NHS FORTH VALLEY. Annual Plan 2015/16. Incorporating the Local Delivery Plan (LDP) 2015/16

Transcription

1 NHS FORTH VALLEY Annual Plan 2015/16 Incorporating the Local Delivery Plan (LDP) 2015/16 Page 1 of 41

2 Contents FOREWORD INTRODUCTION Background Context Key challenges for 2015/ Equality Duty Clinical Services Review and Strategic Planning Framework Strategic Principles National Improvement Priorities and the LDP (Local Delivery Plan) Local Improvement Priorities and Supporting Plans Performance Management NATIONAL IMPROVEMENT PRIORITIES Health Inequalities and Prevention Antenatal and Early Years Safe Care Primary Care Integration Person Centred Care NHS FORTH VALLEY LOCAL IMPROVEMENT PRIORITIES Unscheduled Care Scheduled Care SUPPORTING PLANS Financial Planning Workforce Planning NHS Forth Valley s Contribution To Community Planning APPENDIX 1 - NHS Forth Valley Strategic Planning Matrix Page 2 of 41

3 FOREWORD 2015 is a landmark year in the history of the NHS in Scotland. The creation of fully Integrated Joint Boards for Health & Social Care this year presents a new and exciting opportunity to redefine, recreate, and fundamentally improve how health and social care services are provided, to ensure a coordinated and complementary approach is taken. The Scottish Government s 2020 Vision outlines the key elements of this progressive agenda and makes clear that the NHS has several important contributions to make. Scottish Government s 2020 Vision Our vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting: We will have a healthcare system where we have integrated Health and Social Care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of readmission. The intention behind this significant change is to improve the experience of people and their families when using services and to strengthen their own ability to maintain or improve their health and abilities. Both the NHS and local authorities have a critical responsibility to provide innovative leadership that enables the members of the Integrated Joint Boards to put in place new approaches to service delivery that meet this aspiration. Complementary to the integrated development of Health & Social Care towards the 2020 Vision it is essential to retain a clear focus on consistent and improved delivery of existing health services. Our commitment to health protection, health promotion, the reduction of health inequalities and delivery of safe, effective and person centred healthcare remain of vital importance. This Annual Plan therefore includes a range of Local & National Improvement Priorities that work together to make progress towards the 2020 Vision whilst also strengthening the delivery and positive impact of existing health services. Our aim is to deliver improved consistency between individual needs and the services we provide, more straightforward access to these services, and improved health for the population we serve. Page 3 of 41

4 1. INTRODUCTION This document, the NHS Forth Valley Annual Plan, describes the range of National & Local Improvement Priorities that the health board will take forwards during 2015/16. It is a further iteration of the Local Delivery Plan 2015/16 (LDP) that was accepted by the Scottish Government in March 2015 as the Board s delivery contract for the year. The LDP content has now been augmented with additional information on further Local Improvement Priorities which cover a range of duties and developments integral to addressing local service development requirements or population needs. 1.1 Background Context NHS FV is facing challenges and the constraints of increasing demand and limited resources. We have an ageing population and people are living longer (Figure 1), which occasions both a rise in people in middle or older age and multiple morbidity. In addition the number of single occupancy dwellings is increasing and there are other signs that people may have less family and informal social support than was previously the case. The traditional health service structure needs to change to put the patient in the centre, which aligns with the Scottish Government s 2020 Vision. This will require a shift towards achieving a better balance between hospital centred care and community centred care and from episodic disjointed care towards joinedup integrated care. Figure 1: Population Charts showing the increasing Age Profile in Forth Valley Male Female Male Female 80 to 84 years 80 to 84 years 60 to 64 years 60 to 64 years 40 to 44 years 40 to 44 years 20 to 24 years 20 to 24 years 0 to 4 years 0 to 4 years Furthermore, various reports indicate that high levels of public resources are devoted annually to alleviating social problems and tackling failure demand (the cost and consequences of poverty, unemployment and inequalities) (Christie, 2011). This will be our biggest challenge in ensuring that services are designed around the needs of patients in the future. NHS FV will continue to place a high priority on working with partners to tackle deprivation and inequality and promote health and wellbeing. Page 4 of 41

5 1.2 Key challenges for 2015/16 There are particular risks and challenges that are so significant that they must be highlighted as absolute key priorities for action in 2015/16 and in the longer term. These critical challenges are: Sustainability of Primary Care services. Ensuring positive progress on the Integration agenda during its first year. Creation of the Strategic Plans for Falkirk and Stirling & Clackmannanshire IJBs. Emergency Access, Delayed Discharges and overall waiting times. More targeted focus on Health Inequalities. Recruitment and retention of specialist staff within the National context. Financial constraints. Detail on specific plans to address these challenges is available in later sections of this plan. NHS FV s approach to this increasingly complex environment is also supported by a number of overarching resource management plans which set out the specific actions to underpin how we will address these issues (see Appendix 1). 1.3 Equality Duty 2010 The NHS FV LDP 2015/16 emphasises how important it is to improve the health of the population, and to get the experience of care right for every individual, every time. It recognises that the key to this is recognising the differences across, and within, our diverse population, and on focussing on providing person-centred care. Each Improvement Priority incorporates these principles and therefore directly supports NHS FV in the discharge of the General Equality Duty Clinical Services Review and Strategic Planning Framework NHS FV has embarked on a strategic Clinical Services Review (CSR) with the aim of producing a Healthcare Strategy for that reflects the NHS Scotland 2020 Vision. The main areas being reviewed include: Cancer Care Clinical Support and Infrastructure Emergency Care and Out of Hours Frail Older People and End of Life Care Mental Health and Learning Disabilities Long Term Conditions & Multiple Morbidity Planned Care Care of Women and Children The CSR is expected to advise a range of strategic and tactical developments to modernise clinical services between now and 2020, as well as various opportunities to improve the day-to-day experience of health services. During 2015/16 the development of Strategic Plans with Integration Joint Boards (IJB) will be an important part of the local planning agenda and the CSR will also ensure that NHS FV is ready to engage fully in this undertaking to deliver the outcomes expected in local Single Outcome Agreements. Page 5 of 41

6 1.5 Strategic Principles The principles outlined below are integral to the Board s overall approach to delivery of each National and Local Improvement Priority: Provision of consistently high quality, safe and sustainable services across the whole system, integrating care in partnerships appropriately. Ensuring all care is patient focussed while planning and delivering care in partnership with our population. Increased focus and pace on shifting the balance of care - develop community and primary care services through facilitating supported self management, anticipatory care planning, integrating care pathways, locality planning and workforce development. Minimise time spent in acute care and focus acute care on complex, unscheduled emergency care, specialist elective care with day surgery /23hr surgery the norm, minimising length of stay and ensuring the majority of service provision is as close to home as possible. Collaborative working should be focussed on reducing inequalities, prevention through an asset based approach and on early years. In applying these principles we will take into account the Health and Wellbeing Outcomes (Joint Public Bodies Act 2014) which are set out below: 1. People are able to look after and improve their own health and wellbeing and live in good health for longer. 2. People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3. People who use Health and Social Care services have positive experiences of those services, and have their dignity respected. 4. Health and Social Care services are centred on helping to maintain or improve the quality of life of service users. 5. Health and Social Care services contribute to reducing health inequalities 6. People who provide unpaid care are supported to reduce the potential impact of their caring role on their own health and well-being. 7. People who use Health and Social Care services are safe from harm. 8. People who work in Health and Social Care services are supported to continuously improve the information, support, care and treatment they provide and feel engaged with the work they do. 9. Resources are used effectively in the provision of Health and Social Care services, without waste. The priority actions described in this Annual Plan take full account of these outcomes and are designed to support their delivery. Page 6 of 41

7 1.6 National Improvement Priorities and the LDP (Local Delivery Plan) This year s National Improvement Priorities are: o Health Inequalities and Prevention o Antenatal and Early Years o Safe Care o Primary Care o Integration o Person Centred Care The LDP Guidance, issued on 19 December 2014, also contained a number of standards Boards are expected to deliver in 2015/16 (see Table 1). Table 1 - LDP Standards Linkage to Improvement Priorities NHS LDP Standard LDP Section Detect Cancer Early Health Inequalities & Prevention Cancer Waiting Times Scheduled Care Dementia Post Diagnostic Support Primary Care Treatment Time Guarantee (TTG) Scheduled Care 18 Weeks Referral to Treatment (RTT) Scheduled Care 12 Weeks First Outpatient Appointment Scheduled Care 6 Weeks Diagnostic Waiting Times Scheduled Care Early Access to Antenatal Services Antenatal & Early Years IVF Waiting Times Scheduled Care CAMHS Waiting Times Scheduled Care Psychological Therapies Waiting Times Scheduled Care Clostridium Difficile Infections Safe Care SAB (MRSA/MSSA) Safe Care Drug and Alcohol Treatment Waiting Times Scheduled Care Alcohol Brief Interventions Health Inequalities & Prevention Smoking Cessation Health Inequalities & Prevention GP Access Primary Care Sickness Absence Person-Centred Care Accident and Emergency Waiting Times Unscheduled Care Financial Performance Finance As the formal delivery contract between the Scottish Government and each NHS Board, the LDP is an NHS document, however this year the National Improvement Priorities also placed a requirement on the board to support the wider objectives of the integration of Health and Social Care and the creation and transition of responsibility to each new Integrated Joint Board (IJB). The range and scope of the LDP therefore supports delivery of: The Scottish Government s national performance framework; The Health and Social Care outcomes and indicators; The 2020 Vision for high quality, sustainable Health and Social Care. Page 7 of 41

8 1.7 Local Improvement Priorities and Supporting Plans In addition to the National Improvement Priorities that constitute the LDP, there are a range of Local Improvement Priorities that NHS Forth Valley (NHS FV) will pursue during 2015/16 to meet particular local issues, service development priorities and population needs. The five principle components of the Local Improvement Priorities and supporting plans that are outlined in subsequent sections of this plan are: o Unscheduled Care o Scheduled Care o Financial Planning o Workforce Planning o NHS FV Contribution to Community Planning Other key Local Improvement Priorities are detailed in Table 2: Table 2 Additional Local Improvement Priorities Topic Local Improvement Priority People & community Carer support Review impact of national carers legislative programme, associated guidance and development of the new National Cares Strategy approach. My Name Is... and the Communications Strategy Drive continued improvement in communications, attitude and behaviours centred on the My Name Is... campaign to ensure health care is centred on making a human connection, beginning a therapeutic relationship and building trust. Volunteering Develop further volunteering roles within the organisation to compliment the current workforce Contribute to implementation of the National Volunteering Database Strategic development Stirling Care Completion of Full Business Case (FBC) for this Major capital project Village to support the integration of Health and Social Care in a single Inpatient facility at the Stirling Community Hospital site including collocation of: Four GP Practices Community Nursing Services SAS Emergency and PTS services Diagnostic services Minor Injuries Unit and Out of Hours GP and Nursing care Page 8 of 41

9 Topic Workforce Modern Apprenticeships Local Improvement Priority In support of our strategic vision on youth employment develop an implementation plan to support the introduction of modern apprenticeships, supported & monitored via the Staff Governance Committee and Area Partnership Forum. Clinical Management Infection control Continue to afford Infection Control a high priority within the running and Vale of Leven of the health board. Continue to implement the Local Action Plan recommendations based upon the MacLean report (many recommendations are already in place). The Scottish Government is currently collating the responses from all the boards before issuing a final response to Lord MacLean s report which will be incorporated into the existing local action plan. Older People in Acute Hospitals Infant Cremation Commission Report Work with frontline teams to focus on care that is delivered with Compassion, dignity and respect. Implement tools across all inpatient areas with the aim of improving screening for frailty and improving the early management of delirium. Improve prevention and management of pressure injury; food, fluid and nutrition; falls; and cognitive impairment. Undertake audit on implementation of local action plan developed in collaboration with members from Falkirk Council to address the national recommendations. Report findings to Scottish Government. Cancer Care Neonatal Care Managed Care Networks Benchmarking for Improvement Through the work of the local Cancer Advisory Group and the Clinical Services Review work group, ensure better coordination and integrated planning between the wide range of departments and regional partners involved in Cancer Care including: Community and Acute NHS teams; Diagnostic and Treatment services; Social Care; third sector partners such as Maggies, Marie Curie, Strathcarron Hospital, Macmillan Cancer Support. Use the Neonatal Care in Scotland a Quality Framework to guide the ongoing development of the service provision to meet required standards Review the operation of the Managed Clinical Networks for Stroke, Diabetes, Respiratory, Heart Disease, Neurology and Palliative Care to ensure strong alignment between the work of the MCNs and front line services to ensure these important clinical collaborations can successfully translate national guidance and local improvement plans into better patient outcomes. We will undertake a broad range of benchmarking across key services including Orthopaedics, Ophthalmology and General Surgery to support the principle of reducing time spent in acute care in favour of increased care closer to home, and to ensure departments are providing the best quality services from the resources they are given. Page 9 of 41

10 Topic Local Improvement Priority Operational Management Patient Flow NHS Forth Valley is one of three national pilots working with the Programme Institute of Health Optimisation (IHO) to help reduce delays for patients. The aim of the programme is to even out the peaks and troughs which can leave our hospitals quieter at some periods and very busy at other times. ehealth Civil Contingencies Sustainability Unscheduled Care Continue to harness the opportunities presented by information and communications technology to drive innovation in health care delivery. Particular developments for 2015/16 include: Introduction of an automatic patient appointment reminder service. Implementation of electronic ordering of radiological tests. Deliver the Civil Contingencies Action Plan 2015/2016. Review NHS FV performance against the NHS Resilience Standards and agree action plan to address any gaps. Establish implementation framework and ensure the delivery of NHS Contest (Pursue, Protect, Prepare, Prevent). Implement the approved board estates Sustainability Strategy including Carbon reduction plans 1. Complete the redesign of Ageing and Health front door services through the introduction of frailty criteria. 2. Continue to evolve the Bo ness model of support for frail patients. 3. Establish over 7 days a suitable frailty clinic / service to reduce attendance at Acute Assessment Unit & Emergency Department. 4. Review the pathway for rehabilitation to ensure timely access and reduced length of stay. 5. Focus on implementing robust anticipatory care plans for patients at risk of admission. 6. Establish an unscheduled care network to ensure the 6 essentials of the national unscheduled care improvement programme are fully addressed. 7. Continue to roll out the re-engineering medical flow to all medical wards and orthopaedics by October Review pathways for patients in Orthopaedics, Gynaecology, Mental Health and Medicine to ensure wait for a specialist is reduced. 9. Review internal escalation plan in ED to address surges in demand. 10. Review workforce in ED to ensure staff continue to be aligned with the demand for care. 95% compliance with 4 hour access target by July % compliance with 4 hour access target by November 2015 No 8 hour waits No 12 hour waits Page 10 of 41

11 1.8 Performance Management Context Performance Management is a critical component of the LDP and associated plans. The role of performance management is to ensure that our efforts are clearly targeted and that the intended outcomes of the National & Local Improvement Priorities are achieved. The overall approach, detailed within NHS FV s Performance Management Framework, underlines the principle that performance management is integral to the delivery of quality improvement and central to prioritisation and decision making; effective management of resources; and to good organisational governance & accountability. The Scottish Government has an established set of performance management principles to promote a culture in which targets and standards are delivered within the spirit they were intended, recognising that clinical decision making is more important than the absolute delivery of targets and standards. The principles are: Each performance measure helps to deliver a wider system aim, so the impact on the whole system must be considered. Clinical decision making in the interest of the patient is always more important than unequivocal delivery of targets. NHS Scotland s Performance Management Framework supports delivery of the Scottish Government s overall national outcomes and the Health Directorate s strategic objectives. Performance measures demonstrate progress towards delivering our strategy for improving health & wellbeing outcomes and the quality of patient care. Targets should support diversity and reduce inequalities. Staff should be engaged in target setting and target delivery. Best practice in Performance Management and delivery should be shared. Data and measurement are key aspects of Performance Management. Design the system, deliver the performance. Local flexibility in delivery Performance Management and the Local Delivery Plan (LDP) Progress against NHS LDP Standards will continue to be reported to the NHS Board. However the LDP guidance for 2015/16 also states that Health Boards and their partners in local government must take account of the effect of their plans on the outcomes for health and wellbeing set out in the legislation for the integration of Health and Social Care, and on the indicators that underpin them. Once established during 2015/16, Integration Authorities will lead on their delivery, with the support of Health Boards and Local Authorities. Work is therefore underway to review and create appropriate joint performance management frameworks during this transition year. Page 11 of 41

12 2. NATIONAL IMPROVEMENT PRIORITIES 2.1 Health Inequalities and Prevention Strategic Context The Scottish Government has set out its objectives for addressing inequalities and prevention with an emphasis on the following main areas: Addressing health inequalities with plans focussed on those communities where deprivation is greatest. Health improvement and prevention activity based on the needs of the local population. NHS procurement policies should support employment and income for people and communities with fewer economic levers. Actions relating to employment policies that support people to gain employment or ensure fair terms and conditions for all staff. NHS FV will build on health improvement actions to promote healthy living including preventing obesity, promoting a healthy diet, tobacco related health inequalities, uptake of smoking amongst young people, protecting children from second-hand smoke, supporting smokers to quit and promoting physical activity through workforce and the Health Promoting, Health Service, as well as in the wider community. NHS FV will also continue to work in partnership across the Alcohol and Drug Partnership to target alcohol brief interventions on harder to reach communities including those in deprived areas, and to sustain access to drug and alcohol treatment and to continue to promote recovery from substance misuse as set out in the local FV ADP Strategy and ADP Delivery Plans. We are working within Community Planning Partnerships to meet outcomes within Single Outcome Agreements (SOAs) which will impact on health. There is a contribution from NHS Forth Valley to each Community Planning Partnership, including the development of health inequalities as a cross-cutting issue across all theme groups, the development of an Equality and Diversity Impact Assessment (EQIA) process for CPPs and the application of health impact assessment Progress during The main improvement and prevention activity in included smoking cessation services, health protection including immunisation and population health screening, alcohol brief interventions (ABI), the health promoting health service framework, Keep Well health checks, the delivery of the sexual health and BBV framework, support to community planning and the SOAs and the joint work of the Forth Valley Alcohol and Drugs Partnership. Health Promoting Health Service (HPHS) NHS FV made considerable progress with the HPHS agenda in Improvements in the majority of the areas for development within the monitoring framework were noted with feedback from Health Scotland reporting 25 of the action areas complete, three partially met and two as yet unmet. Page 12 of 41

13 Key areas of progress include the Board s maintenance of the Healthy Working Lives silver award, reaccreditation of the UNICEF Baby Friendly Initiative award for acute services, further development of green space health improvement planning for NHS/ FV estates and the delivery of a number of workplace physical activity programmes and campaigns. Keep Well Forth Valley forms the main deprivation-focussed health care improvement initiative for NHS FV. Our approach has been unique in Scotland and aims to be person-centred and holistic. We have been able to demonstrate good outcomes in identifying unrecognised health risks and providing treatments for over 3000 people undergoing the health assessments each year. Although direct attribution can be difficult, estimates of return on investment are very positive. Tobacco work to protect children from second-hand smoke was progressed through the learning from the smoke-free homes and cars initiative which has commenced in and will build on the Take It Right Outside campaign which is being developed jointly with the British Lung Foundation. The initial pilot work on the Take It Right Outside campaign in included community workshops in five of Forth Valley s communities of greatest need - Camelon, Langlees, Fallin, Raploch and South Alloa. A story-based intervention Jenny and The Bear has been piloted in Primary One. This raises pupils and parents/carers knowledge, influencing paternal/carers behaviours and behaviour change. The Tobacco Action Group are producing a Smoke Free Forth Valley Action Plan for , which will outline the priorities for a co-ordinated partnership approach. Sexual Health (SH) and Blood Borne Viruses (BBV) are more prevalent in certain vulnerable groups. The Sexual Health and BBV (SH & BBV) MCN supports and monitors the five high level outcomes set out in the Scottish Government s SH & BBV Framework document to tackle the health inequalities gap. The aim is to reduce the number of sexually transmitted infections and unintended pregnancies and to ensure sexual relationships are free from coercion and harm in a Scottish society whereby the media are positive and non-stigmatising towards sexual health and blood borne viruses. Early detection of BBVs is leading to increased numbers of affected individuals referred into treatment services with higher cure rates and a decrease in onward transmission of viruses. Procurement. NHS FV use the Scottish Procurement Advertising Portal for all their tenders and within the portal use Quick Quote for goods or services under 25,000. The portal gives Scottish, Small and Medium, Enterprises and Supported Businesses, the opportunity to bid for NHS FV contracts. There is also a Health Promotion programme where we offer local companies access to Healthy Working Lives when we award them business. This has been a great success with participation of all of the local suppliers with whom we work. Our Social Influence Approach has been successfully piloted in secondary schools in This innovative pilot helps young people build a greater understanding of normal behaviours amongst their peers. Results show participants are less likely to engage in high risk behaviours such as smoking and are protected from harm. Page 13 of 41

14 2.1.3 Top Priority Actions 2015/16 Support those most at risk of Health Inequalities through targeted interventions to support vulnerable people and harder to reach communities. Specific actions will include developing employment opportunities within the NHS and local partners for disadvantaged groups especially vulnerable young people; implementing the Gender Based Violence Action Plan; reducing alcohol and drug related harm (ADP); promoting recovery orientated systems of care, identifying unrecognised health risks (Keep Well) and supporting young people to avoid high risk behaviours. Deliver Health Improvement by continuing to prioritise actions to reduce the harmful effects of cigarette smoking (Smoke Free FV Action Plan, Stop Smoking Service) and engaging hard to reach groups. Protect vulnerable groups from harm with a continued focus on Child Protection, roll out the Family Nurse partnership, deliver the BBV and Sexual Health Framework, population health screening and immunisation programmes Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Review to the Performance & Resources Committee or NHS Board. Measures Focus on Health Improvement and Prevention LDP Standard Enabling people at risk of health inequalities to make better choices and positive steps toward better health Sustain and embed Alcohol Brief Interventions in 3 priority settings of primary care, A&E and antenatal, and broaden delivery in wider settings Sustain and embed successful smoking quits, at 12 weeks post quit, in the 40% SIMD areas Prevention -Early diagnosis and treatment improves outcomes People diagnosed and treated in 1st stage of breast, colorectal and lung cancer (25% increase) National Requirement Prevention Screening Programme Performance o Cervical, Bowel, Breast Immunisation Programmes (Adult and Children)- uptake Deliver Child Healthy Weight interventions New diagnosis of Hepatitis C & Hepatitis C treatments completed Keep Well o Number and percentage of Keep Well assessments o o Number of Keep Well 3 month follow ups Number of Keep Well assessments carried out for people within the target areas of relative deprivation. Page 14 of 41

15 2.2 Antenatal and Early Years Strategic Context Forth Valley NHS Board will follow the strategic context set out in Getting it Right for Every Child (GIRFEC), Child Protection Guidance, the Children and Young People (Scotland) Act 2014 and the ongoing work being taken through the Early Years Collaborative. The Children and Young People (Scotland) Act 2014 will significantly impact on shaping the future direction of children s and young people s health, social care and educational services. The Act strengthens the role of early years support in children s and families lives by increasing the amount and flexibility of funded early learning and childcare. It aims to improve the way services work to support children, young people and families by: Ensuring that all children and young people from birth to 18 years old have access to a Named Person Putting in place a single planning process to support those children who require it through a Child s Plan Setting out a definition of wellbeing in legislation Placing duties on public bodies to coordinate the planning, design and delivery of services for children and young people with a focus on improving wellbeing outcomes, and reporting collectively on how they are improving those outcomes Under Part 3, the Act introduces new duties on a range of public bodies for planning and reporting. Specifically it: Puts in place new arrangements for children s services plans that best safeguard, support and promote the wellbeing of children and young people in a particular area; and Places the overarching responsibility for the development of plans for services that safeguard, support and promote the wellbeing of children and young people with Local Authorities and Health Boards Progress during Work is progressing locally to finalise the Child s Plan with implementation planned for 2015/16 in line with the implementation of the Children and Young People (Scotland) Act Interagency discussion and planning in relation to staff training forms part of the implementation plan alongside access to guidance on the use of the Child s Plan. The Early Years Collaborative (EYC) is a key health improvement programme aimed specifically at young children from pre-birth to age eight. All three local authorities have been actively engaged with NHS staff and other partners including the voluntary sector to provide training in EYC methodology and develop local projects. A Children and Young Peoples Strategic Partnership Group has been established to support Stirling and Clackmannanshire Community Planning Partnership priorities. Page 15 of 41

16 The group covers child protection, integrated children service planning, GIRFEC, EYC and corporate parenting. As part of the Early Years Collaborative and the Maternity and Children Quality Improvement Collaborative, midwives are promoting early access to antenatal care for all mothers, alongside tests of change to improve a range of health quality improvements e.g. antenatal smoking cessation, breastfeeding support and attachment. Work is also being undertaken to improve communication with the Named Person at the very start of a child s life. The Child Healthy Weight Programme, namely Max in the Middle (and Max in the Class) will continue in 2015/16. These programmes fit with the conceptual framework of developing resilience and being person centred (over 1500, ten and eleven year olds participate each year and by the very nature of the programme drive forward this agenda), whilst at the same time the interventions are biased towards schools whose catchment area takes in deprived communities. The intervention prides itself on social cohesion and inclusion as is evidenced by the number of pupils with additional needs who participate and thrive on the experience. The National Childsmile programme is fully implemented locally delivering a blend of universal and targeted dental health promotion. While there have been challenges in delivering the specifics of the fluoride varnish target, the programme is delivering a significant number of preventive interventions to children from birth to Primary 4. Public Health Nurses are delivering tailored Parenting Programmes based on family needs for example the Family Nurse Partnership (licensed, outcomes driven programme), 'Incredible Years' for families with additional needs, and the Triple P parenting programme for more general parenting support; baby massage to promote bonding between parent & baby, which is particularly important with families experiencing deprivation; breastfeeding support groups & weaning workshops; under 1 s groups with support from community dieticians delivering 'keen to wean', families with additional needs are supported through multiagency person centred planning Public Health Nurses and community dieticians are providing community food development activity i.e. cooking classes delivered in key regeneration areas Top Priority Actions for 2015/16 Deliver the Children and Young People (Scotland) Act 2014 requirements including the target of providing a Named Person for every child up to age 5 by end March 2016 (Legal Requirement by 1 st August 2016). Ensure that there are arrangements in place by 31 March 2016 to identify every child under 5 who requires a statutory Child s Plan and ensure the workforce has the capacity, training and protocols to deliver the Child s Plan by 1 st August Continue to implement the Early Years Collaborative Programme with partners across NHS FV with the aim of delivering on the stretch aims through a wide range of local initiatives using improvement methodology and tests of change. Page 16 of 41

17 2.2.4 Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Review to the Performance & Resources Committee or NHS Board. Measures Monitoring Implementation of the Children s Act Development of key measures to ensure delivery if key aspects e.g.: o Staff training o Implementation of the Named Person o Preparedness for implementation of the a single statutory Child Plan LDP Standard Antenatal access supports improvements in breast feeding rates and other important health behaviours At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12 th week of gestation by December 2015 National Requirement Participation in Early Years Collaborative Stretch Aims: o To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths and infant mortality o To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected milestones at the time of the child s month child health review, by end-2016 o To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017 Page 17 of 41

18 2.3 Safe Care Strategic Context A Quality Improvement Strategic Leadership Group has been established, cochaired by the Chief Executive and the Nurse Director, who is the Executive Lead for patient safety. The group s role and remit is to provide leadership for national improvement programmes across NHS FV; to ensure management and governance arrangements reflect national programmes; to ensure engagement across all levels of the organisation; to promote integration of quality improvement initiatives across the Board and to take account of internal and external monitoring, assessment and scrutiny. The Quality Improvement Strategic Leadership Group membership includes the clinical leads from each workstream of the Scottish Patient Safety Programme as well as a Directorate General Manager and Associate Medical Director. Programmes overseen by the Quality Improvement Strategic Leadership Group include all workstreams of the Scottish Patient Safety Programme, National Person Centred Health and Care Programme and the Early Years Collaborative. The ten patient safety essentials have been spread to all relevant areas of the Board, including community hospitals and mental health services. Mechanisms to assure performance include the care assurance ward visit programme and infection control team ward visit programmes. NHS FV developed a Quality Improvement Framework (QIF) to support the organisation s approach to ensuring that efficiency, productivity and quality continues to link our endeavours in delivering the overarching vision. The QIF was designed to complement our ways of working, providing a platform for closer integration and alignment of quality improvement activities and programmes, including the Scottish Patient Safety Programme and the Healthcare Associated Infection agenda. During 2015/16 actions will focus on priorities across all improvement programmes and will inform the next iteration of the strategic QIF. A Clinical Outcomes Group reporting through the Board s Governance arrangements has been established to support the Board s Improvement Plan to reduce mortality and harm. NHS FV continues to be committed to safe effective and person centred care being at the heart of all aspects of care and service delivery Progress during Examples for improvements in the safety of care in the last 12 months include: Acute Adult Programme o A continued improvement in HSMR which has contributed to the overall reduction of 21% since o The implementation of a human factors approach in the peri operative work stream including the development of the sterile cockpit. o The roll out of a structured approach to the recognition and response to deteriorating patients. Page 18 of 41

19 o A sustained reduction of falls across inpatient areas. o Sustained improvement and high reliability of the use of the heart failure bundle in the cardiology ward. o Sustained improvement with medicines reconciliation in the acute assessment unit. o 1607 days between cases of ventilator associated pneumonia. Maternity and Children Quality Improvement Collaborative o Implementation of the post partum haemorrhage prevention bundle in the maternity unit. o Sustained reliability of the use of the early warning score in the paediatric ward. Mental Health Patient Safety Programme o Implementation of a 3 stage debriefing process following an episode of restraint in the pilot mental health ward. Primary Care Patient Safety Programme o All Primary Care practices collecting data and driving improvements in the management of patients on warfarin and methotrexate and medicines reconciliation. o 96.5% of practices participating in trigger tool reviews. There has been widespread review of the Vale of Leven inquiry and other external Reviews of Governance. This has been an inclusive approach reporting back to the Performance and Resources Committee and to the Board Top Priority Actions for 2015/16 Ensure that the data collected as part of both the SPSP and the ward assurance systems are fit for purpose and the data is used to drive change in the system. The development of skills in quality improvement methodologies using these and other available data, and the application of these to the provision of safe care, is supported through the work of the Quality Improvement hub and overseen by the Quality Improvement Strategic Leadership Group. Maintain the improvements made in HSMR through co-ordinated implementation of the actions known to reduce harm and ensure the delivery of safe care consistently, including a focus on the management of the deteriorating patient through a local collaborative. Deliver the Vale of Leven action plan in full. Page 19 of 41

20 2.3.4 Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Review to the Performance & Resources Committee or NHS Board. Measure: LDP Standard Staphylococcus Aureus Bacteraemia (SAB) rate Clostridium Difficile (CDI) rate National Requirement Hospital Standardised Mortality Ratio (HSMR) Scottish Patient Safety programme (SPSP) workstreams: - Acute Adult - Maternity & Children - Mental Health - Primary Care Ten patient safety essentials: - Hand Hygiene - Leadership Walk Rounds - Communications: Surgical Brief and Pause - Communications: General Ward Safety Brief - Intensive Care Unit (ICU) Daily Goals - Ventilator Associated Pneumonia Bundle - Early Warning Scoring - Central Venous Catheter Insertion Bundle - Central Venous Catheter Maintenance Bundle - Peripheral Venous Cannullae Stroke care bundle Page 20 of 41

21 2.4 Primary Care Strategic Context The national drivers to enable a successful and sustainable model for primary care are the Scottish Government 2020 Vision and the Health and Social Care integration agenda. Other work including the Scottish Patient Safety programme, review of the GMS Contract, Prescription for Excellence and the national review of Out of Hours services should ensure a focus on quality improvement. Approximately 90% of patient contacts occur in the community where increasingly complex case management is routinely delivered by a wide range of professional staff. Shifting the balance of care away from reactive episodic care in an acute setting to team based anticipatory care closer to people s homes is a vital part of implementing the 2020 Vision. To achieve this outcome requires the development of an informed multidisciplinary workforce to support individuals within their immediate support system and community and within their locality. Localities are a key element within the planning mechanisms for Integrated Health and Social Care. Locally, within Forth Valley these initiatives will be complemented by the Clinical Services Review and work focussed on Locality Planning, alongside the Delivering Quality in Primary Care priorities, which are: Long Term Conditions and Multiple Morbidities Whole System Working focussed on Locality Planning and Anticipatory Care Ensuring safe and efficient quality prescribing Scottish Patient Safety Programme Effective use of workforce resources and integrated workforce plans The Locality Planning work will require each of our evolving localities to focus on outcomes and identify initial priorities for consideration by the Strategic Planning Groups of the Joint Integration Boards. It is anticipated that Locality priorities will inform the allocation of the Integration Fund. This is seen as key to ensuring longer term engagement with Locality work Progress during Within the NHS FV 2014 Annual Plan & LDP, the primary care strategic assessment was included. This provided an analysis of current strengths and weaknesses in developing a model of care aimed at delivering the 2020 Vision. The vision sets out a future where there is an increased ability to live more and higher quality life years at home or in a homely setting. This analysis is presented under six key areas: Service planning Interface and integrated working Infrastructure Workforce Leadership Data to support improvement Page 21 of 41

22 The following section highlights some of the areas of progress and considers current service strengths, current barriers to achieving the future vision, sets outcome proposed local interventions and, where possible, describes the necessary resource shift. 1. Leadership & Workforce - NHS FV has a highly skilled and committed primary care workforce. Challenges are being increasingly experienced within primary care and community settings and these are described in the NHS FV Workforce plan. Particular difficulties include retirement rates amongst an ageing workforce, increasing expectations for flexible working patterns and lessened enthusiasm for the business challenges of independent practitioner status. National action regarding the training arrangements and employment status of the primary care workforce may be helpful in addressing these local challenges. 2. Planning & Interfaces - Locality Planning is a key requirement of integrated Health and Social Care planning. In all practices in Forth Valley participated in Locality Planning work with events attended by over 340 participants from a wide range of professional groups. This type of work provides a useful opportunity to share good practice and requires individual reflection by GPs followed by further discussion initially at a practice level and then with a group of practices within the Locality or CHP that is focussed on improving ways of effective working. In there has been a continued focus on developing whole system pathways aiming to improve collaboration at the primary and secondary care interface. There was also alignment of the work with the safer medicines work stream of the Scottish Patient Safety Programme in Primary Care. Anticipatory Care Plans (ACP) are being developed for the most vulnerable patients and those with most complex needs. These are detailed in the Key Information Summary (KIS) which can be shared with other parts of the healthcare system. This has been supported by excellent engagement of GP practices with the initiative. In Jan 2015, 10,020 individuals in NHS FV had an ACP in place recorded using KIS. This is 3.4% of our population and is significant progress in developing management plans for our most vulnerable patients. There is potential to exploit the benefits of the KIS further by promoting access and enabling it to be more accessible to the whole system and to the individual who it concerns. 3. Technology & Data - NHS FV has been an early adopter of the key information summary (KIS). IT solutions allow access to the KIS by key front line staff out of hours. Whole System Working and Quality Improvement has been taken forward through the Quality and Safety Domain which replaced QIP QOF in 2014 with greater focus on access to general practice, patient safety and anticipatory care, as well as ongoing focus on continued quality improvement using national and local datasets. The work prioritised collaboration at the primary and secondary care interface. It is intended to focus on Results Handling using Bundle methodology in 2015/16. Page 22 of 41

23 4. Contracts & Resources - Ensuring safe and efficient quality prescribing. There has been considerable focus over the last 4 years on improving quality prescribing in primary care in NHS FV. The aim has been to move from being a national outlier with a cost per patient for primary care prescribing over 20 greater than the Scottish average to moving in line with the Scottish average, through the development of our Pharmacy Support team and a Practice based Prescribing Efficiency Programme. This work is being extended through 2015/16 with the focus on a Repeat Prescribing Local Enhanced Service Top Priority Actions for 2015/16 Stabilise the currently available GP workforce to maintain the available medical capacity in primary care by supportive actions for practices facing recruitment difficulties and a proactive approach to those facing future challenge. Develop a broad based multidisciplinary workforce based in primary care including AHPs, community nurses, pharmacists, optometrists, to deliver a model of care that increases the capacity available to see people in a community setting. Provide a sustainable service avoiding the need for admission for those whose needs can be met through self management and the use of anticipatory care plans, concentrating on patients with multi-morbidity and the frail elderly. This builds on learning from the Bo ness project and extends its geographical reach from the current area. Ensure premises and IT infrastructure in primary care are fit for purpose and maximise the opportunity for effective patient care Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Review to the Performance & Resources Committee or NHS Board. Measures LDP Standard First contact with the NHS is often through the GP practice. It is vital, therefore, that every member of the public has fast and convenient access to their local primary medical services to ensure better outcomes and experiences for patients 90% of people will have 48 hour access or advance booking to an appropriate member of the GP team National Requirement Delivery of dementia post diagnostic support Flu immunisation rates Childhood immunisation rates Prescribing costs Allied Health Professionals (AHP) waits Musculoskeletal (MSK) waits see also Scheduled Care Number of patients with an ACP Long term conditions bed days conditions are Asthma, COPD, Diabetes, CHD Page 23 of 41

24 2.5 Integration Strategic Context The Scottish Government launched a consultation on the draft Regulations relating to the Public Bodies (Joint Working) (Scotland) Act The finalised statutory Regulations are intended to provide Partnerships with areas of prescription over and above which local integration arrangements can be supplemented. A suite of integration indicators, to underpin the national health and wellbeing outcomes has also been developed to demonstrate progress. Integrated partnerships will be required to report on the national health and wellbeing outcomes and the underpinning indicators annually. Quality and safety for people who use our services must remain at the forefront during 2015/16 while the system transitions towards integration. The role of clinicians and care professionals, along with the full involvement of the third and independent sectors, service users and carers, will be embedded as a mandatory feature of the commissioning and planning process through the clinical and care governance framework, now agreed, and through locality planning arrangements. Integrated partnerships will be required to establish a strategic planning group to prepare the strategic plan - this group will include representation of these key stakeholders. The Integration of Health and Social Care is a key priority for NHS FV with significant progress being made during A Partnership will be established between the Health Board and Falkirk Council and there will be a Multi Authority Partnership between the Health Board and Stirling and Clackmannanshire Councils Progress during NHS FV Health Board and its Local Authority partners agreed to pursue the Body Corporate model which will result in delegation by Local Authorities and the Health Board of all functions within scope of integration, to a new entity governed by an Integrated Joint Board with accountability for overseeing the provision of functions. A Core Group of Senior Officers from NHS FV and each Local Authority has overseen the actions required to meet the legislative timescales. Transitional Boards have also been established for each Partnership to oversee completion of Integration Schemes; the establishment of fully constituted Integration Joint Boards; Integration Joint Boards standing orders and the appointment of Chief Officer posts. Core (voting) members for each Integration Joint Board have been appointed and form the core membership of the Transitional Boards. Interim Chair arrangements have also been agreed. Positive progress was made during in engaging GPs, Community health staff, Social Work and the Third Sector in locality focused discussions regarding integration and joint priorities. Page 24 of 41

25 Based on a timetable of key milestones issued by the Scottish Government and also to comply with Local Authority and Health Board decision making timescales, a revised timescale has been developed which sets out activity from now until 1 April 2016, which is the date when the integration arrangements are expected to be fully in place. A review of NHS FV s Integrated Healthcare Strategy, is being undertaken with a full Clinical Services Review (CSR) underway. This Review, due to report in the summer, is complementary to the Integration agenda and will support the development of the Strategic Plan Top Priority Actions for 2015/16 Implement Strategic Planning process; establish Strategic Planning Groups; and produce draft strategic plans for consultation during 2015 for approval by Integration Joint Boards by March Agree the distribution of the Integrated Care Fund and Delayed Discharge Fund with a focus on: o Addressing Delayed Discharge o Avoiding Unplanned admission/readmission o Health & Wellbeing in Communities o Support to Carers o Building joint infrastructure including organisational & workforce development Implement agreed transitional arrangements for Community Health Partnerships to ensure continuity of service provision during 2015/16 and support the engagement and involvement of staff and patients including ongoing support to staff, establishment of a Joint Staff Forum, Partnership Forum and Public Partnership Forum Performance Management Performance Management is a legislative requirement for the IJB s with the production of an Annual Report as a minimum. The key measures and targets around integration will be driven by the Strategic Plan and the performance management arrangements will be developed accordingly. Some examples of measures may include Delayed Discharges (note below for ongoing analysis by IJBs), Occupied Bed Days and homecare levels. Cognisance will be taken of the national indicators for the Integration of Health and Social Care that are to be published in March Measures National Requirement From April 2015, no one will wait more than 14 days to be discharged from hospital into a more appropriate care setting, once treatment is complete Total bed days lost to delayed discharge Page 25 of 41

26 2.6 Person Centred Care Strategic Context The Strategic Quality Improvement Framework is an improvement programme dedicated to improving patient experience and delivering person centred services. NHS FV remains committed to improving patient experience as a key aspect of the quality improvement priorities that underpin the efficiency productivity and quality programme in NHS FV. NHS FV continues to implement the National Person Centred Health and Care Collaborative approach, making wider connections with third sector partners, sharing learning across all Boards from Scotland and continuing to ensure that patients voices are central in driving forward improvement. The next Participation Standard Self Assessment will focus on how Boards are using their annual report for Feedback, Comments, Concerns and Complaints. Boards will be expected to demonstrate how the involvement of patients and the public has fed into the improvement work around feedback and complaints. NHS FV will continue to be committed to Person Centred Care as central to all aspects of care and service delivery including staff experience Progress during NHS FV continues to develop their local approach to Person Centred Care, which includes a full review of the Patient Focus and Public Involvement agenda and existing groups. We are currently developing a Person Centred Care strategy and delivery plan, establishing a Person Centred Care Steering Group, supporting implementation of the local Person Centre Health and Care Programme and developing an implementation plan for the Five Must Do s With Me and a reporting mechanism. From September 2014, formal arrangements have been in place to report on specific measures. The focus of the initial measurement and reporting is around the Five Must Do`s With Me. An organisational plan to test spread measure and to implement improvements using improvement methodology has been developed. A clear reporting structure has been established, which facilitates regular reporting to the Person Centred Steering group. The National Better Together results were made available in the week of 25 August The results illustrate comparable scores from all inpatient surveys from , and this year s data. The results of the survey will be used by NHS FV, and the Scottish Government to improve the quality of healthcare in Scotland by focussing on the areas that patients tell us are important to them and where they consider improvement could be made. As part of the Scottish Patient Experience Survey Programme commissioned by the Scottish Government, survey questionnaires were sent out in January 2014 to 928 people who stayed overnight in an NHS FV hospital between 1 April and 30/ September 2013, with 417 patients providing feedback on their experiences. Page 26 of 41

27 This survey aims to use the public s experiences of health and care services to improve local services. In relation to this year s results for Scotland, NHS FV was significantly more likely to report a positive experience in the following themed analysis: Waiting time to see a nurse or doctor Feeling safe in A&E Being bothered by noise from other patients at night Meals Privacy Communication NHS FV has seen a significant statistical improvement in the experience reported which is a very positive position. The national healthcare experience indicator has increased by 3.0, NHS FV has had the highest improvement in Scotland of 6.8. Our results continue to influence our priorities for improvement and inform our person centred programme. To take forward this programme in NHS FV, a Person Centred Health and Care Programme will be supported through a collaborative. The collaborative will provide an opportunity for frontline teams across the system to test changes, share their learning and to connect with a range of people from different backgrounds and care settings. Using the Model for Improvement, teams will be able to test and implement change within their areas. The Person Centred Care Action Plan includes the Participation Standard, Complaints and Feedback, Patient Public Panel (PPP) and Volunteering Top Priority Actions for 2015/16 Continue to implement the requirements of the Patient Rights Act. A key deliverable is the implementation of the Safeguard module that captures local feedback, comments, concerns, compliments and complaints. Following the pilot stage full implementation across NHS FV will be completed by December Additionally, the focus on the performance of managing and handling complaints and feedback will continue. We will endeavour to reduce the number of complaints from patients and public in relation to staff attitude and behaviour. Ensure that NHS FV delivers across the requirements of the Participation Standard. This ensures that the NHS Board meets all requirements for patient and public engagement, including capturing and learning from patient and public feedback. By Autumn 2015, the Board will complete the development of its comprehensive system that captures evidence and demonstrates how feedback drives improvement and supports assurance. Ensure that NHS FV delivers on the national requirements to achieve Person Centred Healthcare by December A key element of this is the engagement, support and development of staff. Under the banner of the First Impressions and Communications Campaign, a suite of education and training including the use of national and local programmes will be delivered. Page 27 of 41

28 2.6.4 Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board. Measures LDP Standard A refreshed Promoting Attendance Partnership Information Network Policy will be published in 2015 Sickness absence 4% National Requirements The Five Must Do s With Me - What matters to you - Who matters to you - What information do you need - Nothing about me without me - Personalised contact Clinical Quality Indicators - Pressure area care - Food, Fluid & Nutrition - Falls Falls with harm rate Percentage of complaint responses within 20 days Reduction in the number of complaints Number of complaints acknowledged in 3 working days Number of complaints referred to Ombudsman Number of complaints upheld by the Ombudsman Percentage of staff having completed an eksf annual review Long and short term absence rates Patient and Carer Experience Page 28 of 41

29 3. NHS FORTH VALLEY LOCAL IMPROVEMENT PRIORITIES 3.1 Unscheduled Care Strategic Context The effective and efficient delivery of unscheduled and Emergency Care is a core function of territorial NHS Boards. NHS Forth Valley continues to support the delivery of unscheduled care participating in National Work and through local improvement initiatives. The improvement work required to deliver sustainable Unscheduled Care Services is a key priority for NHS FV. The improvement work is supported by a dynamic approach to using data to understand and respond to the changing demand for unscheduled care. NHS FV is working with the National Unscheduled Care Team to move from the Local Unscheduled Care Action Plan (LUCAP) and Winter Planning process used in 2014/15 to adopt the 6 Essentials for Improving Patient Safety, Flow and Sustainable Improvement in Unscheduled Care. This builds on our work in 2014/15 supported by the LUCAP, winter plan and the work undertaken on whole system capacity and flow. The most significant factors impacting on the delivery of the 4 hour access target relates to patients waiting for first assessment and flow out of the Emergency Department resulting from patients waiting for a bed or specialist review. Through NHS FV s overview of strategic priorities, a Local Unscheduled Care Action Plan 2 (LUCAP2) was developed with a key focus on whole system capacity and flow. As part of this improvement programme, analysis was carried out across the system to understand causes of pressure points and variation. This analysis underpinned the development of the LUCAP which outlines key actions required to address current pressure areas. From our analysis we identified the most significant contributing factors adversely affecting the 4 hours access target in ED to be the wait for 1 st assessment, time waiting for specialist review; and time waiting for an available bed. However, it is recognised that these often reflect challenges elsewhere in the hospital, community services and primary care. Progress is reported regularly to the Board and Scottish Government. The active partnership between NHS FV and the Scottish Government will continue to ensure sustained progress is made in 2015/16. NHSFV is one of four pilot sites working with the Scottish Government whole system patient flow project and the institute for healthcare optimisation (IHO). The focus on the work initially is to improve through re-engineering medical flow. This will reduce time waiting and improve flow across the day and week Progress during During NHS FV had continued to deliver a portfolio of improvement work with a commitment to Whole System Working. Key actions were agreed to support delivery of the four hour target in respect of improving flow, clear decision making processes, admission avoidance, senior presence within ED and ensuring robust on call procedures to support early escalation. Page 29 of 41

30 In relation to the Delayed Discharge Target the following actions have been taken: An integrated case management approach to all frail elderly commenced in November Substantial investment to provide additional winter contingency beds in Falkirk. Development of the discharge hub and increased staffing to support 7 day cover from January National and local guidance around the Choice Policy has been implemented and care home availability for interim placements has been developed. In April 2013 a new stroke bundle was introduced at Forth Valley Royal Hospital, which has helped to drive improvement and deliver high standards of care. Importantly, the first six months of 2014 saw 89% of stroke patients admitted to the stroke unit within 24 hours Top Priority Actions for 2015/16 Ensure the design of care of the elderly and stroke services provide maximum support to patients and their carers and deliver care in the most appropriate setting, without delay, through appropriate community based services. Enhance the provision of skilled staff available to manage minor injuries and extend this to minor ailments to avoid use of OOH or Emergency Department attendance for patients with these conditions. Use the KIS and ACPs developed for effective communication across all parts of the healthcare system, including with patients and carers to avoid admission or readmission where possible. Takes steps to ensure delivery of the 95% treat, admit or discharge within four hour target Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board. Measures LDP Standard High correlation between emergency departments with four hour wait performance between 95% and 98% and elimination of long waits in A&E which result in poorer outcomes for patients. 95% of patients attending ED / Minor Injuries will be seen, treated and discharged or transferred within four hours. Page 30 of 41

31 3.2 Scheduled Care Strategic Context The Local Delivery Planning Guidance contains a number of standards for 2015/16. During 2015/16 Boards need to improve the 12 weeks outpatient performance to achieve a minimum 95% standard with a stretch aim to 100%. It is also essential that waits of over 16 weeks are eradicated. Further guidance asks that NHS Boards agree a set of trajectories in relation to the 12 week target. The NHS FV improvement strategy includes plans to address inefficiencies in the patient booking process by completely centralising the booking process underpinned by the purchase of an electronic patient reminder service module. Currently NHS FV is working closely with NHS 24 using an agent driven patient reminder service in Ophthalmology and Orthopaedics. It is a legal requirement for boards to comply with the Treatment Time Guarantee (TTG) and, during 2015/16, NHS FV would seek to comply with this requirement. Capacity plans will reflect the demand and capacity for each speciality to ensure a full appreciation of emerging challenges. The approach over 2015/16 is to comply 100% with the legal TTG by consolidating and implementing a sustainable plan that takes account of the working capacity of surgical services and matches this with demand Progress during In NHS FV gave significant priority to the delivery TTG and with the exception of a very small number of patients, the TTG position was delivered. In 2014 NHS FV reorganised the unit structures and delivery model to simplify the process. Diagnostic services have a major role in supporting the waiting time standards especially cancer, RTT and TTG. NHS FV recognises the need for sustainable short waits hence improvement plans are being implemented to comply with the LDP waiting time standards and improve our current position, particularly in relation to Endoscopy. During 2014 NHS FV consistently had, on average, 1,000 patients waiting over 12 weeks. 80% of the outpatients waiting over 12 weeks are within three of the following specialties: Ophthalmology, Orthopaedics and Gastroenterology. The following actions were taken in 2015: Ophthalmology specifically has experienced significant recruitment and unplanned leave issues which have led to a backlog of waits. Plans to reduce the waits over 12 weeks by 200 early in the new financial year are in place. Recruitment will remain a high risk over the coming year but we will improve contingency planning and respond more decisively when waits start to exceed the standard. Recent investment in Gastroenterology has allowed the service to expand the consultant base from five to seven. The service is now looking to review job plans to make best use of the new capacity to reduce long waits within Gastroenterology and Endoscopy services. Page 31 of 41

32 Orthopaedic outpatient waiting times are improving but there are significant waits within the subspecialty of back pain. Redesign programmes are underway and it is the intention of the team to improve waits by delivering national Musculoskeletal (MSK) programme objectives. Significant pressure was also experienced in Psychological Services and CAMHS which are currently being addressed with considerable investment made to secure early improvements Top Priority Actions for 2015/16 Deliver the access standards for patients in Endoscopy, CAMHS, Psychological Therapies and MSK. Maintain the current delivery of TTG and the Cancer standards. Reduce the percentage of patients waiting over 12 weeks for an outpatient appointment in line with a trajectory submitted to SG (see attached file); a minimum 95% compliance and stretch aim to 100% by March 2016, to include delivery of the backstop of 16 weeks. Page 32 of 41

33 3.2.4 Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board. Measures LDP Standard Maintain Early diagnosis and treatment improves outcomes. 31 days from decision to treat (95%). 62 days from urgent referral with suspicion of cancer (95%). People diagnosed and treated in 1st stage of breast, colorectal and lung cancer (25% increase). Maintain 12 weeks Treatment Time Guarantee (100%). Eligible patients commence IVF treatment within 12 months (90%). Deliver 18 weeks Referral to Treatment (90%). 12 weeks for first outpatient appointment (95% with stretch 100%). 18 weeks referral to treatment for Specialist Child and Adolescent Mental Health Services (90%). 18 weeks referral to treatment for Psychological Therapies (90%). From the 1 st of April 2016 the maximum wait for AHP MSK Services from referral to 1 st clinical outpatient appt will be four weeks (for 90% of patients). Services for people are recovery focussed, of good quality and can be accessed when and where they are needed. Clients will wait no longer than three weeks from referral received to appropriate drug or alcohol treatment that supports their recovery (90%). National Requirements Diagnostic 42 day wait Close monitoring of: Outpatient unavailability Inpatient unavailability Page 33 of 41

34 4. SUPPORTING PLANS 4.1 Financial Planning Strategic Context It is essential that local services are as effective and efficient as possible to ensure that we continue to meet demand changes arising from demography, improving care standards, the introduction of new technology, new and changing drug indications and meeting targets and guarantees, while maintaining financial balance. The draft Financial Plan identifies the projected level of cash savings required each year to meet prioritised objectives, including delivery of financial targets. In line with other Health Boards, we are required to deliver a 3% efficiency gain which equates to approximately 13.5m. It is assumed that this requirement will continue for the foreseeable future. This is achieved through a combination of cash releasing savings where costs are reduced in real terms and using resources more effectively so that more can be achieved from the same level of resource. However true cash savings are becoming more challenging to deliver without affecting patient services and more innovative ways of service delivery will be required. The requirement to align resource utilisation to Community Planning Priorities, NHS Priorities, deliver change arising from Integration Joint Board (IJB) Strategic Plans and develop locality planning, will make financial control ever more complex in the timeframe of this Financial Plan. The Financial Plan and Capital Plan was approval at the end of March It will also be updated as we work through and rebalance our resource use as needs and priorities emerge from both the local Clinical Services Review and the Strategic Plans of the two IJBs. However it is important to stress that change brings with it risk. The financial challenge of integrating funding streams from Health and Social Care both of which are pressured at a time when real cost reductions are required to meet pension costs and increased national insurance contributions is significant Progress during In 2014 NHS FV achieved Financial Balance, paid back outstanding brokerage and completed key property transactions Top Priority Actions for 2015/16 Ensure the Board s Clinical Services Review is underpinned by an affordable financial strategy incorporating the impact of demographic change and assessment of national, regional and local service plans including the Strategic Plans of Local IJBs. Ensure the Clinical Services Review is supported by an affordable Capital Plan including and investment programme for primary care, estate, Community Hospitals, IT infrastructure, ehealth and Telehealth developments and a medical equipment replacement programme for Forth Valley Royal Hospital. Ensure the delivery of an Efficiency Programme for 2015/16 covering productivity improvements, cash savings and develop a sustainable Efficiency Programme for the next two years. Page 34 of 41

35 4.1.4 Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board. Measures LDP Standard Operate within agreed revenue resource limit; capital resource limit; and meet cash requirement Detailed actions are described in NHS FV s Financial Plan for 2015/16. Page 35 of 41

36 4.2 Workforce Planning Strategic Context The NHS FV Workforce Strategy was refreshed and approved by the NHS Board in July This Strategy was developed in partnership and details how we, as a Board will deliver our workforce aims: To develop a modern, sustainable workforce To become a model employer To create and maintain a healthy and modern culture The Everyone Matters Implementation Framework details five priorities and these are fully incorporated as part of our Workforce Strategic Vision and its associated programmes of work. The Everyone Matters Implementation Framework is an integral part of our local workforce strategy and an ongoing element of our Workforce and Organisational Development Priorities. Our current focus is on undertaking system wide service reviews, through our Clinical Services Review programme which will ensure that we have appropriate models of safe, quality care in place and a confidence that we are optimising the use of our resources and facilities. This work is key to informing and shaping the new NHS FV Integrated Health Care Strategy Over 80% of our workforce lives within the Forth Valley area. Although the total working age population of Forth Valley (adults aged 16-64) will remain fairly constant over the next 20 years at about 182,000 it is important to recognise that the percentage over age 50 will increase from 36% to 41.7% by Currently NHS FV has an ageing and predominantly female workforce, the demographic of our staff and local communities requires that we deliver innovative, proactive workforce solutions. In common with other Health Boards, NHS FV faces many challenges in relation to the delivery of ongoing, affordable health care within tight financial parameters. Changes to pension and national insurance arrangements along with the challenges of pay, prices, prescribing, achieving and sustaining targets, technology advances, demographic impact and the changes as we implement Health and Social Care Integration will place a much higher risk on the system from 2015/16 and beyond. In order to address these challenges, we remain committed to the continuous development of our workforce through their skills and competencies and to our annual programme of workforce planning. Page 36 of 41

37 4.2.2 Progress during A wide range of activities and plans were successfully taken forward in delivering the five Everyone Matters Priorities within Forth Valley, some of these will continue to support the actions required of Boards for In 2014 NHS FV achieved the Peoples Choice Award for work on attendance management, delivered a system wide inclusive Staff Recognition Scheme and successfully delivered proactive recruitment initiatives. In support of our Strategy and in accordance with CEL 52 (2011), NHS FV has developed workforce plans for all services and staff groups. Integrated Workforce, Service and financial plans continue to support full implementation of our Healthcare Strategy and inform the development of the revised Integrated Health Care Strategy. In recognition of the crucial role that workforce plays in supporting continuous quality improvement to deliver flexible and responsive services, NHS FV and the University of Stirling work collaboratively to deliver National Nursing and Midwifery Workforce Tools and Planning Programme (NMWWP) Workforce Education Toolkit as a four day education programme for all NHS FV Senior Charge Nurses and Band 6 Nurses and Midwives to support succession planning this offers academic credit at SCQF Level 9 through a work based learning (WBL) platform. The NMWWP learning toolkit supports our Senior Charge Nurses, Midwives and Team Leaders to understand workforce planning and to support the workload measurement tools in use across NHS FV. This toolkit has been reviewed nationally and developed now to support Senior Charge Nurses, Midwives and Team Leaders but also aspiring Senior Staff Nurses as well as Clinical Nurse Managers and Lead Nurses, providing the opportunity to develop their understanding of workload and workforce planning and help them use workload measurement tools effectively. NHS FV as part of the workforce planning process has already started to identify potential gaps in future workforce using age demographic information. The medical workforce profile demonstrated that a significant number of our Consultants would be leaving the organisation through retirement. Anticipating this position, NHS FV has been successful in appointing over 40 new Consultants across all specialties. This work will continue in 2015/16. The following considerations continue to be taken into account when planning our current and future Medical workforce: Outputs from Clinical Services Review Age profile Ageing population and Demographics in NHS FV Hard to fill posts Paediatrics, Microbiology, Old Aged Psychiatry, Middle Grade A&E doctors Provision of sustainable services over 7 days Expansion of Regional and National working In 2015/16 this work will be extended to other job families across NHS FV. Page 37 of 41

38 4.2.3 Top Priority Actions for 2015/16 The Workforce Plan : This year, we will complete our 10 th Workforce Plan and this will be published in August This will build on a strong background of effective change management, service redesign and skill mix review consistent with the national and local strategic view under the Everyone Matters 2020 Vision. Workforce Strategy - We will review our Workforce Strategy to reflect the outcome of the Clinical Services Review. This will ensure we continue to deliver the five national priorities within the Everyone Matters Workforce Vision Implementation Framework. Attendance Management We will maintain our current focus in order to improve attendance rates and deliver the national standard Performance Management In addition to the Priority Actions outlined above, the following section sets out the relevant measures that will be used to monitor and assess progress and manage performance. These measures will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board. Measures LDP Standard A refreshed Promoting Attendance Partnership Information Network Policy will be published in 2015 Sickness absence 4% National Requirements Workforce projection submissions Staff Governance Action Plan Everyone Matters Implementation Plan 2015/16 Page 38 of 41

39 4.3 NHS Forth Valley s Contribution To Community Planning Strategic Context The NHS Forth Valley Board contribution to Community Planning supports the delivery of health improvement and health inequalities as recommended by the Christie Commission, and helps to ensure delivery of the Scottish Government s 2020 Vision. Scottish Ministers and Council Leaders agreed the latest generation Single Outcome Agreements (SOAs) in Summer Community Planning Partnerships (CPPs) developed these SOAs in line with SOA guidance published in December The new SOAs represent a key component of strengthened community planning as set out in the joint Scottish Government/COSLA Statement of Ambition. In particular, they demonstrate a clearer understanding of local place and priorities than earlier versions, and plans for the delivery of improved outcomes on these priorities. The SOAs also set out how each CPP is aligning its approach with the four pillars of public service reform: prevention; local integration and partnership; performance improvement, and investment in people. NHS FV is fully committed to supporting delivery of the SOA s in Clackmannanshire, Falkirk and Stirling Progress during Audit Scotland completed a review of CPPs that proposed a number of areas which CPPs should take action on. A number of these areas are already within our local improvement programme. The proposed areas for action included: Strengthening the effectiveness of the leadership, challenges and scrutiny roles at Board level. Streamlining local partnership working to ensure that it is aligned with local improvement priorities. Ensuring that Community Planning arrangements are clear on who has responsibility for: o Agreeing Community Planning/SOA priorities; o Allocating resources and co-ordinating improvement activity; o Implementing improvement activity; o Scrutinising performance and holding partners / others to account. Working with new Health and Social Care IJBs to develop services that meet the needs of local people and support SOA priorities. Setting clearer improvement priorities and focusing on how they will add optimum value as a partnership, when updating the SOA. Using local data on the differing needs of communities to set relevant, targeted priorities for improvement. Starting to align and shift partner s resources toward agreed prevention and improvement priorities. NHS FV completed a comprehensive review of its approach to, and involvement in local Community Planning Partnerships. A short life working group reviewed various activities contributing to the overall objectives and core areas of the SOAs. A number of recommendations were made and presented to the NHS Board for consideration at its meeting in December Page 39 of 41

40 The recommendations, which will be progressed in 2015/16, included: There is a wide range of excellent improvement work underway but there is a requirement to raise the profile of this activity and provide a mechanism for NHS Board level leadership and oversight. The NHS Board joint activity with the CPPs should be subject to oversight through regular updates to the Performance and Resources Committee or NHS Board. There should be consistent Senior NHS representation on the Community Planning Partnership Leadership groups in all the Local Authority Areas. The NHS Board should seek to have a Senior Manager or Non Executive on each CPP Leadership Group. The NHS Annual Plan should include a summary of activity within the SOAs to ensure leadership and allow all NHS Board members and the public visibility and oversight of activity to address inequalities and deliver health improvement. The NHS Board needs to establish greater ownership of overall CPP activity which can only be achieved by proactive engagement in the development of SOA s. The NHS Board will prioritise appropriate professional support to CPPs and SOA activity in future workforce plans Top Priority Actions for 2015/16 To ensure there is consistent senior NHS contribution to leadership of the Community Planning Partnerships in each of the three Local Authority areas. To develop formal NHS Forth Valley Board oversight of the Community Planning Partnerships and delivery of local SOA s through the NHS Board Performance and Resources Committee. To maintain focus on health improvement, prevention and inequalities during the establishment of Health and Social Care Partnerships through proactive engagement in the three local SOAs with emphasis on measurement of impact and outcomes Performance Management In addition to the Priority Actions outlined above, NHS FV will ensure the delivery of outcomes from the local SOAs. These measures will be used to monitor and assess progress and manage performance and will be used at appropriate levels within NHS FV to monitor and drive progress. Regular monitoring will take place at a range of levels from front line, through Directorate Performance Reviews to the Performance & Resources Committee and NHS Board. Page 40 of 41

41 APPENDIX 1 - NHS Forth Valley Strategic Planning Matrix 2015 NHS Forth Valley Integrated Healthcare Strategy (Under Review 2015) NHS Forth Valley Annual Plan Local Delivery Plan (Contract with SG) Financial & Capital Plan Workforce Plan Local Unscheduled Care Plan Activity & Capacity Plan Single Outcome Agreements Winter Plan Underpinned by: Local Strategies e.g. ehealth, Workforce Modernisation Directorate Implementation Plans Page 41 of 41