agencies. 9

10 INTRODUCTION - Each part of the organisation has been asked to look at achieving 2% local savings targets. Over the next two months a firmer financial plan will be developed as the work outlined above in each local planning process is concluded. 5. PERFORMANCE AND ACCOUNTABILITY 5.1 The outcomes based approach will be reflected both in the content of the Corporate Planning and Policy Frameworks and in the plans developed in each part of the organisation. 5.2 The corporate performance system will be reframed to establish: - the requirements of the corporate planning and Policy Frameworks and the commitments in the development plans will be the core element of the corporate performance system and the individual accountability arrangements for Directors; - structured and regular individual sessions between each Director and the Chief Executive will focus on progress on: - delivering plan commitments; - performance measures; - Progressing OPR outcomes. 5.3 The OPRs will have a similar focus and will be timed to engage with and inform the forward planning process. 5.4 In addition to these corporate arrangements Directors in each part of the organisation will be expected to: - deliver, on time by the end of March 2010, a plan which meets the corporate guidance and provides a proper basis for their accountability to the Board Chief Executive; - ensure the plan should also provides a basis for internal accountability and the performance management of their business through the planning year; - have clear performance management and reporting disciplines which demonstrate a focus on the actions and outcomes articulated in its plan and those required to deliver its contribution to corporate planning and Policy Frameworks; - ensure responsibilities for planning and for delivering the plan are clearly defined and incorporated into individual accountability arrangements; - ensure individual objectives properly and consistently reflect key planning responsibilities both with each part of the organisation and for those who carry cross-organisation responsibilities. 6. NEXT STEPS 6.1 The Frameworks are now established for the first year of the new three year planning round. Each Framework describes how further development and updating will take place. The Corporate Planning Group, which brings together senior planners and Directors with the corporate planning team, will be responsible for signing off changes to the Frameworks and to the wider planning system to ensure that we continue to have a collective approach to planning across the organisation and clear lines of accountability. 10

11 INTRODUCTION 6.2 We were always clear that the Frameworks were about primarily about pulling together all of our existing planning and policy material into a consistent and clear shape. Going forward we will expect the Frameworks to provide a basis for wider engagement with staff, the people who use our services and wider communities. 6.3 The indicators part of each Framework will be refined by the corporate performance team for sign off by the Corporate Planning Group to ensure that the Frameworks read across to performance management arrangements at each level of the organisation. 11

12 ACUTE SERVICES ACUTE SERVICES PLANNING FRAMEWORK 1. INTRODUCTION AND CONTEXT 1.1 NHSGGC S overall aim is to deliver effective high quality health services to act to improve the health of our population and to everything we can to reduce health inequalities. 1.2 The key aims for Acute Services are - to improve the health of the population of NHSGGC through the provision of timely and equality focused secondary and tertiary care services for adults, children and babies alike; - to deliver modern healthcare services in keeping with the 21st century; - NHSGGC is entering a new three year planning round for As part of the revised planning arrangements, frameworks are being prepared across a range of planning and policy areas; - the purpose of this document is to provide a framework that sets out the outcomes for Acute Services to be achieved over the next three years and the approach to achieving these. It provides an agreed direction of travel, a context for future decisions and a consistent set of objectives to be achieved through the use of all the levers and resources we have at our disposal. 2. NATIONAL PLANNING AND POLICY CONTEXT AND PERFORMANCE REQUIREMENTS 2.1 National Planning and Policy Context and Performance Requirements Better Health, Better Care sets out the national planning and policy context for improving health and health care within Scotland. It looked to improve the health of the population, to tackle inequality and to establish a range of measures and service models which will improve the quality of healthcare services within Scotland. This initial document is supported by a further series of planning and policy documents which underpin the ethos of this document and which consider how we improve patient pathways, ensuring quicker access from referral through diagnosis to treatment such as the 18 week Referral to Treatment Programme and Better Cancer Care, an action plan. There is a strong emphasis within the Scottish Health system of ensuring care is provided in the right place by the right staff with the right skills with patients and carers as partners in that care. The Long Term Conditions Programme encourages the Health Service to consider how to deliver sustainable improvement in patient centred services focused on self care, specialist care and complex care and to work on shifting the balance of care to provide care out with the acute hospitals where possible. Similarly for children and young people Delivering a Healthy Future: An Action Framework for Children and Young People s Health in Scotland sets out an action plan to assist hospital and community health services to respond to the challenges of improving and maintaining children s health in the 21 st century. Equally there is firm commitment to providing specialist services in the appropriate setting with care provided as locally as possible. The National Delivery Plan for Specialist Children s Services implementation sees investment over the next few years in strengthening both the hospital and the local components of specialist children s services to provide sustainable and equitable services for children and young people across Scotland. 12

13 ACUTE SERVICES Improving the quality of care is considered fundamental to improving healthcare services in Scotland and is taken forward through a number of healthcare initiatives such as the Scottish Patient Safety Programme, which drives improvement in patient care and patient outcomes through the reduction in healthcare associated infections, adverse surgical incidents and adverse drug events as well as to demonstrate improvements in critical care outcomes, care on hospital wards and organisational culture through leadership, which is focused on patient safety. The Quality Strategy also seeks to improve the service quality and patient involvement in serve planning and delivery. Patients as partners as well as staff as partners are also key principles of the health service and programmes such as Better Together, which encourages patients, carers and healthcare staff to work together in partnership to redesign services using the patients experiences to provide improved patient centred care. A Force for Improvement, the Scottish Governments workforce plan to support Better Health Better Care, puts in place an action plan to ensure the workforce is well placed to support the modern service models. There is a strong focus within the Scottish Health system in developing performance measures that support demonstrable improvements in performance across the Health Service. Through the Local Delivery Plan - HEAT Performance Management System the targets and measures that each Board is required to deliver in relation to health improvement, efficiency, access and treatment are set out. These provide NHSGGC with a framework to demonstrate performance improvement. More recently the NHS Scotland Efficiency and Productivity Framework encourages all Health Boards and their service providers to consider their efficiency and productivity to continue to develop and improve patient care and the services provided particularly in the current financial climate. 3. NHSGGC PLANNING CONTEXT AND CHALLENGES GOING FORWARD The Acute Services Division provides secondary and tertiary care for the population of NHSGGC, serving approximately 1.2million people. The Acute Services Division also provides secondary and tertiary care for other West of Scotland Boards and some national tertiary services. 3.1 Strategic Priorities The strategic priorities of the Acute Services Framework are: - local access to core medical and surgical services and consolidate specialist and tertiary services onto fewer sites across the city; - modernised accommodation and improved facilities appropriate to the provision of 21st Century Healthcare Services; - improved access to services through streamlined pathways of care between primary and secondary care including diagnostic services to reduce waiting times for assessment, diagnosis and treatment; - uniform access for routine services across GGC; - an improved patient experience with unnecessary time in hospital reduced or eliminated; - patients treated in the right place by the right people - shifting the balance of care; - clinical teams working together to concentrate clinical expertise and meet the requirements of the European Working Time Directive, the New Deal for Doctors and Modernising Medical Careers - financial balance and affordable future services; - improved efficiency and productivity with delivery of the CRES targets; 13

14 ACUTE SERVICES - continuous improvement of the safety of clinical services, including the implementation of the Scottish Patient Safety Programme; - patient focused services with patient involvement in services design and delivery; - effective working arrangements with partner organisations - CH(C)Ps, Mental Health Partnership, Local Authorities, regional and national partners; - modern technology employed to modernise services and support patient service provision. Set out in the sections below are the vehicles to help deliver the strategic priorities Acute Services Review and Clyde Strategies The planning and implementation of the Acute Services Review (ASR) and the Clyde Strategies, which are crucial in delivering and sustaining services across Glasgow and Clyde, are at the core of the Acute Services Framework and will underpin delivery of the strategic priorities outlined above. The implementation of the ASR offers the opportunity for ongoing redesign of services to support the aims of Better Health, Better Care, strengthening the collaborative integrated approach to service improvement, embedding within it the patient experience information, particularly in relation to performance management and improving the patient journey. The focus on the development of local services and the separation of planned and unscheduled care remains core to the delivery of service improvement and improvements in access. This framework focuses on the 3 years from 2010 to 2013 and in that time the planned changes are: - Acute Services Review and Clyde Strategies Implementation - Glasgow - Acceleration of the ASR - closure of Stobhill Hospital: - closure of Stobhill Hospital and transfer of Services to GRI in 2010/11; - centralisation of Renal and Vascular Services in 2010/11; - rationalisation of Urology Services in 2010/11; - creation of Emergency Receiving Complex/Acute Assessment model. - Construction underway of the New South Glasgow Adult and Children s Hospital and new Laboratories Projects. - Clyde - Implementation of the Vale of Leven Vision. - Centralisation of Clyde ENT IP services in Glasgow. - Centralisation of Clyde Ophthalmology services in Glasgow. - West of Scotland - Centralisation of WOS Gynaecological cancer services at GRI in Finalise proposals for centralisation of WOS Head and Neck Services at SGH Primary Care and Secondary Care Interface The Primary Care Framework identifies a number of systemic issues to be addressed between the acute and primary care services as we plan for future services. In taking the 14

15 ACUTE SERVICES strategic priorities and the planning of services forward the key areas to be considered and addressed through this framework are: - the need for more effective dialogue between acute and primary care clinicians, in particular in relation to the redesign of patient pathways; - the need for much better understanding about how actions in primary care affect secondary care and vice versa, and the drivers of demand in each part of the system; - the need to develop better communication and information flows, in real time and electronically where possible Other Strategies and Frameworks In addition, the Acute Framework will be influenced by the other frameworks which will help to deliver the strategic priorities and with which there will be important interfaces, most notably the Unplanned Care Framework; Long term Condition Framework; Older Peoples Framework; Children and Families Framework; Maternity Services Framework and the Cancer Services Framework. 3.2 Challenges Going Forward Financial Challenge The three years from 2010 onwards represent a time of significant financial challenge for NHS Greater Glasgow and Clyde and the public sector generally. We will be operating in the context of requirements for substantial cost savings against an increasing demand for NHS services. We are therefore planning in an environment where we have to look at radical redesign and transformation across the whole system of care, working together to manage demand and to use all of our resources more effectively. In implementing the framework we need to develop a financial plan which ensures that the outcomes and actions we have set out are supported by the way we use resources Demographic and Health and Inequalities Challenges The population of GGC faces significant and changing health problems. It has shorter life expectancy than the rest of Scotland, and is marked by higher levels of deprivation with its associated impact on health. Health inequalities are increasing, we are facing an obesity epidemic and alcohol is an increasing problem. The population is ageing, but this is happening at different rates. Over the next three years, table 1 shows the expected shifts in the demography of the population that we serve, which is expected to further influence the overall healthcare provision across GGC. In particular the growth in the 65 + population reinforces the need to better consider the models of care and service provision through programmes of work in relation to long term conditions and shifting the balance of care if we are not to see the continuing increases in emergency activity and in the patient over 65 admissions that we have seen over recent years - see table 2 below. Despite much progress over recent years NHSGGC still faces significant health challenges as social disparities and poverty continue to harm and kill our populations. Greater Glasgow and Clyde continues to experience some of the widest variations in health between affluent and poor in society which we must continue to seek to address if we are to improve the overall health of our the population. The inequalities and poor health in our population drive high levels of hospital admissions, GP consultations and the use of a wide range of other services, with particular pressures in emergency care services. 15

16 ACUTE SERVICES Table 1 - Population projections NHSGGC Base Year Population Population % Change Population % Change Population % Change , , , , , , , , , , , , , , , , , , , , , , , , ,645 98, , , ,164 65, , , ,769 22, , , All Ages 1,191,584 1,189, ,188, ,187, Table 2 - Patients Aged 65+ with 2 emergency inpatient stays or more in a year 2006/7 2007/8 2008/9 % Change GGC 10,843 10,929 11, % Inequalities Challenges The significant inequalities in health status and outcomes across the population of GGC need to be considered in planning and delivering services. This requires NHSGGC to - understand where there are differences in access to services or clinical outcomes according to deprivation, age, sex, sexual orientation, race, religion. The lack of information available to support this needs to be progressed; - implement the strong evidence base on effective interventions; - target resources to meet greatest need, provided that it is clearly evidenced based and the implications fully understood Challenges in Relation to Access to Service Improving access and engagement with services is a key priority within Acute Services. There are a number of components to this in terms: - ensuring patients can access acute care at the time they need it and as locally as possible; - ensuring services meet the national access targets; - services are based on understanding the demand and are provided as efficiently and effectively as possible; - services are responsive to patients views Shifting the Balance of Care A key component in managing Acute Care Services is shifting the balance of care. There are many examples of good practice at individual specialty or hospital level but there is no whole system approach to development and delivery of services. Some of the areas to be progressed include: 16

17 ACUTE SERVICES - the need for more effective dialogue between acute and primary care clinicians, and key partners involved in providing unplanned care services, on specific clinical issues, redesign of patient pathways, administrative processes and joint education programmes; - further develop treatment guidelines for Long Term Conditions; - implementation of the Rehabilitation and Enablement Strategy; - the need for much better information and real time feedback on the interface between primary and secondary care; - the potential to build on SCI Gateway to have better real time and electronic information flows and systems including achieving access to SCI Gateway for all partners Workforce Challenge It is important as we move forward that we have an appropriately skilled workforce to meet the service requirements. The Acute Division will continue to take forward work in relation to the development of an Integrated Finance and Workforce Plan which will include supporting the delivery of the ASR/bed model and CRES and consider the Equal Pay issue. Examples of this are: - nurse workload and workforce measurement; - development and implementation of the careers framework in nursing and midwifery looking at the Band 4/level 4 practitioners; - nurse to bed ratios; - new medical workforce model linked to MMC; - workforce challenges initiative Specific work will be taken for to develop workforce and organisational change plans to facilitate: - Vale of Leven Vision; - closure of Stobhill Hospital; - West Glasgow Hospitals by June 2010; - Glasgow Royal Infirmary by late 2010/early 2011; - New South Glasgow Hospitals and Laboratories Projects. Other areas for consideration in relation to workforce are: - implementation of the Careers Framework; - linkage of eksf to Acute Learning Strategy. 4. BACKGROUND ON CURRENT SERVICE, WORKFORCE AND PERFORMANCE The Acute Services Division provides secondary and tertiary care for the population of NHSGGC. It also provides secondary care for other West of Scotland Boards and some national tertiary services. 4.1 Current Service Provision It provides acute care from seven Acute Sites in Glasgow - six Adult sites (Stobhill Hospital, Glasgow Royal Infirmary, Western Infirmary/Gartnavel General Hospital, Southern General Hospital and Victoria Infirmary) and the Royal Hospital for Sick Children (Glasgow) and 17

18 ACUTE SERVICES from three sites in Clyde (Royal Alexandra Hospital, Inverclyde Royal Hospital and Vale of Leven Hospital). The future configuration outlined in the Acute Services Review Clinical Strategy for Glasgow is: - three inpatient acute sites at Glasgow Royal Infirmary, Southern General site (new South Glasgow hospital), and Gartnavel General Hospital; - two A&E Trauma units at Glasgow Royal Infirmary and Southern General Hospital; - an acute GP receiving unit at Gartnavel General Hospital; - five Minor Injuries Units at Glasgow Royal Infirmary, Southern General Hospital, the new Stobhill and Victoria Hospitals and at Gartnavel General Hospital; - two new hospitals at the Stobhill and the Victoria Infirmary site providing ambulatory care; - two maternity units at Southern General Hospital and Glasgow Royal Infirmary; - a new children s hospital co-located with the new adult hospital and maternity unit on the Southern General site. The Clyde Strategies see the following configuration across Clyde: - two inpatient acute sites with A&E trauma services at the Royal Alexandra Hospital and Inverclyde Royal Hospital; - Acute Receiving at the Vale of Leven Hospital; - three Minor Injuries Units at Royal Alexandra Hospital, Inverclyde Royal Hospital and Vale of Leven Hospital; - Maternity Unit at the Royal Alexandra Hospital and two Community Midwifery Units at Inverclyde Royal Hospital and the Vale of Leven Hospital. Over the last few years considerable progress has been made in taking forward the ASR and in developing the Clyde Strategies with key elements of the ASR and strategies already having been delivered including the New West of Scotland Beatson Cancer Centre, the new Victoria and Stobhill Ambulatory Care Hospitals and the South of the Clyde Strategy. 4.2 Activity Changes Over the past three years the Acute Services Division has continued to see and increase in activity generally. In particular there has been a continued rise in emergency demand, which can be seen in the increase in non elective activity and in the A&E attendances. While there has been a slight reduction in inpatient elective work there has been a corresponding increase in day case activity in line with the strategy to increase day case rates within acute services. The referral rates overall indicate a significant rise in referrals over the past three years. In terms of outpatient activity Consultant led outpatient activity has generally remained fairly static; however there has been significant development of nurse and AHP led services not captured in the activity information below. 18

19 ACUTE SERVICES Table 3 - Acute Activity 2006/ / /2009 % Change Inpatient 261, , , % - Elective 70,480 70,362 67, % - Non Elective 190, , , % - Day Cases 133, , , % Outpatient 1,466,684 1,484,412 1,468, % - New 533, , , % - Return 933, , , % A&E Attendances 425, , , % Table 4 - All Specialty Referrals Specialty 2006/7 2007/8 2008/9 % Change Referrals Referrals Referrals Overall GGC 396, , , % 4.3 Current Performance Over the past three years the Acute Services Division have demonstrated considerable performance improvement as it as met and sustained the range of targets such as: - 98% of A&E patients treated/discharged/transferred within 4 hours; - 12 week inpatient/day case and outpatients targets met - with significant progress towards the 18 week end to end referral to treatment target; - 6 week target for 8 key diagnostic tests met and sustained; - 98% of hip fractures operated on within 24 hours of admission to an orthopaedic unit; - 95% of all urgent referrals of patient suspected of having cancer should achieve a maximum wait of 62 days from urgent referral to first treatment; - improved theatre and diagnostics utilisation - with targets met; - on trajectory to meet the HAI improvements for MRSA and C difficile. 4.4 Workforce The Acute Services Division have been taking forward work in relation to pay modernisation and service redesign. Work is ongoing to develop workforce plans. Examples of this include: - nurse workload and workforce measurement; - development and implementation of the careers framework in nursing and midwifery looking at the Band 4/Level 4 Practitioners; - nurse to bed ratios; - new medical workforce model linked to MMC. The work to support the delivery of the ASR/bed model and CRES will continue and will take account of the Equal Pay issue and will underpin an integrated finance and workforce plan. 19

20 ACUTE SERVICES 5. OUTCOMES 5.1 The outcomes will address the following areas: - improved access and engagement with services; - understand and be responsive to the inequalities which affect patients in accessing secondary care services; - improved resource utilisation - improving efficiency and productivity; - modernisation of services; - primary / secondary care interface; - shift in the balance of care of services within primary and secondary care; - improved quality of care; - improved health; - an effective and efficient workforce; - effective organisational arrangements across the different parts of the system. 5.2 The detail of these outcomes, the actions/activity required and the performance measures and changes are described in Attachment 1 of this section. 6. FINANCIAL RESHAPING TO DELIVER THE OUTCOMES INCLUDING EFFICIENCY AND PRODUCTIVITY 6.1 This framework acknowledges the need for greater coherence between financial and workforce plans. It also acknowledges the need for coherence on work already underway across GGC that will integrate and co-ordinate efficiency and productivity activities to reduce over reliance on hospital services whilst improving access to high quality and consistent health and social car interventions. These include: - understanding current services, staffing, finance and what we deliver; - the need to ensure that we are optimising use of resources through redesign and improved productivity/efficiency; - impact of pay modernisation and the link to workforce development to reduce or sustain costs; - utility costs and the need to find better solutions for our buildings. 7. PROCESS TO REFINE AND DEVELOP THE FRAMEWORK 7.1 The process to refine and develop the Acute Services Framework will be through the Strategic Management Group within the Acute Division and through the Directorates of the Acute Division. 7.2 Interface with partners will be through the Corporate Planning Group and other forums that support wider engagement. 20

21 ACUTE SERVICES ATTACHMENT 1: OUTCOMES TO BE DELIVERED OVER 3 YEAR PERIOD ( ) Outcome Actions/Activity Required Change/Progress/Performance Measures/Target A. Improve Access and Engagement with Services A1. Patients can access acute services at the time that they need it as locally as possible. A2. Services provided meet the national access targets. A3. Acute Services provided based on systematic review of demand on services. A4. Acute Services responsive to patient views. - Local outpatient and day case services. - Minor Injuries Services across Acute Sites. - Co-located out of hours services where appropriate. - Specialist inpatient care on fewer sites week RTT target delivered. - Cancer waiting times targets delivered. - 4 hour A&E waiting times standard of 98% met. - Robust information to support effective management of demand. - Demand and capacity aligned. - Improved understanding about how actions in primary care affect secondary care and vice versa, and the drivers of demand in each part of the system. - Patient and public engagement in planning and delivery of services and in service improvement via the work of the community engagement team and through the Patient Public Forum involvement in planning - Waiting times measures. - Day case rates. - HEAT targets/ trajectories - A week waiting guarantee for 1st outpatient appointment/ 9 weeks from being placed on waiting list to admission for IP/DC procedure. - Cancer Targets/monitoring of. - 95% of all patient diagnosed with cancer begin treatment within 31 days of decision to treat, 95%of those referred urgently with a suspicion of cancer begin treatment within 62 days of receipt of referral. - HEAT A9. - Referral management information. - Outpatient to IP/ DC conversion rates. - Capacity and demand information. - Participation standards. - Documented evidence to demonstrate user involvement in an equalities sensitive manner. 21

22 ACUTE SERVICES Outcome Actions/Activity Required Change/Progress/Performance Measures/Target A5. Reduced health inequalities gap between deprived and non deprived populations accessing secondary care services. B. Improve Resources Utilisation B1. Current and future demand for Acute Services is clearly identified and the resources deployed appropriately to deliver the service. groups taking forward the detailed work on the ASR. - Staff have been trained to collect disaggregated patient data (once PMS is operational). - There is a robust systematic process for analysing disaggregated patient data and presenting this for planning purposes. - Identify and address differential access issues. - Target actions and resources to meet the needs of different equality groups and people in deprived communities. - Implementation of the Communications Support and Language Plan. - All patient information conforms to the Accessible Information Policy. - Service Delivery Centres have been assessed for DDA compliance and actions have been taken to remedy any physical access barriers.. - Staff will be trained in appropriate customer care. - Budget and services aligned. - CRES targets delivered. - Financial Break even achieved. - Workforce Planning aligned to Financial Planning. B2. Efficient and economic services. - Develop a comprehensive approach to demand management with CH(C)Ps. - Information available. - Information available and used to underpin service planning. - Evidence of service provision targeted to different equality groups/ people in deprived communities. - Evidence DDA compliance. - Evidence of staff numbers trained. - Financial returns. - CRES target. - Break even position. - Aligned service plans for workforce/finance 22