FORTH VALLEY NHS BOARD
A meeting of FORTH VALLEY NHS BOARD will be held on TUESDAY 27 MARCH 2012 at 9.30AM in the BOARDROOM, FORTH VALLEY NHS BOARD HEADQUARTERS, CARSEVIEW HOUSE, CASTLE BUSINESS PARK, STIRLING.
Please notify apologies for absence to Debbie Innes, Corporate Services Assistant, Tel 01786 457247 Email [email protected]
AGENDA
1/ APOLOGIES FOR ABSENCE
2/ MINUTE OF FORTH VALLEY NHS BOARD MEETING HELD ON For Approval 24 JANUARY 2012
3/ MATTERS ARISING
4/ FINANCIAL & PERFORMANCE ISSUES
4.1 NHS Board Executive Performance Report to end February 2012 For Noting (Paper presented by Professor Fiona Mackenzie, Chief Executive)
4.2 Finance Report for the period ended 29 February 2012 For Noting (Paper presented by Mrs Fiona Ramsay, Director of Finance & Planning)
4.3 Standing Orders including Scheme of Delegation and Standing Financial For Approval Instructions (Paper presented by Mrs Fiona Ramsay, Director of Finance and Planning)
4.4 NHS Forth Valley Local Delivery Plan and Financial Plan 2012/13 – 2016/17 For Approval (Paper presented by Mrs Fiona Ramsay, Director of Finance and Planning)
5/ NHS FORTH VALLEY EHEALTH STRATEGY 2012 – 2017 For Approval (Presentation by Mr Jonathan Procter, Director of Strategic Access & Capacity Planning)
6/ HEALTH AND SOCIAL CARE INTEGRATION For Noting (Paper presented by Professor Fiona Mackenzie, Chief Executive)
7/ REPORTS FROM SUB COMMITTEES
7.1 Minute of Area Clinical Forum meeting held on 19 January 2012 For Noting
7.2 Minute of Clinical Governance Committee meeting held on For Noting 20 January 2012
7.3 Minute of Audit Committee meeting held on 27 January 2012 For Noting
7.4 Minute of Endowment Committee meeting held on 27 January 2012 For Noting
7.5 Minute of Staff Governance Committee meeting held on 3 February 2012 For Noting
7.6 Minute of Acute Services Committee meeting held on 23 February 2012 For Noting
8/ TAKING FORWARD THE EQUALITY AND DIVERSITY AGENDA IN For Noting NHS FORTH VALLEY (Paper presented by Mrs Helen Kelly, Director of Human Resources)
9/ ANY OTHER COMPETENT BUSINESS
Forth Valley NHS Board
27 March 2012
This report relates to Item 2 on the Agenda
Minutes of the Forth Valley NHS Board Meeting held on 24 January 2012
For Approval
FORTH VALLEY NHS BOARD
DRAFT Minute of the Forth Valley NHS Board meeting held on Tuesday 24 January 2012 in the Forth Valley NHS Board Headquarters, Carseview House, Castle Business Park, Stirling.
Present: Mr Ian Mullen (Chairman) Mr Brendan Clark Dr Stuart Cumming Ms Margaret Duffy Mr Charlie Forbes Dr Allan Bridges Mr Tom Hart Mrs Helen Kelly Mr Jim King Professor Angela Wallace Professor Fiona Mackenzie Dr Vicki Nash Mrs Fiona Ramsay Dr Iain Wallace Dr Karen Facey
In Attendance Mr Tom Steele, Director of Strategic Projects and Property Mr Jonathan Procter, Director of Strategic Access & Capacity Planning Ms Beverley Finch, Head of Corporate Services Ms Elsbeth Campbell, Head of Communications Mr David McPherson, General Manager, Forth Valley Facilities Ms Debbie Innes, Corporate Services Assistant (minute)
1. APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of Dr Anne Maree Wallace, Cllr Linda Gow, Ms Fiona Gavine and Councillor Scott Farmer.
2. MINUTE OF FORTH VALLEY NHS BOARD MEETING HELD ON 29 NOVEMBER 2011
The minute of the Forth Valley NHS Board meeting held on 29 November 2011 was approved as a correct record.
3. MATTERS ARISING
There were no matters arising.
4. FINANCIAL & PERFORMANCE ISSUES
4.1 NHS Board Executive Performance Report to end December 2011
The NHS Board considered a paper “Executive Performance Report to end December 2011”.
Professor Mackenzie highlighted the following, as detailed within the report:
Internal site reconfiguration of Falkirk and Stirling Community Hospitals Transfer of services from Bonnybridge Hospital to Falkirk Community Hospital The Impact of Industrial Action Severe weather conditions Final Annual Review letter Governance and Management arrangements Scottish Governments plans for the Integration of Adult and Social care
Professor Mackenzie highlighted that the Chairman’s term of office would end on 29 February 2012. The Scottish Government had arrangements in place to seek a replacement. She also highlighted the Chairman’s leadership in the development and implementation of the Healthcare Strategy, culminating in the Royal opening of Forth Valley Royal Hospital.
On behalf of the NHS Board, Professor Mackenzie conveyed her deepest thanks and appreciation for the leadership and support that the Chairman had given over the years.
The Chairman responded appropriately.
In response to a query from Dr Vicki Nash regarding current performance reporting assessments, Mrs Kelly reported that NHS Forth Valley were refreshing the approach to attendance management and that a paper would be presented at the next meeting of the Performance Management Group.
Mrs Kelly also reported that she had met with Serco to discuss that company’s successful approach to attendance management in Forth Valley Royal Hospital. She reported that feedback received from Absence Management Clinics had been positive and that support from the Occupational Health Department was being explored. The experience of Glasgow City Council in reducing sickness absence was referred to. Mrs Kelly reaffirmed her determination to redouble her efforts to achieve the sickness absence target of 4%.
The NHS Board discussed in detail the following:
Quality Improvement and Assurance – Balanced Scorecard A&E Attendance Gastroenterology Services Scottish Patient Safety Programme Acute Services Reporting
Accident and Emergency attendance and waiting times were also discussed in considerable detail.
The NHS Board proposed that an update on the Scottish Patient Safety Programme and Gastroenterology Services be presented at a future Forth Valley NHS Board Seminar.
After detailed discussion, the NHS Board noted the Executive Performance Report to end December 2011.
4.2 Finance Report for the Period Ended 31 December 2011
The NHS Board considered a paper “Finance Report for the Period ended December 2011” presented by Mrs Fiona Ramsay, Director of Finance and Planning.
Mrs Ramsay highlighted that the operational overspend in-month had reduced from an average of £0.926m in the first three months to £0.311m for December 2011. She also highlighted that this decrease confirmed that the position was on track to achieve planned financial balance in-month for operational services by April 2012.
To date there had been 53 approvals under the Voluntary Severance Scheme at a cost of £3.186m, producing recurring savings of £2.176m.
Mrs Ramsay highlighted that work was progressing to develop the 2012/13 –2016/17 Financial Plan with initial plans scheduled for presentation at January Performance and Resources Committee and final plans for approval at the NHS Board meeting in March 2012.
Mrs Ramsay advised that the meeting arranged with the Scottish Government Health Department to discuss capital issues had been cancelled and would now be held late January 2012.
The NHS Board discussed Prison Service funding, increased incidence of complaints, NHS Forth Valley’s Savings Programme and complex therapies.
After discussion, the NHS Board:
Noted the revenue operational overspend of £5.563m to 31 December 2011 Noted that in-year financial balance was achievable following conclusion of discussions with the Scottish Government Health Department and based on current risk and ongoing delivery of savings Noted that work was ongoing in preparing the 2012/13-2016/17 Financial Plan Noted the balanced capital position, but that discussions with Scottish Government Health Department were required.
4.3 Corporate Plan Mid Year Update
The NHS Board considered a paper “Corporate Plan Mid Year Update”, presented by Mrs Fiona Ramsay, Director of Finance and Planning.
Mrs Ramsay advised that the purpose of the Corporate Plan Mid-Year Review was to report the progress of projects and actions described in the Corporate Plan and highlights of the year to date.
She reported on the following national projects and actions:
The Carers Information Strategy Prison Health Getting it right for Every Child (GIRFEC) AAA Screening Reshaping Older People’s Care/Change Fund Civil Contingencies Eating Disorder Inpatient Unit Royal Hospital for Sick Children (RHSC) & Department of Clinical Neurosciences (DCN)
Mrs Ramsay advised that NHS Lothian had circulated an Outline Business Case for the RHSC and DCN at Little France. In view of timescales this had been discussed by the Executive Group on 23 January 2012 and a letter of support in principle had been sent to NHS Lothian.
Professor Mackenzie reported that the Corporate Plan Mid Year Update demonstrated the ongoing work on a day to day basis.
Following discussion the NHS Board noted the contents of the “Corporate Plan Mid Year Update” paper.
5. NHS FORTH VALLEY INTEGRATED HEALTHCARE STRATEGY 2011-2014
The NHS Board considered a paper “NHS Forth Valley Integrated Healthcare Strategy 2011- 2014”.
Professor Mackenzie reported that the purpose of the paper was to present the updated NHS Forth Valley Integrated Healthcare Strategy 2011-2014 to the NHS Board for approval.
The NHS Board were provided with a report on progress in relation to the development of the updated Strategy at the September 2011 NHS Board meeting and given the opportunity to comment on the draft document at the November 2011, Seminar.
Professor Mackenzie thanked Ms Beverley Finch, Head of Corporate Services, for preparing the draft strategy which included comments from NHS Board members, General Managers and other key individuals.
The NHS Board discussed in detail Governance and Management arrangements, Reducing Inequalities, Quality Improvement Assessment work and the inclusion of Anticipatory Care Planning.
After discussion, the NHS Board:
Approved the NHS Forth Valley Integrated Healthcare Strategy 2011-14 Approved that delegated authority be given to the Chief Executive to incorporate any minor amendments that may be proposed following the Falkirk Partnership Board Meeting in March 2012. Noted that in the unlikely event that proposed amendments made by the Falkirk Partnership Board were of a material nature that these would be presented to the Forth Valley NHS Board for approval prior to inclusion.
6. Reports from Sub Committees
6.1 Minute of the Area Clinical Forum meeting held on 17 November 2011
The NHS Board considered the minute of the Area Clinical Forum meeting held on 17 November 2011.
Dr Bridges highlighted the following:
Healthcare Science - Action Plan Delivering Quality Through the Development of Integrated Care Pathways – Joint Event with NHS Fife Feedback from the Scottish Government Annual Review of NHS Forth Valley
The NHS Board noted the minute of the Area Clinical Forum meeting held on 17 November 2011.
6.2 Minute of the Acute Services Committee meeting held on 22 December 2011
The NHS Board considered the minute of the Acute Services Committee Meeting held on 22 December 2011.
Dr Nash highlighted the following:
Financial and Performance Report to end November 2011 Compendium Report Waiting Times Highlight Report to end September 2011 18 Week RTT Accident and Emergency position 4 Hour Access Target Workforce Model for Acute Hospital Nursing
The NHS Board noted the contents of the Acute Services Committee meeting held on 22 December 2011.
6.3 Minute of Clackmannanshire and Stirling Community Health Partnership Board meeting held on 13 December 2011
The NHS Board considered the minute of the Clackmannanshire and Stirling Community Health Partnership Board meeting held on 13 December 2011.
Professor Mackenzie highlighted the following:
Clackmannanshire and Stirling Community Health Partnership Terms of Reference Performance Reporting Membership of the Clackmannanshire and Stirling Community Health Partnership Role and remit of the Clackmannanshire and Stirling Community Health Partnership
The NHS Board noted the contents of the minute of the Clackmannanshire and Stirling Community Health Partnership Board meeting held on 13 December 2011.
6.4 Minute of the Staff Governance Committee meeting held on 13 December 2011
The NHS Board considered the minute of the Staff Governance Committee meeting held on 13 December 2011.
Dr Facey highlighted the following:
Reshaping the Workforce – Workforce in Transition Health & Safety Update – Staff Incidents Organisational Development Update Transfer of Prison Healthcare Services – Workforce Issues Attendance Management Staff Governance Standard Review
The NHS Board noted the contents of the Staff Governance Committee meeting held on 13 December 2011.
7. NHS Forth Valley Environment Strategy 2009-2014
The NHS Board considered a paper ‘NHS Forth Valley Environment Strategy 2009-2014’ presented by Mr David McPherson, General Manager, Forth Valley Facilities and Surgical Services.
Mr McPherson reported that the purpose of the paper was to highlight the changes to the Environment Strategy created by the revised HEAT target and to review action dates.
The NHS Board discussed the key issues and financial implications.
The importance of complying with both Scottish Government Health Department targets and European legislation was discussed. Mr McPherson highlighted that failure to comply with legislation would have severe penalties and potential legal action.
After discussion, the NHS Board:
Approved the changes to the Environment Strategy in support of the revised HEAT target Agreed to provide continued support to the Board level Environment Champion Recognised the need to continue to invest to support the implementation of the Environment Strategy
8. Any Other Competent Business
There being no other competent business the Chairman closed the meeting.
FORTH VALLEY NHS BOARD
27 March 2012
This report relates to Item 4.1 on the Agenda
Executive Performance Report to end February 2012
(Paper presented by Professor Fiona Mackenzie, Chief Executive)
For Noting
1
NHS Forth Valley Board Executive Performance Report February 2012
2 Contents Page
Purpose of report 3
Chief Executive’s Summary 3
Performance Summary 7
Corporate Risks 10
Recommendation 11
Appendix 1 - Healthcare Associated Infection Reporting 12 Template
Appendix 2 - Performance Dashboard & trend information Attached
3 1. PURPOSE OF REPORT
The purpose of the Board Executive Performance Report (BEPR) is to provide assurance to the NHS Board of the overall performance of NHS Forth Valley against aims relating to the continued development of the Quality Improvement agenda, which includes national Health, Efficiency, Access and Treatment (HEAT) targets, local priorities and significant risks.
2. CHIEF EXECUTIVE’S SUMMARY
Health Secretary Nicola Sturgeon recently announced the appointment of Mr Alex Linkston CBE as the new Chairman of NHS Forth Valley. Mr Linkston is a former Chief Executive of West Lothian Council and brings to the Board a vast amount of public and voluntary sector experience. He has a strong focus on customer service for which, under his leadership, the council won many awards. I am very pleased to welcome him, on behalf of Board Members, to the Forth Valley NHS Board.
In relation to the ongoing delivery of the Healthcare Strategy work continues at both Falkirk and Stirling Community Hospitals including internal site reconfiguration and a detailed demolition programme. Since the last reporting period all planned service moves at Falkirk Community Hospital have taken place, including the transfer of Medical Records and the Ophthalmology service from Stirling Community Hospital and demolition of the older parts of the former hospital site is nearing completion. The use of wards 18 and 19 at Falkirk Community Hospital is now planned for review to support the transfer of services from Westbank and Dunrowan. Recommendations to declare these premises surplus to requirements will then be made to the Board.
At Stirling Community Hospital, there has been widespread communication highlighting the relocation of the Minor Injuries Unit to the ground floor of the former maternity block which was formally opened to the public on 27 January 2012. The GP Out of Hours Service is situated alongside the MIU. A phased demolition programme has already commenced with the Laboratory, Theatres and Mortuary blocks and work has started to prepare the Queen Elizabeth Wing for demolition. Further progress will be reported to the Board in future months including the work to prepare service moves from both Bannockburn and Kildean hospitals which have been declared surplus to requirements. Both moves are scheduled to take place by the Autumn 2012.
Work continues to develop proposals for the development of a new care village within the grounds of the Stirling Community Hospital site which could transform the way health and social care services are delivered to older people. This is joint partnership venture between NHS Forth Valley, Stirling Council and Forth Valley College. The vision for the new care village not only addresses key local priorities to improve services for older people but will also help meet national plans to integrate adult health and social care services.
All three organisations have signed an Initial Agreement, which outlines the range of options available and identifies a preferred way forward to meet the
4 needs of older people. The initial agreement was approved by Stirling Council at its meeting on 1 March, 2012 and NHS Forth Valley Board Members will be asked to consider and approve the Agreement later today on the Board agenda. If approved, an Outline Business Care will be developed to examine and assess the options further and develop more detailed plans.
During the last month it was formally confirmed that a new Maggie’s Centre is to be built in the grounds of Forth Valley Royal Hospital, just a short walk from the oncology centre. The centre will provide an expert programme of emotional support and practical advice within a homely environment giving hope to the thousands of people across the region who are affected by cancer every year. Walk the Walk, the grant-making breast cancer charity has already pledged £3 million to help build the new centre.
With regards to osteoporosis, a new DXA scanner has been installed in Forth Valley Royal Hospital to allow patients from Forth Valley to have their bone health assessed locally. The scanner is part of NHS Forth Valley’s wide Falls, Fracture Prevention and Bone Health strategy, which identifies falls reduction and bone health in older people as a priority area. Initially the service will be offered to patients from Forth Valley between the ages of 50 and 75 with a fracture. Further work will be done to explore the possibility of extending the scheme to patients who have other risk factors for Osteoporosis. A Falls Resource Pack has been developed alongside a new Falls Sense on-line education programme. This programme will be available to social care and voluntary sector staff as well as the general public. It is anticipated that this service will assist with the early diagnosis of osteoporosis which in turn will help patients self manage their condition, maintain an independent life at home for longer and reduce the number of attendances at the Emergency Department and a reduction in hospital admissions.
In terms of finance, the operational overspend to the end of February is £5.830m with an in-month overspend of £ 0.080m. The in-month operational overspend continues to reduce and based on the current trend which is broadly in line with anticipated reduction the target of achieving operational in- month balance by April 2012 will be achieved. It is important that savings delivery continues to be pursued to ensure delivery of in-month financial balance. Discussions with SGHD have concluded and agreement reached about a package of support in 2011/12 to be repaid over a five year period through the proceeds from property transactions. This allows confirmation based on current trend and risks that financial balance will be achieved this year.
The LDP 2012/13 including the Financial Plan has been submitted to SGHD in accordance with timescale.
An initial draft of the Financial Plan 2012/13 to 2016/17 was presented to the March Performance and Resources Committee with the final draft Plan scheduled for consideration at the March 2012 Board Meeting.
5 The Board continues to give consideration to the review of Governance arrangements. Further discussions will be taking place over the coming months and will be reported to the Board at its May meeting alongside a full update on management arrangements.
A single national workforce information system, the Employee Support System (eESS) is being introduced for each NHS Board in Scotland. eESS will support HR and payroll processes, linking HR, payroll and other systems (eg time and attendance (SSTS). NHS Forth Valley is an early adopter of the system and it is anticipated that phased implementation will commence in Spring 2012.
On behalf of the Board I was very pleased to accept a cheque recently for £175,000 from the WRVS in Forth Valley. The cheque was presented by Mrs Angela Geer, UK Director of Older Peoples services for the WRVS. The presentation was attended by Margaret Paterson Head of Service for the WRVS for Scotland and Grahame Rose the Local WRVS Manager. A number of the local volunteers from Falkirk and Stirling hospitals were also present including Sheila Pheely Local Volunteer Manager. The donation will go towards continuing the work in relation to outings and art and creative activities with older people begun by the previous donation received from the WRVS. It will also be used to help develop volunteering with the WRVS throughout Forth Valley and specifically the creation of a sensory garden in each of the two Community Hospitals which will be of significant benefit to patients, carers and staff. The donation is the single biggest corporate donation which has been received in Forth Valley.
I am very pleased to advise that a new neonatal scanner has been purchased with funds raised by two charities SPIFOX (Scottish Property Industry Festival of Christmas) and So Precious, a local Stirling charity who have worked tirelessly to raise the funds required. On behalf of the Board I would like to formally thank both charities for their invaluable contribution which could help save the lives of premature and sick babies in the neonatal unit at Forth Valley Royal Hospital
A UNICEF UK Baby Friendly Initiative assessor has recently visited NHS Forth Valley and was so impressed with the commitment of staff and the knowledge and enthusiasm shown that a Certificate of Commitment towards achieving Baby Friendly Accreditation will shortly be awarded. The certificate is the first part of the accreditation process which is associated with implementing best practice standards for breast feeding.
An audit of NHS Forth Valley supervisors of midwifery took place on 1 March by the Local Supervising Authority, South East and West of Scotland Regions. The Audit report following the visit was extremely positive with all standards being met with the exception of one which related to supervisors of midwifery and supervisee ratios. The Audit team were particularly impressed with the amount of innovative work that had been undertaken in the past year despite the challenges of transition from the old maternity Unit to the new site at
6 FVRH both in terms of practice changes and site changes. The report will be presented to the Clinical Governance Committee as usual for consideration.
NHS Forth Valley has achieved outstanding results in certain target groups in the latest flu campaign. At the end of January 2012 almost 80% of people over the age of 65 were protected from flu and 60% of people with chronic disease who are in the high risk group have been vaccinated. This is currently the highest uptake of any of the Scottish health boards. Whilst these are excellent results I would urge people not to become complacent.
National No Smoking Day was on 14 March 2012. NHS Forth Valley continue to urge people to give up smoking and between January and December 2011 staff in Forth Valley supported 719 men and 995 women to quit smoking. In response to CEL 2012 (01) Health Promoting Health Service and concerns that have been raised in relation to smoking on NHS Forth Valley premises a survey has recently been conducted at the FVRH site. As a result, the Executive Group are in the process of reviewing the NHS Forth Valley smoking policy.
An innovative scheme which introduces people with mental health problems to the green space surrounding Forth Valley Royal Hospital has been honoured at the inaugural RSPB Nature of Scotland Awards. The “Branching Out” scheme is hosted by staff from Westbank Day Hospital and Bellsdyke wards, who work in partnership with Forestry Commission Scotland. Patients are encouraged to take part in a mixture of conservation, field craft, environmental art and gentle exercise-based activities.
Key areas of performance are highlighted in the following performance summary with further specific detail contained in appendix 2.
7
Performance Summary
NHS Forth Valley continues to deliver strong performance overall. Key highlights are noted below with the supporting appendix 2 showing trend information against developing quality measures which include all Key and several Standard HEAT targets.
3. HEALTH - Modernising Services
Integrated Healthcare Strategy Work continues to oversee progress with the implementation of the Strategy in respect of Falkirk and Stirling Community Hospitals and other accommodation moves across Forth Valley.
The Integrated Healthcare Strategy has been reviewed and was approved at the NHS Forth Valley Board in January 2012.
4. EFFICIENCY - Ensuring Effective Use of Resources
HEAT Key Measure Efficiency - Absences The target of 4% by March 2009 was unmet with absence management continuing to provide challenges for NHS Forth Valley The January 2012 position of 5.95% is an increase of 0.37% against the December 2011 position of 5.58%, and remains above the trajectory. The year to date rolling average is 5.35%. The overall Board position is aggregated from Acute 5.87%, CHP 6.82%, Corporate 3.62%, and Forth Valley Facilities (FVF) 6.69%. All services except CHPs showed increased absence in the month; Acute (0.13%), Corporate (0.30%), Forth Valley Facilities (1.78%). CHPs showed a decrease in absence in the month (-0.17%).
5. ACCESS - Modernising Services
HEAT Key Measures Access - Inpatients, Outpatients, A&E, Diagnostics and Cancer
Inpatients At the end of February 2012 there were 191 patients waiting over 9 weeks, a reduction of 20% on the previous month A forecast range of 80 – 130 patients waiting over 9 weeks at the end of March has been provided to the Scottish Government which is consistent with the previous months assessment Anaesthetics workforce pressures are affecting surgical specialties which is adding pressure within the system
8 Out-patients At the end of February 2012 there were 526 patients waiting over 12 weeks, a reduction of 215 on the January position The position for March 2012 remains challenging and clinical units continue to work through plans Forecast position for March 2012 is consistent with previous months, with a range of 280 to 350 patients waiting over 12 weeks There are emerging pressures in Respiratory Medicine that may have an adverse effect on this assessment
Cancer Quarterly assessment Published results show that NHS Forth Valley has achieved the required Cancer waiting time target for both 31 and 62 day targets: o In the period Oct-11 to Dec-11, 95.9% of patients were treated within 62 days of referral o In the period Oct-11 to Dec-11, 95.1% of patients were treated within 31 Days of diagnosis
8 Key Diagnostic Tests Zero patients waited over 6 weeks at the end of February 2012
4 Hour A&E Wait In February 2012, 93.7% of patients waited less than 4 hours between arrival at the A&E unit and admission, discharge or transfer This remains below the national target of 98% by 4.3% however is a 1.4% improvement on February 2011 Work with the Scottish Government reviewing emergency pathway has been carried out. This is expected to help provide some of the sustainable solutions going forward. Focused work continues to address issues in respect of breaches with NHS Forth Valley reporting no 12 hour breaches
18 Week RTT Performance The 90% target was achieved in December 2011 and has been sustained in January 2012 with 90.2% of patients were treated within 18 weeks
Substance Misuse By March 2012, 90% of clients will wait no longer than 5 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery The January 2012 position for Alcohol Misuse is 97.3% with the position in respect of Drug Misuse 96%, with the combined position 96.7% By March 2013, 90% of clients will wait no longer than 5 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. A combined trajectory in respect of this has been submitted to Scottish Government and agreed
9 Child and Adolescent Mental Health (CAMHS) By March 2011 no client will wait longer than 52 weeks from referral to treatment for specialist CAMHS Services - target achieved. This will be reduced to 39 weeks by March 2012 and 26 weeks by March 2013 At February 2012, no patients waited over 39 weeks from referral to treatment
Audiology By December 2011 no one will wait longer than 18 weeks from referral to treatment. The target was delivered in December however recent changes in circumstances have affected the resilience of this service leading to a 20% reduction in performance since the beginning of the year The February 2012 position is 71% of patients seen within timescale The main issues are staffing related
6. TREATMENT - Improving the Quality of Patient Care
Healthcare Associated Infection (HAI) HAI remains a priority in Forth Valley.
Heat Targets The number of staphylococcus aureus bacteraemia (SABs) for February 2012 was 7 New denominator and target for 2011/12 with a target of 0.26 or less per 1000 occupied bed days. The position for February 2012 is 0.4 The number of Clostridium Difficile Infections (CDI) in patients 65 years or over in February 2012 was 1 The rate of CDIs for patients 65 years or over was 0.2 per 1000 occupied bed days Hand hygiene compliance was 98% for January 2012
A&E Attendance This target continues to provide challenges for many Boards across Scotland with NHS Forth Valley activity fluctuating against the agreed trajectory points In February 2012 there were 1538 A&E attendances per 100,000 population This is 41 above the agreed trajectory of 1497 and an improvement against the January position of 1663 with the same trajectory point of 1497
Delayed Discharge There were zero delays over six weeks recorded at the February 2012 census There remain a number of delays under 6 weeks, 26 at the February census, that are causing capacity challenges within the system Overall however there has been a steady improvement in the position Activity continues in both health and Local Authorities to achieve and maintain the census date targets and to consolidate the position
10 Health and Local Authority continue to work with families to support an appropriate move into care with interim placements where necessary. Weekly meetings and ‘man-marking’ of patients is used to support this activity. Due to a number of reasons there are limited vacancies across the care home sector adding to pressure within the system
7. CORPORATE RISKS
Corporate Risks continue to be reviewed on a monthly basis by the Executive Performance Management Group (PMG). The Corporate Risk Register (CRR) has been transferred to the Safeguard system which offers a number of benefits in particular ‘real time’ information management. This allows risks to be reassessed as soon as the owner updates any actions. A substantial review of the CRR was carried out in February 2012. In line with the Risk Register Guidance this will be carried out on a quarterly basis, with the next review expected in May 2012. Key risks are highlighted to the NHS Board through this Board Executive Performance Report. Significant risks are detailed below.
Finance Risk and Efficiency Savings Finance risk for 2011/12 is high as noted in the Executive Summary. All efforts are focussed on ensuring financial balance with specific actions detailed including voluntary severance scheme, management review and service by service reviews and national procurement review, however, given the current economic position this is proving extremely challenging.
A new financial risk in relation to implementation of the National Single Instance (NSI) has been included in the CRR in February 2012. The risk is that a fully functioning ledger and reporting system will not be in place to support financial reports in April 2012. Weekly discussions and progress reports are being provided by NSS with Directors of Finance assessment of current project status awaited.
Clinical Risk Provision of healthcare and risk assessment/management for restricted patients who are managed via Health MAPPA (Multi-Agency Public Protection Arrangements) and those for sex offenders in the community managed via non-health MAPPA. Current control measures including access to relevant policies, systems and procedures within mental health services and access to training in MAPPA awareness and risk management are in place however the risk is highlighted in the CRR as a service gap exists to meet full requirements.
Service Impact of Industrial Action New risk included in CRR related to potential further industrial action and impact on critical healthcare services. Business continuity plans have been reviewed and are in place. Learning has been captured from the industrial action on 30th November. Monitoring will continue and further meetings planned to review status.
11 Inability to meet waiting time targets There are a number of service issues in respect of capacity and workforce causing difficulty in respect of delivery against the access targets. Contingency plans are in place for each specialty and progress is regularly reviewed at the Performance Management Group.
Workforce planning Work is on-going to deliver an affordable workforce plan in line with Financial Savings Plan and the Local Delivery Plan. The development and implementation of the workforce plans is an iterative process accordingly the time line for associated workforce changes requires to take into account key steps identified in the organisational change policy.
Delayed discharges To meet and sustain the delayed discharge zero position in partnership against the current financial pressure continues to pose challenges. A focus on further reducing this target from over 6, to over 4 weeks, over the next year (LDP 2012/13) places additional pressure on the delayed discharge work. A range of actions are in place to reduce delays for patient discharges including Joint Improvement Team working with local authority partners and health.
8. RECOMMENDATION
The Board is asked to note: The key items of information detailed within the Chief Executive’s Summary of this report The main areas highlighted in the Performance Summary, noting the February 2012 position The Corporate Risks reported The Healthcare Associated Infection Reporting Template (HAIRT) in Appendix 1 The Performance Summary and trend information detailed in Appendix 2
Author of Paper Name Designation Beverley Finch Head of Corporate Services
Approved By Name Designation Fiona Mackenzie Chief Executive
March 2012
12 Appendix 1
Healthcare Associated Infection Reporting Template (HAIRT) Section 1 – Board Wide Issues
This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the ‘Healthcare Associated Infection Report Cards’ in Section 2.
A report card summarising Board-wide statistics can be found at the end of section 1
Key Healthcare Associated Infection Headlines for March 2012 Announced HEI Inspection to Forth Valley Royal Hospital
o On March 6th, notification was given to NHSFV that an announced inspection to Forth Valley Royal Hospital will be performed on Tuesday the 3rd April 2012.
HEI inspections to Community Hospitals
o SGHD announced that it is the intention of the HEI Inspectorate to start inspecting community hospitals from September 2012
HEAT Targets
o Clostridium difficile infections (CDI) remain stable across NHS Forth Valley and remains one of the lowest rates in Scotland.
o Staphylococcus aureus bacteraemias (SABs) remain statistically stable across NHS Forth Valley. There was only one SAB last month that was hospital attributed.
New addition to the HAIRT report - ANNEX 1 o Following discussion with SGHD we are now permitted to include additional graphs in an annex detailing healthcare and community acquired SABs, to give a more accurate SAB breakdown across NHS Forth Valley.
Staphylococcus aureus (including MRSA)
Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:
Staphylococcus aureus : http://www.nhsinform.co.uk/Health-Library/Articles/S/staphylococcal- infections/introduction
MRSA: http://www.nhsinform.co.uk/Health-Library/Articles/M/mrsa/introduction NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248 13 A new HEAT target has been set for 2012/13 that all Health Boards across Scotland achieve a SAB rate of 0.26 per 1000 AOBDs. Our rate between April 2010 and March 2011 was 0.44 per 1000 AOBDs.
Following epidemiological analysis of our data, we are now working with various stakeholders to look at areas such as wound management and the appropriate use of invasive devices to help further reduce our numbers.
Over the last 12 months, our average number of SAB cases is 7 per month. In February 2012, the number of patients with a SAB infection was 7. Only one case was hospital attributed.
Clostridium difficile
Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at: http://www.nhsinform.co.uk/Health-Library/Articles/C/clostridium-difficile/introduction NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/clostridiumdifficile.aspx?subjectid=79
A new HEAT target has been set for 2012/13 that all Health Boards across Scotland achieve a CDI rate of 0.39 per 1000 OCBDs. Our rate between April 2010 and March 2011 was 0.19 per 1000 OCBDs.
Over the last 12 months, we have managed to reduce the number of CDIs to an average of 3 per month. In February 2012 there was 1 case of CDI reported.
Hand Hygiene
Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: http://www.washyourhandsofthem.com/ NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at: http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx
This month, the HPS national audit report for November / December 2011 gave NHS Forth Valley top marks with 97% compliance with hand hygiene opportunities. Results for January / February hand hygiene audit will be available in the next publication of the HAI reporting template.
14 Cleaning and the Healthcare Environment
Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national cleanliness compliance monitoring can be found at: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: http://www.nhshealthquality.org/nhsqis/6710.140.1366.html
Outbreaks
During the months of January and February 2012 there were no outbreaks of norovirus or any other pathogenic organism reported. A weekly update from Health Protection Scotland can be found at: http:/www.hps.scot.nhs.uk.
Other HAI Related Activity Local Infection Control Team NHS FV has an Infection Control Team which: • Advises and trains staff in how to prevent infection and to ensure no transfer of infection occurs. • Develop infection control programmes, e.g. hand hygiene, MRSA screening, surveillance etc.
Scottish Patient Safety Programme A number of areas in the programme focus specifically on reducing healthcare associated infection in theatres, general wards and in critical care units and work is currently underway in pilot areas within Forth Valley Royal Hospital. The work of the SPSP is integrated with all of the other actions described in this report that are being taken forward in NHS Forth Valley to reduce HAI.
Three examples of the work to reduce healthcare associated infection are: - preventing ventilator associated pneumonia and catheter related blood stream infections in critical care and increasing hand hygiene in wards.
Public and Patient Involvement Forth Valley is fortunate to have a committed patient and public involvement through the Patient Public Forums in the 3 Community Health Partnerships and the Patient Public Panel who are actively engaged in improving healthcare services including preventing HAI and monitoring domestic services.
Patient Panel members are working collaboratively with the Infection Control team performing HAI monthly compliance audits across Forth Valley Royal Hospital and the community hospitals.
MRSA Screening Since January 2010 NHS Forth Valley has been successfully screening all elective admissions and specific emergency admissions for MRSA. This is a government initiative to help reduce the incidence of MRSA cross infection throughout NHS Scotland. Scottish Government published the Pathfinder Report detailing the findings of the three boards which piloted the MRSA screening programme prior to the rest of NHS Scotland; from this report, amendments to the screening rationale have been changed and patients are now screened following a Clinical Risk Assessment (CRA).
15
Risk Management The risks around managing HAI are considered at every clinical level and included in Risk Registers held in departments. HAI also features in two different sections of the Corporate Risk Register (CRR). The CRR is reviewed every month to make sure all actions to manage any risks are being taken.
Primary care Primary care covers a wide area, and includes community hospitals, dental practices and GP practices across NHS Forth Valley. The Infection Control Team provides a full time 5 day service (out of hours covered by the Duty Microbiologist) to Primary care; the service includes advice, support, audit and education and training. This service is crucial; reducing the incidence and number of patients with a HAI in Primary care, can help reduce the HAI incidence in the acute hospitals. For instance strict antimicrobial management in the community can reduce patients developing conditions such as C.difficile Infections (CDI) or even the potential development of multi resistant bacteria which could be subsequently introduced to the hospital environment.
16
NHS Forth Valley Total Staphylococcus aureus Bacteraemia Cases (all ages)
14
12 This report card details our Board wide performance for SABs (MRSA and MSSA), CDI's, Hand Hygiene and Cleaning Compliance. 10 8 Reports published by Health Protection Scotland detailing the national progress of 6 the SAB and CDI targets indicate that NHS Forth Valley remain statistically stable 4
and in line with the rest of Scotland. 2
0 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 H and Hygiene Monitoring Compliance (%) 7 6105 51071248 5 7 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 98 97 98 100 97 99 99 99 96 98 98 98 MRSA Bacteraemia Cases (all ages)
12
Cleaning Compliance (%) 10 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 8 95 95 93 95 95 96 96 96 96 96 96 97 6
4
2 Estates Monitoring Compliance (%) 0 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 96 98 97 97 99 99 100 99 99 99 99 99
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 0320 0312 1111
Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)
8 12100 7 1080 6 8 5 60 4 6 3 40 4 2 20 2 1
0 00 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11Mar-11 Apr-11 Apr-11 May-11 May-11 Jun-11 Jun-11 Jul-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Dec-11 Jan-12 Jan-12 Feb-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 724451133121 7385 576103746 17
Quarterly rolling year Clostridium difficile Infection Cases per 1000 total occupied bed days for HEAT Target Measurement
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0 Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13
Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oc t 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance 0.20 0.17 0.15 Target 0.39 0.39 0.39 0.39 0.39 0.39 0.39 0.39 0.39
Quarterly rolling year Staphylococcus aureus Bacteraemia Rates per 1000 Acute Occupied Bed Days for HEAT Target Measurement
0.5 0.45 0.4 0.35 0.3 0.25 0.2 0.15 0.1 0.05 0 Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13
Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oc t 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 18 Actual Performance 0.44 0.41 0.45 Target 0.26 0.26 0.26 0.26 0.26 0.26 0.26 0.26 0.26
Healthcare Associated Infection Reporting Template (HAIRT) Section 2 – Healthcare Associated Infection Report Cards The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals which do not have individual cards, and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics.
Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website:
Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139§ionID=1 Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346 MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252§ionID=1 For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card. Understanding the Report Cards – Hand Hygiene Compliance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website: http://www.washyourhandsofthem.com/ Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.
Understanding the Report Cards – Cleaning Compliance
Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table form.
Understanding the Report Cards – ‘Out of Hospital Infections’ Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and sources not related to healthcare. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital.
19
Forth Valley Royal Hospital Total Staphylococcus aureus Bacteraemia Cases (all ages)
5
4
3 This report card details the SAB (MRSA & MSSA), CDI, Hand Hygiene and
Cleaning Compliance for Forth Valley Royal Hospital. 2
1
0 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Hand Hygiene Monitoring Compliance (%) 0 000 12 11 024 1
Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 9997981009798979896989898 MRSA Bacteraemia Cases (all ages)
5
Cleaning Compliance (%) 4 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 3 96 97 95 95 94 96 95 96 96 96 96 97
2
1 Estates Monitoring Compliance (%) 0 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 99 100 100 99 100 99 100 99 100 100
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 0 000 00 00 000 1
Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)
5 1005
4 480
3 360
2 240
1 120
0 0 0 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11Mar-11 Apr-11 Apr-11 May-11 May-11 Jun-11 Jun-11 Jul-11 Jul-11 Aug-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Dec-11 Jan-12 Jan-12 Feb-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 20 001 00 11 100 0 000 12 11 024 0
20
Community Hospitals Total Staphylococcus aureus Bacteraemia Cases (all ages)
1 0.9 0.8 This report card includes SABs and CDIs acquired in our community hospitals. 0.7 0.6 The hospitals include Stirling Community Hospital, Falkirk Community Hospital, 0.5 Bonnybridge Hospital, Bo'ness Hospital, Bellsdyke Hospital, Clackmannan 0.4 Hospital, Bannockburn Hospital and Lochview. 0.3 0.2 0.1 0 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12
Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 0 000 00 00 000 0
MRSA Bacteraemia Cases (all ages)
1 0.9 Cleaning Compliance (%) 0.8 0.7 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 0.6 95 95 92 95 95 96 96 95 95 95 96 97 0.5 0.4 0.3 0.2 Estates Monitoring Compliance (%) 0.1 0 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 97 99 97 98 98 98 99 98 98 99 98 99
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 0 000 00 00 000 0
Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)
5 1001 0.9 4 0.880 0.7 3 0.660 0.5 2 0.440 0.3 1 0.220 0.1 0 00 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11Mar-11 Apr-11 Apr-11 May-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Nov-11 D Dec-11 ec-11 Jan-12 Jan-12 Feb-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11Jan-12Feb-12 10 000 00 00 000 0 000 00 00 000 0
21
Out of Hospital Infections Clostridium difficile Infection Cases
10
9
8
7
6
5 This report card details all SAB and CDIs that were not acquired during their stay at hospital. 4
3
2
1
0 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 3 144 31 12 202 1
MSSA Bacteraemia Cases MRSA Bacteraemia Cases
10 10
9 9
8 8
7 7
6 6
5 5
4 4
3 3
2 2
1 1
0 0 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12
Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 717435593506 021003121110
22
ANNEX 1. Healthcare & Community acquired Infections In this annex, is the breakdown of the 'out of hospital' infections described on the previous page.
Healthcare acquired SABs are infections that can be associated and attributed from previous hospital admissions; this group is an area where the Infection Control team actively investigate and if it is suspected the infection has arisen from a previous hospital admission, it is treated as a hospital acquired SAB; although due to the strict HPS definitions of acquisition type it is classified as out of hospital.
Community acquired SABs are those that have not had any healthcare contact or intervention and as such are outwith our control to reduce these infections.
Healthcare MSSA Bacteraemia Cases Healthcare MRSA Bacteraemia Cases
12 12
10 10
8 8
6 6
4 4 2 2 0 0 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 16334 4423 06 2100 2111 010
Community MSSA Bacteraemia Cases Community MRSA Bacteraemia Cases
6 12100
5 1080
4 8 60 3 6 40 2 4 20 1 2
0 00 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Apr-11Apr-11 May-11 May-11 Jun-11 Jun-11 Jul-11 Jul-11 Aug-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Jan-12 Feb-12 Feb-12
Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 01101 1512 00 0000 1010 100
23
24 Appendix 2
Quality Improvement and Assurance A Strategic Balanced Scorecard for NHS Forth Valley has been developed with on-going work in respect of providing and building upon the qualitative and quantitative data which will enable and support improvement and assurance. The local focus is across the six dimensions of quality with a balanced approach to measurement. This is reflected in the on-going development of a strategic dashboard and the refocusing of the Board Executive Performance Report.
Format The following templates update the position against locally developed quality indicators and HEAT targets Progress symbols are noted as:
Improvement in period
Position maintained
Deterioration in period
Where trajectories have been agreed, this will be reported as red, amber or green
R Off trajectory >5% Minor deviation from A trajectory <5% G On track
The narrative will provide contextual information and support
1
Balanced Scorecard – End February 2012 Updates
Equitable EQ6 Child Healthy Weight – Green to Amber
Safe S2 Adverse events – Amber to Green
Efficient E1 Finance – Red to Amber E9 Did Not Attend –Amber to Green E11a Theatre Efficiency – under run – Green to Amber
Timely No Change
Effective V1a Antimicrobial use – Acute – Amber to Green V5b Delayed discharge >6 weeks – Amber to Green
Person Centred No Change
2 NHS Forth Valley Strategic Balanced Scorecard Performance Dashboard February 2012
Equitable Imp RAG Efficient Imp RAG Timely Imp RAG
EQ1 a) E thn icit y rec ord ing - pat ien ts A E1 Finance A T1 1 8 wee k Refe rral to Treatm en t G
b) E thn icit y rec ord ing - s taff A E2 Non Core Staff Costs A T2 a) Cancer 31 day target G
EQ2 Suicide rate G E3 Prescribing GG b) Cancer 62 day target
EQ3 Cardiovascular health checks G E4 Secondary Care Doctor's appraisalG T3 Access to drug treatment G
EQ4 Smoking cessation G E5 Average length of stay G T4 Access to child & adolescent mental health G
EQ5 A lcoho l b rief in terve ntion G E6 Bed occupancyG T5 % A&E waits <4 hours R
EQ6 Child Healthy W eight A E7 Inpatient cancellations A
EQ7 Fluoride varnish A E8 Same day surgery A Effective Imp RAG
EQ8 Breastfee ding rate R E9 Did Not Attends G V1 a) Antimicrobial use - Acute G
E10 Pre-operative stay GGb) Antimicrobial use - Primary care
Safe Imp RAG E11 a) Theatre efficiency - under run A V2 Em ergency bed days >75 years G
S1 Hospital standardised m ortality rate GAb) The atre e fficiency - late start V3 Boarding G
S2 Adverse events G E12 Attendance management R V4 A&E attendance A
S3 Acute Assessment Unit Cardiac arrest calls G V5 a) Delayed discharge >6 weeks G
S4 Staphylococcus Aureus Bacteraemia A b) Delayed discharge <6 weeks A
S5 Clostridium Difficile G V6 Bed days lost due to delayed discharge A
S6 Hand hygiene G
Person Centred Imp RAG Improvement in period Off trajectory >5% R P1 Inpatient survey - care experience G Minor deviation from Positio n m aintained A trajectory <5% P2 C om pla int s R Deterioration in period On track G P3 Clinical quality indicators G
P4 Long Term Conditions G
P5 Patien ts adm itted to stro ke unit G
3
Dimension of Quality:
EQUITABLE (EQ)
4 EQUITABLE: PERFORMANCE TRENDS
EQ1a: Ethnicity recording - % of patients where ethnicity EQ1b: Ethnicity recording - 95 % of staff to have their has been recorded ethnicity recorded Target: 100% Position: 51% @ Nov 2011 Target: 95% Position: 93.4% @ Dec 2011
% Ethnicity Completeness % Known Ethnicity of Staff in SMR & EDIS datasets 10 0 % 70% 60% 80% 50% 60% 40% 30% 40% 20% 20% 10 % 0% 0%
The above graph highlights that 51% of patients had The above graph shows that 93.4% of staff have ethnicity recorded at Nov 2011 ethnicity recorded which remains slightly below the The recording of ethnicity is not consistent across all 95% target the units This figure is updated on a quarterly basis with the March figure due for reporting in May 2012
EQ2: HEAT Target - reduce Suicide Rate between 2002 EQ3: HEAT Target - achieve agreed number of and 2013 by 20% Cardiovascular Health Checks during 2011/12 Target: 14 Position: 11.9 @ Dec 2010 Target: 1000 Position: 1525 @ Dec 2011
Suicide Rates per 100,000 Number Cardiovascular Health Population Checks 1800 20 1600 1400 15 1200 1000 10 800 600 5 400 200 0 0
A ct ual Traject ory Actual Traject ory
The above graph shows that NHS Forth Valley is A target for 2011/12 has been agreed as 1,000 ahead of the target for December 2010 Cardiovascular Health checks to be carried out by The measure is as a rate per 100,000 population March 2012 The next update is due summer 2012 The above graph highlights that excellent progress continues in respect of this target with 1525 checks carried out against a trajectory of 750, exceeding the target end point
5 EQUITABLE: PERFORMANCE TRENDS
EQ4: HEAT target - deliver smoking cessation services EQ5: HEAT Target - achieve agreed number of Alcohol to contribute to NHS Scotland target of 80,000 Brief Interventions during 2011/12 successful quits (at one month post quit) over the 3 year period ending March 2014 Target: 3002 Position: 531 @ Sept 2011 Target: 3676 Position: 6291 @ Dec 2011
Number of Successful Number of Alcohol Brief Smoking Quit Attempts Interventions 3500 7000 3000 6000 2500 5000 2000 4000 150 0 3000 1000 2000 500 10 0 0 0 0
A ct ual Trajectory A ct ual Traject ory
A target for the 3 year period ending March 2014 has been agreed as 3002 successful quits. This is A target of 3676 Alcohol Brief Interventions to be within the 40% most deprived SIMD areas achieved by March 2012 has been agreed The above graph highlights a position of 531 in Sept The December position of 6291 interventions against a trajectory of 500 exceeds the trajectory of 2757 and the March 2012 The total number of quits to Sept is 889 against a target trajectory of 834 Work continues to progress well across a range of Enhanced recording and data gathering is in place settings which include areas that are not measured to maximise quit rate capture for Keep Well clients, as part of the target i.e. community pharmacies and pharmacies and GP practices through Keep Well EQ6: HEAT Target - achieve agreed completion rates EQ7: HEAT Target - 60% of 3 and 4 year olds in each for Child Healthy Weight interventions over the 3 year SIMD quintile to have twice year Fluoride Varnish period ending March 2014 Applications by March 2014 Target: 883 Position: 0 @ Dec 2011 Target: 60% Position: 1.82% @ Sept 2011
% 3 or 4 yr olds with at least 1 Number of Child Healthy Fluoride Varnish Application Weight Interventions 12 . 0 % 900 800 10 . 0 % 700 8.0% 600 500 6.0% 400 4.0% 300 200 2.0% 10 0 0.0% 0
FV Traject ory Activity Traject ory Scot land The above graph shows the agreed trajectory for The position at September 2011 is 1.82% which is this period highlighting that the activity within Forth 8.18 behind the agreed quarterly trajectory of 10% Valley is aligned to the school year Scotland position for September is 2.26% against a Intervention is being delivered through two linked plan of 13.3% mechanisms - Max in the Middle and Max in the Targeting of 3-4 yr olds in the poor social economic Class (new to this academic year) quintiles in the first instance has reduced the overall Interventions run in two waves; September- performance December 2011 and January–March 2012 From October 2011 a fee for Independent dental The intervention has run with 75 classes to date contractors was introduced to carry out this work with 4 more running next week with improvements anticipated in the better off 79 classes with approximately 1,975 participants quintile in the ensuing months will yield an estimated 300 interventions by end of Complexity of the target and its measurement have March. This figure will be confirmed in May 2012 been raised centrally and are under discussion
6
EQUITABLE: PERFORMANCE TRENDS
EQ8: Standard HEAT Target - increase Breast Feeding for 0-8wk old babies to 27.7% by March 2011 Target: 27.7% Position: 23.3% @ March 2011
% Breast Feeding at 6-8 30% weeks
25%
20%
15 %
10 %
FV Traject ory Scot land
The above graph shows that NHS Forth Valley is behind the target with 23.3% at March 2011 against a target position of 27.7% The Scotland position for March 2011 was 26.1% There are wide variations in rates across the area due to socio-economic factors Each CHP group along with acute services is working with partners to ensure focus on areas of inequality e.g. healthy start
Breastfeeding at the 6-8 Week Review by CHP 2010-2011 Exclusive Any breastfeeding Clackmannan 21.5% 27.5% Falkirk 19.2% 27.3% Stirling 34% 44%
7 Dimension of Quality:
SAFE (S)
8 SAFE: PERFORMANCE TRENDS
S1: Scottish Patient Safety Programme - 15% reduction S2: Scottish Patient Safety Programme - 30% reduction in in Hospital Standardised Mortality Rate (HSMR) adverse events
Target: 15% Position: 1.02 @ quarter end Sept 2011 Target: 17.5 per thousand Position: 10.6 @ Nov 2011
Standardised Mortality Ratio (SMR) Regression line
2.0
1.5
1.0
Standardised Mortality Ratio Mortality Standardised 0.5
0.0 Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep 2006 2007 2007 2007 2007 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011p 2011p 2011p HSMR with regression line Oct 2006 – Sept 2011 for Taking the NHS Forth Valley baseline of 25.4 a 30% NHS Forth Valley acute hospital sites. reduction in adverse events sets a target reduction to HSMR compares actual deaths with expected deaths 17.5 per thousand within 30 days of admission. It fluctuates over time Twenty case notes are reviewed monthly and assessed and is influenced by various factors such as age and using the Global Trigger Tool, which is a tool to identify diagnosis of patient. This will vary between hospitals triggers that may indicate patient harm. The process of HSMR is intended to monitor trends over time with a review identifies if this is indeed harm that resulted from view to seeing improvements against target healthcare or if the event was part of the illness process Data is published quarterly with 0.89 the Scotland itself position for quarter ending Sept 2011 Data is reported on a retrospective basis Data for quarter ending December 2011 is due for The November rate showed a decrease to a rate of 10.6 publication at the end of May 2012 per 1000 patient days. Average change per quarter is -1.0% S3: Acute Admissions Unit Cardiac Arrest Calls - S4: HEAT Target – further reduce Healthcare Associated Reduction in Cardiac Arrests to less than one cardiac Infections by 2012/13 so that Staphylococcus Aureus arrest per month by the end of the year Bacteraemia cases are 0.26 or less per 1000 occupied bed days Target: <1 Position: 0.62 @ Jan 2012 Target: 0.26 Position: 0.4 @ Feb 2012
Cardiac Arrests & Cardiac Arrest Calls in Acute Rate of M RSA/M SSA per Admissions Unit 10 1000 Occupied bed days 9 0.9 8 0.8 s 7 0.7 0.6
ission 6 5 0.5 4 0.4 3 0.3
per 1000 adm 2 0.2 1 0.1 0 0 0 0 0 1 1 1 -1 -11 1 -1 t-1 c g- c c e un e Aug-1 O D Feb-1 Apr -11 J Au Oct-11 D Cardiac arrest calls Cardiac arrests FV Traject ory Goal Line Scot land Data is per 1000 admissions Trajectory agreed from June 2011 to March 2013 from a Target to reduce cardiac arrests to less than one per baseline position of 0.5 month by end December 2011 The number of patients with SABs in February was 7; 1 There has been an increase in the average number hospital acquired, 6 healthcare acquired of admissions to AAU by about 50% from The in month position is 0.4 against a trajectory of 0.36 approximately 1000 per month to over 1500 following Scotland position for quarter ending Sept 2011 is 0.33 the move to Forth valley Royal Hospital with a target of 0.33
9 SAFE: PERFORMANCE TRENDS
S5: HEAT Target - reduce Clostridium Difficile Infections S6: Scottish Patient Safety Programme - % of staff (CDIs) for patients 65 or over to 0.39 or less per 1000 undertaking Hand Hygiene practice as per infection total occupied bed days by March 2013 control requirements Target: 0.39 Position: 0.2 @ Feb 2011 Target: 95% Position: 98% @ Jan 2012
C.Difficile Infections per 1000 occupied bed days (aged 65+) % SPSP Hand Washing 0.7 Compliance 0.6 100% 0.5 95% 0.4 90% 0.3 85% 0.2 80% 0.1 75% 0 70%
FV Trajectory Scot land Activity National Audit
NHS Forth Valley is maintaining the target with an in The above graph highlights that the January 2012 month rate for February 2012 of 0.2 against a local Scottish Patient Safety Programme Hand hygiene trajectory of 0.33 compliance is 98% The number of patients 65 years or over with Health Protection Scotland (HPS) national audit Clostridium Difficile Infections (CDI) for February report for January/February 2012 gave NHS Forth was 1 which was healthcare acquired Valley 97% compliance The Scotland position for September 2011 was 0.31 against a trajectory of 0.49
10 Dimension of Quality:
EFFICIENT (E)
11 EFFICIENT: PERFORMANCE TRENDS
E1: Finance – forecast financial balance E2: Non Core Staff Costs
Target: Breakeven Position: £5.830 Target: Reduction Position: £10.088m spend for overspend at 29 Feb 2012 period to 29 Feb 2012
In-month Operational Financial Position 1,100,000 Non-Core Staff Costs Trend 2011/12 1200 1,050,000 2010-11 2011-12 1,000,000 1000 950,000 800 900,000 850,000 600 £ 800,000 400 750,000
200 700,000 650,000 0
cumulative over / (under) spend (under) / over cumulative Apr-11 May-11Jun-11 Jul-11 Aug-11Sep-11 Oct-11 Nov-11Dec-11Jan-12 Feb-12 Mar-12 600,000 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Period
£5.830m operational overspend to end of February Non core staff costs include bank, agency, locum, 2012 overtime and on-call costs In month trend continuing to improve in line with Costs remain higher than the same period to last forecast year with February reporting a similar upward trend With the in year agreement finalised with Scottish as last year Government Health Department, financial balance Just short of 80% of the costs in the current year in-year is forecast relate to Nursing Bank Staff (43%) and Medical Agency, Locum and Bank (37%) E3: Reduce prescribing costs per patient E4: % Secondary Care Doctors appraisals completed
Target: £184.38 Position: £193.03 @ Dec 2011 Target: 100% Position: 98.5% @ Dec 2011
Health Boards GIC per patient £210 2008 - 2011. 3-Year Total at December 2011
£200 No appraisal completed £190 for 3 year period 08-11
£180 Form 4 received and £170 completed Annualised Totals
£160 Not applicable - new in
£150 post first appraisal 2011
£140 Identifed individuals who Jul-06 Jul-07 Jul-08 Jul-09 Jul-10 Jul-11 Apr-07 Apr-08 Apr-09 Apr-10 Apr-11 Oct-06 Oct-07 Oct-08 Oct-09 Oct-10 Oct-11 Jan-07 Jun-07 Jan-08 Jun-08 Jan-09 Jun-09 Jan-10 Jun-10 Jan-11 Jun-11 Mar-07 Mar-08 Mar-09 Mar-10 Mar-11 Feb-07 Feb-08 Feb-09 Feb-10 Feb-11 Aug-06 Sep-06 Nov-06 Dec-06 Aug-07 Sep-07 Nov-07 Dec-07 Aug-08 Sep-08 Nov-08 Dec-08 Aug-09 Sep-09 Nov-09 Dec-09 Aug-10 Sep-10 Nov-10 Dec-10 Aug-11 Sep-11 Nov-11 Dec-11 May-07 May-08 May-09 May-10 May-11
NHS Ayrshire & Arran NHS Borders NHS Dumfries & Galloway NHS Fife no longer need NHS Forth Valley NHS Grampian NHS Greater Glasgow & Clyde NHS Highland appraised NHS Lanarkshire NHS Lothian NHS Tayside Scotland
Form 4 received and completed - 294 The national graph above continues to demonstrate No appraisal completed for 3 year period 08-11 - 2 an ongoing reduction in the NHS Forth Valley Not applicable - new in post first appraisal 2011 – 21 average cost per patient. Identified individuals who no longer need appraised – 19 A second phase of the prescribing incentive scheme is underway. All Consultants and Specialty Doctors have been advised of their Enhanced Appraiser All processes moved to Enhanced Appraisal from November 2011 Appraisals now allocated on a monthly basis and reporting will begin to reflect this from January 2012
12 EFFICIENT: PERFORMANCE TRENDS
E5: Standard HEAT Target – Emergency inpatient E6: % occupancy rate average length of stay in days Target: 3.5 Position: 3.33 @ Feb 2012 Target: see text Position: see text
Emergency Inpatients Avg % Occupancy Avail Staff Length of Stay (days) Beds by Hospital 4 10 0 . 0 % 3.5 3 90.0% 2.5 80.0% 2 1. 5 70.0% 1 60.0% 0.5 0 50.0%
FV Traject ory FCH FVRH Scot land SCH
Average length of stay for emergency inpatients Breakdown by hospital for February 2012 is: for February is 3.33 days o Falkirk Community Hospital – 96.4% This is ahead of the target point of 3.5 days o Forth Valley Royal Hospital – 87.3% The most up to date figure for all Scotland is 3.4 Occupancy rate of acute beds in Scotland at days at March 2011 September 2011 was 80.8% (source of data: ISD This is provisional and is against an end target website) of 3.8 85% occupancy for acute beds is the accepted standard in acute beds and allows for optimum flow
E7: % of elective patients whose procedure is cancelled on the day of planned procedure or one day before – this is across all specialties with cancellations from all sources Target: 5% Position: 12% @ Jan 2012
Operations Cancelled as % Theatre Cancellations (All Specialties) by Reason 70 of Elective Admissions 60 35% 30% 50 25% 40 20% 15% 30 10 % 20 5% 0% 10
0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12
Anaesthetist Cancelled Patient Cancelled Surgical/Clinical No Be ds
The January 2012 position for operations The number of cancellations for January was 134 cancelled was 12% 41 were due to the patient cancelling There is a local 5% target with no aligned No beds, surgical/clinical issues and anaesthetist trajectory cancelling account for the remaining 93 cancellations Activity excludes trauma
13 EFFICIENT: PERFORMANCE TRENDS
E8: Standard HEAT Target - increase Day Case & E9: Standard HEAT Target - reduce outpatient ‘Did Not Outpatient rates combined Attend’ rates (DNA) Target: 84% Position: 83.9% @ Dec 2011 Target: 7.8% Position: 5.8% @ Feb 2011
% BADS Daycase % Ne w Outpatie nt DNAs Procedures 90% 14 . 0 % 12 . 0 % 80% 10 . 0 % 70% 8.0% 6.0% 60% 4.0% 2.0% 50% 0.0%
FV Traject ory Scot land Traject ory Actual
The above graph shows that NHS Forth Valley day The position for February is 5.8% which is 2% case and outpatient activity is maintaining a position ahead of trajectory > 80% but remains slightly below the trajectory of There is ongoing active implementation and 84% at 83.9% monitoring of Patient Access Policy in respect of Further shift in procedures carried out as day cases ‘Did Not Attend’ patients or as out patients following the Phase 3 move
There is up to a 3 month lag time therefore activity figures are provisional and will be updated on a rolling basis monthly E10: Standard HEAT Target - 15% reduction of pre- E11a: Reduction in theatre under run hours as % of operative stay by March 2013 available (allocated planned) hours Target: 0.19 Position: 0.08 @ Dec 2011 Target: 5% or less Position: 12.2% @ Jan 2012
Pre Operative LOS (Days) Under Run Hours as % of Available Hours 0.70 0.60 20.0% 0.50 15. 0 % 0.40 0.30 10 . 0 % 0.20 0.10 5.0% 0.00 0.0%
FV Trajectory % Under Runs Target Scot land
The trajectory agreed with National Theatre The above graph shows that NHS Forth Valley Implementation Group is that 8% or less planned continues to stay ahead of target with a position at list hours will be lost through theatre sessions December 2011 of 0.08 days running under hours by December 2011 with a Day surgery admission is the norm for patients further reduction to 5% by March 2012 unless indicated otherwise An under run is when a theatre session is finished Ensuring robust pre-operative pathway reduces early by 45 minutes or more with the number of need for admission before day of surgery theatre list under run hours as a percentage of Elective pathway agreed for all specialties and planned list hours providing the measure includes pre-operative assessment The Forth Valley position for January is 12.2% of available hours lost through under runs. This is an improvement on December but remains 5.2% behind the trajectory point of 7.0%
14 EFFICIENT: PERFORMANCE TRENDS
E11b: Theatre late start hours as % of available E12: Standard HEAT Target - Attendance Management (allocated planned) hours - to reduce sickness absence to 4% by March 2009 Target: 3% or less Position: 3.7% @ Jan 2012 Target: 4% Position: 5.95% @ Jan 2012
Late Start Hours as % of Sickness Absence Available Hours (% Hours Lost over total 7.0% hours available) 8% 6.0% 5.0% 6% 4.0% 4% 3.0% 2.0% 2% 1. 0 % 0% 0.0%
FV Traject ory % Lat e St art Hours Target Scot land
The target set by the National Theatre The March 2009 target of 4% was not achieved Implementation Group is that 3% of hours or less Focus on absence management continues as will be lost through theatre sessions starting late by challenge remains in achieving this target December 2011 The January 2012 position of 5.95% is an increase A late start is recorded when theatre commences of 0.37% against the December 2011 position of 15 minutes or more after the expected start time 5.58% with the number of hours lost to late starts as a percentage of planned list hours providing the measure The position for January is 3.7% which is 0.7% behind the target of 3% however an improvement on the December 4.3% position
15 Dimension of Quality:
TIMELY (T)
16 TIMELY: PERFORMANCE TRENDS
T1: HEAT Target - 18 week Referral to Treatment (RTT) T2a: HEAT Target - 95% of patients with Suspicion of cancer treatment is 62 days or less by December 2011 Target: 90% Position: 90.2% @ Jan 2012 Target: 95% Position: 95.9% @ Dec 2011
18 Week Referral to % Cancer treated within 62 Treatment days of Referral 10 0 % 100%
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
FV Trajectory FV Traject o ry Scot land Scot land
In January 2012, 90.2% of patients were treated At December 2011, 95.9% of patients were seen within 18 weeks. This remains ahead of the within 62 days this slightly exceeds the target which December 2012 target of 90% was achieved The Scotland position at target end date was 92.1% Challenges remain within outpatient ophthalmology, rheumatology and respiratory, along with orthopaedic and general surgery inpatients
T2b: HEAT Target - 95% of patients with cancer treated T3: HEAT Target - by March 2012, 90% of clients will within 31 days by December 2011 wait no longer than 5 weeks & no client will wait longer than 10 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery Target: 95% Position: 95% @ Dec 2011 Target: 90% Position: 96.7% @ Jan 2012
% Cancer patients treated % P atients waiting < 5 within 31 days of Diagnosis weeks for drug or alcohol 100% treatment from referral 10 0 % 90% 90% 80% 80% 70% 70% 60% 60% 50% 50%
FV Traject ory Combined Drug Scot land Alcohol Traject ory
Current activity exceeds the new target and in month trajectory point of 81% with a combined performance In December 2011, 95% of patients were treated of 96.7% within 31 days. The December target point was Local monitoring differentiates between alcohol achieved (97.3%) and drugs (96%) Local action plans in place to reflect challenges that The December 2010 target of ‘90% of clients will be continue within Breast Cancer and Urology Cancer offered a treatment date within 4 weeks of referral’ services to ensure the target is sustained was achieved and has been maintained This data is provisional as performance is reported
quarterly
17 TIMELY: PERFORMANCE TRENDS
T4: HEAT Target - Faster access to Child & Adolescent T5: HEAT Target - Zero patient will wait over 4 hours for Mental Health Specialist Services (CAMHS) - 0 patients discharge or transfer from A&E waiting > 26 weeks March 2013 Target: Zero >26 weeks Position: 98% @ Feb 2012 Target: 98% Position: 93.7% @ Feb 2012
A&E % Waiting <4 hrs 100% of patients seen within 39 weeks – March 10 0 % 2012 target 95% 90% 98% of patients seen within 26 weeks – March 85% 2013 target 80% 75% 70%
FV Traject ory Scot land
By March 2011 no client will wait longer than 52 At the end of February 2012, 93.7% of patients weeks from referral to treatment for specialist waited 4 hours or less for discharge or transfer from CAMHS Services – target achieved A&E This will be reduced to 39 weeks by March 2012 This is an in-month deterioration of 0.2% against a then 26 weeks by March 2013 January 2012 position of 93.9% however a 1.4% Trajectory for this target to March 2013 submitted improvement against February 2011 to Scottish Government in November 2011 Focused work continues to address issues in respect of breaches however NHS Forth Valley is reporting no 12 hour breaches
18 Dimension of Quality:
EFFECTIVE (V)
19 EFFECTIVE: PERFORMANCE TRENDS
V1a: National target – ≥95% of antimicrobial V1b: % seasonal variation of defined daily doses of prescriptions for empirical therapy are in line with local quinolones within primary care policy Target: ≥ 95% Position: See text Target: ≤ 5% Position: -3.9
From April 2011, revised targets have been set for NHS Scotland use of antibacterials in primary care by NHS antimicrobial prescribing nationally for Acute Care. Board, percentage seasonal quinolones 2010/11 (Winter v Any areas of non-compliance with policy are Summer) investigated by Acute Care Team Consultant with prescriber The quinolones are a family of synthetic broad-spectrum Findings are fed back to Clinician and Antimicrobial antibiotics. The term quinolone(s) refers to potent synthetic Management Group chemotherapeutic antibacterials Medical compliance at February 2012 is 100% Surgical compliance at December 2011 is 100% V2: HEAT Target - to reduce Emergency Bed days in V3: Reduction in the number of patients boarded out with age 75+ (rate per 1000 population) by March 12 their specialty Target: 4006 Position: 3915 @ Nov 2011 Target: Reduction Position: 138 @ Feb 2012
Acute Emergency Bed Days Cumulative Boarders Aged 75+ (Rate per 100 0 500 0 population) 900 800 4000 700 3000 600 500 2000 400 10 0 0 300 200 0 10 0 0
FVRate SurgicalRat e MedicalRate Traject ory
The November 2011 position of 3915 is ahead of There were 138 patients boarded outwith their the agreed trajectory point of 4013 and the target for speciality in February 2012 with an overall improving March 2012 trend
*This position is currently provisional
20 EFFECTIVE: PERFORMANCE TRENDS
V4: HEAT Target - to reduce A&E attendances to 1500 V5a: Standard HEAT Target – no delayed discharges >6 (rate per 100,000 of population) by March 2014 weeks Target: 1500 Position: 1538 @ Feb 2011 Target: 0 Position: 0 @ Feb 2012
A&E Attendances per 100,000 Delayed Discharges Over 6 3000 population weeks by CHP 2500 30 25 2000 20 150 0 15 10 0 0 10 50 0 5 0 0
Forth Valley Traject ory FV Falkirk Scot land Stirling Clacks
The February 2012 position of 1538 is 41 above the The total number of delayed discharges over 6 weeks trajectory of 1497 at the February census was 0 The Scotland position for January was 2126 To Note: New HEAT target for 2012/13 No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013; followed by a 14 day maximum wait from April 2015
V5b: Reduction in the number of delayed discharge V6: Reduction in the number of bed days lost due to patients waiting < 6 weeks delays in discharge Target: Reduction Position: 26 @ Feb 2012 Target: Reduction Position: 547 @ Feb 2012
FV Bed Days Lost due to Delayed Discharges Under 6 Delayed Discharges weeks by CHP (excluding special codes) 60 3000 50 2500 40 2000 30 150 0 20 1000 10 500 0 0
FV Falkirk Total bed days lost Stirling Clacks Over 6 weeks
The attached graph highlights that there were 26 A total of 547 bed day were lost in February with zero delays under 6 weeks at the February census over 6 weeks The improved position from an August 2011 high The overall trend is downward has been maintained
21 Dimension of Quality:
PERSON CENTRED (P)
22 PERSON CENTRED: PERFORMANCE TRENDS
P1: Patient Experience P2: Complaints 20 day response rate
Target: Improvement Position: 74.5@ 2011 Target: 70% Position: 52.54% @ Jan 2012
120.00
100.00 Inpatient Inpatient Survey 2010 Survey 2011 80.00 Scotland 78.3 78.1 60.00 Forth Valley 74.2 74.5 40.00 20.00
0.00 Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- Jan- 10 10 10 10 11 11 11 11 11 11 11 11 11 11 11 11 12 Acute CHP Total Target
NHS Forth Valley Patient Experience co-ordinator continues to support individual wards and The above graph highlights that NHS Forth Valley’s departments in undertaking patient experience year to date cumulative position is 52.54%, which is surveys. This is ongoing work, with all acute inpatient behind target of 70% areas at Forth Valley Royal Hospital now online CHP position is 88.89%; Acute position is 46% Work has now been completed in respect of building Work is on going with the Patient Public Panel to a generic Patient Experience questionnaire aligned explore ways in which patient public partners can with the Better Together national survey support the complaints process, e.g. capturing questionnaire into the ‘Transforming and Improving complainant’s experience of the process Care’ database. Wards are beginning to receive Learning from complaints is taken forward within the graphic representation of results for use as feedback units and at ward level. P3: Clinical Quality Indicators – falls, nutrition, pressure P4: Reduction in the number of bed days for long term area care conditions Target: 95% overall Position: 95.7% @ Dec Target: Reduction Position: 5859 @ Nov 2011 compliance 2011
Lo ng T erm C ond it ions, B ed % Compliance for Clinical Days per 100,000 population Quality Indicators 100% 8500 96% 8000 92% 7500 88% 7000 84% 6500 80% 6000 5500 5000
Falls Fluid, Food, Nutrition Trajectory FV Pressure A rea Care Scot land
The above graph represents NHS Forth Valley’s compliance with the 3 National Clinical Quality NHS Forth Valley continues to perform well against Indicators of falls (97%), pressure area care this target which was previously a key HEAT compliance (95%) and food, fluid and nutrition measure compliance (95%) The position for November 2011 is 5859 bed days Leading Better Care facilitator and Lead Nurses are per 100,000 population working closely within any areas that have been highlighted as having challenges in respect of overall compliance to support improvements within these areas
23 PERSON CENTRED: PERFORMANCE TRENDS
P5: HEAT Target - all patients admitted with a diagnosis of Stroke will be admitted to a stroke unit on day of admission or following day by March 2013 Target: 90% Position: 88% @ Dec 2011
% Admitted to Stroke unit same day of admission 100% 80% 60% 40% 20% 0%
FV Trajectory Scot land
The position for December 2011 is 88% against a trajectory of 68.7% The Scotland position for December was 83% for same day admissions to stroke units
*Patients discharged prior to spending 2 nights in hospital excluded
24
FORTH VALLEY NHS BOARD
27 March 2012
This report relates to Item 4.2 on the Agenda
Finance Report for the Period Ended 29 February 2012
(Paper presented by Mrs Fiona Ramsay, Director of Finance and Planning)
For Noting
1. Summary
This report provides a summary of the financial position for NHS Forth Valley as at 29th February 2012.
There is a statutory requirement for NHS Boards to ensure expenditure is within the Revenue Resource Limit (RRL) and Capital Resource Limit (CRL) set by the Scottish Government Health Department (S.G.H.D.).
The Table below provides a summary of the out-turn position:
Annual Actual Actual Budget Overspend / Overspend / Plan (Underspend) (Underspend) to 31/01/2012 to 29/02/2012 £m £m £m Resources Revenue Resource Allocation Core 434.102 0.000 0.000 Revenue Resource Allocation Non Core 67.489 0.000 0.000 Anticipated Resource Allocations 0.099 0.000 0.000 Income - other Scottish Boards 7.095 0.069 0.051 Income - Junior Doctors (NES) 6.275 0.000 0.000 Income - Miscellaneous 4.413 (0.006) (0.005) Total Resources 519.473 0.063 0.046
Expenditure Plan Corporate and External Boards 113.053 0.109 (0.268) Acute Services 169.078 2.562 2.739 Waiting Times 0.209 3.294 3.706 CHP, Prescribing and Other Areas 222.806 (0.152) (0.301) Committed Balances / Contingency 14.327 0.000 0.000 Total Expenditure 519.473 5.813 5.876
Total Net Revenue Out-turn 5.750 5.830
Net Capital Out-turn 0.000 0.000
The Operational Position to 29th February 2012 shows an overspend of £5.830m (overspend of £5.750m to end of January) on core services prior to offsets available, with the main areas of overspend being rehabilitation services, surgical unit nurse staffing, biologic drugs, delivery of Access Targets, Mental Health Services and AHP Services. To date Primary Care Prescribing is reporting an underspend as does Area Corporate Services.
1
The operational overspend in-month has reduced from an average of £0.926m in the first three months to £0.080m for February. This decrease confirms position is on track to achieve planned financial balance in-month for operational services by April 2012. The graph below illustrates the trend to date and includes the projected position from September onwards.
Operational Overspend in month 2011/12
1.2
1
0.8
0.6 £m
0.4
0.2
0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Actual Projected
Strict controls remain in place regarding vacancy management with Director of Human Resources / Director of Finance approval required for any post advertised outwith NHS Forth Valley, the prescribing efficiency group meets regularly, and operational group reviewing savings projects with red risk status and remaining balance to be identified.
Progress has continued with the VSS (Voluntary Severance Scheme) and to date there have been 57 approvals under VSS with a cost of £3.567m and producing recurring cost reductions of £2.377m. Panel is scheduled to meet in late March.
The Committed Balances / Contingency relates to the following areas: Capital Grants Voluntary Severance – for staff leaving in March and where commitment confirmed in 2011/12 but leaving date later in 2012 Brokerage Funding to offset operational overspend Annually Managed Expenditure Items
As previously reported, dialogue has been ongoing regarding NHS Forth Valley financial position including the particular issues faced during implementation of the Healthcare Strategy. Agreement has been reached as reported to the November Performance and Resources Committee. This funding combined with ongoing savings delivery allows confirmation that financial balance can be achieved this year. Repayment of this transitional funding is planned over a five year period using proceeds from the sale of assets. This repayment is incorporated into the 2012/13 Five Year Financial Pan scheduled for Board approval in March 2012 and previously outlined to the Performance and Resources Committee.
2
Savings Plans to deliver underlying financial gap of £11.244m have been prepared with outline areas reported to the Performance and Resources Committee in October. Where feasible these are being linked to the Voluntary Severance Scheme programme to generate further management and admin savings.
The draft LDP (Local Delivery Plan) was submitted to S.G.H.D. on 17th February 2012 as required. A meeting was held with S.G.H.D. on 27th February 2012 to discuss the draft Financial Plan. Based on discussions held and subject to NHS Board approval of the Plan at the March Board meeting it is anticipated that the LDP will be signed off by the end of March 2012.
3
2. Revenue Resource Limit
During the month of February 2012 the following allocations were received from the S.G.H.D.:
£m Core Revenue Resource Allocation as at 31st January 2012 433.963 Additional Non-recurring for sustainable Waiting Times standards 0.100 Depreciation adjustment transferred to Non-Core Allocations -0.093 Other 0.132 Core Revenue Resource Allocation as at 29th February 2012 434.102
Non-Core Revenue Resource Allocation at 31st January 2012 50.236 Impairments – PFI Assets 2.995 Impairments – non PFI Assets 15.642 AME Provision – return of funding -1.500 Depreciation adjustment transferred from Core Allocations 0.093 Donated Assets Depreciation 0.023 Non-Core Revenue Resource Allocation at 29th February 2012 67.489
Total Revenue Resource Allocation as at 29th February 2012 501.591
In addition to the notified Revenue Resource Limit of £501.591m, a further £0.099m is expected during the year, resulting in an anticipated Revenue Resource Limit of £501.690m. This anticipated funding includes:
Various allocations totalling £0.099m
Also indicative funding of £31.291m to match the net expenditure during 2011/12 has been provided for remaining Family Health Services (Dental, Ophthalmic and Pharmacy contractors) - this funding remains ‘non-cash limited’.
4
3. Corporate and External Boards
The financial position for Corporate and External Boards to 31st January 2012 is an underspend of £0.268m (£0.109m overspend to the end of January).
Corporate and External Boards Revenue Resource Analysis for Annual Cumulative Year to Date The Period to 29th February 2012 Plan Plan Actual Variance £m £m £m £m
NHS Glasgow 18.267 16.744 16.775 0.031 NHS Lothian 11.683 10.710 10.879 0.169 Golden Jubilee NH 1.164 1.067 1.447 0.380 Other NHS Scotland 4.259 3.904 3.691 (0.213) Other Healthcare Providers 2.353 2.157 2.145 (0.012) UNPACS / NCAs / Exclusions 4.521 3.931 3.484 (0.447) Community and Voluntary Sector 1.809 1.483 1.483 0.000 Area Corporate 34.471 30.744 30.433 (0.311) Healthcare Strategy 2.223 2.025 2.160 0.135 Capital Charges 13.055 11.561 11.561 0.000 Annually Managed Expenditure - Impairment 18.195 2.994 2.994 0.000 Loss on Sale of Assets 1.053 1.053 1.053 0.000
Total 113.053 88.373 88.105 (0.268)
Externals net underspend of £0.092m (£0.004m overspend at end of January) Updated information has now been received on activity and costs for the NHS Lothian SLA for 2011/12. The data is being reviewed locally and the position requires to be finalised by end of March.
NHS Greater Glasgow and Clyde have provided a draft SLA position for 2012/13 in advance of the new financial year, which will greatly assist Financial Planning by reducing uncertainty in-year.
Area Corporate: £0.311m underspend (£0.241m underspend to end of January) The underspend combines the impact of tight vacancy controls and the Voluntary
Severance Programme.
Healthcare Strategy: £0.135m overspend (£0.151m overspend to end of January) The overspend is predominantly due to higher than budgeted expenditure on legal and advisor fees.
5
4. Acute Services
Forth Valley Acute Services Revenue Resource Analysis for Annual Cumulative Year to Date The Period to 29th February 2012 Plan Plan Actual Variance £m £m £m £m
Surgical and Cancer Services 50.297 45.767 46.528 0.761 Medicine, Emergency Services and Rehabilitation 45.798 42.008 43.666 1.658 Women & Children's and Clinical Services 37.509 34.278 34.219 (0.059) Forth Valley Royal Hospital – Unitary Charge 33.848 32.233 32.182 (0.051) FVRH Transitional Costs 0.351 0.351 0.401 0.050 Corporate and HQ costs 1.275 1.216 1.596 0.380
Total 169.078 155.853 158.592 2.739
Waiting Times/ Access Targets 1.759 1.386 3.710 2.324 Top slice Golden Jubilee 90% (1.550) (1.382) 0.000 1.382 Net Waiting Times/ Access Targets 0.209 0.004 3.710 3.706
The Acute Services financial position as at 29th February 2012 reflects a cumulative overspend of £2.739m (overspend of £2.562m to 31st January).
The February position represents an adverse movement from January of £0.177m. Budget phasing and biologic spend which is the main cause of fluctuation will be reviewed for 2012/13.
Complex therapy drugs continue to present as a significant cost pressure with combined year to date pressure of £1.558m.
Medical locum expenditure, both agency and on payroll, has significantly increased during 2011/12.
Main points to highlight are:
Surgical and Cancer Services: overspend of £0.761m (overspend of £0.737m last month) Reduction in in-month overspend has continued evidencing management actions delivering savings.
Medicine, Emergency Services & Rehabilitation: overspend of £1.658m (overspend of £1.482m last month) MECAR unit hosts the majority of complex therapy and of the overall Unit overspend £1.224m relates to this issue (£0.163m of in-month overspend). Work on prescribing efficiencies in the West of Scotland has focussed on this area as a priority as it is an increasing pressure for all Boards. Provision has been made in next year’s Financial Plan to cover this.
6
Women & Children and Clinical Services: underspend of £0.059m (underspend of £0.057m to end of January) The position remains broadly breakeven, with some underlying financial pressures on laboratory services and sexual health services, which are being largely offset by underspends against pay in other areas.
Corporate and Headquarters: overspend of £0.380m (overspend of £0.430m to end of January) This reflects in part budgetary changes associated with nursing model of care with the balance of the overspend as in previous months relating to interpreter fees, taxis and postages.
Transitional Costs It is anticipated that minimal costs will be recorded through transitional costs in the remaining months.
Waiting Times/ Access Targets Current position to the end of February 2012 is an overspend of £3.706m (overspend of £3.293m to end of January). Efforts are focussed on reducing reliance on additional sessions which attract overtime and premia rate payments. Premia costs increased substantially during the month reversing the previous trend – further information required in this area. The longer term priority is ensuring sustainable plans within available resources.
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5. CHP, Prescribing and Other Area Services
CHP, Prescribing & Other Revenue Resource Analysis Annual Cumulative Year to Date For period to 29th Feb. 2012 Plan Plan Actual Variance £m £m £m £m
Clackmannanshire CHP 34.364 30.930 31.238 0.308 Falkirk CHP 21.969 19.002 19.002 0.000 Stirling CHP 9.618 8.215 8.214 (0.001) AHPs 11.646 10.692 11.029 0.337 Prescribing 62.968 57.311 56.365 (0.946) FV Facilities 16.593 14.630 14.630 0.000 Complex Care 4.074 3.749 3.749 0.000 Resource Transfer 18.104 16.595 16.596 0.001 Primary Medical Services 39.084 33.084 33.084 0.000 Prison Healthcare 4.386 4.012 4.012 0.000 Total 222.806 198.220 197.919 (0.301)
Family Health Services 31.291 28.017 28.017 0.000
Clackmannanshire, Falkirk and Stirling CHPs The financial position on CHPs at 29th February 2012 £0.308m overspend – Clackmannanshire CHP breakeven – Falkirk CHP £0.001m underspend – Stirling CHP £0.337m overspend – AHPs (Allied Health Professionals)
Each of the CHPs endeavour to achieve financial breakeven for the year as efficiency programmes progress, however due to low staff turnover levels overspends are reported. Focus within Clackmannanshire CHP is predominantly on delivery of Mental Health Service Savings.
Complex Care Complex Care is reporting breakeven at the end of February and forecasts a breakeven position at March 2012.
Forth Valley Facilities Forth Valley Facilities’ financial position at the end of February is a balanced position and forecasts a breakeven position at March 2012.
Prescribing An underspend of £0.946m is reported for the eleven month period ended 29th February. (This reflects nine months actual data combined with estimates for January and February).
8
Interrogation of the most recent actual data reveals that the number of items prescribed in December was 2.8% higher than the same period last year, resulting in cumulative item growth of 2.2% for first nine months of 2011-12 compared to 2010- 11. This was in line with expectations and trends experienced in previous years (as patients prepare for winter and stock up before pharmacy closures over the Christmas and New Year period).
The average cost per item reported for December decreased by 7p per item compared to November – this has been incorporated in the projections for January and February.
The overall position will be kept under review as actual prescribing data becomes available during the remainder of the financial year, particularly in relation to potential volume fluctuations. However, current information suggests that an underspend of c£1.2m will be reported as at 31st March
Primary Medical Services (PMS) Breakeven is reported for the eleven month period ended 29th February. This masks a range of pressure areas largely within Board Administered Funds (e.g. maternity leave cover, employer’s superannuation and Golden Hellos). At present, these pressures are being offset by fortuitous underspends on other elements of the PMS budget.
The overall position will be kept under review during the remainder of the financial year. In the meantime, breakeven is forecast at 31st March.
Prison Healthcare November marked the transfer of responsibility for prison healthcare from the Scottish Prison Service to NHS Scotland. Funding to meet the associated costs of the transfer was allocated to Boards in August (£1.837m).
Under merger accounting principles, we must account for the costs of the service for the full financial year i.e. from 1st April 2011. Corresponding budgetary and expenditure details for the period 1st April to 31st October have now been provided and accounted for, and as a result the overall budget has increased to £4.386m. Breakeven is forecast at this stage.
Family Health Services Funding for the remaining Family Health Services (Dental, Ophthalmic and Pharmacy contractors) remains ‘non-cash limited’. Details of expenditure are identified below.
Year to Date Year End Family Health Services Actual Forecast For period to 29th February 2012 £m £m
General Ophthalmic Services 4.669 5.000 General Dental Services 14.587 16.391 General Pharmaceutical Services 8.761 9.900 Total Family Health Services 28.017 31.291
9
Resource Transfer (breakdown for information)
Resource Transfer Annual Cumulative Year to Date For period to 29th February 2012 Plan Plan Actual Variance £m £m £m £m
Clackmannanshire 2.832 2.596 2.596 0.000 Falkirk 10.467 9.595 9.595 0.000 Stirling 4.761 4.364 4.365 0.001 Perth & Kinross 0.013 0.011 0.011 0.000 Total Expenditure 18.073 16.566 16.567 0.001 Retraction - Nursing Homes 0.031 0.028 0.028 0.000 Total Expenditure 18.104 16.594 16.595 0.001
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6. Capital Resource Limit
Overall Position The forecast Capital expenditure for year-ended 31st March 2012 is currently £80.377m. This funding stream is made up of £73.101m confirmed from the Scottish Government Health Department (S.G.H.D.) and £4.273m in anticipated Core allocations. This is inclusive of capital grant funding to the value of £1.455m and £1.548m in forecast Capital receipts that have been deducted from the charge against the Capital Resource Limit (CRL) of £77.374m. Details can be seen at Annex 1 to this report.
Expenditure Expenditure to 29th February 2012 was £78.426m inclusive of an in-month increase to the value of £0.359m. Significant expenditure can be summarised as:
Ringfenced Allocations – expenditure on projects being funded from ringfenced allocations equates to £67.697m being the total value forecast for financial year 2011/12. This expenditure is in relation to the balance sheet addition for Phase 3 of the new Acute Hospital at Larbert.
Strategic Priorities – expenditure on Strategic Priorities projects as at 29th February totals £6.103m that represents 87% of the available budget. To date a total of £4.824m has been spent on projects relating to the new Forth Valley Royal Hospital and £1.121m on the decommissioning of the old Falkirk and Stirling Royal Infirmary sites. In addition, there has also been £0.158m spent on the refurbishment of boundary walls at the old Bellsdyke Hospital development site.
Primary & Community Care Modernisation – further minor expenditure was incurred during February on the Primary & Community Care Modernisation Programme bringing the total to date up to £0.279m from an available budget of £0.455m.
Community Hospitals – work is ongoing in developing the Community Hospital projects and to date £0.953m has been spent on the Falkirk Community Hospital site and £0.304m on the Stirling Community Hospital site.
Area Wide Expenditure - Area Wide expenditure to the end of February 2012 amounted to £3.063m inclusive of an in-month increase to the value of £0.319m. £1.155m has now been spent on projects relating to the IM&T Strategy and a further £0.510m on the area-wide medical equipment replacement programme. There has also been a total of £0.028m expenditure incurred in relation to the Prison Healthcare Transfer to the National Health Service, and £1.370m utilised to capitalise the Forth Valley Royal Hospital Bed Management Contract leasing arrangement.
11
The summarised position is identified below and a more detailed analysis is attached as Annex 1.
Plan to Actual Variance Capital Resource Limit Date to Date to Date Plan Forecast Variance for the period to 31st December 2011 £m £m £m £m £m £m
Resources Approved Capital Resource Limit 5.404 9.999 4.595 5.404 5.404 0.000 Ring fenced allocations 67.697 67.697 0.000 67.697 67.697 0.000 Capital Grants 0.730 0.730 0.000 1.455 1.455 0.000 Anticipated Capital Allocations 4.595 0.000 (4.595) 5.821 5.831 0.000 Total Resources 78.426 78.426 0.000 80.377 80.377 0.000
Expenditure Ring fenced Expenditure 67.697 67.697 0.000 67.697 67.697 0.000 Regional Priorities 0.027 0.027 0.000 0.050 0.050 0.000 Strategic Priorities 6.103 6.103 0.000 6.975 6.975 0.000 Primary & Community Care Modernisation 0.279 0.279 0.000 0.455 0.455 0.000 Community Hospitals 1.257 1.257 0.000 1.500 1.500 0.000 Area Wide Expenditure 3.063 3.063 0.000 3.700 3.700 0.000 Total Expenditure 78.426 78.426 0.000 80.377 80.377 0.000
Saving/ (Excess) Against CRL 0.000 0.000 0.000 0.000 0.000 0.000
Property proceeds received in 2011/12 have been planned as first instalment of brokerage repayment and total £1.417m.
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7. Savings Programme
A summary of the Savings Report is attached at Annex 2.
Savings delivered to date total £20.236m with no significant changes. There are a number of areas where full year achievement is reported but no savings to date e.g. Operational Savings Balance £1.751m. Detailed work is close to conclusion for delivery of recurrent savings for these areas but non-recurrent savings / underspends are covering any in-year gaps.
Work is progressing on 2012/13 – 2016/17 Financial Plans with initial presentation to the January Performance and Resources Committee.
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8. Risk
A short summary of the most significant risks are outlined in the table below:
Key Assumptions/Risks Risk rating/Impact/£ Delivery of significant cash savings in Medium Risk : High Impact 2011/12 given low staff turnover rates Risk level has reduced in respect of delivering of (3.7% estimated in 2010/11) and in-year financial balance following confirmation timescale involved in consultation of transitional cost support from S.G.H.D. regarding service change
Delivery of further significant real cash High Risk : High Impact : £42.255m recurrent by savings in period 2012/13 – 2015/16 March 2016. Position will be updated as part of the Financial Plan 2012/13.
Delivery of 18 week Referral to Treat High Risk : High Impact : £4.000m commitment plus extension of At the same time as seeking significant cash programme to other care savings from services to meet demographic and groups/treatment lists inflationary pressures it is becoming increasingly difficult to maintain premia cost spend on waiting list activity resulting in high cost per case for no additional clinical benefit/outcome Equal Pay Medium Risk : High Impact : unquantified
Unitary Charge Inflation High Risk : Medium Impact : £1.376m recurrent per annum i.e. potential for £6.880m recurrent at end of 5 year period. Recent announcements indicate R.P.I. (Retail price Index) reductions. An update will be included in Financial Plan for 2012/13.
Continued increase on Utilities / Travel High Risk : Medium Impact : not quantified. costs given trend in oil prices / Middle Current estimate 23% p.a. increase in future East crisis years.
Continued increase in CNORIS / Legal High Risk : Medium Impact : not quantified Claims cost particularly the Risk reduced in-year as nationally costs are lower implications of recent No Fault than anticipated but future year costs predicted to compensation rise. Implications of National Pay Policy – Medium Risk : High Impact : £2.000m p.a. assumed 1% but may be higher given £8.000m recurrent by end of period current R.P.I.
1% uplift per annum may not be High Risk : High Impact : £4.000m recurrent p.a. sustainable over 5 year life £16.000m recurrent by end of period. Plans currently being updated.
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Sustainability of receiving NRAC High Risk : High Impact : £1.150m p.a. uplift when overall resource reducing – £4.600m recurrent by end of period. local population continues to rise NHS Forth Valley is currently £11.1m below its target share of NHS resources. Risk likely to reduce for 2012/13 where NRAC funding increases have been included in Spending Review. Impact of low staff turnover rates on High Risk : estimated risk £ 0.904m ability to release cash savings from identified Savings areas Impact of voluntary severance scheme High Risk : estimated risk £ 3.000m not being affordable Confirmation of S.G.H.D. transitional support has resulted in release of local funding to support scheme up to £4m. Estimate further £3m required to meet management and admin savings. Operational Savings target not yet High Risk : estimated risk £ 1.751m signed off Outline schemes prepared and operational group completing detail. Non-Recurrent Review / Provision Low Risk : risk £ 1.648m review Now managed in-year. Volatility of current accounting High Risk: risk dependent on timing of planning treatment of Bellsdyke property sale permission for individual sites. and need to review accounting Estimate for 2011/12 is a loss of £0.816m which treatment of abnormal costs has been incorporated into year end projections. SERCO discussions Low Risk: recurrent position predominantly addressed. Conclusion reached and final outcome for backdated costs incorporated into projections.
PFI Anticipated Allocation As part of the final transfer review these are adjustments subject to further scrutiny. The Financial Model is scheduled to be re-run at the end of the Project and experience from other areas indicates this is a risk but there is no particular pattern which would allow quantification. Impairment Associated with the major service changes ongoing there is also a relatively high level of impairment identified some of which will only be confirmed later in the year dependent on indexation.
The main risks re Capital are: - timing and value of property proceeds - retention of savings achieved on FVRH equipment project - balance sheet treatment of Managed Bed Service Contract (estimated value under review) - confirmation of Capital Allocations.
An updated risk schedule has been prepared as part of 2012/13 Financial Planning process.
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9. Balance Sheet and Cash Requirement
The Balance Sheet indicates the value of fixed and current assets and liabilities for the period and the position at the year-end.
Opening Current Closing Balance Sheet as at 29th February 2012 Balance Position Balance £m £m £m Non-Current Assets Property, Plant & Equipment 437.260 500.531 501.538 Intangible Fixed Assets 1.689 1.689 1.690 Financial Assets 12.603 12.497 12.600 Total Non-current Assets 451.552 514.717 515.828
Current Assets Assets classified as held for sale 1.784 0.965 0.000 Inventories 0.921 0.900 0.920 Other current assets 0.000 0.000 0.000 Trade & other receivables 8.699 918 8.7007. Cash & cash equivalents 0.031 0.313 0.027 Total Current Assets 11.435 10.096 9.647
Total Assets 462.987 524.813 525.475
Current Liabilities Provisions -5.968 -5.965 -5.970 Trade & other payables -60.578 -60.580 -60.580 Other financial liabilities 0.000 0.000 0.000 Total Current Liabilities -66.546 -66.545 -66.550
Total Assets Less Current Liabilities 396.441 458.268 458.925
Non-current Liabilities Provisions -12.194 -8.105 -12.195 Trade & other payables -285.570 -343.414 -345.000 Other financial liabilities 0.000 0.000 0.000 Total Non-current Liabilities - 297.764 -351.519 -357.195
Total Net Assets 98.677 106.749 101.730
Taxpayers Equity General Fund 30.529 38.622 27.360 Revaluation Reserve 67.686 67.685 73.919 Donated Asset Reserve 0.462 0.442 0.451 Total Taxpayers Equity 98.677 106.749 101.730
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10. Conclusion
The Board is asked to
note the revenue operational overspend of £5.830m to 29th February 2012
note that following conclusion of discussions with S.G.H.D. and based on current risks and ongoing delivery of savings in-year financial balance is projected.
note work on-going preparing 2012/13 – 2016/17 Financial Plan with Plan scheduled for consideration and approval at March Board meeting.
note the balanced capital position projected
Fiona Ramsay Director of Finance and Planning 19th March 2012
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ANNEX 1
NHS FORTH VALLEY Position at 29th February 2012 Year end -Forecast CAPITAL RESOURCE LIMIT Plan Actual Variance Plan Forecast Variance As at 29th February 2012 £'000 £'000 £'000 £'000 £'000 £'000
NON-CORE FUNDING SGHD - IFRS Impact 67,697 67,697 0 67,697 67,697 0 Total Non-Core Income 67,697 67,697 0 67,697 67,697 0
PLANNED NON-CORE EXPENDITURE New Acute Hospital - Balance Sheet Addition 67,697 67,697 0 67,697 67,697 0 Total Non-Core Expenditure 67,697 67,697 0 67,697 67,697 0
Non-Core Balance Available / (Required) 000000
SOURCES OF CORE FUNDING Scottish Executive Funding - General Allocation 3,855 3,855 0 3,855 3,855 0 SGHD - Pfi Reversionary Interest -4,610 -4,610 0 -4,610 -4,610 0 SGHD - Pfi Reversionary Interest Assumed Allocation 4,610 4,610 0 4,610 4,610 0 SGHD - New Acute Hospital 6,369 6,369 0 8,029 8,029 0 SGHD - NSS Equipping 171 171 0 189 189 0 SGHD - HUB Initiative 27 27 0 50 50 0 SGHD - Primary & Community Care Modernisation Programme Underspend 279 279 0 455 455 0 SGHD - Healthcare Associated Infection 0 0 0 107 107 0 SGHD - Prison Healthcare Transfer 28 28 0 69 69 0 SEAT Eating Disorders - NHSFV Contribution 000-74 -74 0 Total Core Incone 10,729 10,729 0 12,680 12,680 0
Planned Core Expenditure
Regional Priorities HUB Initiative 27 27 0 50 50 0 Wos - Quarriers Homes 000000 Total 27 27 0 50 50 0 Strategic Priorities Healthcare Strategy Project Costs 51 51 0 51 51 0 Bellsdyke Wall 158 158 0 160 160 0 New Acute Hospital - Equipment Phase 3 3,885 3,885 0 4,000 4,000 0 New Acute Hospital - Variations 286 286 0 700 700 0 New Acute Hospital - Signage 38 38 0 45 45 0 New Acute Hospital - Park including Maintenance 2 2 0 175 175 0 New Acute Hospital - Car Park 442 442 0 442 442 0 Clacks Lifecycle Costs 000000 SGHD - NSS Equipping 171 171 0 189 189 0 Demolitions / Decommissioning 1,070 1,070 0 1,213 1,213 0 Total 6,103 6,103 0 6,975 6,975 0 Primary & Community Care Modernisation Programme Infection Control Equipment 0 0 0 42 42 0 Park Street FCH 174 174 0 291 291 0 Bo'ness Health Centre 17 17 0 25 25 0 Dunblane Health Centre 53 53 0 53 53 0 Doune Health Centre 1 1 0 10 10 0 Clackmannan Health Centre 21 21 0 21 21 0 Dollar Health Centre 13 13 0 13 13 0 Total 279 279 0 455 455 0 Community Hospitals Falkirk Community Hospital 953 953 0 1,200 1,200 0 Stirling Community Hospital 304 304 0 300 300 0 Total 1,257 1,257 0 1,500 1,500 0 Area Wide General Expenditure IM & T Strategy 948 948 0 1,144 1,144 0 IM & T Strategy (2) 207 207 0 500 500 0 Healthcare Associated Infection - Icnet 0 0 0 107 107 0 Prison Healthcare Transfer 28 28 0 69 69 0 Medical Equipment Replacement Programme 510 510 0 510 510 0 Contingency 000000 Total 1,693 1,693 0 2,330 2,330 0 Area Wide Other Expenditure Statutory Compliance 000000 FVRH Bed Management Contract 1,370 1,370 0 1,370 1,370 0 Total 1,370 1,370 0 1,370 1,370 0
Total Net Core Expenditure 10,729 10,729 0 12,680 12,680 0
General Balance Available / (Required) 000000
Savings/(Excess ) Against Capital Resource Limit 000000 ANNEX 2
NHS FORTH VALLEY April - February March 2012 Risk SAVINGS PLAN 2011/12 Planned Actual Variance Planned Projected Variance as at 29th February 2012 £'000 £'000 £'000 £'000 £'000 £'000
Primary Care Prescribing 3,154 3,154 0 3,441 3,441 0 LOW
External : Cross Boundary Flow : Greater Glasgow and Clyde 1,008 862 -147 1,100 1,100 0 MED External : Cross Boundary Flow : Scottish Ambulance Service 317 317 0 362 362 0 LOW External : Total 1,325 1,178 -147 1,462 1,462 0
Management Review : General Manager Posts x 2 70 70 0 84 84 0 LOW Management Review : organisational structure 0 0 0 0 0 0 MED Management Review : Total 70 70 0 84 84 0
Income : NES : Clinical Simulator 196 196 0 214 214 0 LOW Income : Falkirk : Rates Rebate 115 115 0 115 115 0 LOW Income : Pharmacy Stock Write Off 0 0 0 261 261 0 MED Income : VAT recovery : Fleming case 94 94 0 145 145 0 MED Income : Total 405 405 0 735 735 0
Acute : Corporate : reduction in ABC ambulance journeys 26 26 0 30 30 0 LOW Acute : Corporate : reduction in taxi journeys - labs 18 0 -18 20 20 0 HIGH Acute : Corporate : reduction in taxi journeys - patients 18 0 -18 20 20 0 HIGH Acute : Corporate : winter capacity funding 417 417 0 500 500 0 LOW Acute : Corporate : Total 478 443 -35 570 570 0
Acute : MECAR : reconfigure junior doctors rota at Phase 3 - reduce by 5 wte 150 55 -95 175 175 0 HIGH Acute : MECAR : reduce bank spend in nursing by 15 wte 150 0 -150 175 175 0 HIGH Acute : MECAR : reconfigure out of hours service to 2 centres 139 68 -71 162 162 0 HIGH Acute : MECAR : Hospital at Night Integration 131 67 -64 150 150 0 HIGH Acute : MECAR : end admin bank and fill duties via wider discussion 117 12 -105 132 132 0 HIGH Acute : MECAR : phase 3 CAU extended day and limited overnight service 85 43 -42 99 99 0 HIGH Acute : MECAR : halt band 2 and Band 5 Fixed Term Contracts 57 76 19 63 63 0 LOW Acute : MECAR : reconfigure smoking cessation and redeploy post holders 47 47 0 55 55 0 LOW Acute : MECAR : redeploy 2 Band 6 Discharge co-ordinators to vacancies 39 37 -2 46 46 0 LOW Acute : MECAR : relocate Band 7 non-clinical co-ordinator posts 30 29 -1 34 34 0 LOW Acute : MECAR : end use of locums to fill junior gaps daytime/weekdays 28 28 1 30 30 0 LOW Acute : MECAR : reduce consultant responsibility payments by 3 10 16 6 12 12 0 LOW Acute : MECAR : cease payments to support hospital social work service 9 0 -9 11 11 0 MED Acute : MECAR : halt temporary contract for Delayed Discharges 8 8 0 9 9 0 LOW Acute : MECAR : redesign phlebotomy - hold vacancy 9 14 5 10 10 0 LOW Acute : MECAR : transfer locum bank to staff bank and redeploy to clinical admin 7 11 4 8 8 0 LOW Acute : MECAR : epilepsy post - redesign 6 37 31 7 7 0 LOW Acute : MECAR : reduce public holiday expenditure 6 6 1 6 6 0 LOW Acute : MECAR : Ambulatory Care - avoid investment 263 333 70 300 300 0 LOW Acute : MECAR 1,291 887 -404 1,484 1,484 0
Acute : Surgical Services : Ambulatory Care - Medical EPA 73 73 0 110 110 0 LOW Acute : Surgical Services : Designed Delivery Model : ITU/CCU Redesign 175 175 0 200 200 0 LOW Acute : Surgical Services : Orthopaedic Knee Implants 83 109 26 90 90 0 LOW Acute : Surgical Services : Ambulatory Care - Outpatient Redesign 70 12 -58 80 80 0 HIGH Acute : Surgical Services : Designed Delivery Model : Theatre Efficiency 40 40 0 45 45 0 LOW Acute : Surgical Services : Ambulatory Care - one site working travel costs 27 24 -3 30 30 0 MED Acute : Surgical Services : Orthopaedic Hip Implants 20 25 5 26 26 0 LOW Acute : Surgical Services : Haemastatic Dressings 6 6 0 7 7 0 LOW Acute : Surgical Services : Orthopaedic Trauma Implants 0 0 0 0 0 0 LOW Acute ; Surgical Services : Orthopaedic Extremities 0 0 0 0 0 0 LOW Acute ; Surgical Services : Surgical Face Masks 0 0 0 0 0 0 LOW Acute ; Surgical Services : Head Wear 0 0 0 0 0 0 LOW Acute : Surgical Services 494 464 -30 588 588 0
Acute : Women and Children : Demand Management 128 131 3 150 150 0 LOW Acute : Women and Children : Designed Delivery Model : Labs and Radiology 117 114 -3 130 130 0 LOW Acute : Women and Children : Designed Delivery Model : Midwifery Nursing 91 90 -1 100 100 0 LOW Acute : Women and Children : EPA reductions 64 64 0 70 70 0 LOW Acute : Women and Children : Fiscal Contract 11 11 0 13 13 0 LOW Acute : Women and Children : Family Planning Fees 0 2 2 0 0 0 LOW Acute : Women and Children : Pacs Refresh Contract Price -1 8 9 0 0 0 LOW Acute : Women and Children : Sexual Health Non P 0 1 1 0 0 0 LOW Acute : Women and Children : Discharge Notes 0 2 2 0 0 0 LOW Acute : Women and Children : Adjustment to equip lease single site 0 6 6 0 0 0 LOW Acute : Women and Children : Termination of equipment contract 0 2 2 0 0 0 LOW Acute : Women and Childrens 410 431 21 463 463 0
Clacks CHP : Mental Health : Provision of IPCU beds to Lanarkshire 23 0 -23 25 25 0 HIGH Clacks CHP : Mental Health : Provision of IPCU beds - balance 0 0 0 0 0 0 MED Clacks CHP : Mental Health : Community Services Redesign 35 35 0 38 38 0 LOW Clacks CHP : Mental Health : EPAs/Lochview/Out of Area/Low Secure Beds 0 0 0 0 0 0 MED Clacks CHP : Mental Health : Reduce Consultants On Call Rota 6 6 0 7 7 0 LOW Clacks CHP : Mental Health : Reduction in LD Nurse Bank 16 16 0 17 17 0 LOW Clacks CHP : Mental Health : Clinical Nurse Management Restructure 83 12 -71 100 100 0 MED Clacks CHP : CREATE 6606 60LOW Clacks CHP : Locality Resources 9 9 0 10 10 0 LOW Clacks CHP 178 84 -94 203 203 0
Falkirk CHP : Complex Care 92 92 0 100 100 0 LOW Falkirk CHP : CREATE 17 17 0 18 18 0 LOW Falkirk CHP : Community Nursing 138 138 0 151 151 0 LOW Falkirk CHP and Complex Care 247 247 0 269 269 0 ANNEX 2
NHS FORTH VALLEY April - February March 2012 Risk SAVINGS PLAN 2011/12 Planned Actual Variance Planned Projected Variance as at 29th February 2012 £'000 £'000 £'000 £'000 £'000 £'000
Stirling CHP : AHP : Heads of Service 138 138 0 157 157 0 MED Stirling CHP : AHP : Clinical Service Model 0 0 0 0 0 0 MED Stirling CHP : Community Nursing : Bank Spend 61 61 0 67 67 0 LOW Stirling CHP : CREATE 11 11 0 12 12 0 LOW Stirling CHP : Fixed Term Contracts 4 4 0 4 4 0 LOW Stirling CHP : Community Nursing (less offset) 97 97 0 106 106 0 LOW Stirling CHP 311 311 0 346 346 0
Facilities : Admin and Clerical post 23 23 0 25 25 0 LOW Facilities : Sleepknit (Community) 18 18 0 20 20 0 LOW Facilities : Water 37 37 0 40 40 0 LOW Facilities : Clacks Contract Specification 46 46 0 50 50 0 LOW Facilities 124 124 0 135 135 0 LOW
Procurement 434 434 0 521 521 0 LOW
Strategy Implementation : asset management 1,308 1,308 0 1,676 1,676 0 LOW
Strategy Workforce Model - Acute 528 73 -456 634 634 0 HIGH
Review Use of Funding Allocations 494 494 0 545 545 0 LOW
Total Savings Plan reported 30th May 2011 11,251 10,107 -1,145 13,156 13,156 0
Operational Savings Balance 1,532 0 -1,532 1,751 1,751 0 HIGH
Area Corporate : HR (FYE of 10% - staffing associated) 89 89 0 97 97 0 LOW Area Corporate : Finance (FYE of 10% - staffing associated) 128 128 0 140 140 0 LOW Area Corporate : Medical Director (FYE of 10% - staffing associated) 111 111 0 121 121 0 LOW Area Corporate : ICT (FYE of 10% - staffing associated) 121 121 0 132 132 0 LOW Area Corporate : Total 449 449 0 490 490 0 LOW
Management Restructure (CY 3 months: recurrent impact above) 278 278 0 333 333 0 LOW
Redeployment List: 11 posts at 25k full year 229 229 0 275 275 0 LOW
Hospitality / Catering 44 44 0 50 50 0 LOW
Fixed Term Contracts: 50 posts at 25k : six months in CYE 521 521 0 625 625 0 MED
Contingency Reserve 917 917 0 1,000 1,000 0 LOW
SGHD Support 1,879 1,879 0 2,050 2,050 0 LOW
Final Savings Plan 17,100 14,423 -2,677 19,730 19,730 0
Pressures/Non-recurrent/Provision review 7,462 5,814 -1,400 7,847 7,847 0 MED
Savings still to be identified 0 0 0 2,973 -2,973 HIGH
Total Savings Plan reported 29th February 2012 24,561 20,236 -4,325 30,550 27,577 -2,973
Forth Valley NHS Board
27 March 2012
This report relates to Item 4.3 on the agenda
Standing Orders including Scheme of Delegation and Standing Financial Instructions
(Presented by Mrs. Fiona Ramsay, Director of Finance)
For Approval
SUMMARY
1. TITLE OF PAPER
Standing Orders including Scheme of Delegation and Standing Financial Instructions.
2. PURPOSE OF PAPER
The paper seeks consideration of the updated Standing Orders. These Papers were reviewed by the Audit Committee on 23rd March 2012.
This is part of a scheduled annual review process and normally the next scheduled review would be due March 2013. Given the current review of Governance and a Management Structures it is anticipated that a further significant revision will be required during 2012.
3. KEY ISSUES
Standing Orders
Minor changes to the main Standing Orders Section to reflect Audit Report comments covering
- appointed Chief Executive and Director of Finance are automatically Executive Directors - proceedings are not invalidated as a result of vacancies or a defect in the appointment to Committees - participation in meetings can be made from a remote location
Each Committee has had the opportunity to review its remit with the following changes :-
- Audit Committee : revision to reflect Performance and Resources Committee remit - Clinical Governance : inclusion of assurance on information governance - Clinical Governance : Ethical Issues Sub-Committee : inclusion of Head of Spiritual Care in Membership - Clinical Governance : Organ Donation : change in meeting frequency minimum to once every six months - Joint Clackmannanshire and Stirling Community Health Partnership Board : addition - Clackmannanshire Community Health Partnership Board : deletion - Stirling Community Health Partnership Board : deletion - Clackmannanshire Community Health Partnership Sub-Committee : amended remit item1 - Stirling Community Health Partnership Sub-Committee : amended remit item 1 - Pharmacy Practices Committee : amended Terms of Reference approved in November 2011 - Performance and Resources Committee : addition (SO documentation /index to be updated)
Decisions retained by the Board
No changes proposed
Standing Financial Instructions
No changes made at this point – will require major revision as part of Management Structure change and to reflect very recent Procurement CEL. Regarding the latter issues regarding mandatory nature of national contracts require changes to a range of documentation and this will be completed as a single process
Scheme of Delegation
Changes made as follows :-
Replace Head of Financial Services with Assistant Director of Finance (Planning and co- ordination) Inclusion of Signature of PAS (Patient Access Scheme) sign-off to Director of Pharmacy Inclusion of Non-Clinical Records Process management to Head of Corporate Services Replace FVRH Project Director with Director of Projects and Property in terms of Project Agreement cost neutral amendments
The Scheme of delegation will require major review as part of the Management Structure changes planned.
4. FINANCIAL IMPLICATIONS
There are no financial implications arising from this paper.
5. WORKFORCE IMPLICATIONS
There are no workforce implications arising from this paper.
6. RISK ASSESSMENT AND IMPLICATIONS
No requirement for risk assessment given nature of paper.
7. RELEVANCE TO STRATEGIC PRIORITIES
Provides governance framework within which strategic priorities operate.
8. RELEVANCE TO DIVERSITY AND / OR EQUALITY ISSUES
There are no specific implications.
9. RECOMMENDATION(S) FOR DECISION
The Board is asked to approve the updated Standing Orders and to note that further revision will be required during 2012.
10. AUTHOR OF PAPER/REPORT:
Name: Designation: Date Fiona Ramsay Director of Finance 20th March 2012
Forth Valley NHS Board
27 March 2012
This report relates to Item 4.4 on the agenda
NHS Forth Valley Local Delivery Plan and Financial Plan 2012/13 -2016/17
(Presented by Mrs. Fiona Ramsay, Director of Finance)
For Approval
SUMMARY
1. TITLE OF PAPER
Local Delivery Plan and Financial Plan 2012/13 – 2016/17
2. PURPOSE OF PAPER
The paper seeks approval of the Local Delivery Plan, Financial Plan and Capital Plan 2012/13 – 2016/17
3. KEY ISSUES
The Local Delivery Plan is the annual agreement between SGHD (Scottish Government Health Directorate) and local NHS Boards in terms of specific delivery targets.
Draft Plans are submitted in February with final Plans submitted mid-March each year.
Submissions cover the following :-
Target Trajectories Risk Management Plan for each trajectory Contribution to Single Outcome Agreements Quality Outcomes Approach Workforce Issues Financial Templates
The following Annexes to this Paper cover the following :-
Trajectories and associated risk management plan Contribution to Single Outcome Agreement Financial Plan 2012/13 – 2016/17 Capital Plan 2012/13 – 2016/17
Regarding SGHD agreement to submitted trajectories it should be noted that dialogue is ongoing regarding 75+ readmissions.
The Financial Plan attached confirms planned recurrent and in-year financial balance across the timeframe of the Plan recognising that there remain challenging financial times ahead and significant cash savings to deliver.
The Capital Plan confirms in-year financial balance across the timeframe of the Plan
It is anticipated that the overarching Corporate Plan for the Board will be considered athe the May 2012 Board Meeting
4. FINANCIAL IMPLICATIONS
The financial implications are covered in the Financial Plan and Capital Plan attached
5. WORKFORCE IMPLICATIONS
Workforce risks and issues are covered for each of the trajectories.
6. RISK ASSESSMENT AND IMPLICATIONS
Risk Assessments have been completed and are included for each trajectory and within the Financial Plan and Capital Plan
7. RELEVANCE TO STRATEGIC PRIORITIES
Confirms NHS Forth Valley commitment to delivering key national priorities
8. RELEVANCE TO DIVERSITY AND / OR EQUALITY ISSUES
There are no specific implications.
9. RECOMMENDATION FOR DECISION
The NHS Board is asked to
Approve the Local Delivery Plan 2012/13 noting that one trajectory remains under discussion with SGHD Approve the Financial Plan 2012/13 – 2016/17 as per attached Approve the Capital Plan 2012/13 – 2016/17 as per attached
10. AUTHOR OF PAPER/REPORT:
Name: Designation: Date Fiona Ramsay Director of Finance 21st March 2012
Local Delivery Plan 2012/13
Risk Management Plan and Trajectories
NHS Forth Valley
NHS Forth Valley March 2012 1
HEATS TARGETS FOR 2012/13
To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25%, by 2014/15
At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours
Reduce suicide rate between 2002 and 2013 by 20%
To achieve 14,910 completed child health weight interventions over the three years ending March 2014
NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within- Board SIMD areas over the three years ending March 2014
At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014
NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009
By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery
Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) from March 2013; reducing to 18 weeks by December 2014; and 18 weeks referral to treatment for Psychological Therapies from December 2014
Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between 2009/10 and 2014/15
No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013, followed by a 14 day maximum wait from April 2015
To improve stroke care, 90% of all patient admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013
Further reduce healthcare associated infections so that by 2012/13 NHS Boards’ staphylococcus aureus bacteriamia (including MRSA) cases are 0.26 or less per 1,000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 65 and over is 0.39 cases or less per 1,000 total occupied bed days
To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14
NHS Forth Valley March 2012 2
To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung caner by 25%, by 2014/15
NHS BOARD LEAD David McPherson, General Manager Mary Orzel, Cancer Services Manager
Suggested trajectory 2005/2009 2012/2013 2013/2014 2014/2015 16.3% 17.6% 19.0% 20.0%
Delivery and Improvement Risk Management of Risk The focus of the Detect Cancer Early The Lead Cancer Team, diagnostic Clinical Leads and Programme is to improve outcomes. It is a Senior Managers met with the Scottish Government whole systems approach that will involve Cancer Taskforce team in January 2012 to discuss local third sector, public health, primary care and plans for achieving the aims of the programme. the acute sector. The national TV and Radio campaign will raise awareness of the Detect Early Cancer Steering group and Implementation benefits to presenting early. The campaign groups have been established. The Steering group will then move on to promote awareness of includes Clinical and Managerial Leads from across Forth screening programmes and the symptoms Valley system, including Public Health, Communications and signs of individual tumour types - and Finance. Forth Valley is also represented on the breast, colorectal and lung later in the year, national Communications sub group. starting with breast first. Local links to the national programme board will be A national Communications sub group is managed locally through the Cancer Board Structure, supporting the Detect Cancer Early which is chaired by the Consultant Cancer Lead and Programme and it has produced a list of attended by Clinical Leads from each of the key tumour stakeholders who require details of the sites, Diagnostics and Senior Managers. Local Issues are social marketing campaigns. A toolkit is taken through Regional Cancer Advisory Group (RCAG), being devised which will be sent to all attended by the Consultant Cancer Lead and Senior stakeholders including advice on Planning Manager. RCAG has key national links. engagement with the general public around the campaign to ensure that local Health Locally the 5 year Cancer Strategy Plan is being Boards are responsive to the increase in refreshed. The associated action plan links to the NHS demand for services. Forth Valley Integrated Health Care Strategy, Better Cancer Care Strategy and the Cancer Task Force action The National Programme Board has plan. acknowledged that it is difficult to predict accurately the impact on workload as a The impact on referrals from GPs will be monitored result of any new social marketing through the monthly audit data and reviewed by the campaign. From similar initiatives in Steering Group. England there has been a 48% increase in the number of people over 50 who visited Staging information is captured by Cancer Audit for the their GP with the relevant symptoms. This Managed Clinical Networks. equates to one additional patient per practice per week. In addition to this, the The Detect Cancer Early Operational subgroup looking at pilot bowel cancer campaign resulted in a 'staging' is reviewing the definitions of staging. This work 32% increase in urgent GP referrals for is ongoing with local representatives inputting to the suspected bowel cancer across both pilot definitions group. This work is still to reach a conclusion. regions over a 6 month period. The National Programme Board will closely Pathologists in Forth Valley work to up-to-date monitor the impact to ensure that the staging classifications and are part of wider pathology overall programme is fully evaluated well in networks. advance of official publication of survival outcomes. Criteria and definitions are still being discussed nationally Any increase in patients presenting for with a meeting early March to examine this further. The NHS Forth Valley March 2012 3
investigations will have resource outcomes will determine what data is collected and how implications in particular for diagnostics; this will be done locally. Radiology, Pathology and Endoscopy. In addition, if the goal is to increase the Multi Disciplinary Teams (MDT’s) are governed through number of 'stage 1' cancers detected it is our Multi Disciplinary Team constitution. In Forth Valley important that we are clear about what cancer audit data is collected and discussed at the MDT's 'stage 1' is. where it is also signed off by the Clinical Leads. The data is input to the regional system, E-case, which may It is recognized that action needs to be following discussion be expanded out nationally. taken to improve data quality at Board level.
Workforce Risk Management of Risk An increase in patients presenting to their Work with our baseline figures and once underway will GPs and subsequent referral for review monthly to assess the level of additional demand investigation and possible treatment will on diagnostics and treatments. have an impact for resources across the cancer pathway in particular diagnostics, Link in to any feedback from the national programme and chemotherapy. board.
It is not currently possible to quantify this The funding available will provide opportunities to train until we know what impact the programme staff in both specialist imaging (US mammography etc) will have in terms of patients presenting and also radiographer reporting. Over time, this will help earlier. both with capacity and reporting pressures. Outsourcing of non-complex reporting may also be an option.
The Steering group will oversee any increase in demand and subsequent proposed developments.
This work will also link into NHS Forth Valley’s current workforce plans.
Finance Risk Management of Risk An increase in workload will put pressure The 'Detect Cancer Early' initiative will be backed by £30m on available financial resources. nationally with a recurring revenue allocation of £15m.
A modelling tool used by the National Programme Board to arrive at the national funding allocations has been shared to assist with the local allocation of resources.
Equalities Risk Management of Risk The gap will increase between those who Link with the current Keep Well projects which are running present early and those hard-to-reach in areas of high deprivation. groups who present late or groups where poor screening uptake already exist. The national communications subgroup is producing guidance on engaging the public ‘in the field’ and signposting members of the public to services. Forth Valley is represented on the group and will engage locally with ‘field’ workers. Our local communication strategy will be agreed and monitored by the Steering group.
NHS Forth Valley March 2012 4
At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours
NHS BOARD LEAD Gillian Morton, General Manager Gail Bell, Senior Midwife
Suggested trajectory 2010 Apr-Jun 12 Jul-Sep 12 Oct-Dec 12 Jan-Mar 13 Apr-Jun 13 Jul-Sep 13 86.1% 80% 80% 80% 80% 80% 80% Oct-Dec 13Jan-Mar 14 Apr-Jun 14 Jul-Sep 14 Oct-Dec 14 Jan-Mar 15 80% 80% 80% 80% 80% 80%
Maternity services are pivotal to many other services and agendas therefore the need to continue clear links and defined pathways with other agencies is essential.
Maternity Services within NHS Forth Valley continue it’s commitment to supporting HEAT targets via several national agendas and frameworks including The Refreshed Framework for Maternity Care in Scotland; Keeping Childbirth Natural and Dynamic (KCND); Getting it Right for Every Child (GIRFEC) and the Early Years Framework; The Refreshed Framework for Improving Maternal and Infant Nutrition and the Vulnerable Families Pathway including the current target:
Delivery and Improvement Risk Management of Risk Not achieving target Education and information for all parents-to-be Appropriate access and contact to maternity services Not maintaining current target status for clients Improving understanding for stakeholders regarding Inadequate data collection systems targets and expectations. Improving understanding for stakeholders regarding Inability to further increase targets and expectations. This has been discussed at engagement with the harder to reach the Maternity Services Liaison Committee. This group groups meet to raise awareness and utilise the expertise around the table to inform the Unit’s actions. This group has multi-agency professionals as well as lay representation. Link with the Communications Department to support our engagement with the local authorities to ensure this agenda is included in the local authorities newsletters, thereby reaching all homes within NHS Forth Valley. On-going involvement with local and national contacts regards implementation and progress on target Refresh appropriate KCND pathway work Improved accuracy in collation of statistics/data which must include ‘real-time’ data Currently do not have the appropriate IT systems therefore funding required to upgrade current system in the absence of a national solution
NHS Forth Valley March 2012 5
Workforce Risk Management of Risk Inadequate workforce resource to On-going workforce planning involvement at local and achieve target national levels Workforce inability to assess health On-going review of model of care and social care needs. Ensuring adequate support in place for the Additional Support Midwifery Sister to undertake her role with the vulnerable client group Support H.I.S in their learning needs analysis to ascertain gaps in current knowledge and skills. Inhouse skills gap analysis may need to be considered with appropriate training given.
Finance Risk Management of Risk Impact of on-going services Ensure the HEAT target remains part of the Units finance planning processes Current financial climate Appropriate use of resources Access monies released to the Board to support the Unit savings requirements required update of MATSYS, our current data system HEAT target should form part of the Boards Performance Management framework and will be reported to the Board through the Board Executive Performance Report
Equalities Risk Management of Risk Difficulty in accessing hard to reach Continued engagement with hard to reach groups groups Involvement and appropriate support for teenage pregnancies Social and cultural influences affecting Continued input from Additional Support Midwifery early engagement with maternity Sister to support more vulnerable patients with multi- services disciplinary input and planning Ensure adequate support for the Additional Support Midwifery Sister undertaking her role Interagency workings with migrant populations Adequately trained and skilled staff to offer support based on individual client needs Ensure equity across services with support from Equality and Diversity and access to appropriate interpreting services for all
NHS Forth Valley March 2012 6
Reduce suicide rate between 2002 and 2013 by 20%
NHS BOARD LEAD Anne Maree Wallace, Director of Public Health Kathy O’Neill, General Manager
No trajectory requested
Work on the mental health targets and commitments for Delivering Mental Health continue to be taken forward by the multi-agency Forth Valley Mental Health Delivery Plan Group. This work is integrated with local initiatives and includes the development of new Models of Care, and new ways of working in mental health. NHS Forth Valley continues to contribute to the ‘Towards a Mentally Flourishing Scotland’ work, particularly via the multi-agency CHP Mental Health Planning Groups which have developed specific action plans. Work on anticipatory care also encompasses broader mental wellbeing. The legacy of the Mental Health Collaborative includes continuing support to a range of initiatives relating to the mental health HEAT targets, improving the efficiency of mental health services and improving the patients’ experience.
A major Review of Adult and Old Age Community Mental Health Services (CMHS) is fully underway and is building on the new pathways developed for the Acute Admission Services Mental Health Model at Forth Valley Royal Hospital. The CMHS Review has introduced the development of new Resource Centre based models which promote more effective ways of working and further enhance partnership working. The new Models will be required to respond to key initiatives including Integrated Care Pathways, the Psychological Therapies target and the need for improvements in efficiency and effectiveness. The latter will involve the roll-out of Releasing Time to Care in the Community.
There are clear links with the ongoing work in respect of Alcohol Brief Interventions (ABI), Access to Drug and Alcohol treatment, Child and Adolescent Mental Health Services (CAMHS) and Psychological Therapies (PT) targets. In addition, the transfer of A&E services to Forth Valley Royal Hospital took place in August 2011 and are now co-located with Mental Health Services. To further augment mental health responses an Emergency Assessment Hub has been introduced. These innovations will support delivery of this agenda and the associated targets.
There is a key focus on training within Forth Valley with regard to suicide assessment and prevention, as well as Scottish Mental Health First aid. The target of 50% of frontline staff trained in suicide assessment and prevention techniques continues to be sustained.
Delivery and Improvement Risk Management of Risk Rates: Multi-factorial nature of suicide rates Partnership work is ongoing with local multi-agency out with NHS control groups considering risk factors, with encouragement to include suicide in SOAs to ensure ongoing focus Education. Insufficient capacity to deliver Service Managers within Health and the 3 Local training Authorities have been asked to support ring-fenced time for ASIST / SafeTalk Trainers to deliver training Existing ‘lapsed’ trainers are being encouraged to take up refresher training to increase the trainer pool The need for additional trainers (including those for Scottish Mental Health First Aid) has been identified and has been discussed with NHS Service Managers and Local Authority Managers as well as senior representatives of other mental health agencies, including the third Sector A program of training for 2012 will be provided for key staff, including those working in mental health related agencies Discharge Planning: the transition from The discharge pathway from hospital to community is hospital to community is not fully under review with the intention of ensuring rapid coordinated exchange of information with community services and GP, and patient / family involvement in post-discharge
NHS Forth Valley March 2012 7
care Crisis Management: sufficient support The Intensive Home Treatment Team (IHTT) remains arrangements are not in place at times of focused on preventing unnecessary admission and crisis supporting early discharge The roles of the IHTT and local Community Mental Health Teams have been clarified with regard to crisis management to prevent care ‘gaps’ arising An Emergency Admission Hub for mental health referrals has been established at Forth Valley Royal Hospital. This will improve out of hours coordination, response times, and joint working with A&E Psychological Therapies: psychological The Psychological Therapies Delivery Group is services can be accessed at times of need coordinating work regarding improving access to services This work has included a major scoping exercise which has identified potential capacity outwith the specialist / highly specialist services, and what further training is required to increase capacity via supervised practice Training in suicide assessment and The Forth Valley Lead Trainer in suicide assessment prevention is not integrated with other and prevention continues to attend related national National and local initiatives events to ensure the training agendas are coordinated The relevance of this training to other mental health initiatives, including Closing the Gaps, A Fuller Life, See Me, Breathing Space and Towards a Mentally Flourishing Scotland, continues to be reinforced at NHS Board and local planning levels to ensure an integrated and supportive approach to delivery At a local level, the association of the principles of the training has been fed into service improvement initiatives such as new Models of Care which promote Recovery, the development of Integrated Care Pathways (depression in particular) and in the development of Joint Health Improvement Plans with Local Authority partners in each of the 3 CHPs GPs are unable to access suicide Ways of making the training more accessible to GPs assessment and prevention training are being considered by potentially providing shorter locally developed evidence-based training. This may be informed by national guidance. Those GPs who have attended the training have provided positive feedback Clinical practice does not improve following Individual practitioners, and their Managers, have been training advised to include this training in Personal Development Plans and in Clinical Supervision The training has been linked to the implementation of new Models of Care for Acute In-patient Services and Community Mental Health Services, including the electronic FACE care planning program, across adult and old age psychiatry services to promote good practice in risk assessment and management processes.
Workforce Risk Management of Risk Key frontline staff cannot be released to Senior Managers in Health and Local Authorities are attend training being asked to consider this training as a continuing priority for 2012 The training is not viewed as a continuing The inclusion of ASIST and safeTalk (and potentially priority STORM) training at induction for new staff is widely
NHS Forth Valley March 2012 8
supported and continues to be pursued within NHS mental health services
Finance Risk Management of Risk The direct and indirect costs of delivering Service Managers in Mental Health and Acute the training cannot be sustained Services are being asked to continue to prioritise this training ASIST and safeTalk have been included as mandatory training in the draft Forth Valley Mental Health Nursing Training and Education Strategy Choose Life funding (held by Local Authorities) continues to fund direct costs including accommodation and training materials The Choose Life leads in each agency will be approaching Service Managers to promote uptake of the training as a priority for the Board and Councils
Equalities Risk Management of Risk GPs and other community-based staff do Consideration is being given to making the training not uptake the training resulting in poorer more accessible to GPs by potentially providing quality suicide assessment and prevention shorter locally developed evidence-based training or for equalities groups introducing shorter training based on national guidance Community Psychiatric Nurses and Social Workers continue to be targeted to attend ASIST training A large number of staff from a wide range of community based agencies with an interest in mental health for example: youth workers, family support workers, and voluntary organisation staff, have attended Safe Talk and ASIST training enabling the practice of these skills across the wider community Equality and Diversity workbooks have been developed to support staff within Mental Health Services to raise staff’s awareness of equalities/inequalities issues Artificial ‘age barriers’ may prevent access All training related to suicide assessment and to support prevention is accessible to staff from all age-based Care Groups in NHS Forth Valley
NHS Forth Valley March 2012 9
To achieve 14,910 completed child health weight interventions over the three years ending March 2014
NHS BOARD LEAD Anne Maree Wallace, Director of Public Health Graham Foster, Consultant in Public Health
Suggested trajectory Apr 11 - Jun 12 Apr 11 - Sep 12 Apr 11 - Dec 12 Apr 11 - Mar 13 283 283 433 583 Apr 11 - Jun 13 Apr 11 - Sep 13 Apr 11 - Dec 13 Apr 11 - Mar 14 583 583 733 883
Delivery and Improvement Risk Management of Risk 18 hour school based intervention is Intervention is largely NHS Funded and is designed to innovative non-medical model which relies address components of curriculum for excellence upon support from Schools facing financial Positive evaluations and links to Curriculum for and performance pressures Excellence will be used to promote widespread adoption of intervention in local schools Requirement to measure BMI before and Programme will be revised to try and divert attention away after increases focus on weight which may from BMI whilst still capturing participants’ data undermine core philosophy, create stigma or cause parents to withdraw children Direct involvement of programme Funding from core programme will be used to secure input managers is vital to successful delivery of from experienced programme managers programme Intervention is designed to deliver long Continue to stress long term outcomes. Conduct height term health benefit and maintain healthy and weight measurements as far apart as permitted weight not promote short term weight loss
Workforce Risk Management of Risk Programme relies upon a small cohort of Training has been extended to class teachers, school trained staff nurses and community support workers and will continue to be delivered within programme Programme uses contractual workers for Programme managers work to identify future contract dance and drama components workers and retain existing team Cost of formal BMI measurement and Use funding to train existing staff reporting through CHSP reduces resources for delivery
Finance Risk Management of Risk Impact of organizational savings plans Evidence of effectiveness/best value of existing funding in achieving outcomes
Equalities Risk Management of Risk Project may have greater impact on pupils Intervention is inclusive whole class approach from more affluent background Intervention is targeted at schools with poorest performers and in areas of greatest social need Intervention does not require financial commitment from participants Project may exclude those for whom NHS FV has systems in place in respect of English is not a first language translation/adaptation of information into alternative formats on needs led basis
NHS Forth Valley March 2012 10
Project uses methodology that excels at including and involving all children Project may overly focus on a particular Project is a whole class approach with strong and client group positive prevention messages Max is clearly aimed at all children in the class
NHS Forth Valley March 2012 11
NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014
NHS BOARD LEAD Anne Maree Wallace, Director of Public Health Hazel Meechan, Health Promotion Manager
Suggested trajectory Apr 11 - Jun 12 Apr 11 - Sep 12 Apr 11 - Dec 12 Apr 11 - Mar 13 1,251 1,501 1,751 2,001 Apr 11 - Jun 13 Apr 11 - Sep 13 Apr 11 - Dec 13 Apr 11 - Mar 14 2,252 2,502 2,752 3,002
Delivery and Improvement Risk Management of Risk Reduction of, or deficiency in, the number Maximise data capture through pharmacy and primary of smokers wanting to quit resulting in care ensuring timeliness and accuracy fewer referrals and target not being Through service redesign, identify peaks and troughs in achieved numbers of people attending service and quitting at one month and identify further opportunities through NHS and community planning processes to promote the smoking cessation service Appropriately market the service Ensure learning associated with successful targeting of hard to reach groups is maximised and continues to be disseminated appropriately across the overall programme
NHS Forth Valley’s preferred approach to Continue with work in respect of developing links to Health Improvement is through generic Health Promoting Health Service, and primary behaviour change utilising our Anticipatory anticipatory care and the therapeutic encounter Care Programmes within our 3 CHPs, Develop CHP orientation for smoking cessation work Health Improving Health Services and Further develop work in respect of smoke free services Smoking Cessation programmes. These across all sectors of health care within Forth Valley in programmes should positively impact on line with any relevant national guidance the smoking cessation target along with other areas of Health Improvement. If NHS Forth Valley is unable to move towards this generic health behaviour change these opportunities to engage could be lost.
Workforce Risk Management of Risk Posts not continued or vacant Advocate the continuation of smoking cessation related posts Discontinuation of posts/ vacancies and Develop and reinforce sustainable approaches by changes in recruitment practices due to mainstreaming and promoting activities within all required global efficiency saving healthcare settings Expand and continue to promote CHP orientation for smoking cessation work Staffing issues reviewed through general workforce plan
NHS Forth Valley March 2012 12
Finance Risk Management of Risk Impact of organizational savings plans Evidence of effectiveness/best value of existing funding in achieving outcomes
Increased prescribing costs Work with Pharmacy Director ensuring that local prescribing policy adhered to
Equalities Risk Management of Risk Unable to demonstrate an adequate Further linkage to Keep Well and its outreach as well as proportion from deprived populations as planning of promotion of the smoking cessation service required by the new target within services supporting people who live in the required quintile areas for the HEAT target, e.g., through targeted smoke free homes and childsmile interventions.
NHS Forth Valley March 2012 13
At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014
NHS BOARD LEAD Anne Maree Wallace, Director of Public Health Derek Richards, Consultant in Dental Public Health
Suggested trajectory Jun-12 Sep-12 Dec-12 Mar-13 25.0% 30.0% 35.0% 40.0% Jun-13 Sep-13 Dec-13 Mar-14 45.0% 50.0% 55.0% 60.0%
Delivery and Improvement Risk Management of Risk Childsmile programmes in place which Through the use of educational events, and national currently target those in worst SIMD and local guidelines quintiles. Provide local advice and support using Dental Health Support Workers (DHSWs) Failure to meet targets in better off SIMD New item of service fee for independent contractors’ quintiles due to lack of co-operation from practitioners introduced in Oct 2011 should have a local independent contractors. (Those in positive impact poorer SIMD quintiles will be included in school-based schemes provided through salaried service however those in better off quintiles may not be seen as at risk by independent dental contractors.)
Workforce Risk Management of Risk Delays in recruitment of additional support Work with Finance, Human Resources and Community staff that are required to extend existing Health Partnerships to ensure recruitment plans go Childsmile programmes forward Independent contractors will need to Active support for independent contractors using amend working practices and practice staff Childsmile staff will require training
Finance Risk Management of Risk Currently ring-fenced funding for Childsmile Evidence of effectiveness/best value of existing funding in programmes – potential risk should this achieving outcomes funding be removed
Equalities Risk Management of Risk Successfully reaching the target across The more targeted school based approach for those in the each of the quintiles may result in the poorer quintiles should achieve greater uptake and has the existing gradient across the quintiles being potential to achieve greater reductions perpetuated
NHS Forth Valley March 2012 14
NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009
NHS BOARD LEAD Tom Steele, Director of Strategic Projects and Property Colin Russell, Energy and Environment Manager
Suggested trajectory - Carbon emissions 2009/10 2012/13 2013/14 2014/15 8,378 7,647 7,417 7,195
Suggested Trajectory - Energy consumption 2009/10 2012/13 2012/13 2014/15 222,192 215,593 213,437 211,302
Delivery and Improvement Risk Management of Risk The CO2 emissions reduction target has Health Facilities Scotland (HFS) has devised a been set for a five year period. Significant methodology which makes allowance for changes to the changes to the estate will take place or are floor area in use across the estate. This does not however planned for implementation during this modify absolute consumption figures which will rise during period. Although the new sites should be the first half of the 5 year period. more efficient there will be prolonged periods of double running leading to increased consumption. Energy consumption in the period Arrangements are in place to monitor energy consumption immediately after opening a new building in all new and refurbished properties and review can be high as systems are tuned to give performance internally or with the PFI contractors. their optimum performance.
NHS Scotland has reduced its CO2 An awareness of current best practise and developing emissions by 25% since 1989-90. Many of technologies must be maintained in order to fully exploit the obvious measures to improve efficiency opportunities for improved performance. have been implemented. In the short term there are a few projects that can be implemented without major capital expenditure, but in the longer term performance improvements will become increasingly difficult to achieve. The major reorganisation of service Overall performance across the estate will be monitored as delivery across the NHS Forth Valley facilities open and close. Metrics other than absolute should ultimately result in more energy energy consumption will be used that demonstrate efficient buildings but it will make the improvement despite changes to the building portfolio. delivery of a sustained year on year Assistance/guidance from HFS will be sought as improvement during the transition difficult. necessary. The collection of accurate and verifiable The performance of the PFI contractors will be monitored data, provided in a timely fashion by the closely. Early action taken to establish a sound working private finance initiative (PFI) contractors is relationship between the various parties involved has been currently working well but the experience of successful but a continued involvement with the PFI sites others suggests this may present a risk. will be necessary to ensure the Boards requirements are met. NHS Forth Valley has made little use of Renewable energy projects need to be considered against renewable energy as an emission reduction different criteria to other investment in plant and tool. There is increasing pressure through machinery. The decision needs to be based on whole life building regulations to make renewables a costs rather than the ‘front end’ capital cost. feature of new build projects and major refurbishment. NHS Forth Valley March 2012 15
Workforce Risk Management of Risk The commencement of the Carbon As far as possible information gathered for one scheme Reduction Commitment Energy Efficiency will be used for the others. Some prioritisation of workload Scheme in April 2010 has imposed an and reduction of time spent on lower priority tasks may be additional administrative workload with its necessary. complex reporting system and emissions trading which has yet to be established. This new task along with other initiative to monitor performance will be time consuming and reduce the time available to the implementation of energy abatement projects. The post of Information and Monitoring Enhanced administrative support has been provided and Officer is currently unfilled. This manning will divert some of the more routine tasks away from the gap is likely to lead to some lower priority Energy and Environment Manager but priority should be work being delayed or abandoned. given to recruiting a replacement Information and Monitoring Officer. Hospital staff transferred to Forth Valley Energy Efficiency Groups have been established at the Royal Hospital (FVRH) will need to be new PFI hospitals to provide a focus on maintaining staff reminded of their responsibilities towards awareness. energy efficiency even though the building is operated by SERCO
Finance Risk Management of Risk The Government decision to scrap Innovative funding routes will be exploited when possible. recycling payments from the Carbon Grant funding and ESCO arrangements are under Reduction Commitment (CRC) and take investigation. the money into the Exchequer imposes a significant additional financial burden at a time when capital funding is likely to be less readily available. Securing funding for Energy Efficiency Schemes will be more difficult. Introduction of Carbon Reduction Scheme Ensure understanding of impact of Scheme is fully – given first full operational year impact understood and that local messages regarding energy may not be fully understood usage continue to be reinforced
Equalities Risk Management of Risk The improvement of energy efficiency should not present a risk to any of the six equalities groups, and/or for people living in socio-economic disadvantage
NHS Forth Valley March 2012 16
By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery
NHS BOARD LEAD Jonathan Procter, Director of Capacity & Access Elaine Lawlor, Forth Valley ADP Co-ordinator
Suggested trajectory Apr-Jun 11 Apr-Jun 12 Jul-Sep 12 Oct-Dec 12 Jan-Mar 13 89.1% 82.0% 83.0% 85.0% 88.0%
Delivery and Improvement Risk Management of Risk Unmet need in the community may Ensure LEAN principles and Demand, Capacity, Activity translate to increased demand, influenced and Queue methodologies are fully applied to all by a reduction in waiting times etc aspects of service across the system Continue to monitor the case-management approach to ensure focus on recovery, moving people on (and out of treatment) Revisit Capacity/ Workforce Plan along with referral and assessment processes
Service is focussed too narrowly Review Model of Care early Spring Continue to implement redesign plans , quality improvement work Implement all recommendations from Quality Alcohol Treatment and Support (QATS) and the Drug Strategy Commission Address any gaps emerging from the Alcohol and Drug needs assessment, to support the vision of providing the most appropriate treatment at the right time with the right support in line with the Quality Strategy Further develop links with Keep well, therapeutic encounter training, Health Promoting Health Service Fully implement new Community Rehabilitation Model Ensure the Access Policy for all Substance Misuse Services is monitored, via outcomes framework
Increased demand due to transfer of prison Prison healthcare staff now feeding in to HEAT health services to NHS. planning, thus providing accurate projections of future treatment need
Psychological therapies target overlaps There will need to be appropriate dialogue and training with drug and alcohol treatment target undertaken with both services to ensure that the waiting times database system is used appropriately Time frame differential will need to be laid out for staff to be able to interpret clearly i.e. 18wk RTT for Psychological therapies and 5wk RTT for drug and alcohol
Workforce Risk Management of Risk Risk of not having all GPs on board with Advocate for inclusion of primary care work in Quality the opiate prescribing, local enhanced and Outcomes Framework (QOF) service. Develop anti-stigma work with staff across Primary/ Secondary Care. Introduction of the locality-based Addiction Recovery
NHS Forth Valley March 2012 17
Service has addressed inequity in provision of GP prescribing across Forth Valley
Staff don’t fully engage with the recovery Develop a recovery focussed treatment system, ethos or there is a lack of commitment incorporating the therapeutic encounter approach Workforce development through workforce strands of Alcohol and Drugs Partnership (ADP) Delivery Plans and the Service Redesign capacity plan. Work in partnership with National Bodies to develop a comprehensive workforce development strategy Develop an action plan from the survey results of Recovery Capital Questionnaire
Finance Risk Management of Risk Risk of reduced partnership funding Advocate protection of budget/ increased funding where justifiable. Development of partnership agreement to mitigate risk. Using methodology such as logic modelling to demonstrate impact of retraction/ disinvestment on issues such as community safety, child protection, Blood Borne Virus transmission etc Continue to monitor spend against the alcohol and drug allocation in a transparent fashion, monitoring all investment for alcohol and drug support across the area
Outcomes monitoring , service compliance Engagement and consultation with services has allowed them to be fully involved in the development of the outcomes template. System users fully utilising national waiting times database, accessing system reports, recording data entries accurately. Promoting ownership of service performance Undertake improvement work to support Scottish Morbidity Record (SMR) performance ,in readiness for the alcohol component which is being developed currently
Equalities Risk Management of Risk As the target for waiting times is 90% to fall Work within the defined maximum wait. Aim to provide within the limits, it may be that the other collaborative input from a range of services to meet 10% is disadvantaged. This group is likely needs of service users. to be more deprived, have complex Learn from the programme of EQIA work undertaken problems, and likely to be more ‘chaotic’ with all FV services as to what issues may present barriers to access. All actions from EQIA’s incorporated within Integrated Clinical Governance Workplans
NHS Forth Valley March 2012 18
Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) from March 2013; reducing to 18 weeks by December 2014;
NHS BOARD LEAD Jonathan Procter, Director of Capacity & Access Kathy O’Neill, General Manager Joanne Devlin, Service Development Manager
Suggested trajectory Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 25 25 20 20 20 15 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 14 13 11 8 5 0
Delivery and Improvement Risk Management of Risk There is a limited service for children with Additional resources for psychological services will be learning disability. Demand exceeds utilised to build capacity within LD services in CAMHS capacity, therefore creating a risk of delivery on this for this client group.
Primary Mental Health Workers’ (PMHW) Attempts will be made to differentiate which patient data activity is currently not included in the needs to be reported on for the HEAT target reporting requirements. Activity undertaken by this area of service still goes largely under-reported. Planned work on developing current information systems to report on consultation activity in CAMHS will capture areas of joint working between tiers 2 and tier 3 services which currently increase capacity and access in tier 3. There is however still a concern that current data collection output is failing to reflect unmet need within CAMHS services Existing staff numbers in CAMHS are Defining core CAMHS business has aided in the insufficient to meet demands of referral development of clearer referral criteria and better numbers. management of referrals into CAMHS The roll out of an electronic referral system to referrers will continue to build on this work in 2012. The development of CAMHS ICPs will focus on service provision and efficiencies. The development and roll out across Forth Valley of an early access clinic using our PMHW service (previously ‘drop in’) have gone some way in building capacity in the core service and will continue to be prioritised in 2012. Data Sources. Current data system Data collection and reporting has continued to improve. requires clinical and administrative staff to A system is in place for obtaining, checking and be timely and accurate in the recording of submitting the data to ISD on a monthly basis. the data.
A risk to improvement will be outcomes not CAMHS will continue to work with e-health and with the adequately captured within current data capacity and access team to identify and develop systems. Adequate information systems required data collection and analysis systems which will are required to ensure appropriate data allow reporting on HEAT targets and CAMHS balanced capture for monitoring and development scorecard. purposes.
Workforce
NHS Forth Valley March 2012 19
Risk Management of Risk NHS Forth Valley had jointly developed a PMHW service re-design Primary Mental Health Worker service, in Team job planning partnership with the three local authorities Implementation of the CAMHS competency framework Funding from the Local Authorities is now to develop skills and identify training needs. being re-invested in other areas of service provision leaving our current PMHW service and our early access clinic at risk.
Significant loss of key staff in late Ensuring that service work plan is up to date, cross 2011/early 2012 resulting in a change in cover has been identified and the team receive the management structure. necessary management support to develop their roles in the new structure. Forth Valley CAMHS is a small service with a relatively low WTE per 100K of population in comparison with other CAMHS services in Scotland and therefore there is a significant challenge to consistently offering a high quality of service provision when dealing with even a small number of vacant posts. Significant staff movement, maternity leave and management re-structure over the last 4 months have impacted on the ability of the service to devote necessary time and focus on non-clinical tasks in areas of service and professional development as clinical staff have adapted job plans to manage the clinical risk. Despite this the service has over this same time period consistently managed to deliver fast access to CAMHS services meeting current RTT expectations with the exception of LD. It is expected that the service will have filled all current vacancies by June.
Finance Risk Management of Risk PMHW funding withdrawn by local authority The service will continue to look at how to retain and partners in 2012. protect this area of service through the redesign of current services and workforce planning. Providing cover for staff on maternity CAMHS are attempting to employ as many efficiencies as leave:, recruitment for locum cover can possible and during times of greater clinical demand will only be funded by monies saved when staff prioritise clinical work and cut back on non-clinical work. are unpaid maternity leave, thus resulting in time periods of no cover.
Equalities Risk Management of Risk Children with learning disability have Those therapies that we are able to deliver are evidence access to fewer therapies due to limited based and delivered by appropriately qualified and number of staff experienced staff. Forth Valley CAMHS Learning Disability (LD) service continues to remain at risk in delivering the RTT target of 26 weeks by 2013. All waits over 26 weeks can currently be attributed to LD cases awaiting appropriate intervention. To increase capacity in this area we have recently undergone a programme of multidisciplinary training in ADOS to include services outwith CAMHS who currently work with children and young people with LD. In addition, we are in the process of developing a new psychology post within CAMHS to support the work of
NHS Forth Valley March 2012 20
the LD service. Development of Services for Looked After Clinical psychologist for LAAC has been employed in and Accommodated children(LAAC) partnership with Falkirk Local Authority. The service plans to continue to liaise with its Stirling and Clackmannanshire local authority partners to have similar services developed across the patch. Unavailability of appropriate premises to Plans to relocate one CAMHS site into shared premises deliver services on Stirling Community Hospital requires further review to ensure the accommodation meets the required specification of the service.
NHS Forth Valley March 2012 21
Deliver faster access to mental health services by delivering 18 weeks referral to treatment for Psychological Therapies from December 2014
NHS BOARD LEAD: Jonathan Procter, Director of Capacity & Access Kathy O'Neill, General Manager Graham Mclaren, Service Development Manager
Trajectory due for submission end October 2012
Delivery and Improvement Risk Management of Risk NHS Forth Valley has the lowest number of Discussions are underway to ensure the most effective Clinical Psychologists per capita of any and efficient use of this limited, but highly skilled, resource. Board in Scotland. A ‘stepped care’ model is partially in place A proposal for a pilot of the ‘Steps for Stress’ approach in Forth Valley. Further work is required to has been approved and is now being rolled out across strengthen the provision of services in the Forth Valley. This will introduce evidence-based stress ‘mild to moderate’ mental health problem management techniques to significant numbers of people, tier. on a planned programme basis, in each of the CHP areas.
The range of Psychological Therapies skills An initial Training Needs Analysis has been completed across Forth Valley, outwith the specialist which has begun to establish a baseline of current departments, is not fully understood nor is skills, practice and supervision arrangements. This the extent to which qualified or trained staff information will continue to be refined and recorded in are practicing. a dynamic database and is informing the targeting of training needs and supervision. NHS Scotland intends to develop a tool to support Boards to collect and collate this data as part of a process of establishing capacity. Improving access to Psychological Therapies (PT) is a key component of the Review of Community Mental Health Services for Adult and Old Age Psychiatry. The latter is underway and includes discussion on redesigning local structures to clarify pathways and improve access. Current understanding of the demand for Support is being provided to the highly specialised Psychological Therapies in Forth Valley is Psychological Therapies departments to define and variable. A data system (PIMS) is in place refine data capture for the target. This is proving to be and is used in the specialist PT services complicated and time-intensive but is improving data (Clinical Psychology, Dynamic quality. A phased roll-out of reporting on the target has Psychotherapy, and Behavioural been agreed, starting with the 3 highly specialised Psychotherapy). Psychological Therapies departments. Training for senior clinicians and managers (delivered However, the PIMS system does not by ISD) in Demand, Capacity, Activity and Queue currently provide the necessary data fields management has taken place. The use of activity for recording the reporting measures for the tracking tools is widespread across Community Mental HEAT target. Health Services, and are informing workload reviews
In addition, staff outwith the specialist PT and service redesign. services, and who are practicing a PT, do The PIMS system administrator has set up the not currently record this activity or use the required fields to enable reporting on the target. This PIMS system consistently. will essentially be the same as the process for the CAMHS target. At this time, the recording of clinical The approach to recording clinical outcomes is being outcomes is variable across services. The discussed by the PT Delivery Group. However, specialist Psychological Therapies services national guidance is anticipated regarding the use of record outcomes routinely but other teams CORE.
NHS Forth Valley March 2012 22
and departments are less likely to do so. Locally, the electronic FACE Care Planning programme has been introduced across Adult and Learning Disabilities services, and is being rolled-out in Old Age Psychiatry services. This programme incorporates a range of validated clinical outcome measurement tools. Clinicians will be required to utilise appropriate tools to measure progress and effectiveness of interventions. There may be a requirement to agree an ‘approved’ suite of tools for this purpose. There are significant challenges regarding The PTTC is working with Heads of Service and engaging all departments and individuals Service Managers to promote the target in relation to delivering PT skills in reporting relevant current practice. activity. The workforce and service is A roll-out programme of training regarding the target, diverse in this respect and much work criteria and reporting processes will be required across remains to enable full reporting on the the Mental Health Services. target. Increased requirement to use the PIMS Additional hardware has been made available in system will require greater availability of clinical areas over the past year, and will be available PCs for data entry. In addition, an increase during 2012 for OAP services. However, there may be in staff time entering data on PIMS which a continuing need for additional PCs, laptops and was not previously entered will detract from other IT equipment (e.g. Notebooks). time available for patients. Recent Improvement Methodology initiatives (i.e. Releasing Time to Care and Lean methodology) have surveyed how staff time is spent. This information has been made available to managers who are considering more efficient use of time in their clinical areas. In addition, the role of Admin staff in supporting clinicians to free-up time is being explored.
Workforce Risk Management of Risk The target requires a comprehensive range The Training Needs Analysis has provided good of skills available across mental health information on this. The Psychological Therapies services, both in-patient and community. Training Coordinator in Forth Valley is providing Current information suggests that a targeted training sessions to begin to build the range significant number of staff will have to be of supervision and basic ‘low intensity’ skills available. released to attend training to increase A significant number (n = 72) staff have attended the capacity. winter 2011 training provided by the Psychological Interventions Team. It has been agreed that staff working in Old Age Psychiatry and Learning Disabilities Services are the priority groups. Improving access to Psychological Therapies is a key component of the Review of Community Mental Health Services for Adult and Old Age Psychiatry. The latter is underway and includes discussion on redesigning local structures to clarify pathways and improve access. Crucially, steps are being taken to develop supervision structures that will support safe practice. Higher level skills, as defined in the NES A strategy is being developed to enable staff who have Matrix, are also required and are crucial to these skills, but are not using them, to begin to increasing capacity and capability to treat practice with clinical supervision. people with moderate mental health Two places on the Dundee Cognitive Behavioural problems. These skills can only be Therapy (CBT) course have been secured for staff acquired through more prolonged and working in OAP services. intensive training from accredited courses.
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Finance Risk Management of Risk It is anticipated that a significant amount of Wherever possible and appropriate, in-house and NES training (to varying levels) will be required funded training will be delivered to minimise cost and over the duration of the target but maximise effect. The higher level skills of, for example, particularly the first 18 months in order to Psychology and Behavioural Therapy, will be used to improve performance. This will have a up-skill staff. A further Forth Valley course in financial impact with regard to releasing Mentalisation is being delivered locally in early 2012, staff to attend courses and in the cost of and sessions in Emotional Freedom Technique are course fees and other expenses. also provided. Available training budgets (e.g. nursing) are being utilised to help prioritise more extended/intensive training.
Equalities Risk Management of Risk The provision of and access to An Equity Audit (2008) in Forth Valley highlighted Psychological Therapies is inequitable inequity of provision. Since then, the Behavioural across Forth Valley. This is true in terms of Psychotherapy service has improved access (for all geographical availability as well as age and aged above 18 years) in Clacks and is now taking this diagnostic groups. It is evident that people forward in Falkirk and Stirling CHPs. aged over 65 years have less access to GP and other referrers have been reminded that the Psychological Therapies than people of Clinical Psychology and Behavioural Therapy services working age. are available to older people. Increasing capacity and skills within the broader workforce will improve the provision of, and access to, Psychological Therapies across Forth Valley. Old Age Psychiatry and Learning Disabilities services are the priorities.
NHS Forth Valley March 2012 24
Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between 2009/10 and 2014/15
NHS BOARD LEAD Margaret Duffy, Chief Operating officer Ian Aitken, General Manager
Trajectory to be agreed prior to end March 2012
NHS Forth Valley is well below the national position in terms of this target with a decreasing trend over recent years with significant changes to the bed base. In terms of acute occupied beds Forth Valley has the lowest rate nationally but the highest turnover of beds. Predicting continuance of this trend is challenging in light of the next phase of the service changes over the coming months, the bedding down of these changes and the ongoing complexity within local partnerships of delayed discharges etc. impacting on overall capacity.
Locally this target is considered in partnership. The forthcoming approach to the Change Fund is the requirement to support the overall aim of shifting the balance of care. The agreed strategic approach across Forth Valley is to: Maintain people in their place of residence, preventing acute admission/attendance by early intervention and planning for people with long term conditions/offering rapid alternatives to admission and expediting any discharge Ensure a consistent and sustainable approach to shifting the balance of care across the partnerships Ensure greater focus and measurement on the quality of outcomes, minimising variation for the populations of Forth Valley Ensure robust pathways for supporting patients in care homes to prevent admissions, continue to develop and implement care pathways for people with long term conditions Maximise Ambulatory Care options for older people on a day to day basis for a range of conditions
Enablers Greater focus on re-enablement as a core principle – developing further approaches such as the Northwest Rural Project in Stirling, and seeking sustainable options against the key aims of the projects e.g. admission avoidance, expediting discharge, reablement etc. Further development of approaches to Intermediate care and reablement in Stirling and Falkirk Focus on carers support Telehealth/Telecare – urban and rural settings
Delivery and Improvement Risk Management of Risk The healthcare strategy supports delivery Ensuring a strategic approach to delivery of this target of care to older people closer to home. The considering the multifaceted aspects of urgent and physical relocation of the Acute hospital emergency care locally. The linkage to Long Term and community hospitals is nearing Conditions, A&E attendance, previous HEAT targets completion with only Stirling community focussing on dementia are critical to delivery, along hospitals – inpatient reconfiguration with ensuring a partnership approach. outstanding. Target sits within CHP performance frameworks as well as Acute. To ensure Community Hospitals are The work relating to the linkage of targets specifically appropriately staffed and equipped to relates to the inpatient flows, specialist wards and deliver a range of rehabilitation, palliative reconfiguration of in-patient rehabilitation beds in care and long term care options. preparation for the new acute hospital model. Work to support this focuses on consistency of care. Capacity Planning Robust daily capacity planning in place using Overall bed capacity across Forth Valley at predictive tool across 7 days. times is challenging. increased delayed All aspects of activity to support this impact on the 75+ discharges for example could adversely bed day target e.g. Discharge Planning , Rehabilitation impact on focussed approach to target focus, focus on self management Rehabilitation Implementing a range of ambulatory care pathways
NHS Forth Valley March 2012 25
Delivering appropriate patient pathways for and support for people in care homes establishing a new Rehabilitation and Ambulatory care virtual ward to support people living at home models. Develop pathways for defined patient populations with criteria identified for transfer of care between and across services and facilities. Inform the work to transform the inpatient configuration Use new protocols per specialty, for example to decrease length of stay (LoS) to 4 days for orthopaedic hip replacements. This relates to work on efficiency and productivity. All general hospital admissions >65 have cognitive assessment as routine, with additional training to help with differential diagnosis of dementia and delirium. Work undertaken through a workgroup designed to extend knowledge of Dementia and of pathways from ‘Front Door’ through wider service has been completed with an Action Plan now in place. Discharge Introducing more proactive discharge planning to Ineffective discharge planning process. complement existing practice and balance admission Effort to reduce unnecessary variation in and discharge over 7 days. practice and facilitate lower levels of Focus that discharge planning starts pre-admission for delayed discharges also focussing on elective patients at pre-operative assessment. synchronisation of care for complex Planned Date of Discharge (PDD) commenced and as discharges to reduce delay in access to at February 2011 90% of patients have a PDD – a diagnostics and Allied Health Professions significant improvement. (AHPs) etc. This work continues from Initiatives such as the North West Rural and 2010/11 reablement Projects focussing on e.g. admission avoidance, expediting discharge, re-enablement etc. Long Term Conditions (LTC)Linkages Self Management The principles of good LTC care including A key aim of a self management framework is to self management and the development of a coordinate activities to support people to live at home and more anticipatory approach such as ACP reduce the risk of hospital admission. development is a cultural change for many A ‘Self Management Toolkit’ and ‘My Support Plan’ patients and staff. The availability to access were developed and are now widely used in Forth training for staff in the principles of self Valley with focus on staff training and awareness management remains a challenge in terms Existing self Management databases merged with the of spreading the approach although Service Information Directory (SID) to ensure good significant progress made in year. Focus quality information on SM programmes is easily on alternative approach to patient accessible engagement key. Supporting the development and implementation of the
key information summary
Anticipatory Care Plans (ACPs) Focus on case finding, managing expectations, culture change & patient carer involvement. Consideration to ACPs after unscheduled admission and use of hand held ACPs LTC priorities of self management, condition management and complex care Effective development of a robust Patients identified by Scottish Patients at Risk of community infrastructure to permit a shift in Readmission and Admission (SPARRA) are supported the balance of care and ensure the by GP practices using a preventative approach to sustainability of the target and delivery of planning care that will help to avoid unnecessary the desired model of care to fulfil the aims admissions to acute and emergency care. of the Strategy. SPARRA data is now being shared with all GP practices on a quarterly basis. Part of the Whole System Working Project ensures relevant data going to GPs with Significant Event Analysis performed on unscheduled admissions
NHS Forth Valley March 2012 26
Reducing admissions could inadvertently This requires to be considered and the impact on LoS have a negative impact on length of stay. modelled against trajectory. A differential for patient grouping should be produced. Maintaining and sustaining wider stake- Ongoing partnership working and linkage of targets. holder involvement and ensuring the integration across different work streams to influence changes required for achievement of HEAT targets and the Single Outcome Agreement.
Workforce Risk Management of Risk Primary Care & Community Care Service Releasing/developing capacity in primary care and workforce capacity and skills e.g. in self community services - Review of District Nursing Services care and GP services. Workforce implications arising from MMC Part of Urgent and Emergency care redesign and and introduction of European Working Workforce in Transition Project. Time Directive
Finance Risk Management of Risk Significant efficiency savings to be made Under review through the financial planning process. 2011/12 and 2012/13. Action to achieve Considered a target to be delivered in partnership. this target in line with Integrated Strategy Joint Commissioning Plans with Local Authorities however external enablers may require linked to utilization of the Change Fund to make a revenue. difference to service impact
Equalities Risk Management of Risk Identification of equality profile of patients Work to enhance data collection and patient profiling on- accessing emergency care beds going.
NHS Forth Valley March 2012 27
No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013, followed by a 14 day maximum wait from April 2015
NHS BOARD LEAD Margaret Duffy, Chief Operating Officer James Cassidy, Service Manager
Suggested trajectory Oct-11 Apr-12 Jul-12 Oct-12 Jan-13 Apr-13 914118 50
Delivery and Improvement Risk Management of Risk Failure to deliver on nationally expected Reliance on Delayed Discharge Coordinator target of 6 weeks delayed in an NHS Ensure sustainable partnership working – Micro facility, reducing to 4 weeks by April 2013 Management group, support from Joint Improvement and 2 weeks by April 2015 team, Forth Valley wide steering group On-going development of improved patient pathways Use of National electronic recording system – EDISON, developments of Business Objects (by March 2012) with ‘live’ reports accessible to EDISON users Facilitate earlier referral to Local Authorities with multi agency decisions and agreements on ‘Clinically Ready for Discharge’
Failure to deliver Single Shared Continued Partnership working with on-going fostering Assessment and accommodation to meet of relationships particularly through, the re-shaping future care needs care agenda and change fund developments, Care Home Sector vacancy management (improving flow)
Workforce Risk Management of Risk Not being able to deliver a full functioning Self directing and prioritising workload Delayed Discharge Coordinator role (0.6 in- Support from JIT (national guidance) post provision and 0.4 vacant) Support from Falkirk CHP, advising on appropriate early discharge where health care can be delivered by District Nursing in the home Exploring opportunities to fill 0.4 vacant hours
Unable to deliver Secretarial support to Currently, wider role of secretarial support is being Delayed Discharge function (essential role) reviewed
Finance Risk Management of Risk Project finance is withdrawn for staff posts Project agreed as essential positions by Delayed i.e. Delayed Discharge Coordinator and Discharge Steering Group Secretarial support
Increased delays and increased bed days Monitoring and reviewing all delays lost National changes in use of electronic recording Ensuring and maintaining a reduction in both areas to ensure targets are met Joint Commissioning Plans with Local Authorities linked to utilization of the Change Fund to make a difference to service impact
NHS Forth Valley March 2012 28
Equalities Risk Management of Risk Care Home Sector is viewed as only Use of single shared assessment – identifying and option for Older People – no access to meeting needs appropriately care at home Use of Re-shaping Care and change fund to enhance Inequity in provision of intermediate Care at Home care facilities across Forth valley Through Micro Management Meeting and through Inequity across Forth Valley to meet regular reporting though Health and Local Authority targets structures
NHS Forth Valley March 2012 29
To improve stroke care, 90% of all patient admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013
NHS BOARD LEAD Ian Aitken, General Manager Deirdre Anderson, Service Manager
Suggested trajectory 2010 Apr-Jun 2012 Jul-Sep 2012 Oct-Dec 2012 Jan-Mar 2013 39.3% 82.5% 85.0% 87.5% 90.0%
Delivery and Improvement Risk Management of Risk Pressures on stroke beds from other Use existence of HEAT target as means of protecting admissions to Forth Valley Royal Hospital Stroke Unit beds. Cooperate in other areas of responsibility to ensure overall functioning of general acute services are as efficient as possible and so minimise possibility of resource appropriation. Sustain stroke pathway and Stroke Specialist intervention at front door admission/assessment areas to quickly identify appropriate admissions for stroke unit. Increasing number of stroke admissions Use patient pathways and rehabilitation goals/milestones to ensure most efficient use of capacity and monitor performance through monthly reporting of KPI’s Continue to develop means of supported discharge to shorten in-patient stay Ensure neurovascular clinic continues to provide early assessment and intervention Failure to implement revised service Goal setting and timescales to be implemented objectives and sustain key performance Feedback progress/issues through Stroke improvements as indicated through Management Team and introduction of a Stroke Scottish Stroke Care Audit System Quality and Risk Group (SSCAS) review undertaken December Ensure key performance deliverables contained within 2011: service objectives for 2012-2013 Aspirin Time to CT Swallow Testing
Workforce Risk Management of Risk Ensure sustainability of Ageing and Health Continue to review ways of working for ageing and consultant input to Stroke Services, health in conjunction with speciality ward, front door including Neurovascular clinic (consultant and community hospital modelling of medical contract conclusion Autumn 2012) workforce. This will involve review of job plans and delivery of services Sustainability of delivery of CHSS Nurse Three year funding for this post concludes March services 2012. Agreement reached with Chest Heart and Stroke Scotland (CHSS) to fund whole post for financial year 2012-2013 Agreement reached to review contribution of post in line with stroke service objectives (under development) Commitment also agreed to try and establish funding source for NHS Forth Valley to fund ½ of the CHSS nursing post on a continual basis from April 2013
NHS Forth Valley March 2012 30
Job planning for participation of a longer Evaluation of SEAT pilot programme concluded. term plan for thrombolysis by telemedicine Agreement to be sought through NHS Forth Valley Board for commitment to continuation of Out of Hours (OOH) thrombolysis through provision of £15k to fund NHS Forth Valley financial contribution to hub and spoke model delivered by NHS Lothian (NHS Forth Valley only sustainable option). Ongoing training and development for Stroke Training and Awareness Resource (STAR) Community Hospital staff to facilitate training programme being used. Ongoing training appropriate early discharge from acute unit requirements identified through personal development programme. Shadowing programme for Community Hospital staff in place.
Finance Risk Management of Risk Sustainability of NHS Forth Valley Funding to be approved on recurring basis for NHS Forth contribution to thrombolysis model and Valley contribution to thrombolysis model commitment to ½ funding of CHSS nurse post Review of CHSS service delivery and business case to be prepared for continuation of ½ funding of CHSS nurse post from April 2013.
Equalities Risk Management of Risk Impact on accessibility to equality groups EQIA completed prior to transition – June 2010 Action plan in place, adverse effects identified and actions in place to address same
NHS Forth Valley March 2012 31
Further reduce healthcare associated infections so that by 2012/13 NHS Boards’ staphylococcus aureus bacteriamia (including MRSA) cases are 0.26 or less per 1,000 acute occupied bed days
NHS BOARD LEAD Anne Maree Wallace, Director of Public Health Jonathan Horwood, Infection Control Manager
Suggested trajectory Jun-11 Jun-12 Sep-12 Dec-12 Mar-13 0.42 0.32 0.30 0.28 0.26
Delivery and Improvement Risk Management of Risk The new target set for 2012/13 using acute Leadership provided by HAI Executive lead occupied bed days instead of case Continue to improve surveillance forms and analysis of numbers will present a more challenging data target to achieve for NHSFV given the low Full Root Cause Analysis performed on all SABs AOBD rate per head of population. including hospital, healthcare, community, community hospitals and nursing home acquired Risk of: Hospital and healthcare (if applicable) acquired SABs Insufficient understanding of SABs and attributed to a ward are discussed with ward staff to number which are preventable form an action plan Identification of areas with higher rate of SAB Insufficient surveillance acquisition Monthly patient review meetings are carried out to Inappropriate management of venflons discuss individual patients Roll-out of interventions to appropriate areas within timescales using SPSP methodology The use of Chloraprep as a skin decontaminant Education and training in understanding of sepsis and good aseptic technique for catheter insertion, PVC insertion, taking of blood culture samples etc Non-compliance with interventions being Closer links with Practice Development, clinicians, rolled out AMDs and SMs/GMs have been created Audit in place to ensure compliance Non-compliance with improvement Sustaining focus on problematic areas interventions Escalation of any anomalies, trends or concerns to SM/GMs, clinicians, AMDs and clinical governance Monitoring of compliance during audit and inspection processes Enhanced data collection enables rapid response to areas requiring support Lack of standardisation of procedures Collaboration with PDU and the ICT to ensure throughout NHSFV consistency of practice Link with SPSP to use improvement methodology to increase consistency Lack of sustainability of interventions and Links have been forged with the General Managers, management actions operational service managers, AMDs and other key personnel Communication via various reports, committees and groups
NHS Forth Valley March 2012 32
Workforce Risk Management of Risk Lack of ownership of the HAI agenda at Senior Charge Nurse has HAI as part of their job ward level descriptions An infection control audit rolled out to all clinical areas and performed by ward staff. Reports are sent to local clinical governance. Audits are overseen by the Area Prevention & Control of Infection Committee (APCIC). HEI operational group perform leading better care audits to clinical areas to ensure compliance Infection control compliance audits performed in all ward areas and reported to management lines Mock HEI-type unannounced inspections performed on a monthly basis and reported to the Chief Executive Continuation of education and training packages relating to SABs e.g. Sepsis study event, venflon management training etc Infection control advice/issues escalated to SMs/GMs, Clinicians and AMDs if required Enhanced Infection Control support to ward staff Review of the role of the Cleanliness Champion
Finance Risk Management of Risk At operational level - inefficient use of To continue to review the Infection Control Service for resources improvement and efficiency Strategically finance considered as part of overall financial plan
Equalities Risk Management of Risk There is a risk that the importance of Ensure all leaflets, including those in other languages infection prevention measures are not are kept up-to-date and widely available adequately communicated to patients Ensure staff have a good understanding of infection whose first language isn’t English or who control through education and training so this can be may have learning difficulties communicated to patients Programme of EQIAs on-going
NHS Forth Valley March 2012 33
Further reduce healthcare associated infections so that by 2012/13 the rate of Clostridium difficile infections in patients aged 65 and over is 0.39 cases or less per 1000 total occupied bed days
NHS BOARD LEAD: Anne Maree Wallace, Director of Public Health Jonathan Horwood, Infection Control Manager
Suggested trajectory Jun-11 Jun-12 Sep-12 Dec-12 Mar-13 0.17 0.33 0.33 0.33 0.33
Delivery and Improvement Risk Management of Risk Maintaining the decrease in C Diff cases to Clear leadership provided by HAI Executive lead achieve the 2012/13 position. All cases of C difficile are reviewed by the microbiologist prior to submission to HPS to ensure accurate reporting Introduction of stool charts to ensure appropriate testing - must be no.5-7 on the Bristol Stool Chart before they are tested for C difficile An Enteric Integrated Care Pathway has been rolled out across NHSFV Monthly patient review meetings are carried out to discuss individual patients with CDI Enhanced surveillance performed on all cases of C difficile Full RCA performed on all hospital and healthcare acquired CDIs Antimicrobial Policy has been issued that complies with ScotMARAP requirements Monitoring and management of antibiotics associated with CDI by the Pharmacy Department and Microbiologist Maintain good links with HPS and emerging national guidance Non-compliance with interventions being Patient isolation introduced. Environmental cleaning Hand hygiene and protective clothing Terminal Clean to environment Adherence to antimicrobial formulary Inability to influence GP and hospital Antimicrobial Policy has been issued that complies with doctor’s antibiotic prescribing practice. ScotMARAP requirements Guidelines are to be made easily available to medical staff through means that include: o using portable formats such as laminated cards or explanatory leaflets o printing of guidelines on admission proforma o affixing copies to notes trolleys o making guidelines available on hospital intranets Workshop on antimicrobial prescribing for clinicians Project in primary care to reduce quinolone use Surveillance of healthcare acquired CDIs performed
NHS Forth Valley March 2012 34
Lack of sustainability of interventions and Links have been forged with the General Managers, management actions operational service managers, AMDs and other key personnel Letters sent to AMD and ward from Infection Control highlighting either infection or non-infection Monitoring of progress through Antimicrobial Management Group and Infection Control Team meetings HAI Executive lead to continue to chair the Antimicrobial Management Group Perception of improvement may be tainted Accurate information about C diff and its causes and the by inaccurate understanding of C.diff by number of cases is published on a monthly basis to all the public relevant stakeholders
Workforce Risk Management of Risk Lack of ownership of the HAI agenda at Senior Charge Nurse have HAI in their job descriptions ward level An infection control audit rolled out to all clinical areas and preformed by ward staff. Reports are sent to local clinical governance. Audits overseen by the Area Prevention & Control of Infection Committee (APCIC) HEI operational group performed leading better care audits to clinical areas to ensure compliance Infection control compliance audits performed in all ward areas and reported to management lines Mock HEI-type unannounced inspections performed on a monthly basis and reported to the CEO Continuation of education and training packages relating to CDI available to all staff Infection control advice/issues escalated to SMs/GMs, clinicians and AMDs Enhanced Infection Control support to ward staff Review of the role of the Cleanliness Champion
Finance Risk Management of Risk At operational level - inefficient use of To continue to review the Infection Control Service for resources improvement and efficiency Strategically finance considered as part of overall financial plan
Equalities Risk Management of Risk There is a risk that the importance of infection Ensure all leaflets, including those in other languages are kept up- prevention measures are not adequately to-date and widely available communicated to patients whose first language Ensure staff have a good understanding of infection control isn’t English or who may have learning through education and training so this can be communicated to difficulties patients. EQIA completed on CDI guidance
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To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14
NHS BOARD LEAD Margaret Duffy, Chief Operating Officer Ian Aitken, General Manager
Suggested trajectory Mar-10 Sep-11 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 1,529 1,734 1,665 1,663 1,662 1,661 1,659 1,658 1,657 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 1,656 1,654 1,653 1,652 1,650 1,649 1,648 1,647 1,645 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 1,644 1,643 1,641 1,640 1,639 1,638
Delivery and Improvement Risk Management of Risk Patterns of attendance Working with Scottish Government colleagues to Trajectory set before the move to Forth understand the switch in activity following the move to Valley Royal Hospital. Resulting in reduced FVRH using post code and GP practice data activity to the Minor Injuries unit in Stirling Work ongoing with communications colleagues to Community Hospital develop a marketing strategy to encourage patients to access appropriate minor injuries services
Increase in Lanarkshire & Fife patients Data sharing with NHS Lanarkshire & Fife, SAS & since the transfer of acute services to Forth NHS 24 and continued planning intervention at board Valley Royal Hospital level
Overall pattern of attendance and Introduction of a GP in the Emergency Department in unscheduled care demand on services March 2012 to support redirection to appropriate increasing services and shifting the balance of care. Work is continuing with the Scottish Government’s Emergency Access Delivery Team, reviewing patient flow in support of tackling the 4hr wait position and also attendance at ED
Increased attendance of children 0-4years Continuous analysis of data in regards to this age group ED/Paediatric working group established to include CHP, child health, local authority colleagues. Objectives are to ensure data sharing, education of parents re health care services and review pathways
Cultural aspects of A&E attendance and The ‘Know Who to Turn To When you are III’ required change in pattern. Public Campaign continues and as above the plan to have a information and communication of GP in ED is aimed at appropriate signposting and an alternatives to attendance and the new education role. Work continues via the triage process Minor Injuries service at Stirling Community to redirect patients appropriately Hospital.
Inappropriate use of the Emergency Continued monitoring and ongoing work with surgical Department for patients returning with post colleagues operative problems
The algorithms used by NHS 24 to refer Continue to work with NHS 24 colleagues to identify patients to Emergency Department, do not those patients referred inappropriately and ensure always match local arrangements redirection to the most appropriate service. As above
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this will be addressed with the introduction of the GP in ED
Partnership Working Work continues to further develop information shared There is a significant Primary Care and with GPs about their practice in comparison with other Local Authority/Community Care input local practices. Information is being reviewed on the required to achieve a reduction in rates of referral patterns and attendance rates at A&E by A&E attendance practice through GP Practice Profiles supported by the Whole System Working Project. This links to the activity on Long team Conditions and actions in support of a reduction all bed days but will support the 75+ bed days target for 2011/12 (see 75+ narrative)
Reliance on ‘shifting the balance of care’ The Emergency Care Network oversees and co-ordinates initiatives and redesign of whole systems to improvement work to ‘Implement whole system changes reduce A&E attendances. Success linked and develop integrated working with partners’. For to Integrated Healthcare Strategy and example: working with partners. Work with SAS to agree local protocols and develop alternatives to managing 999 calls Tackle SGHD Key Milestones associated with A&E Attendance Working groups in place including Mental Health, Paediatrics & Alcohol Social marketing campaign commenced in February 2011 and continues advising the public of the services available and how to access these
Workforce Risk Management of Risk Workforce shortfalls in achieving delivery of Review and amend workforce plan with the use of data linked initiatives e.g long tern conditions, community outcome of reducing multiple NHS FV is continuing to review the current trainee and psychiatric readmissions. For workforce and moving towards a trained workforce to example, changes to medical trainee deliver services. The ongoing development of the skilled programmes and gaps in the allocation of nursing workforce to support the model of care medical trainee workforce and associated performance issues are leaving a shortfall Improvement project ongoing within the Emergency in the workforce Department which includes a range of qualitative assessments to inform a staff development programme. Potential of target being seen as distorting clinical flexibility Ongoing work with the integrated model of ‘Out of Hours’ services and use of resources Appropriate planning and recruitment /retention of enough skilled staff to enable the vision for the future
Finance Risk Management of Risk Working with financial constraints of the Involve all staff in redesign and keep informed of whole system – development versus progress to ensure ownership with teams delivering managing existing services. services
Working with partners with differing Joint work continues to ensure a shared agenda financial priorities. explaining the benefits to all areas Joint Commissioning Plans with Local Authorities linked to utilization of the Change Fund to make a difference to service impact’ See workforce above. NHS Forth Valley March 2012 37
Equalities Risk Management of Risk Impact accessibility to equality groups On-going programme completed regarding equality and pending move to Forth Valley Royal diversity data collection/analysis including identification Hospital (FVRH) of key themes EQIA completed on current A&E service delivery. Since the move to FVRH Programme of work being completed regarding gender based violence, routine enquiry and enhancing patient pathway
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NHS Board Local Delivery Plan 2012/13 — Contributions to Single Outcome Agreements
1. NHS Board: NHS Forth Valley
2. Community Planning Falkirk Partnership:
Early years, children and young people 3. Summary of critical In 2010/11 an update was provided on the development of a new integrated structure of children’s service issue: provision ‘the Children’s Services Locality Model’. In the past year there has been an acceleration of focus both nationally and locally on the ‘early years’. In ‘Renewing Scotland’s Public Services: Priorities for reform in response to the Christie Commission’ (Scottish Government 2011), the Government commits to intensifying its focus on prevention with a particular focus on the first few years of life. The Falkirk Community Planning Partnership shares this commitment. The Falkirk Single Outcome Agreement, the Strategic Community Plan and its associated plans all acknowledge that it is during our very earliest years and even pre-birth that a large part of the pattern for our future adult life is set. The early years therefore represent a key opportunity to break cycles of inequality and poor outcomes through action on the wider social and economic determinants of health.
There has been a review of the progress of the Falkirk Integrated Children’s Services Plan 2010-2015, the ongoing Implementation of GIRFEC, a review of Public Health Nursing, the development through the Community Planning Partnership of ‘Equally Well in Falkirk: A framework for improving health and reducing health inequalities 2011-2015’ and ‘Towards a Fairer Falkirk: Tackling poverty and inequalities 2011-2021’.
All of the above prioritise action focussed on the early years, children and young people and are underpinned by the national integrated policy framework i.e. Equally Well (2008, 2010) The Early Years Framework (2008) Achieving Our Potential: A Framework to tackle poverty and income inequality in Scotland (2008)
The ‘Falkirk CHP Health and Wellbeing profile 2010’ complimented by the ‘Falkirk CHP Children and Young People Health and Wellbeing Profiles’ (2010) provide a valuable evidence base of health and health inequality indicators used by the Community Planning Partnership to inform prioritising, planning and decision making aimed at improving health outcomes and reducing health inequalities in the early years.
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Implementation of GIRFEC in collaboration with 3 Local Authorities, Central Scotland Police and 4. Community Planning NHS Forth Valley Partnership Outputs: Development of Integrated Assessment Framework Development of information sharing procedure Multi-agency training Co-ordinated Children’s Services Public Health Nursing in Schools Child Protection Improving maternal and infant nutrition
Review of progress of Falkirk Integrated Children’s Service Plan 2011 – 2015 Development and implementation of Early years Framework; Development of Corporate Parenting Strategy Development of Equally Well in Falkirk Development of poverty strategy ‘Towards a Fairer Falkirk 2011 – 2021
Single Outcome Agreement (Local Outcomes) 5. Local Outcome(s): Falkirk’s second Integrated Children’s Services Plan was prepared in accordance with guidance issued by the Scottish Government in March 2008. It takes account of the local outcomes which contribute to Falkirk’s Single Outcome Agreement. The Plan was agreed by the Community Planning Partners in March 2010. Since the plan was approved, partners have been working together to improve outcomes for our young people as described in the plan:
Outcome 1: All Falkirk children will be happy and healthy and enabled to make positive decisions about their own health and well-being; Outcome 2: All Falkirk children will achieve their potential through learning and creativity, developing the skills and knowledge to make them fulfilled, happy adults; Outcome 3: All Falkirk children will grow up in a safe environment where they are protected, loved and enabled to enjoy their lives.
These specific outcomes for children and young people also impact on other local outcomes contained in our Single Outcome Agreement. These include: Our area will be recognised as having a culture of aspiration and ambition; Our workforce will be highly skilled; Our citizens will be supported to make positive health choices in order that they can live longer; Reduced health inequalities; Disadvantaged communities will benefit from better services; Vulnerable children will be protected; People will have equitable access to local health, support and care; Our citizens will be protected;
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Citizens and communities will be encouraged to take responsibility for their own health and wellbeing; Our citizens continue to access critical services that meet their needs.
The following national outcomes are relevant to this critical issue: 6. National Outcome(s): Our children have the best start in life and are ready to succeed Our young people are successful learners, confident individuals, effective contributors and responsible citizens We have tackled the significant inequalities in Scottish society Our public services are high quality, continually improving, efficient and responsive to local people’s needs We will live longer, healthier Lives We have improved the life chances for children, young people and families at risk.
Implementation of GIRFEC in collaboration with 3 Local Authorities, Central Scotland Police and 7. Please detail the specific NHS Forth Valley contribution of the NHS Although the work to implement GIRFEC was initially very much focused in Falkirk, over the past 12 months, developments have increasingly been taken forward on a Forth Valley basis. The NHS Forth Valley Child Board in tackling this Health Commissioner represents the NHS Board on the GIRFEC Group which has an overall strategic view critical issue? of services that relate to all children and young people in the Forth Valley area. This Group reports to the G5.
Development of information sharing procedure If children and families are to receive the right support at the right time by the right service there is a reliance on appropriate, timely information sharing. To ensure confidentiality, a common approach to gaining consent and sharing information when appropriate was introduced with the development of an information sharing procedure for Falkirk. This was led by NHS staff supported by the NHS Forth Valley Information Governance team. This procedure is integral to the Forth Valley Information Sharing Protocol.
Development of Integrated Assessment Framework The Integrated Assessment Framework (IAF) has been developed as a tool which assists appropriate information sharing, across agencies, consistency in assessment and integrated planning and reviewing. The Forth Valley IAF is based on improving outcomes for children and young people, embedding the principles of GIRFEC in service delivery and planning. The framework requires a child-centred approach and the assessments are carried out “with” the child and family not ‘to’ the child or young person and family. A multi-agency IAF Steering Group is leading the developments and has representation from all agencies working with children and young people including NHS Forth Valley Public Health Nursing representatives.
Having been piloted and revised over the past 12 months with the involvement of NHS Public Health Nursing staff, the IAF and associated guidance is currently being adopted across services to replace what was a
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complex mix of paperwork. Implementation will greatly simplify and streamline assessment and planning processes for children and families.
Multi-agency Training Implementing change requires simultaneous change in culture systems and practice. To support this, the Falkirk Multi-Agency Training Group has developed and piloted a programme of multi agency modular training. This group is well represented by a range of Falkirk CHP staff, a number of which are trained trainers to deliver key modules taking a multi-agency approach. The Falkirk Group links to the Forth Valley Multi-Agency Training Strategy Group. This group is again well represented by a number of NHS Forth Valley staff. The training programme is currently underway and will be continually evaluated and developed.
Co-ordinated Children’s Services Last year we reported on the development and implementation of a new structure to deliver Children’s services using a ‘Locality’ approach. This approach is designed to facilitate delivery of the GIRFEC principles, with the aim of improving outcomes for our children and young people. The localities are designed to take an early intervention approach to help prevent children and young people moving towards being at risk. NHS Forth Valley continues to be a key active partner on the Multi Agency Groups (MAG) which meet fortnightly to consider and discuss relevant information from multiple sources e.g. Public Health Nurses, and to agree collaborative actions aimed at delivering positive outcomes for children. Concerns are raised with the MAG using the IAF as described above. ‘Business’ MAG meetings are held 4 times per year to reflect on practice, evaluate outcomes, review progress and discuss local themes.
Falkirk School Nursing Services Falkirk School Nursing services also make a significant contribution to the MAGs attending the fortnightly meetings. Other key contributions of Public Heath School Nursing include: Initial Referral Discussions (IRD) and Young Runaway Discussions (YRD) School Nurses are contacted by Child protection department to share any relevant information. Child protection work is integral to the school nurses role, attendance at CPCCs, core groups and review meetings involving school age children across Falkirk. Identifying health needs, supporting care planning and liaising with wider health services. The school Nursing Service is aware of children who are looked after and can support the identification of unmet health needs and planning of care. All Looked After Children are routinely offered a Health Assessment within 4weeks of becoming ‘looked after’
o The School Nurse offers children who are looked after at home on a supervision requirement a health assessment. Following the assessment, analysis and planning will take place and a review date set. o NHS Forth Valley looked After Children (LAC) and Young Peoples Health Team offer children who are looked after away from home a health assessment, linking with the School Nursing Service as appropriate. o What were the key issues to our success? Partnership working to develop communication pathways between Local Authority, NHSFV LAC and Young Peoples Health Team and School
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Nursing Service The Public Health Nursing Team for Schools offer health assessments and reviews, health screening and deliver school based immunisation programmes. The team comprises of Public Health Nurses (Specialist Practitioner), Registered Nurses and Healthcare Assistants who are based in a local Health Centre and work over a number of schools in the area. Pupils, parents/carers can request a health appointment at any time. Other health professionals and teaching staff can also request a health appointment for the child or young person with parental and or young person’s consent. Health reviews will take place as necessary involving a parent questionnaire, a check of health records and if required screening of growth and vision.
Child Protection The focus on the protection of children remains a key priority for NHS Forth Valley and partner agencies. We continue to work together to deliver better services to vulnerable children and their families. A standing item on each Falkirk Children’s Commission agenda is a report from the Child Protection Committee (CPC). This ensures that all Commission members are aware of the work of the CPC and ensures that the key role early intervention services play in keeping children and young people safe is understood by all. In accordance with the Scottish Action Plan on Child Internet Safety and Responsible Use 2011/12, the Falkirk Children’s Commission is working with the Child Protection Committee to ensure child internet safety and responsible use is embedded into local practice.
A rolling programme of Child Protection Training for staff is being delivered by NHS Child Protection Nurse Advisers. NHS Forth Valley has prioritised the training in all key areas of the organisation where staff are working directly with children and vulnerable adults and in these areas training has been achieved in over 90% of staff.
SCSWIS inspected services to protect children in the Falkirk Council area in May and June 2011. Particular strengths identified that made a difference to children and families included: Very effective communication with families, helping them to understand what they need to do to help keep their children safe Prompt and effective action by services to help keep children safe High quality support to carers, helping them to meet the needs of vulnerable children. Services working very well together to help keep children who can no longer live at home remain in their own community
Examples of good practice identified were: Young Runaways Protocol ensures that when missing children are traced, they receive the support they need The development of the Intensive Family Support Service (IFSS) helps young people to receive specialist support without having to live outwith their own homes A multi-agency internet safety strategy helps children to avoid danger when using computers and mobile phones NHS Forth Valley March 2012 5
SCSWIS agreed the following areas for improvement with services in the Falkirk Council area: Improve the quality of assessment of risks and needs and individual children’s plans. Increase the pace of change by ensuring that managers at all levels recognise their responsibilities for driving improvements in practice. Continue to strengthen joint self-evaluation to ensure that it results in improved outcomes for the neediest children.
An action plan is currently under development aimed at addressing these recommendations for improvement.
Improving maternal and infant nutrition The diet and nutritional status of the mother before conception and during pregnancy, the feeding received by the infant in the first few months of life, the process of weaning onto solid foods and the diet and nutrition status of the growing infant all contribute significantly to the long term health of the population. The Falkirk CHP General Manager is the identified lead for Forth Valley for maternal and infant nutrition and chairs the multi-agency Forth Valley Maternal and Infant Nutrition Steering Group.
A Falkirk sub group is responsible for ensuring the development and implementation of a co-ordinated programme of activities involving a range of community planning partners e.g. Improving access and uptake of Healthy Start including delivery of training; Improving breastfeeding rates through implementation of UNICEF Baby Friendly Initiative in the Community; Health Visitors in Falkirk facilitate breastfeeding groups across all CHP localities in a range of community settings.
REVIEW OF PROGRESS OF FALKIRK INTEGRATED CHILDRENS SERVICE PLAN 2011 – 2015 Development and implementation of Early years Framework Multi-agency work has been undertaken to develop and implement the Early Years Framework. An NHS Public Health Practitioner is represented on a sub Group of the Early Years Framework Advisory Group to take forward a review of Parental Education and Support to ensure a coherent and appropriate range of opportunities. NHS Health promotion staff are also represented on the Curriculum for Excellence Health and Wellbeing Group to provide expert advice and guidance on health improvement. Currently Health Promotion is supporting the development of a Substance Education Framework for ages 3 -18 in Falkirk.
Development of Corporate Parenting Strategy The Council has developed a Corporate Parenting Strategy to ensure support from all services for Looked After Children while they are in care and when they make the transition to adult life. There is a comprehensive action plan covering a range of issues, including health, education, moving into work or further education and accommodation, which are intended to ensure Looked After Children achieve the same outcomes as other children and young people.
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NHS Forth Valley Looked After and Accommodated Children (LAAC) Nurses work in partnership with a range of services in the Local Authority and third sector providing assessment and expert advice for children being looked after away from home. Recently LAAC nurses have been working in partnership with Nutrition and Dietetics and residential units in the development of ‘Eating Well Guidance’ to ensure that looked after children are accessing a healthy balanced diet. The success of the Guidance has resulted in its roll out for use with foster carers.
Throughcare and Aftercare Nurses (TCAC) work with young people leaving care. TCAC Nurses offer assessment, health promotion advice and referrals to appropriate services that enable young people to take greater control of their health and wellbeing.
Development of ‘Equally Well in Falkirk’: ‘Equally Well in Falkirk’ (EWIF) has been produced by the Falkirk Health Improvement and Health Inequalities Group (HIHI) with the aim of providing all community planning partners with a high level outcomes focussed framework and action plan that can be used to help facilitate the step change required to achieve a fairer Falkirk in terms of health outcomes, where all our communities have improved health and inequalities in health are reduced. EWIF is integral to both the ‘Integrated Children’s Service Plan’ and ‘Towards a Fairer Falkirk’. EWIF identifies Early Years and Young People as a priority theme for actions aimed at reducing health inequalities including: To review parental education and support to ensure coherent and appropriate range of opportunities; To promote maternal and infant nutrition through developing supportive environments, practical support for parents & carers, communicating consistent messages, policy support and education and training; To build on health promoting schools ethos and fully embed Curriculum for Excellence ‘responsibility of all’ – literacy, numeracy, health & wellbeing - experiences and outcomes; To engage with Falkirk Community Planning Employability Partnership in order to identify actions to support training, employability and health for young people; To develop mechanisms to increase identification and community-based support for smoking cessation and steps to reduce childhood exposure to second hand smoke
Development and implementation of poverty strategy ‘Towards a Fairer Falkirk 2011 – 2021’ ‘Towards a Fairer Falkirk’ recognises poverty as a key determinant of health and health inequalities experienced by children. In order to mitigate the impacts of poverty in relation to health and reduce health inequalities, the strategy commits to working with Community Planning partners to:
Routinely consider inequalities in planning and delivery and thereby maximise the potential for Falkirk to successfully reduce health inequalities and deliver on health outcomes; Integrate an approach based on prevention and early intervention ; Develop our Early Years Framework that sets out the Council’s approach to targeting and working
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with our most vulnerable children and young people aged 0-8 years and their parents; Build on our approach to Corporate Parenting and ensuring our most disadvantaged children have the encouragement and support to achieve; Develop an approach to ensure that children and young people are not disadvantaged educationally as a consequence of living in poverty; Increase young people’s confidence and self esteem; Develop services for young people with a disability; Reduce the potential for our young people to develop harmful lifestyles;
The Fairer Falkirk Group oversees the implementation and monitoring of the strategy and Falkirk CHP is represented by a Public Health Practitioner.
Falkirk CHP is committed to improving outcomes for children and young people as part of the Falkirk 8. Please explain the ways Community Planning Partnership. The Falkirk Children’s Commission has a strategic role as a cross-cutting in which the NHS Board thematic multi-agency group looking at children and young people issues and oversees the development, implementation and monitoring of the Integrated Children’s Service Plan. It has driven the development, pilot is working in and implementation of the Coordinated Children’s Services consistent with the principles of Getting it Right collaboration with for Every Child. Community Planning Partners to tackle the Falkirk’s Integrated Children’s Services Plan serves as the key partnership document for the early years, critical issue? children and young people and seeks to ensure that all children and young people are Safe, Healthy, Active, Nurtured, Achieving, Respected, Responsible and Included. It also recognises the importance to improve outcomes for our most vulnerable groups, including: looked after children and children who are looked after away from home; children who live in the most deprived 15% datazones (SIMD1); children with a disability; children from minority communities; young carers and children on the Child Protection register.
The Falkirk CHP General Manager and Child Health Commissioner represent the NHS on the Commission and the Falkirk Council Integration Support Manager is a member of both the Commission and the Falkirk Health Improvement and Health Inequalities Group and serves as a key link between both. This facilitates an integrated approach to planning and decision making with regards to improving health and reducing health inequalities in the early years and the structure promotes the development of a range partnership working as described in section 7 above.
Falkirk has also established an Early Years Framework Advisory Group, with strong NHS representation to implement recommendations outlined within the Early Years Framework. It is recognised that Children’s and young people’s issues span across services and partnership groups. There is a strong consensus across the community planning partnership that improving outcomes for children and young people, and reducing inequalities for our most vulnerable children and families, is everyone’s responsibility and requires joined up responses.
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The mechanism for monitoring and review of the Integrated Children’s Service Plan (ICSP) is under 9. Please explain how the development and links closely to the work being carried out on the IAF. As part of the monitoring and review, it is planned to use an outcomes based framework which can measure improvements in outcomes at both
NHS Board is individual and population level. This framework is currently being piloted and its use is currently being performance managing negotiated with a national Third Sector organisation. it’s contribution to tackling this critical The outcomes illustrated in the ICSP, EWIF and Towards a Fairer Falkirk frameworks are aligned to those in issue and how this is the Falkirk Single Outcome Agreement (SOA). The SOA is the main vehicle through which the impact of these strategy and their associated action plans are monitored. The Falkirk HIHI Group provides a bi-annual reported into the CPP? report on the implementation of ‘Equally Well in Falkirk’ to the Falkirk Community Planning Leadership Board and the Falkirk CHP Joint Management Group which in turn reports to the Falkirk CHP Partnership Board. The Chair of the Falkirk HIHI is also represented on the Forth Valley Health Improvement and Health Inequality Group chaired by the NHS Forth Valley Director of Public Health. The Children’s Commission also provide bi-annual reports to the Falkirk Community Planning Leadership Board.
The Falkirk CHP Joint Performance Management Group is currently developing a joint performance reporting framework for reporting performance to the CHP Partnership Board. This will incorporate a suite of relevant indicators including those for the early years, children and young people and they will be integral to those in the SOA, the ICSP and EWIF.
In the context of the CPP, the NHS Board demonstrates continuous improvement through its contribution to 10. Please explain how the SOA monitoring reports in relation to the SOA outcome indicators. As described above, a Joint Performance NHS Board will Framework is currently being developed for reporting performance to the CHP Partnership Board. This will use outcome indicators aligned to local SOA outcomes and HEAT indicators. demonstrate continuous improvement in the In the context of the NHS Board, the clinical governance strategy 2009-2012 is underpinned by principles course of tackling this including; ‘commitment to working in partnership with public, patients and local authority partners as a critical issue? means of improving health and healthcare and reducing health inequalities’
The Clinical Governance Strategy underpins the delivery of this core principle and through the organisational framework, objectives and reporting structures, provides assurance to the Board that effective and robust systems are in place, to ensure that improvements in the quality of care are at the heart of the organisation.
Performance is managed at various levels throughout the organisation and in the partnerships it engages with. Examples include: Individual eKSF personal development plans; Review of clinical care through a range of measures including both clinical outcomes data, professional reports and patient experience; Formal reporting through regular reports and minutes for the CHP Joint Management Group, CHP Partnership Boards, CHP Sub-Committee, Community Planning Partnership Leadership Board, Children’s commission, Falkirk Health Improvement and Health Inequalities Group, Child Protection
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Committee, Forth Valley GIRFEC Group and the G5; The ongoing development and monitoring of specific clinical governance objectives; Monitoring of performance in relation to National Standards and guidance; The production of annual clinical governance reports by both the operational groups and the NHS Forth Valley Clinical Governance Committee.
Internal Audit and annual accountability reporting also provide a vehicle for continuous improvement.
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Appendix 1 Reporting Structures NHS FV Community Planning Partnership Board Leadership Board
CHP Partnership Board
CHP Joint Management Group
Economic Community Fairer Falkirk Sustainable Development Falkirk Health Safety Developme and Tourism Improvement & Health t Inequalities
Equal Community Public Sector Opportunities Engagement Reform
Children and Young People
Education Service CHILDREN’S Community Services COMMISSION Police EXECUTIVE NHS Forth Valley
CVS Falkirk & District SCRA Children’s Rights Officer Corporate & Social Work Services Neighbourhood
Falkirk Youth Justice Child Protection Voluntary Sector Local Delivery of Group Committee Forum Children’s Services
Social Work Services Social Work Services CVS Falkirk & District NHS Forth Valley March 2012 11
NHS Board Local Delivery Plan 2012/13 — Contributions to Single Outcome Agreements NHS Forth Valley 1. NHS Board:
2. Community Planning Stirling Partnership:
Stirlingshire is a local authority that covers a mixture of town and rural areas with about 70% of the 3. Summary of critical population living in a town or close to one and the remaining 30% in a rural situation. There are stark issue: differences between the affluent parts of the county and the more deprived areas and this does pose challenges in providing public services to opposite ends of the spectrum. The Community Planning Partnership is vital to identify and address these issues and to do so in an integrated way involving all partners.
NHS Forth Valley is an integral contributor to the Stirling Community Planning Partnership and the Healthy Stirling Partnership (HSP) chaired by the Stirling CHP general manager proposed a ‘healthy village’ or ‘assets based’ approach to the health inequalities issue.
Three priority areas were identified and discussed by the HSP health inequalities sub group and Fallin was identified as the area to take forward.
Fallin is a small town in Stirlingshire that falls into the 15% most deprived centile and has a known issue of employment poverty, with a significant percentage of the working age population on job seekers allowance and incapacity benefits/severe disability allowance. This is a direct link to it being significantly income derived also and it is a town that is classed as rural, but the majority of homes do not have a car so public transport is also an issue. From a health point of view there is a high prevalence of diabetes, COPD as well as patients hospitalised as an emergency.
The HSP sub group (containing representatives from Third Sector, Health and Local Authority) identified 4. Community Planning certain key principles to inform the healthy village approach. Partnership Outputs: These are: Prevention and Early Intervention Considerate to individual values A shared attitude and vision
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Co-Production amongst all stakeholders 5 Key rules: more doing / less talking, organic, not prescriptive, seize opportunity, sustainable.
The Stirling SOA highlights the local priorities as Developing Vibrant, Resilient Communities where people 5. Local Outcome(s): are proud to live and work and have grouped this in 10 strategic aims as follows: Where people are proud to work by
Opening Stirling to investment Growing the visitor economy Nurturing local business Removing barriers to employment Learning for life, work and wellbeing
Where people are proud to live by Combating anti social behaviour Tackling housing needs Addressing underlying causes of poverty Supporting and care for the vulnerable Improving the environment
As of March 2012 the Fallin Healthy Village is still at the community consultation phase and this will be entered into in April 2012 and will consequently determine the focus for action.
The following national outcomes are relevant to this critical issue: 6. National Outcome(s): We live longer healthier lives
We have tackled the significant inequalities in Scottish society
Our public services are high quality, continually improving, efficient and responsive to local people’s needs
NHS Forth Valley has embedded tackling inequalities as part of the SOA and is aware of the fact that some 7. Please detail the specific communities of both people and places in Stirling suffer adversely in contrast to the prosperity of the area as contribution of the NHS a whole. There is an emphasis placed on working in partnership to address the needs of the local population and to ensure that performance management is in place to demonstrate the effectiveness of the policies and Board in tackling this services. This group includes Health, Local Authority and Third Sector representatives. Health chairs the critical issue? performance management sub group and it reports to a joint management team (consisting of senior CHP health staff and senior LA staff) to ensure partnership knowledge is shared and acted on.
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NHS Forth Valley provides leadership and direction for the HSP through the CHP general manager. It 8. Please explain the ways provides co-ordination of the health inequalities sub group through the Health Promotion lead officer and a in which the NHS Board senior Health Promotion officer is leading on the community engagement element with an officer from the local authority and third sector. Further work will be done in partnership with the CPP to consult and then act is working in on the priorities determined by the local population and not by ‘figures of authority’. collaboration with Community Planning Partners to tackle the critical issue?
NHS Forth Valley will analyse the feedback from the community consultation process with its’ operational 9. Please explain how the partners and report progress through the HSP sub group and then to the HSP. The HSP will in turn report to NHS Board is the Executive Delivery Group (of the CHP) and the project board of the CHP. performance managing it’s contribution to tackling this critical issue and how this is reported into the CPP?
As part of the project a sub group will be set up that will gather baseline information – some of this will be 10. Please explain how the already reported nationally – such as unemployment figures and other SIMD information. There will also be NHS Board will local viewpoints garnered – via healthy cafes, individual interviews and other means. This will allow a mixture of hard data and the softer, more qualitative feelings that the local people have about their demonstrate continuous community. This information will be updated and trends analysed to determine how effective the healthy improvement in the village approach has been. course of tackling this critical issue? The HSP will look closely at the results of this endeavour and if it is proving successful would look to roll it out to other, similar communities in the area.
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NHS Board Local Delivery Plan 2012/13 — Contributions to Single Outcome Agreements
1. NHS Board: NHS Forth Valley
2. Community Planning Clackmannanshire Alliance Partnership:
The critical issue is how to engage with communities in as asset based approach in order to tackle health 3. Summary of critical inequalities.
issue: Overall, inequalities in Clackmannanshire have been improving in recent years with the county currently ranked 17th out of the 32 local authority areas in terms of overall deprivation, an improvement from 15th in 2006 and 14th in 2004. Three communities have seen a marked improvement in rankings and have moved out of the 15% most deprived in Scotland - these are Sauchie & Fishcross, Devon Village and Coalsnaughton.
Despite improvements across the overall deprivation, we have seen the position of our most deprived areas worsen in the past six years. Two areas which are in the 5% most deprived areas in Scotland are Bowmar and Hawkhill, both in Alloa South and East.
Hawkhill is the second most deprived area in Clackmannanshire; it shows significant issues in relation to educational attainment, unemployment and health related inequalities. With the support of partners, NHS Forth Valley led a project to introduce an Asset Based Approach to the community of Hawkhill.
This part of Alloa has traditionally been included in Alloa South and East – but there is a specific area of 3 streets and about 158 households with 550 people living there, that has a strong community identity and this is Hawkhill. There is a high rate of people who are employment deprived. In the 16-24 age group, 17.8% are claiming job seekers allowance, with 11.9% seeking this allowance in the 24-49 age bracket. Other key benefits (job seekers, ESA, incapacity, lone parents and other income related benefits) also have high uptake levels with 32.5% of people aged 16-24 claiming and 53.4% of those aged 25-49. Life expectancies of 67.9 years for males and 75.5 years for females compared to the national average of 74.5 and 79.5 also highlight the health related issues.
NHS Forth Valley is integral to the Clackmannanshire Alliance with ongoing involvement in and development
NHS Forth Valley March 2012 15
of partnership working including a joint management group and a joint performance management sub group which is developing performance measures based on the priorities for the county.
The Hawkhill part of Alloa is the second most deprived area in Clackmannanshire and the Violence 4. Community Planning Reduction Unit had already started work gathering statistical evidence from it showing the potential benefits Partnership Outputs: to the community and the services working in it, from an Asset based approach. In Hawkhill itself, there was a strong local identity with a community Centre that Local Authority activists had recently taken over.
The Clackmannanshire Alliance supports an assets based approach led by Health staff and to include all key services as well as the local community.
The Clackmannanshire SOA highlights the local priorities as: 5. Local Outcome(s): Clackmannanshire has a positive image and attracts people and business Communities are more inclusive and cohesive People are better skilled, trained and ready for learning and employment Communities are, and feel, safer Vulnerable people and families are supported Substance misuse and its effects are reduced Health is improving Our environment is protected and enhanced Our public services are improving
The Hawkhill priorities named at a listening event attended by local residents were: develop a community playgroup or nursery increase presence be services to reduce anti-social behaviour Support groups for single parents, elderly and teenagers establish a mens group within the centre build better parks and child friendly facilities in the area improve road safety eg parking / speed bumps hold more events which get the whole community involved
The following national outcomes are relevant to this critical issue: 6. National Outcome(s): We live longer healthier lives We have tackled the significant inequalities in Scottish society Our public services are high quality, continually improving, efficient and responsive to local people’s needs
NHS Forth Valley March 2012 16
NHS Forth Valley is providing leadership and direction for this project with the input of a Senior Health 7. Please detail the specific Promotion officer as well as administrative support and General Manager involvement. contribution of the NHS NHS Forth Valley chairs both the strategic and operational groups and links with all the key partners that Board in tackling this include fire, police, housing, local authority officers and councillors, and community members working critical issue? alongside health.
Briefings are prepared for the Clackmannanshire Alliance and CHP committees detailing the work and plans of action.
All levels of NHS are involved and contributing to this project and include a Public Health Consultant, Lead 8. Please explain the ways Nurse, General Manager, Lead Health Promotion Officer and Health Promotion Officer. They support and in which the NHS Board work with people from the local community, housing, Forth Valley College, police, fire, violence reduction unit, third sector and community planning. Together they plan and implement the project involving the local is working in community by ensuring constant feedback and by facilitating conversations with the local community. collaboration with Community Planning The needs of the community are decided by the community and the services and third sector staff plan Partners to tackle the suitable interventions to help meet these needs. critical issue?
The areas of improvement expected that were articulated at the listening event can be summed up as: 9. Please explain how the NHS Board is improved health outcomes increased employment / training / volunteering opportunities performance managing reduced crime & violence it’s contribution to a stronger sense of feeling safer in the local area tackling this critical issue increased confidence in Public Sector Agencies and how this is reported into the CPP? The listening event in September 2011 established a baseline and will be repeated to ensure the needs of the community are being met.
Regular updates will be provided and comparisons made to the baseline data and monitored to evidence the expected improvements by the Clackmannanshire Alliance to the Community Planning Partnership.
A data group is working to collate a broad baseline of data from a variety of sources and partners. This 10. Please explain how the data will be revisited at certain points in the future and it is hoped that there will be improvements to these NHS Board will statistics.
demonstrate continuous In addition, this group will gather qualitative data in the form of good news stories originating from the improvement in the Hawkhill area. It will highlight pieces of work that have taken place between the local community and NHS Forth Valley March 2012 17
course of tackling this partners and residents and at regular stages ask residents to score how they feel about their area in an critical issue? attempt to build a more rounded picture of the work that is taking place in the Hawkhill area.
The success of the Asset Based work will be evaluated by the Clackmannanshire Alliance and if successful, will be rolled out to other communities as a core model of engagement with communities.
NHS Forth Valley March 2012 18 NHS FORTH VALLEY
FINANCIAL PLAN 2012/13 – 2016/17
1. Introduction
This paper outlines the Financial Plan 2012/13 – 2016/17.
It covers the following areas :-
- Background - NRAC (National Resource Allocation Committee) and uplifts - Existing Baselines - Pay, Prices and Prescribing - Managing existing and future pressures - Savings Requirement and Plans - Summary Risk Schedule - Brokerage Repayment Schedule - Future Years
2. Background
It is important to recognise the improvement in the financial position looking forward and the reasons for the current outlook. These can be summarised as follows :-
Significant Progress on implementation of the Healthcare Strategy
o FVRH fully operational from July 2011 and the transfer of services from Stirling Royal Infirmary o Majority of ‘transitional costs’ cease by 31 March 2012 o Service transfers to Falkirk Community Hospital supporting the planned moves from sites such as Bonnybridge Hospital o Planned service transfers in progress and scheduled for completion in early 2012/13 to Stirling Community Hospital supporting the planned moves from sites such as Bannockburn Hospital o Significant demolition programme on the old FDRI and SRI sites significantly reducing the building footprint.
Use of a local Voluntary Severance Scheme which to date at a cost of £ 3.567m supporting a reduction in whole time equivalent of 53 and a cost reduction of £2.374m. A further panel is scheduled in March 2012 where it is expected the balance of available funding will be utilized and providing further cost reduction.
Delivery in-year of primary care prescribing savings of £ 3.441m. Primary Care prescribing is also reporting an underspend in 2011/12 which presuming sustained in 2012/13 will provide a helpful contribution to 2012/13 cash savings target of £3m
1
Steady progress to achieving in-month operational financial balance during 2011/12 and on track for April 2012 operational financial balance prior to inclusion of new Savings Plans.
Significant efforts by all departments and staff have supported the changes and improvements over the last few years and these will need to continue.
3. NRAC and uplifts
The Allocation Letter from SGHD confirming 2012/13 allocations and providing indicative allocations for the two following years was received on 10 February 2012.
This confirmed revenue funding as follows for NHS Forth Valley :-
£’m
Baseline 2011/12 revenue allocation 402.134
1% uplift (all territorial Boards) 4.056 *
Access Support (existing funding) 4.070
Change Fund increase 0.519 *
NRAC parity (NRAC gaining Boards only received) 2.902 *
Prisoner Healthcare (full year funding) 4.536
Baseline Allocation 2012/13 418.217
* indicate those areas where there is flexibility in the use of resource and it is additional
For NHS Forth Valley this represents a ‘notional’ uplift of 4% against an average ‘notional’ uplift of 2.9%. The higher than average percentage is caused by two amounts – movement to NRAC parity (£2.902m) and transfer of prisoner healthcare funding (£4.536m) – the latter reflects that this area has approximately 25% of prisoner population but only 5.3% of general population of Scotland. It is important to ensure that although prisoner funding has been included in baseline allocations this should be excluded from any NRAC parity consideration.
Indicative uplifts of 2.8% and 2.6% have been provided for 2013/14 and 2014/15 respectively plus indicative national NRAC parity funding of £ 42m has also been notified but without specific indication to NRAC gaining Boards. As previously indicated given NHS Forth Valley population is projected to increase beyond the Scottish average for the foreseeable future it is likely that NHS Forth Valley would continue to gain unless the formula for either of the other two indicators (morbidity and life circumstance or
2 remote and rural) changed significantly. NRAC funding increase of £3m has been assumed in 2013/14 and 2014/15.
For the remaining two years of the Plan an uplift of 2.5% has been assumed.
4. Existing Baseline
The vast majority of NHS resources are already committed before the start of the year for staffing levels, supplies including drugs and cost of health care buildings.
The summary position reflecting the recurrent baseline before uplifts and savings have been incorporated :-
2011/12 2012/13 £'m £'m
Notified General Allocation 402.792 418.217 Anticipated Allocations / Earmarked Recurrent 71.784 53.068 FHS Non-Discretionary 31.291 Other Income 9.660 9.499 N.E.S. Income 1.501 1.393
Total funding 485.737 513.326
£'m £'m Forth Valley Acute including FVRH 153.278 157.797 Primary Medical Services 36.673 37.288 Clacks CHP 30.494 32.676 Falkirk CHP 18.670 20.091 Stirling CHP 21.109 8.197 Allied Health Professionals 11.384 Complex Care 4.349 4.274 Primary Care Prescribing 57.719 62.803 Forth Valley Facilities 14.484 14.515 Capital Charges 7.032 12.311 Resource Transfer 17.992 18.082 Cross Boundary Flow / Other Providers 42.318 41.469 Other Community 1.006 1.096 Area Corporate 29.156 32.075 Ring-fenced funding allocations and local resource 33.095 23.575 Banked Funding – Transitional Costs 5.933 Uplift : NRAC : Change Fund : (Prescription Income) 12.439 11.111 Prisons 4.536 Planned Savings -11.244 FHS Non-Discretionary 31.291
Total 485.737 513.326
3
It is difficult to compare between Financial Years as during strategy implementation services and supporting budgets have moved managerial units. Other areas of change include an increase in Area Corporate funding to support FVRH rates bill of over £2m and national change in eHealth Funding mechanism which means funds transferred to eHealth on a permanent basis from Ring-Fenced funding allocations.
4. Pay Prices and Prescribing
The following planning assumptions have been used in preparing the Financial Plan
12/13 13/14 14/15 15/16 16/17
Basic Pay Increase 0% 1% 1% 2% 2%
Basic Prices Increase 2% 2% 2% 2% 2%
Rates 5.63% 5% 5% 5% 5%
Unitary Charge 4.52% 3.5% 3.5% 3.5% 3.5%
Energy 20% 20% 20% 20% 20%
Resource Transfer 0.5% 1.5% 1.5% 1.5% 1.5%
Cross Boundary Flow 1% 2.8% 2.6% 2.5% 2.5%
Prescribing 6% 6% 6% 6% 6%
In addition to the above provision has also been made for the following :-
Pay Award in 2012/13 for staff who earn below £ 21,000 Consultant Discretionary Points Award in 2012/13 Agenda for Change incremental drift in future years New Drugs
Annex A summarises the estimated uplifts plus provision for Pay, Prices and Prescribing together with a small number of other commitments which are outlined in the next Section. This confirms that for inflation increases the projected uplift/NRAC can cover projected increased costs.
5. Managing Existing and Future Pressures
Whilst there a number of service pressures that will always require to be managed the four most significant current areas over recent times are
4 Access - estimated cost 2012/13 £ 3.000m Biologics – estimated cost 2012/13 £1.600m Red Risks Savings Areas £ 3.400m Tertiary Services – risk of up to £1m
Access and Biologics have been budgeted for at the levels above for 2012/13 and are included in Annex A.
Regarding Red Risk Savings Areas there is a continual work programme to seek and identify further areas of savings but the move to in month operational balance confirms that alternative proposals are being identified to cover red risk areas. This work will continue during 2012/13.
Tertiary Services / Cross Boundary Flow – this position fluctuates between years with the most significant risk being Lothian. SEAT Boards require to focus on early agreement on cross boundary flow costs in 2012/13.
In addition there are three areas identified as national priorities for improvement / change – increasing usage of diabetic insulin pumps : waiting times/access to subfertility services and management of obesity. Estimated provision has been made within the Financial Plan to cover each area until local detailed plans are complete and/or clarity around future targets.
It is estimated that cash savings of up to £10m per annum may be required in future years to support
The increasing population in NHS Forth Valley whilst NRAC is phased over a longer timeframe Demographic change including an increase in older population and changes associated with areas where improved survival rates where individuals with more significant needs require support in the community Anticipatory and preventative spend to seek to influence needs in future years Consideration of new technologies and introduction of new therapies where evidence of effectiveness support prioritization Future workforce changes and workforce profiles
6. Savings Requirements and Plans
As reported throughout the year NHS Forth Valley had an underlying recurrent deficit of £ 11.244m. It is imperative that the system returns to recurrent financial balance. Savings Plans had been prepared to ensure this gap was closed. A summary table is attached at Annex B – in the LDP submission £ 0.700m has been identified as ‘yet to be identified’ and this is deemed to be within tolerance levels. Non-recurrent savings have been identified that can cover this gap in the interim.
This equates to 2.7% of funding and is in line with the national average.
5 In terms of delivery the primary care prescribing underspend in 2011/12 demonstrates good progress in delivery of 2012/13 requirement. The VSS programme has helped support delivery of part of the Management and Admin Savings but further savings are still required in 2012/13.
Strict controls will remain in place regarding vacancy management with the Director of Human Resources / Director of Finance approval required for any post advertised outwith NHS Forth Valley, Prescribing Efficiency Group meets regularly, compliance with national procurement contracts reviewed and operational efficiency group reviewing savings projects with red risk status.
As indicated in the previous section savings requirement of approximately £10m per annum should be planned for. Work on identification of future savings continues and progress will be reported to the Performance and Resources Committee.
7. Summary Risk Schedule
A summary risk schedule is attached at Annex C. This risk schedule supports the risks identified in the Corporate Risk Register
A more detailed risk schedule is held within the Finance Department.
8. Brokerage Repayment Schedule
Annex D provides the planned brokerage repayment schedule which is expected to be confirmed with SGHD as part of LDP approval process. Every opportunity should be taken to repay brokerage as early as possible so for example should sales profile change for the Bellsdyke Development releasing profit at an earlier date this funding would require to be used to re-pay brokerage as a first call.
6 9. Future Years
Following completion of the major healthcare projects it is an opportune time to review the current profile of spend against delivery of strategic objectives. Consideration of how this is best taken forward will be incorporated into the Corporate Plan scheduled for Board consideration in May 2012.
It is also important to note areas which will be key to moving forward
Understanding of the changing demographics and impact on services Targeting of preventative spend to address inequalities and to ensure best outcome achieved for resources available Joint work across the public sector in respect of Early Years and Health and Social Care Integration Future direction of Pay Policy
10. Recommendation
The NHS Board is asked to approve the Financial Plan 2012/13 – 2016/17
Mrs Fiona Ramsay Director of Finance and Planning 21st March 2012
7 NHS FORTH VALLEY FINANCIAL PLAN - SUMMARY (Board 27.3.12) Annex A
Recurrent Non-Rec Total Recurrent Non-Rec Total Recurrent Non-Rec Total Recurrent Non-Rec Total Recurrent Non-Rec Total Narrative 2012/13 2012/13 2012/13 2013/14 2013/14 2013/14 2014/15 2014/15 2014/15 2015/16 2015/16 2015/16 2016/17 2016/17 2016/17 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000
Board Base Uplift (1% then 2.8% then 2.6%) 4056 4056 11357 11357 10841 10841 10695 10695 10962 10962 NRAC 2902 2902 3000 3000 3000 3000 Change Fund Increase 500 500 Brokerage Repayment - revenue -3853 -3853 -2482 -2482 -714 -714 Anticipated Allocation (from 2011/12) 115 1088 1203 Other Local Funding 8106 2579 10685 100 950 1050 2205 2205 98 98 Balance Carried Forward 00000000 Savings 374 374
Total Increase 15179 4167 19346 14457 -2529 11928 13841 -277 13564 10793 -714 10079 10962 0 10962
Pays Basic (0% in 2012/13 : 1% per annum then 2%) 2031 2031 2052 2052 4145 4145 4228 4228 Staff who are paid less than £ 21,000 600 600 Consultants Discretionary Points 160 160 Agenda for Change Incremental Drift 1500 -600 900 900 -450 450 700 -350 350 400 -200 200 Other Pay Pressures
Prices Basic Uplift (2%) 726 726 740 740 756 756 770 770 785 785 Unitary Charge (4.52%) 1656 1656 1340 1340 1387 1387 1436 1436 1486 1486 Energy (20%) 228 228 274 274 329 329 394 394 473 473 Rates (5.63%) 252 252 212 212 223 223 234 234 246 246 Resource Transfer (0.5%) 90 90 273 273 277 277 281 281 285 285 External Cross Boundary Flow (1%) 408 408 1154 1154 1101 1101 1087 1087 1114 1114 External Cross Boundary Flow outgoing (1%) -71 -71 -201 -201 -192 -192 -189 -189 -194 -194
National CNORIS 368 368
Prescribing Price and Volume Increase (6%) 4712 4712 4995 4995 5295 5295 5612 5612 5950 5950 New Drugs 600 600 1000 1000 1000 1000 1000 1000 1000 1000 Complex Therapies 1600 1600
Other Access Target delivery 3000 3000 Change Fund increase /slippage repayment 500 500 1667 1667 Bus Contract Expansion of Local Renal Service 60 60 86 86 22 22 QOF - previously non-recurrent 285 285 Regional Cancer Funding 10 10 Strategy - Travel Plan 75 75 75 75 Bus Contract 1284 1284 1284 1284 448 448 National Planning Forum - increase in bariatric surgery 48 48 Carbon Reduction Scheme - increase 60 60 Brokerage Repayment -3853 -3853 -2482 -2482 -714 -714 Contingency 79 79 462 462 691 691 Diabetic Pumps 100 100 SubFertility 100 100 200 TV Licences 6 6 Transitional Costs - Excess Travel 540 540 540 540 540 540 180 180 Stirling Care Village - IA max case 98 98 Home Oxygen Service 115 115 Rates 582 582 Bellsdyke Development 1689 1689 Future Savings Requirement -4775 170 -4605 -4811 200 -4611
Total Commitments 15179 4167 19346 14457 -2529 11928 13841 -277 13564 10793 -714 10079 10962 0 10962
Balance Remaining 000 000 000 000 000 NHS FORTH VALLEY - Savings Plan (high level summary) Annex B
Total Plans Risk £'000
Further Management and Corporate Savings 1500 Medium (across all areas)
Regional Working - joint posts 500 Medium
Primary Care Prescribing 3000 Medium
Supplies 500 Medium
Operational Management 1100 Medium
Income Generation 50 Low
Demand Management (endoscopy,labs and radiology) 250 High
Integrated Care Models 250 High
Review Out of Hours / Crisis Services 285 High
Review/Integration of Day Services 320 High
Service for high cost/vulnerable patients 170 Medium
Health Promotion 100 Low
Long term conditions 170 Low
Further use of technology 220 Medium
Further travel and transport reduction 210 Medium
Cross Boundary Flow 580 High
Property Related inc rates, energy 210 Medium
Utilisation of 'bundled' allocations 390 Medium
Contingency 739 Low
Balance to be Identified 700 High
11244
NHS FORTH VALLEY BROKERAGE REPAYMENT SCHEDULE - 2011/12 - 2015/16 Annex D
Narrative 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 Total £'000 £'000 £'000 £'000 £'000 £'000 £'000
Brokerage Provided by SGHD 2100 10000 12100
Total Brokerage 2100 10000 12100
Planned Repayment from Property Proceeds Bellsdyke Land Development 578 739 1317 Craigenhall 490 490 5 Randolph Court 150 150 Alloa Health Centre Land 149 150 299 Camelon Health Clinic Land 0 0 Bo'ness Hospital - land 50 50 Larbert House 1000 1000 Gladstone Place 965 965 Clackmannan County Hospital 330 330 1 Randolph Road Stirling 450 450
Bellsdyke Profit - based on existing Development Agreement 3853 2482 714 7049
Total Repayment 1417 3634 3853 2482 714 12100
Balance Remaining 2100 10683 7049 3196 714 0 0 NHS FORTH VALLEY
CAPITAL PLAN 2012/13 – 2016/17
1. INTRODUCTION
This paper presents the draft NHS Forth Valley Capital Plan 2012/13 – 2016/17 for consideration.
This Plan reflects confirmed SGHD (Scottish Government Health Directorate) funding for 2012/13 and indicative allocations for the following two years. For the two years beyond the current Spending Review a similar level of funding to 2014/15 has been assumed.
This paper covers the following areas
Strategic Context Funding issues including implications of IFRS (International Financial Reporting Standards) Regional Priorities Strategic Priorities Primary Care Modernisation Community Hospitals Area Wide Expenditure including eHealth and medical equipment Property Sales Affordability including revenue implications Issues and Risks
2. STRATEGIC CONTEXT
As reported in previous years Capital Plans the public sector resource for Capital Funding has reduced dramatically over recent years. There has also been a move away from PFI/PPP Projects (Private Finance Initiative) towards the HUB Model
Main issues for consideration are as follows :-
National
Significant reductions in Public Sector Capital Funding National priorities identified as Forth Crossing : Schools Programme and South Glasgow Hospital Development Major NHS Projects include Grampian Emergency Care Centre and re-provision of Edinburgh Sick Childrens Hospital / Neurosciences Capital Planning arrangements change for NHS including central pooling of Property Sales and top-slicing to fund national NHS priorities Development of the Scottish Futures Trust including the Hub Initiative for Joint Projects and NPD (Not for Profit Distributing) Projects Publication and implications of ‘State of the Estate’ Local
Ensure completion of Healthcare Strategy Maximise space utilisation of FVRH (Forth Valley Royal Hospital) and Clackmannanshire Healthcare Facility Minimise estate footprint to maximise resource in services Joint Asset Management Report with other public sector partners Investment in Projects to support savings delivery eg energy efficiency : eHealth including telehealth
3. FUNDING ISSUES INCLUDING IFRS IMPLICATIONS
The Scottish Government Health Directorate confirmed the following allocations on 22 February 2012. 2012/13 £’m
Notified Capital Resource Limit 4.986
Discussed but not confirmed
Primary Care Modernisation Fund 0.725
Hub Initiative 0.450
UK GAAP Reversionary Interest (PFI) 4.610
IFRS Reversionary Interest (4.610)
Anticipated Capital Resource Limit 6.161
(Note plan on a UKGAAP basis but account on IFRS (International Financial Reporting Standards)
Funding available is expected to be targeted at addressing backlog maintenance and equipment replacement.
Alternative funding routes are being highlighted to Boards through the Scottish Futures Trust including the HUB Initiative and NPD Model – both revenue funded models. As previously indicated NHS Forth Valley currently carries a significant future revenue cost through existing PFI Projects. Whilst national planning guidance indicates that for the new arrangements up to 85% of new revenue costs associated with the capital components of the Projects will be funded from national funds any risk associated with this will mean for NHS Forth Valley that a greater proportion of local revenue funds would require to be tied to long term contract payments. It is also not yet clear how such funding will be considered against the NRAC formula distribution of revenue.
2
4. REGIONAL PRIORITIES
The current Capital Funding formula adjusts resource distribution to reflect services provided in the Tertiary Centres to patients in surrounding Board areas to meet the equipment and other similar requirements.
Where significant strategic change is envisaged then Boards are expected to contribute an appropriate Capital Funding share as well as meeting revenue costs of regional projects. There is one specific project already agreed previously through the West region and included in previous years Capital Plans as follows :-
Quarriers Home relocation to South Glasgow
Funding for the Hub Initiative of £0.450m reflecting the share and working capital requirements for the East Central Territory have also been reflected.
5. STRATEGIC PRIORITIES
This Section reflects the components of the Capital Plan required to complete the Healthcare Strategy implementation.
The Equipping Project for FVRH completed in 2011/12 so the two remaining areas within this Section of the Plan are transport infrastructure associated with the Section 75 Agreement for FVRH and completion of the demolition programme on the Community Hospital sites. The latter is essential to remove remaining transitional revenue costs associated with the Strategy.
6. PRIMARY CARE MODERNISATION
Capital Funding has been provided to support specific Primary Care Premises requirements including addressing issues contained in the State of the Estate in terms of backlog maintenance in Health Centres and to support projects identified from the Primary Care Premises Review.
7. COMMUNITY HOSPITALS
Funding has been provided to complete the property related work to allow final service moves to both Falkirk and Stirling Community Hospitals.
Regarding future investment the Initial Agreement supporting the development of a Care Village jointly with Stirling Council and Forth Valley College is scheduled to be considered at the Board Meeting on 27th March 2012. This Project is being routed through the HUB initiative and therefore from an NHS perspective is a revenue finance project and therefore is not included in the Capital Plan for funding.
3
It is likely that consideration will be given to a similar project on the Falkirk Community Hospital site. This will require to be supported by plans based on service need and development.
7. Area Wide Expenditure
There are three main areas of planned spend as follows :-
eHealth
Capital Funding to support the priorities in the eHealth Strategy scheduled for consideration at the March 2012 Board Meeting
Medical Equipment Replacement Programme
There has been very significant investment in Medical Equipment as part of FVRH Project. As a consequence a significant proportion of equipment is new – future years Plans will however identify a sizeable pressure in 7-10 years time when such equipment will require to be replaced.
The Medical Equipment Group oversee the prioritisation of equipment requests from Units/Departments.
Property Maintenance
Funding has been earmarked to help address issues such as backlog maintenance highlighted in the national ‘State of the Estate’ Report. Whilst a significant proportion of NHS Forth Valley Estate is new with revenue payments covering lifecycle costs it is important that issues associated with the remainder of the estate are addressed.
8. Property Sales
Under new Capital Planning arrangements Property Proceeds are passed to SGHD and they are then utilised to support priority investment areas. A specific arrangement for NHS Forth Valley for 2011/12 and 2012/13 is in place that allows NHS Forth Valley Property Proceeds to be utilised to support repayment of SGHD Brokerage provided for Transitional Costs during implementation of the local strategy. This totals an estimated £ 3.634m in 2012/13.
Specific agreement has also been confirmed with SGHD allowing the receipts from the Bellsdyke Development which is a long-standing committed sale over a number of years to be retained locally.
4 There are a number of expected sales in future years arising from site rationalisation as part of the Healthcare Strategy including :-
Bannockburn Hospital Site Bonnybridge Hospital Site Kildean Hospital Site Orchard House Hospital Site (part) Surplus land at Falkirk Community Hospital Site Surplus land at Stirling Community Hospital Site
8. AFFORDABILITY INCLUDING REVENUE IMPLICATIONS
Affordability including the associated revenue and life cycle cost of Capital Spend must always be considered. However given that the majority of the Capital Plan provides funding for backlog maintenance and for completion of existing work there is limited additional revenue requirement from proposed Plan. In a number of areas funding is being used to support cost reduction.
As indicated SGHD provide revenue funding for up to 85% of additional revenue costs associated with property spend for HUB projects which supports affordability of such projects. There remains a risk that the consequences of this will impact on future NHS Board allocations ie top-slice on a national basis and the impact of such a mechanism on the NRAC parity positions is as not yet known.
5 9. ISSUES AND RISKS
High level risks and issues include:-
Public Sector Capital Availability : revised Capital Planning process and impact of pre-determined national priorities on public sector capital availability
Property Sales - values dependant on property market detailed planning permission for individual sites required before Bellsdyke proceeds are realised
Revenue Risk - impact of revenue model of funding future projects on a national basis - risk of 85% national funding for HUB Projects being fully utilised
NRAC Funding - impact on timing of projects and overall affordability of projects
Inflation - building inflation following economic downturn
10. CONCLUSION
The NHS Board is asked to
To approve the Capital Plan 2012/13 to 2016/17 in Annex A
Fiona Ramsay Director of Finance & Planning 21st March 2012
6 CAPITAL PROGRAMME 2012/13 - 2016/17 (Final) ANNEX A NHS FORTH VALLEY
Prior 2012 / 13 2013 / 14 2014 / 15 2015 / 16 2016 / 17 Future Total TABLE 1 Year Years Scheme Spend £'m £'m £'m £'m £'m £'m £'m £'m
SOURCES OF GENERAL FUNDING Scottish Executive Funding-General 3.855 4.986 5.515 6.255 6.255 6.255 33.121 SGHD UKGAAP PFI Reversionary Interest 4.610 4.610 4.610 4.610 4.610 4.610 136.930 164.590 SGHD UKGAAP PFI Reversionary Interest - New Acute Hospital -4.314 -4.314 -4.314 -4.314 -4.314 -4.314 -130.750 -156.634 SGHD UKGAAP PFI Reversionary Interest - Clacks Resource -0.296 -0.296 -0.296 -0.296 -0.296 -0.296 -6.180 -7.956 Hub Initiative 0.050 0.450 0.500 SGHD Primary & Community Care Modernisation Programme Underspend 0.455 0.725 0.500 0.500 2.180
Total General Income 6.161 6.015 6.755 6.255 6.255 0.000 35.801
Planned General Expenditure
Regional Priorities Hub Initiative 0.050 0.450 0.500 WoS - Quarriers Homes 0.169 0.169 Total 0.050 0.619 0.000 0.000 0.000 0.000 0.000 0.669 Strategic Priorities New Acute Hospital - Life Cycle Costs 144.535 144.535 New Acute Hospital - Camelon Roundabout 0.500 0.500 Clackmannanshire Health Resource Life Cycle Costs 7.340 7.340 Demolitions 1.258 0.755 1.000 3.013 Total 1.258 0.755 1.500 0.000 0.000 0.000 151.875 155.388 Primary & Community Care Modernisation Programme Primary Care Premises Review 0.430 0.265 0.500 0.500 0.500 0.500 2.695 Bo'ness Health Centre 0.025 0.235 0.260 P&CCMP General 0.000 0.225 0.500 0.500 0.750 0.750 2.725 Total 0.455 0.725 1.000 1.000 1.250 1.250 0.000 5.680 Community Hospitals Falkirk Community Hospital 1.200 0.250 1.450 Stirling Community Hospital 0.300 1.150 1.450 Total 1.500 1.400 0.000 0.000 0.000 0.000 0.000 2.900 Area Wide Expenditure Information Management and Technology Strategy 1.144 0.667 0.567 1.514 1.514 1.514 6.920 Information Management and Technology Strategy 2 0.500 0.500 0.500 0.500 0.500 0.500 3.000 Medical Equipment Replacement Programme 0.500 0.500 0.750 1.750 1.750 1.750 7.000 Property Maintenance 0.000 0.995 1.698 1.991 1.241 1.116 7.041 Total 2.144 2.662 3.515 5.755 5.005 4.880 0.000 23.961 Area Wide Other Expenditure Bed Management Contract 1.370 0.125 0.405 1.900 Total 1.370 0.000 0.000 0.000 0.000 0.125 0.405 1.900 Leasing Arrangements Care Village - HUB Finance On-Balance Sheet Addition 0.000 Total 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Total General Expenditure 6.161 6.015 6.755 6.255 6.255 152.280 190.498
Balance Available/(Required) 0.000 0.000 0.000 0.000 0.000 -152.280 -154.697
Forecast Property Sales Bellsdyke Land Development 0.578 0.739 2.290 1.041 0.716 0.500 4.324 10.188 Larbert House 1.000 1.000 Craigenhall 0.490 0.490 Gladstone Place 0.965 0.965 5 Randloph Court, Stirling 0.150 0.150 Bannockburn Hospital Land 1.000 1.000 Bonnybridge Hospital Land 1.260 1.260 Clackmannan County Hospital Land 0.330 0.330 Kildean Hospital Land 0.780 0.780 Orchard House Hospital Land 0.450 0.450 Alloa Health Centre Land 0.149 0.150 0.299 Camelon Health Clinic (TS) Land 0.000 Graham Avenue, Larbert, Garages Land 0.013 0.013 Barnton Street 0.100 0.100 1 Randolph Road, Stirling 0.450 0.450 Bo'ness Hospital Land Sale 0.050 0.050 Surplus Falkirk Royal Infirmary Site Land 0.000 Surplus Stirling Royal Infirmary Site Land 0.000 Total 1.417 3.634 2.290 1.041 0.716 0.500 7.927 17.525
Forth Valley NHS Board
27 March 2012
This report relates to Item 5 on the agenda
eHealth Strategy 2012-17
(Presented by Jonathan J Procter, Director of Strategic Access & Capacity Planning)
For Approval
SUMMARY
1. EHEALTH STRATEGY 2012-17
2. PURPOSE OF PAPER
The eHealth Strategy outlines the priorities for computer-supported healthcare in NHS Forth Valley over the next 5 years.
3. KEY ISSUES
The key priorities for NHS Forth Valley eHealth over the next 5 years will be:
. Development of a Clinical Portal Bringing together all elements of the patient record together in an easy-to-use, electronic health record will provide patient information to clinicians where & when required.
. Intelligent Diagnostic Test Requesting & Reporting The introduction of “Order Communications” will streamline the diagnostic test requesting process, reducing duplication of tests and eliminating elements on test preparation. In addition clinicians will be able to monitor requests.
. Hospital Prescribing & Medicines Administration ePrescribing and the subsequent recording of medicines administration should increase patient safety and reduce costs
. Community eHealth The development of an electronic community health record will support multi-disciplinary team working, leading to more effective care pathways and “releasing time to care”. Cognisance of supporting joint working will need to be considered.
. Telehealth When redesigning clinical services, consideration will be given to telehealth and other enabling technologies.
. Patient Portal Providing the ability for patients to interact with the NHS online. Facilities would include booking appointments, repeat prescriptions and eventually access to the patient’s record online.
. Partnership Working The appropriate sharing of citizen information (such as assessments) with partner organisations (eg social work) can only be achieved efficiently & effectively electronically. To support seamless care, a simple effective and secure approach needs to be implemented.
. Single PAS A single Patient Administration System across NHSFV will reduce support and maintenance costs, as well as encouraging consistency.
. Robust Infrastructure Fast, reliable access to information where & when required is crucial. Opportunities for integration and collaboration with Councils and other partners will be explored.
. Paper light NHS Forth Valley The culmination of many of the above priorities will be the facility to move towards a paperlight clinical environment. There are several pre-requisites – a robust reliable infrastructure; effective access control; key patient information available – however the key perquisite will be clinicians using the electronic health record.
4. FINANCIAL IMPLICATIONS
The financial plan for the eHealth Strategy follows a business case model. That is any development should be at worst self-financing and in most cases deliver efficiencies for the organisation.
5. WORKFORCE IMPLICATIONS
Use of computer technology is becoming an essential skill for all clinicians – this is reflected in the workforce development planning. In addition eHealth initiatives are often implemented in tandem with process redesign. NHS Forth Valley has a good track record of realising of benefits through eHealth-supported redesign.
Inevitably there may be implications for staffing requirements as part of eHealth developments. These will be managed in line with the Workforce Management Strategy.
6. RISK ASSESSMENT AND IMPLICATIONS
Risks to implementation of our strategy are recorded within the Corporate Risk Register that is routinely monitored through the Performance Management Group and relevant Board Committees. All business cases and project initiation documents include risk management.
7. RELEVANCE TO STRATEGIC PRIORITIES
The eHealth Strategy is aligned with the Integrated Healthcare Strategy and the national eHealth Strategy
8. RELEVANCE TO DIVERSITY AND / OR EQUALITY ISSUES
An Equality Impact Assessment has been undertaken.
9. CONSULTATION PROCESS
The refresh of the strategy (2012-2017) was untaken by the eHealth Consultant. A series of presentations, workshops and discussions were carried out with representatives of the following groups:
Clinical Units & CHPs Associate Medical Directors/CHP Clinical Leads Advisory Groups Executive Group/PMG Public Representative Groups Key Departments eHealth Groups Partner Organisations Internal Audit Scottish Government eHealth Directorate
In October 2011 a draft strategy was made available to all staff (via Staff News & Intranet website) for comment. An overview of the draft strategy was presented to NHS Board members in February 2012 along with a presentation of key system developments.
10. RECOMMENDATION(S) FOR DECISION
The Forth Valley NHS Board is asked to: -
Approve the NHS Forth Valley eHealth Strategy 2012-17.
11. AUTHOR OF PAPER/REPORT:
Name: Designation: Jonathan J Procter Director of Strategic Access & Capacity Planning
Approved by: Name: Designation: Prof Fiona Mackenzie Chief Executive
NHS Forth Valley eHealth Strategy 2012-17
FOREWORD
Over the last few years a quiet revolution has happened in the way healthcare is supported in NHS Forth Valley. Previously referrals took days to arrive at the hospital from practices – valuable days in the care process. Patients were discharged from hospital with a handwritten, dare I say sometimes illegible note for their GP. Laboratory results were sent to the ward who requested them – but the patient had moved. Hospital capacity was managed by staff who walked round the wards counting empty beds. Radiology images were available only if the clinician had the paper record.
All this has changed: • referrals are not just instantly available but also contain protocol-based information automatically extracted from the GP record • medication is recorded on admission and updated on discharge • discharge letters, containing full medication details, are sent electronically, available to the GP within minutes of discharge • laboratory results are available where and when required online • patient movement, and subsequent bed availability, is updated using electronic whiteboards • radiology images are not only available online but can be manipulated to provide the clinician with a better view • clinical correspondence is available online where and when required • patient assessments are increasingly available online to support shared care • ward (hand written) white boards have been revolutionised with electronic replacements that support patient care as well as bed capacity management.
This has been achieved by clinicians embracing the technology and taking a pragmatic approach recognising that it is about continuous improvement rather than “big bang”. Alongside the more obvious benefits of eHealth, has come an increasing consistency in the way things are done – this is a major principle of the national Quality Strategy.
There is still a long way to go. Technology has a lot to offer but we must continue to focus on maximising the benefits from systems. Introducing new equipment, new ways of working is not easy. The updated eHealth Strategy outlines how we hope to help improve the healthcare processes in Forth Valley. The strategy remains focussed on supporting direct patient care, whilst not forgetting the valuable contribution Information Management & Technology (IM&T) plays in other areas such as finance, performance management and strategic planning.
An increasingly prominent focus of the Strategy is on patient/public use of eHealth, whether passively on information websites or more actively through patient portals, touchscreen check-ins, self- assessments and telecare. eHealth has a role empowering the patient as a partner in their healthcare.
This strategy outlines how we will continue to build on our successes, which have been on both local and national stages. It illustrates how eHealth will support the Healthcare Strategy and become embedded in care processes.
Fiona Mackenzie Jonathan Procter Chief Executive Director/Executive Lead for eHealth
NHS Forth Valley eHealth Strategy 2 of 42 21 February 2012
ACKNOWLEDGEMENTS
We would like to acknowledge the following for their input to this document:
• Clinical & non-clinical staff from across Forth Valley • Partner organisations, including Clackmannanshire, Falkirk & Stirling Councils • Public & patient representatives • Scottish Government eHealth Directorate
Date of Publication: March 2012 Date of Review: March 2015
NHS Forth Valley eHealth Strategy 3 of 42 21 February 2012
Contents
Executive Summary...... 6 1 Introduction ...... 9 1.1 NHS Forth Valley ...... 9 1.2 Vision ...... 9 1.3 Aims & Objectives...... 9 1.4 Principles ...... 9 2 Strategic Context...... 10 3 Current Position & Future Direction...... 12 3.1 Supporting Health Improvement ...... 12 3.1.1 Strategic Development ...... 12 3.1.2 The Health of the Population...... 12 3.1.3 Child Health...... 13 3.2 Involving the Public...... 14 3.2.1 Digital Inequality ...... 14 3.2.2 Provision of Information...... 14 3.2.3 Public Consultation...... 15 3.2.4 Empowering the Patient ...... 15 3.3 Supporting Patient Care...... 17 3.3.1 The Electronic Health Record ...... 17 3.3.2 Patient Identification ...... 18 3.3.3 Clinical Communications Î Workflow...... 18 3.3.4 Primary Care ...... 19 3.3.5 Community & Mental Health...... 21 3.3.6 Emergency & Urgent Care ...... 23 3.3.7 Outpatient Clinics ...... 24 3.3.8 Inpatients...... 25 3.3.9 Diagnostic Services...... 25 3.3.10 Women & Children...... 26 3.3.11 Tertiary Care/Regional Developments ...... 27 3.3.12 Care Pathways...... 27 3.3.13 Telehealth/Telecare ...... 28 3.3.14 Health Records/“Turning off the paper”...... 29 3.3.15 Access to Records ...... 30 3.3.16 Service Information ...... 30 3.4 Supporting Clinical Governance ...... 31 3.4.1 Monitoring & Informing Service Provision ...... 31 3.4.2 Supporting Effective Care ...... 31 3.4.3 Performance Management...... 31 3.4.4 Data Quality...... 32 3.4.5 Equality & Diversity ...... 32 3.5 Working in Partnership...... 33 3.5.1 National Bodies ...... 33 3.5.2 Sharing Information ...... 33 3.6 Supporting Corporate Functions...... 34 3.6.1 Financial Services ...... 34 3.6.2 Human Resources...... 34 3.6.3 “Office” & Directory Services ...... 34 3.7 Promoting the Benefits of New Technology...... 36 3.7.1 Education & Training ...... 36
NHS Forth Valley eHealth Strategy 4 of 42 21 February 2012
3.7.2 Benefits Realisation...... 36 3.7.3 Innovation...... 36 3.8 Infrastructure...... 37 3.8.1 Availability ...... 37 3.8.2 Security & Confidentiality ...... 37 3.8.3 Identity Asset Management...... 38 3.8.4 Technical & Support ...... 38 3.8.5 Standards ...... 38 4 Management Arrangements ...... 39 4.1 Local strategy development...... 39 4.2 Taking the strategy forward ...... 39 4.3 National Governance ...... 39 4.4 Supporting Strategies ...... 39 4.5 Resourcing...... 40 4.6 Implementation ...... 40 4.7 A Responsive Strategy ...... 40 5 ANNEXES ...... 41
NHS Forth Valley eHealth Strategy 5 of 42 21 February 2012
Executive Summary
In August 2000 Forth Valley NHS Board agreed the Area-wide IM&T Strategy. This strategy provided a clear direction for the NHS in Forth Valley. The strategy was refreshed in 2004-05 and again in 2008-9. The main strands were:
• The development of an electronic health record, allowing real-time access by care professionals to up-to-date patient information subject to agreed access • The implementation of IT systems to directly support clinical care. • Better access to information on clinical effectiveness, quality of care and clinical decision support • Improved electronic clinical communication between clinicians. • Promotion of appropriate exchange of information with partner organisations, including local authorities • Underpinning initiatives with a robust and reliable infrastructure, with appropriate security and confidentiality
Since 2000 eHealth has revolutionised the way that healthcare is provided. Today most clinical communication, such as referrals, discharge letters, lab results and radiology images are available online and most are sent electronically. Bed capacity is managed online. Medicines reconciliation is recorded online checked against the latest GP current medication for the patient. Performance Dashboards provide up-to-date information and statistics and email has largely replaced the internal memo and, in many cases, external paper mail. Online protocols, guidelines and research help clinicians and support development of care pathways.
Easy, fast & up-to-date patient information leads to safe, effective & efficient care
The strategy builds on previous local strategies and the national eHealth strategy published in September 2011. The main priorities of the national eHealth Strategy are:
• maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money • support people to manage their own health and wellbeing, and to become more active participants in the care and services they receive • contribute to shifting the balance of care and support people with long term conditions and mental health problems • improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality • improve medication management as an essential part of peoples’ care
Core to this strategy is the concept of a “Paperlight NHS Forth Valley” – the retirement of the paper casenote. This will require not only adequate, robust & reliable information systems but, more so, a change in working practices from all staff involved in the care of the patient.
The benefits of a “Paperlight” health service include:
• Access to patient information where and when required, both within and outwith NHSFV • A fuller patient record • Fast, effective and efficient workflow, through instant clinical communication • Automatic documentation of workflow • Reduction in transportation, filing & storage costs for paper casenotes
All of which leads to a better patient experience as decisions are better informed and not delayed awaiting paper results.
Public access to services increases convenience, care outcomes and efficiency
Another key theme of the strategy, tying in with the Quality Strategy, is one of consistency. Consistency leads to better quality of service, patient safety, clinical governance, but also reduction in costs. eHealth offers possible improvements to the patient journey impossible with paper-based systems. eHealth can provide information where and when required; it can support and validate clinical
NHS Forth Valley eHealth Strategy 6 of 42 21 February 2012
decisions; it can prevent clinical incidents; and can provide an audit trail not possible with paper-based systems.
More prominent in this strategy is patient involvement - booking appointments online; self check-in at outpatient clinics; self-care supported by telehealth; or ultimately access and contribution to their own patient record. The plans for developing public access to superfast broadband outlined in Scotland’s Digital Future will be a key enabler. The public will be encouraged to become fuller partners in their own care, leading to improved outcomes.
The computer is an essential part of a clinician’s toolkit
This strategy outlines the future direction of travel, particularly highlighting areas requiring consideration as part of the implementation of the NHS Forth Valley Healthcare Strategy and nationally Better Health Better Care. The strategy is also consistent with the national eHealth Strategy recognising that NHS Forth Valley must play its part in wider eHealth agenda.
The evolution of eHealth in NHS Forth Valley is illustrated below:
Protocol-based Referral Discharge Electronic Health Record Online Diagnostic Results Emergency Care Summary (Clinical Portal) Websites Referral Management Test Requesting & Reporting Practice & Community Patient Tracking (Order Comms) Profiles Bed Management Hospital Prescribing Internet Access Medicines Reconcilliation Community eHealth GP Systems Patient Engagement Out of Hours Telehealth Mental Health Assessment Digital Dictation Partnership Working Barcoded Wristbands Nurse Handover Single PAS Service Information Infrastructure Activity Dashboards
Although realisation of benefits has always been implicit in the philosophy of eHealth implementation in NHS Forth Valley, this strategy gives it greater prominence. Simply installing a system is not enough – the challenge is ensuring the benefits identified in the original rationale are realised. NHS Forth Valley will continue to place great emphasis on getting the most from eHealth systems – eHealth embedded within the clinical care process as appropriate. This approach echoes the National Architecture Vision of ‘re-use before buy, buy before build’.
NHS Forth Valley have always taken a pragmatic approach to implementation with an emphasis on benefits realisation, recognising that systems, or indeed clinical processes, are rarely perfect. A degree of flexibility is often required to achieve progress.
A key challenge in the current financial environment is efficiency, or more explicitly, cost reduction. The financial model for this strategy requires that any development must demonstrate prior to commencement that it will, as a minimum, be cost neutral, and in many costs deliver savings.
The document remains a visioning document with little mention of specific system names – what is important is the direction of travel, not whether system A or system B should be used.
NHS Forth Valley eHealth Strategy 7 of 42 21 February 2012
The main priorities of the NHSFV eHealth Strategy over the next few years will be:
Development of a Clinical Bringing together all elements of the patient record together in an Portal easy-to-use, electronic health record will provide patient information to clinicians where & when required.
Intelligent Diagnostic Test The introduction of “Order Communications” will streamline the Requesting & Reporting diagnostic test requesting process, reducing duplication of tests and eliminating elements on test preparation. In addition clinicians will be able to monitor requests.
Hospital Prescribing & ePrescribing and the subsequent recording of medicines Medicines Administration administration should increase patient safety and reduce costs
Community eHealth The development of an electronic community health record will support multi-disciplinary team working, leading to more effective care pathways and “releasing time to care”
Telehealth When redesigning clinical services, consideration will be given to telehealth and other enabling technologies.
Patient Portal Providing the ability for patients to interact with the NHS online. Facilities would include booking appointments, repeat prescriptions and eventually access to the patient’s record online.
Partnership Working The appropriate sharing of citizen information (such as assessments) with partner organisations (eg social work) can only be achieved efficiently & effectively electronically. To support seamless care, a simple effective and secure approach needs to be implemented
Single PAS A single Patient Administration System across NHSFV will reduce support and maintenance costs, as well as encouraging consistency.
Robust Infrastructure Fast, reliable access to information where & when required is crucial.
Paperlight NHS Forth Valley The culmination of many of the above priorities will be the facility to move towards a paperlight clinical environment. There are several pre-requisites – a robust reliable infrastructure; effective access control; key patient information available – however the key perquisite will be clinicians using the electronic health record.
NHS Forth Valley eHealth Strategy 8 of 42 21 February 2012
1 Introduction
1.1 NHS Forth Valley
A range of health care services are provided to the population of Forth Valley including acute, community and primary care services. These are delivered from a variety of settings including acute hospital, community and day hospitals, health centres and clinics, GP, dental, pharmacy and ophthalmic practices. As the NHS Forth Valley Healthcare Strategy develops a range of changes are anticipated to enhance the standard of care for local people and visitors. NHS Forth Valley has three Community Health Partnerships; working closely with Local Authority partners, the voluntary sector and others to improve the health and healthcare of local communities though increased integration of services. The healthcare strategy is dependent on a range of developments in our eHealth/IM&T infrastructure.
1.2 Vision
The long-term vision for eHealth/IM&T developments is to provide the relevant information under the appropriate safeguards whenever & wherever required, utilising effective modern technological solutions, supported by training.
1.3 Aims & Objectives
This eHealth Strategy provides a summary of the main aims for development of information and IT within NHS Forth Valley. Its purpose is to inform the development of information systems up to 2015/2016 and it encompasses the services delivered throughout the NHS Forth Valley area in order to:
• Investigate, measure and monitor the health of the population • Maximise public and patient health gain from information technology • Provide information electronically to support clinicians and our partners in direct patient care and in development areas of Managed Clinical Networks and Clinical Governance • Promote the benefits of new technology and encourage innovation, and support these with training
1.4 Principles
The development of eHealth to support the Local Healthcare Strategy is underpinned by the following key principles:
• Clear benefit to the quality of clinical services should be apparent from the patient's perspective • There should be a move towards area-wide, cross-sector developments and common IM&T standards • Access to required information by appropriate staff at required time should be available • There should be comprehensive use of security and confidentiality measures and adherence to statutory requirements and professional guidance • Where possible, information should be accessed at source and entered only once • Strategic & management information should be a by-product of clinical information • Information should be useful and relevant to the originator of the data; this will lead to high- quality, accurate data • Where appropriate, existing systems should be utilised • Access to high quality training for all to support the use of systems
NHS Forth Valley eHealth Strategy 9 of 42 21 February 2012
2 Strategic Context
Forth Valley Health Board and associated hospitals developed its first IM&T Strategy in 1996, however this strategy concentrated largely on infrastructure. In August 2000 Making IT Better for Patients first articulated how the use of IT systems might directly support patient care. Since 2000 the “eHealth” strategy has been refreshed regularly building on both national and local NHS policy/strategy and the emerging technologies.
Delivering for Health set out a programme to shift the balance of care towards a system which emphasises a wider effort on improving health and well-being. A strong emphasis was placed on making the NHS an integrated service, so that patients experience a smooth and quick journey of care wherever and however they access services. In particular, there is a focus on wherever possible strengthening local services, with more support for self-care, more intensive case management for individuals with serious long term conditions, and with more capacity for local diagnosis and treatment. Accordingly, Delivering for Health1 looked for effective information systems and improved patient records as part of the infrastructure to enable the overall health care system, and wider care sector, to function effectively. There was a commitment to implement a national information and technology system including an Electronic Health Record2. Better Health, Better Care3, whilst not detailing specific eHealth initiatives, highlights a number of proposals which will require significant eHealth support. The first national eHealth Strategy was developed in June 2008.
More recently, the Scottish Government produced its Efficiency and Productivity Programme Delivery Framework4. The Programme aims to improve consistency of care, create a culture to support the efficiency agenda from a quality improvement perspective and provide a structured framework to support NHS Boards deliver greater efficiency and productivity over the next three years.
The Scottish Government has developed a Quality Strategy5 with the intention that Scotland will be recognised as a world leader in healthcare quality. The Strategy will be founded on the Institute of Medicine's six dimensions of quality (see diagram 5) and in particular, will focus on driving quality through delivering a patient- centred, safe, and effective healthcare system, whilst ensuring efficiency, equity, and timeliness are embedded within the joined-up actions taken forward locally and nationally.
NHS Scotland’s eHealth Strategy6 outlines an incremental, pragmatic approach building on progress that has already been made. There are 5 strategic objectives - they are to use information and technology in a co-ordinated way to:
• maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money • support people to manage their own health and wellbeing, and to become more active participants in the care and services they receive • contribute to shifting the balance of care and support people with long term conditions and mental health problems • improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality • improve medication management as an essential part of peoples’ care :
NHS Forth Valley eHealth Strategy 10 of 42 21 February 2012
The national eHealth Strategy encourages an outcomes-based approach, encouraging NHS Boards to work towards a convergent national approach based on evidenced added value from developments. The annexes contain the national outcomes-based template matching NHSFV initiatives with national priorities.
The recent publication of a Review of ICT Infrastructure in the Public Sector in Scotland by John McClelland7 highlighted a number of areas where ICT could enhance public services. The report recommended sharing of ICT infrastructure, ICT procurement, Data Centres and ICT support services across public sector organisations (eg health, local authorities, Police, Education, Central Government). The McClelland Report also made extensive reference to the proposed extension of public access to broadband across Scotland outlined in Scotland’s Digital Future8.
The NHSFV Healthcare Strategy9 highlights the following priorities for 2011-2014:
• Prevent ill health • Improve the experience of patients and involve them in their care • Increase the quality, safety and consistency of care • Work in partnership • Increase the effectiveness and efficiency of the services we provide • Deliver care as close to home as possible
To support this strategy there is a need for a number of eHealth-based initiatives:
• Access to up-to-date accurate patient information when and where required – this can only be achieved electronically • Patient/public interaction with the service via technology • Effective electronic workflow between care settings • Booking and scheduling of outpatient/day surgery care based around the patient rather than the service. • Online access to agreed protocols and guidelines for care. • Real-time information to support operational management • Joined up approach to support services with partner organisation
Provision of clinical records to the increasingly dispersed service is challenging in terms of ensuring the patient information is available where and when it is required.
Clinical governance is a framework in which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. The achievement of the 18 week referral to treatment target continues to be a significant challenge – eHealth initiatives underpin many of the process redesign and monitoring required10.
Information about standards of care is already available from a variety of sources, including clinical records, audit activities and departmental meetings. In recent years this has been enhanced by various information sources including clinical systems, clinical dashboards and practice profiles. Any future implementation of eHealth systems must continue to support clinical governance.
In addition to the key strategic issues mentioned above, the eHealth strategy is informed by, and should support, national and local strategies.
NHS Forth Valley eHealth Strategy 11 of 42 21 February 2012
3 Current Position & Future Direction eHealth developments in NHS Forth Valley will be prioritised on the predicted benefit to patients and the anticipated improvement in the health of the population. Benefit from eHealth developments should be supported by appropriate evidence.
Although the primary function of many systems will be to support the clinical process, it is important that maximum benefit should be derived from the information collected whilst ensuring patient confidentiality and compliance with the Data Protection Act 1998. Management information should, as far as possible, be a by-product of information collected for “front-line” clinical purposes.
3.1 Supporting Health Improvement 3.1.1 Strategic Development Strategy development needs to be supported by reliable and accurate information on:
• Effectiveness • Morbidity (predominantly from the NHS) • Predicted population by age groups (provided by Census and Registrar General) • Social factors (provided by local authorities) • Lifestyle (provided by local & national surveys) • Public Opinion (provided by surveys) • National Guidance • Legal Requirements/Legislation
Staff involved in the development of strategy should have ready access to NHS-wide intranet, the Internet, national guidance, and summary population and activity information. Supporting this process, library services will migrate increasingly towards electronically accessed information. A separate Library & Knowledge Services Strategy is available.
Activity information should be derived from operational and clinical systems. Clinical data collection systems will not be developed primarily to provide information for strategy development. Staff involved in strategy development will be encouraged to access, analyse and interpret information directly rather than through “information” staff. An online “information centre” will provide easy navigation to existing routine and other analyses.
The monitoring of health status and the provision of health care is a statutory function. Nationally available information resources (e.g. ISD website, HEAT) provide an increasingly useful high-level benchmarking of Health Status and Health Care; however more specific analyses will often be required (e.g. health needs assessments, more detailed waiting time information).
There is a need for the NHS to utilise the more holistic decision support techniques, such as forecasting, statistical epidemiology, continuous quality improvement, control charts, computer simulation, what-if analysis and general modelling methodology in evaluating the proposed configuration of services. These services can be provided internally or externally (ISD, Universities, etc).
3.1.2 The Health of the Population The Annual Report of the Director of Public Health informs the Healthcare Strategy regarding priorities for development. At the heart of the report are not only the trends in health status and performance against local and national targets, but also the relative inequalities in health between different sectors in the Forth Valley area and across the UK. The investigation, measuring and monitoring of the health of the population provide an essential element to improving that health status, whether by preventative or reactive initiatives.
NHS Forth Valley has a number of systems supporting screening programmes. As future screening programmes are developed or redeveloped, eHealth systems will support the call and recall processes.
NHS Forth Valley eHealth Strategy 12 of 42 21 February 2012
3.1.3 Child Health Child Health, and in particular Child Protection, is a high priority for NHS Forth Valley. Currently NHS Forth Valley does utilise the nationally developed Child Health Surveillance (Pre-school) and Standard Immunisation Recall System (SIRS) to support and monitor the health of children. However, much of the Child Health service is supported by manual/paper-based processes. The nationally-led systems are likely to be replaced in the next few years.
There is a need to modernise not only the supporting systems, but also the underlying processes.
The introduction of systems to support the nationally led Special Needs, School Nursing and the online Scottish Birth Record will be investigated, in line with national systems development.
NHS Forth Valley will follow national guidance to facilitate the sharing of information with partner organisations. In particular it is important that there is effective, yet secure, sharing of information relating to Child Protection. NHS Forth Valley will work with the local councils and Police to ensure eHealth facilitates this information sharing (see also Sharing Information).
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3.2 Involving the Public
The general public has always been interested in health and health care and, with the increasing media coverage and use of the Internet, is more informed about treatments available, health scares, etc11.
3.2.1 Digital Inequality In October 2004 only 48% of Scottish households had access to the internet. By 2011 the UK figure had risen to 74% of households12 13, with Scotland trailing slightly at 61% in 2011. Take-up of broadband for the local council areas ranges from 65% to 69% in 2011. In Scotland over 93% of households have digital TV access in 2011, whilst 88% have mobile phones14.
In 2010, 30.1 million adults in the UK (60 per cent) accessed the internet every day or almost every day15. This is nearly double the estimate in 2006 of 16.5 million. Over recent years the ways to access the internet have increased and become more user-friendly – mobile phone, digital TV, SmartTV, games console, etc
In May 2011 Office of National Statistics reported that over 80% of Scots had used internet – conversely almost 20% had never used the internet16.
Internet use is linked to various socio-economic and demographic indicators, such as age, location, marital status and education. For example, the majority of those aged 65 and over (60 per cent) had never accessed the internet, compared with just 1 per cent of those aged 16 to 24. While 97 per cent of adults educated to degree level had accessed the Internet, 45 per cent without any formal qualifications had done so.
In 1999 the Scottish Executive considered development exclusively on websites as inappropriate until plans to expand internet access were underway17. With the increasing use of a wide range of web- enabled devices a large proportion of the population expects information and services to be available online.
However, the main NHS “customer-base” tends towards from those socio-economic/demographic groups which have lower internet access (eg elderly). Caution is still required when considering internet-based services; however consideration should be given to patient access where appropriate.
The Scottish Government and local councils have a number of initiatives providing public access to the internet. These initiatives will increase the proportion of the public being “digitally connected”, either via PC, Digital TV or other devices. NHS Forth Valley will continue to develop the use of web-based services for the public – these will empower the public and lead to service efficiencies.
3.2.2 Provision of Information A well-informed public can make more effective use of the health service. The internet and other media have a role in facilitating deeper understanding amongst patients. The NHS Forth Valley public website outlines the health services available in the area and provides primary care practitioner details and other relevant information:
• Local available services and how to access them • Health Promotion • Health Education • Self-care • Effectiveness of treatments • How to make complaints • Health of the population of Forth Valley
This website will continue to be developed and the public will be encouraged to be involved in this development.
The Freedom of Information Act18 gives the public a right to access information held by public organisations, subject to specific exemptions. The NHSFV public website will increasingly provide the public with the more commonly requested information.
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The public have access to internet sites such as Health Scotland and NHSFV Health Promotion, which provide health promotion material. Beyond this service information (eg clinical guidelines, patient pathways, etc), though aimed at clinicians, is available to the public – by continuing to provide this information the patient can be empowered to become a true partner in the clinical decision process.
3.2.3 Public Consultation Communication is not just about informing - it also involves listening. Further it is about creating understanding to allow patients to become real partners in their care and make truly informed decisions. Webpages can support the consultation process through email, electronic questionnaires and discussion boards. This will be informed by the developing Patient Focus Public Involvement Strategy.
With specific respect to eHealth Strategy, NHSFV will continue to look for patient / public involvement through various groups & fora including Public Partnership Forums, Patient Panel, Public Involvement Network, Local Community Councils, and Community planning partners actively encouraging them to take an interest in eHealth issues
3.2.4 Empowering the Patient Increased involvement of the public in provision of healthcare, through technology can improve the efficiency of the service – for example, over 91% of the UK public (in 2011)19 had mobile phones capable of receiving text message reminders for appointments, potentially reducing failures to attend. Other service industries such as banking (online banking) and supermarkets (self-checkout) provide evidence that involving the public can reduce the administrative burden and provide benefit to the customer/patient.
A couple of potential examples for a patient attending an outpatient clinic:
• a patient could complete the required information (ie personal details, self-assessment) online at home prior to attending • a patient could complete the required information (ie personal details, self-assessment) using a touchscreen device on arrival at the clinic
The public currently have the right to access their Health records20 21. NHS Forth Valley would like to move towards a safe and secure method to allow the public direct access to their health record. As well as supporting relevant legislation, easy access to their own health record would encourage self-care and improve data quality. An area of particular priority would be patients with long term conditions.
The table below illustrates areas where NHSFV would like to use public participation to enhance the service for both user and service:
Development Benefit to Public Benefit to Service
Online access to patient records Able to review at leisure Patient as partner in clinical decision Better informed
Access to test results
Partner in clinical decision process
Patients correcting or updating Ownership of information More accurate information records (eg address)
Patients self-monitoring against Ability to set targets Patient as partner in care targets (eg weight-loss, smoking, diabetes) Ability to check progress Additional information
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Online booking of appointments More convenient Reduced failures to attend (see primary care) More control Reduced admin costs
Quicker
Remote printing of repeat More convenient Reduced admin costs prescriptions (see primary care) Reduced number of GP appointments
Online “email” consultation (see Quicker Quicker primary care) More appropriate for nagging Reduced number of GP worries appointments
Telecare Self-monitoring (see Reduced number of Reduced number of telecare section) appointments appointments
Ownership of condition More appropriate use of services
Self-care
Email/SMS appointments (see Quicker Low cost secondary care)
Email/SMS appointment Appointment no missed Reduced ‘failures to attend’ reminders
Self check-in at outpatients (see Quicker Reduced admin secondary care)
Ultimately these various public-facing initiatives will be brought together to form a “patient portal” – a web-based area where the patient can request appointments, review correspondence & test results, set personal goals/targets (eg BMI), etc allowing patients to become true partners in their own health care. This will have particular benefits for those with longer term conditions.
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3.3 Supporting Patient Care 3.3.1 The Electronic Health Record The development of electronic health record is central to this strategy. Having a real-time, updateable person-based care record available when required provides clinicians with many benefits22 23 24 25 26 27, including:
• Improved communication between care professionals through sharing of information • Improved consistency and quality of care through multidisciplinary care protocols as an integral part of electronic health records • Enabling quicker clinical decisions, as diagnostic information (e.g. labs, radiology) are available immediately • Fewer repeated tests • Improved overall efficiency, as nearly all services/professional groups can share patient and management data quickly and reliably without retyping or postal delays • Reduced records handling and storage • Real-time support from the electronic health record, as it details services currently received and summarises patient history • Better-integrated care through shared care records • Increased patient safety through correct patient identification and access to the wider patient record
The electronic health record will be developed using an evolutionary approach – this approach is reflected in the national eHealth Strategy. The virtual record will not be a single system but a combination of specialist systems. The electronic health record will allow all clinical staff access to appropriate patient information, subject to access rights.
Lab SCI Results Store Radiology PACS Images A&E A&E attend- System ances Allergies & ECS Current Medication Demog- CHI or raphics NHS & Store Social eCART Work or MAS Assess- Out of ments Out of Hours Care Hours Clinical System EDMS Letters Referrals Gateway or EDMS
Se Cli Ac pa nic ces ra al P s C te or on Sy tal tro ste l ms
The Clinical Portal will be the “window” to this virtual electronic record (see diagram). The Clinical Portal solution will allow clinicians to:
1. Log on with a single username and password (see later) 2. Access patient information via the appropriate system without the need to re-enter logon details 3. access patient information without the need to re-enter the patient details
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The screenshot below is from the NHS Tayside “demonstrator” Clinical Portal and illustrates how the electronic health record may look.
Key to the Clinical Portal will be effective systems integration. NHSFV will use the nationally procured integration tool, Ensemble, and will work with other Boards to standardise interfaces as far as possible.
3.3.2 Patient Identification
For the electronic health record to be successful, the use of the Community Health Index (CHI) on all clinical communications, paper or electronic, is essential. The CHI will be available to all systems locally via the SCI Store.
The use of CHI is not simply an eHealth issue – incorrect identification of the patient is a clinical safety issue. The mismatching of lab results can result in incorrect diagnosis and subsequent treatment. The mismatch of a blood transfusion can result in very serious consequences.
To support the universal use of CHI, the wide spread use of barcodes (eg on requests, blood packs, patient wristbands, etc) together with scanners improve data quality and speed by minimising requirement to type in information and improve patient safety.
For all new systems CHI should be the main identifier.
3.3.3 Clinical Communications Î Workflow eHealth is seen as a critically important supporting tool, supporting the current care pathways and influence the redesign of care pathways.
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Electronic protocol-based referrals reduce the workload at practices through automatic completion of basic information (patient demographics, prescribing information, etc). On receipt of these e-referrals the details automatically populate the secondary care systems, again reducing administrative workload. Referrals are clinically managed online by secondary care clinicians, with the referrer being informed instantly of the outcome.
In addition key clinical communications from secondary care to primary care (eg lab results, discharge letters, referral acceptance) are transmitted electronically. This is safer, more secure and faster, supporting continuity of care between services. NHSFV will continue to extend the use of eReferral where appropriate.
Workflow communications will continue to be a major focus of eHealth Strategy, however, not simply replicating existing workflow but enhancing and supporting innovation. For example, recent pilots have shown that an online “referral for clinical advice” can reduce the need for actual referrals, whilst also saving time for both GP, consultant and the patient.
In addition to completing internal NHS workflows (eg AHP services), there are still many workflows that could be streamlined through effective use of technology, including:
• Outpatient clinic outcomes (eg the clinic outcome letter & medication communications) • Social Work • Child Protection
As the diagram above illustrates a secondary benefit of electronic workflow is the automatic “filing” of communications into the Electronic health record (via an Electronic Document Management System)
Clinical email has proven a simple yet effective and secure approach for clinicians to communicate. Whilst increasingly the more structure workflow described above will be preferred, it is anticipated that clinical email will continue to provide a pragmatic solution to some communication requirements.
3.3.4 Primary Care Following the report on GP IT Systems28, over the last few years General Medical Practices (GMPs) have been migrating across to EMIS. NHSFV agreed with its GPs that there were significant benefits to moving to a single supplier across the area, including consistency of training, data standards, support and importantly providing a common platform for future developments. All practices should now be using EMIS.
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The intention will be for all practice systems to be hosted centrally within NHSFV to enable fast and consistent technical support, reducing the burden on practice staff.
With all practices using the same system, the use of EMISweb will provide opportunities for controlled sharing of key information to support continuity of care outwith both normal practice hours and across different sectors. For example, increasing community nurses are working/covering across several practices – EMISweb will enable them to access and update patient information ensures improved patient care.
Access to patient information is required by GPs, not just in the consulting room, but also out and about. Increased use of mobile devices (eg tablet PCs, PDAs, etc) will provide information either real-time (via remote access) or near-real-time (download/upload synchronisation).
Today much of the GP clinical correspondence is online (eg referrals, discharge documentation, lab results, radiology reports) – this has encouraged a consistent approach whilst speeding up the process. The main exception is the requesting of pathology tests and the referral to radiology. The introduction of a system to automatically populate diagnostic test requests, transmit this information to diagnostic services, monitor progress and receipt test results will both save time and, more importantly, improve patient safety. See later for more details.
Recently Rheumatology & Respiratory Services have been piloting the use of SCI Gateway to offer GPs an online clinical advice service, where the consultant can provide responses to specific patient queries. The “referral for advice” automatically includes relevant patient details including current medication, and the referral and advice are documented and stored for clinical governance purposes. The pilot was very successful, with some “physical” referrals being avoided, and rollout to other services is to be considered.
Taking the “referral for advice” a step further, many patient consultations in primary care could be avoided by patients being offered an “email consultation”. The patient sends in a question online, the GP responds online and the conversation is filed in the patient record. At least one practice in NHSFV is already trialling this approach.
A key issue that will need to be addressed over the next few years is that of patient confidentiality and the sharing of patient information. This is particularly relevant in Primary Care due to the contractor status of practices. Patients expect the confidentiality of their health information to be respected and the Data Protection Act supports this view. Patients also expect the healthcare professional to have access to their health information where and when required to provide safe and effective care and the Data Protection Act supports this view also. Patients do not necessarily recognise the organisational boundaries. There is a need to balance to risks of confidentiality breaches with the risks to effective clinical care and to agree policies to minimise both.
If GPs are predominantly using electronic records then the ability to pass that record between practices when patients change practices must be addressed.
In the early section on Empowering the Patient, there were a number of initiatives that will impact on Primary Care:
• At present patients phone the receptionist for an appointment – appointments are rarely refused. Giving patients the ability to book appointments online should not change the number of appointments but will reduce the amount of time the receptionist has to answer the phone – it also allows the patient more choice regarding when the appointment is.
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• Allowing patients to print off their repeat prescriptions will reduce appointments and reduce the administrative burden on the practices. Combined with the evolving Community Pharmacist role (see below), this could have significant benefits for both patients and the health service.
It is worth noting that patient access to primary care services is not unproven – all the initiatives mentioned are already in place in practices in Scotland, including NHS Forth Valley, and elsewhere.
In 1994 practices in Forth Valley were the first in Scotland to receive practice activity information – Practice Profiles. Since then the information has become more sophisticated both in content, presentation and access. The profiles provide valuable information to support self-audit and planning, as well as supporting the contracting process. The profiles will continue to evolve – with more sophisticated data warehousing technologies, there should be a move towards near-real-time practice activity. This would allow practices to be more agile in responding to particular issues – for example, changing prescribing practices or referral patterns. The use of EMISWeb will provide a platform for enhanced, potential real-time, reporting.
All General Pharmaceutical Practices (GPPs) are now connected to the NHS network, with access to clinical email and other eHealth support. As the role of both pharmacist prescribers and the Chronic Medication Service develop, access to current medication information will be essential. Access to current medication and allergy information for community pharmacists should be considered given the role of community pharmacists in providing out-of-hours services for the NHS. Access to test results for community pharmacists could also be beneficial as their clinical role develops.
Some GPs & Community Pharmacists have identified a need for better two-way communication – another area of potential for “referral for advice”.
Electronic transmission of prescriptions - minor ailments service, acute and chronic medication services - supports both the efficient reimbursement of pharmacists but more crucially a more convenient and effective service to patients.
All General Dental Practices (GDPs) are now connected to the NHS network, with access to clinical email and other eHealth support. In addition the majority of practices now refer to secondary care using the eReferral system.
NHSFV has been piloting the use of eReferral from Community Ophthalmic Practices – the early indications support pilots in other areas that eReferral is faster, more complete and easier to process by the Ophthalmology service. The rollout of this facility also matches the general strategic view that all referrals should be electronic. Whilst widespread connection of Ophthalmic practices to the NHS Network (cf GDPs, GMPs, GPPs) may not be financially viable, NHSFV will endeavour to provide GOPs with eReferral.
3.3.5 Community & Mental Health In supporting service change in “Shifting the Balance of Care” good quality information on services provided in the community will be essential. Further, as care is provided more in the community, the development of electronic records to support community staff will be essential.
Community services currently use a computerised system (PiMS). However this is predominantly used as a patient administration system. A Community eHealth paper in 2010 recommended moving away from PiMS and towards a single PAS across NHSFV (see Health records section).
The community health record will support a multi-disciplinary approach, allowing shared access to assessment information as well as supporting workflow. Highlighted in the review of community nursing in Clackmannanshire, eHealth will help reduce administration work for nurses, releasing time for patient care. Online records will also allow more flexible working as nurses move towards more team-based working.
Mental Health and Learning Disability services require similar shared assessment and workflow type functionality; however this service has already invested in the FACE assessment approach and associated online system. Whilst moving towards a single assessment system may form a longer term strategy, it is not considered a strategic priority to address this over the next few years – the Clinical Portal will address any need for shared information.
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Inpatient Mental Health does not currently have bed management, eDischarge or Medicines Reconciliation (cf acute services). NHSFV will introduce this functionality, ensuring consistency of approach across all inpatient facilities. Similarly outpatient management systems (mentioned in a later section) will be consistent across NHSFV, where appropriate.
Whilst less “linear” than acute services, workflow management (eg referrals, discharges, etc) should be controlled ensuring clinical governance. eHealth systems, such as SCI Gateway, can support this. Already a single point of referral for Mental Health services in Clackmannanshire is less confusing for GPs and supports effective management of care and resources. eHealth has a role to support the management of long term conditions such as diabetes, asthma, deafness, etc. eHealth support can be broken down into a series of types:
• Supporting self-care, either by an electronic record (supporting target-setting, etc) or by provision of support information
• Supporting remote monitoring (eg diabetes) using telecare technology
• Provision of registers to support epidemiology, research and planning
NHSFV supports developments in all these areas. The challenge is building viable business cases to allow these, often innovative, to become mainstream rather than pilots. Inevitably these will be considered on a case-by-case basis.
Working with national agencies the electronic Palliative Care Summary allows patients via their GP to highlight their wishes with respect to end-of-life care. Though based on similar technology to the Emergency Care Summary (see later section), this national system requires patients to “opt-in”.
In October 2011 the NHS took over responsibility for the provision of healthcare within Scottish Prisons. There are 3 prisons in the NHSFV area – Corntonvale, Polmont and Glenochil. Currently the use of IT within Prison Health is minimal, however for health provision to become integrated with the wider NHSFV provision the following will be considered as minimum requirements:
• Access to NHSmail • “Practice-level” electronic health record system • eReferral • Online access to diagnostic results • Online access to Electronic health record /Clinical Portal as appropriate
Whilst separate organisations, there is a requirement for social work and health service provision to be integrated. Subject to appropriate permissions, assessment information should be shared between (health & social) care professionals; and workflow should be efficient and effective. As organisations evolve it will be necessary to ensure that IT systems are supporting seamless care to the patient/client. The eCare Project has not delivered benefits locally - the Forth Valley Partnership needs clear direction and support both locally and nationally to ensure there is a way forward agreed by all partners.
A particular workflow is the management of child protection. The nature of this sensitive area requires fast, effective but secure communications. Councils, being co-ordinators of child protection incidents, need to receive concerns, identify the extent of the concerns and inform all potential care professionals (including police) of current investigations. IT systems need to reflect and support the agreed processes. Similar systems are required to support vulnerable adults and flag up potentially violent persons. Any flags need to be readily accessible to healthcare professionals at the point of contact (or before) with the patient.
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3.3.6 Emergency & Urgent Care eHealth already has a key role in the effective provision of emergency & urgent care services including Accident & Emergency, Minor Injury Services and out-of-hours services, in conjunction with NHS24.
The availability of limited emergency care summary (ECS) information (see screenshot) on patients online is already proving valuable in supporting seamless patient care. In Forth Valley access to ECS has been extended to clinicians in all acute admissions. In particular, access, with patient consent, to allergies and current medication for inpatient services pharmacists provides more accurate drug history information and subsequently reduces medication-related risk.
Further potential benefits have been highlighted – for example, automatic population of the medicines reconciliation on admission which would save time and reduce human error. However any extension to the use of this information will be carefully considered both locally and nationally.
Currently A&E and Common Assessment Unit (CAU) assess and treat patients in cubicles with the shared computers outwith the cubicles. For the paperlight hospital to become a reality, PCs need to available at the point of care – for example, the patient arrives in the cubicle, the clinician scans the barcoded wristband and the patient record appears on-screen.
Currently the A&E system is used to track patients with limited clinical benefit. Next steps will be to further exploit the clinical aspects of the system including seamless access to ECS and generation and sending of electronic Discharge Letters (with storage on the document management system – see EDMS below). As a decision is made (patient admission, referral to specialty, discharge, etc) the A&E system should automatically pass the relevant information to the “downstream systems”.
NHSFV notes that the national funding for EDIS ceases after 31 March 2013. NHSFV will consider longer term provision of A&E support following the agreement of a single PAS/PMS (see below).
The Service Information Directory contains agreed clinical pathways available online to clinicians. However in a busy clinical environment, this information needs to be more embedded in systems – either as embedded guidance or longer term as prescribed workflows in the system.
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The GP Out-of hours Service currently uses the NHS Tayside system, TAYCARE, to support and record activity. This system has limited functionality and will be replaced over the next year. The new system will enable seamless communication with NHS24 and ECS, together with improved clinical support.
The provision of paper health records to support urgent & emergency care is difficult – many other NHS Boards do not provide paper records. NHSFV has persisted in trying to provide patient information in the belief that this information is valuable to support patient care. It is believed that in the near future the provision of paper records should be stopped with patient information available online.
3.3.7 Outpatient Clinics The workflow relating to consultant outpatient clinics is increasingly supported by ICT systems:
• The protocol-based referral is send electronically, having automatically populated key information from the GP system • The referral is “vetted” online by the clinician, with a confirmation sent back to the referrer. • The appointment is booked, with the system supporting patient-focussed booking • The outpatient management system supports the receptionist managing the clinic • The clinician dictates a clinic outcome letter which appears in a worklist for the secretary • The secretary types the letter which automatically is stored in the electronic Document Management system (EDMS - see later)
However there is more than can be done to support the whole outpatient clinic process:
• The appointment could, if desired by the patient, be sent by email or to a mobile phone – quicker & saving postage costs • The patient could choose their appointment slot online – convenient, reducing failures to attend and admin resource • The patient could self check-in using touchscreens on arrival, collecting valuable information and freeing-up reception time • The clinician should be able to order diagnostic tests or refer the patient online – reducing paper forms and improving workflow • The clinician could dictate the letter direct using voice recognition software, reducing secretarial time • The “request for medication change” could be generated & send electronically rather than given to the patient – improving clinical governance and patient safety • The letter could be send electronically to practices – saving transportation and filing costs
At the core is the consultation itself. In 2010 and 2011, NHSFV have been looking to pilot/introduce “paperlight clinics” – that is, clinics with no paper record provision. A number of paperlight clinics have been established using EDMS as a source of clinical correspondence. The provision of paper records has a significant overhead associated with it – pulling files, transportation, filing, etc. Online patient records need to be reliable, robust and easy-to-use. Additionally all clinicians need to “buy-in” to the concept.
Clearly the types of information required will vary between specialties, however NHSFV is committed to reducing paper trails and the associated governance risks and costs. Additionally it is hoped that together with wider organisational development, eHealth will encourage a more consistent outpatient clinic process.
The scheduling of outpatient clinic facilities is complex. A recent project outlined the need for scheduling software, potentially linking through to theatre scheduling and bed management. Whilst the full pathway scheduling may be longer term eHealth should support outpatient facility scheduling, preferably within the outpatient management system, but if not then a separate scheduling system. This would reduce the administrative burden and clinic cancellation.
These changes should become the default position for all outpatient clinics, with minor variations to suit local requirements. This will lead to increased standardisation and thereby an improved quality of service.
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3.3.8 Inpatients The Healthcare Strategy and Delivering for Health both indicate shorter lengths of stay and increased turnover of patients in the acute setting. Effective bed management is crucial to this way of working – the hospital managers and clinicians need up to the minute bed availability.
All acute and rehabilitation wards use a generic ward management, eWARD. This provides support for care planning, ward rounds, discharge management (sent electronically to GPs and community nurses) and capacity management. In particular eWARD supports effective and safer medicines reconciliation on admission and discharge, automatically populating the discharge correspondence. All acute services wards now use an electronic Whiteboard to support patient care and bed management in “near-real- time”.
NHSFV will extend the functionality provided by eWARD to all other inpatient facilities – that is, Mental Health and Learning Disabilities inpatient wards. This will support consistency of approach in discharge planning, pharmacy and bed management.
The success of eWARD has been due to the system development responding to service requirements – clinicians, eHealth professionals and systems developers working together to support care processes. The eHealth support in inpatient facilities will continue to evolve as clinicians become more confident with eHealth. For example, the development of functionality to support management of non-elective admission via the Common Assessment unit and A&E will lead to a more streamlined clinical process whilst saving clinical time through reduced duplication of data entry.
Currently the prescribing and administration of medicines is paper-based with significant potential for error through poor handwriting. The current system is also inefficient both in terms of supporting the most cost-effective prescribing of medicines and the staff time spent managing the paper based prescribing, supply and administration. Development and implementation of an electronic prescribing and administration system, with embedded decision support will improve the quality and efficiency of the prescribing process. Needless to say, the introduction of electronic prescribing and administration will be a significant project, not just from a system perspective but from changing ways of work.
In-house systems and paper-based systems are increasingly difficult to support and often encourage unnecessary inconsistency. The use of such systems will be reduced by either utilising existing mainstream systems or building eForms in EDMS (see Health records section below).
Together with introducing diagnostic test requesting (see section below) NHSFV intend to move towards a paperlight inpatient ward over the next 3 years.
Management of inpatient wards will be enhanced by the further development of dashboards providing clinicians and managers with “near-real-time” activity and performance statistics.
Currently the Theatre Management Systems does not provide national data returns and is increasingly “old-technology”. Though not considered an immediate priority, a business case to replace the theatre management system should be considered in the next 4 years.
Of more immediate priority is provision of appropriate information at the pre-operative assessment and the ability for anaesthetic records to be maintained in real-time through the various stages. This would reduce clinical risk and unnecessary duplication.
3.3.9 Diagnostic Services Film-less diagnostic images through use of Picture Archiving and Communications Systems (PACS) has been introduced as part of the planning for the new acute hospital. PACS provides fast, easy,
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universal access to diagnostic images and reports, allowing clinicians, referring physicians, radiologists, and other authorised staff to view images and information on-site or at remote locations.
Provision of laboratory results and radiology reports via SCI Store allows clinicians across NHSFV easy access to a patient’s current and past results. Further lab results are now passed electronically direct to GPs, removing the need for paper results.
The introduction of barcoded addressographs Clinician decides across acute services has to request test significantly reduced processing times and demographic errors. However the requesting Request is and processing of automatically diagnostic requests populated with remains an major area for patient demographics & improvement. The requester details introduction of “intelligent test requesting” would support safer and more efficient processing of test Clinicians ticks requesters (see required tests + workflow). free text if required
Intelligent Test Requesting would support protocol-based requesting (cf electronic referrals) but also provide clinicians with a contemporary list of test requests. The likely benefits are reduction in duplicate tests and prompting of clinicians to record Request Details actions against results, as well as streamlining the requesting process. As automatically approximately 50% of diagnostic tests are requested from primary care, it is populate important that Intelligent Test Requesting is area-wide. Diagnostic System
There are a number of options to implementing Intelligent Test Requesting (also known as Order Comms), which will be considered as part of a business case Requesting development. Intelligent Test Requesting is considered a critical element of the Clinician can move towards a paperlight NHSFV. check progress of requests at any time online The laboratory system in NHSFV is almost 20 years old, although it has been upgraded several times during this period. The general opinion is that the data quality and structure in the current system is poor, with an associated clinical risk. In conjunction with the business case development for Intelligent Test Requesting, When result is consideration should be given to improving this situation. Laboratory systems are available, flagged expensive, therefore consideration should be given, not only to replacement but also up to requesting clinician to the option of reconfiguration/data clean-up. Again a business case will be developed as appropriate.
3.3.10 Women & Children Maternity services have been recording episodes on a clinical system for over 10 years. This system, though modernised/upgraded 5 years ago, now has gaps in functionality and options for replacing/redeveloping should be considered. Consideration should be taken of the regional/national requirements as well as local needs.
The Scottish Women’s Handheld Maternity Record (SWHMR) has proved popular with pregnant women. A potential development of this concept would be to make the record available electronically with women and clinicians sharing access. As well as supporting a partnership approach, this would reduce the risk of lost records. NHSFV supports a move towards a national SWHMR-enabling system, however in the absence of such a development, NHSFV will look to procure or develop their local maternity system to support web-based access by expectant mothers.
Currently Child Health Services use a suite of national systems, which support national reporting. These systems are old-fashioned with limited access and do not support the care professional. The
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paper records are required by staff in the community and in schools, however the central storage means wasted time travelling to and from this central filing location. A medium term aim is to review Child Health processes with a view to supporting remote access to records.
Child Protection is a major priority for all local public service partners. The management of child protection cases should be supported by effective information sharing. NHSFV staff should be aware of children and associates who are either on child protection registers or subject to child protection investigations, and effective and efficient processes supported by IT systems to aid investigations should be in place.
The Community eHealth system currently being implemented will support both Child Health services and Child Protection processes.
3.3.11 Tertiary Care/Regional Developments Whilst 90% to 95% of care for the Forth Valley population is provided within NHS Forth Valley, a significant minority is provided outwith. This includes the regional and national centres such as the Beatson Oncology Centre and the Golden Jubilee Waiting Times Centre, but also more routine cases.
Together with other NHS Boards, NHSFV will contribute to effective but appropriate sharing of patient records. NHSFV is supportive of the national convergence on Ensemble as the preferred system integration layer and the national systems architecture to support sharing of patient information.
Further NHSFV will develop the use of SCI Gateway as the nationally agreed method for protocol- based tertiary referrals. Already NHSFV sends Cardiology referrals to Golden Jubilee Hospital using this method.
NHS Forth Valley will consider regional developments with partner NHS Boards, where on a geographic basis or in relation to size of board. Current examples include Chemotherapy ePrescribing, Telemedicine and Renal Services. The “regional” grouping will depend on the clinical services – for example, stroke services in NHSFV tend to participate on an east of Scotland basis whilst cancer services are based around a west of Scotland basis. In other instances, a partnership of smaller (non- teaching) boards might be appropriate. Regional developments will require to be approved as outlined in the financial plan.
3.3.12 Care Pathways The use of generic systems can support consistency of care and workflow across NHSFV – for example, eReferral, eDischarge, Medicines Reconciliation, Patient Administration, etc. However there will be occasions where specific care pathway support systems are required.
Clinical support systems provide a number of benefits to the clinician including:
• Clinical access to patient demographics and medical history • Protocol-based support for diagnosis and treatment in accordance with agreed clinical pathways • Ability to record and monitor clinical assessments • Ability to record and view current medications and interventions, including prescribing (particularly useful in multi-disciplinary care) • Ability to review workload and effectiveness
The requirement for clinical support systems will vary between care pathways. For many pathways the generic support systems (eWARD, EDIS, MIDIS, etc) will be sufficient. Other pathways may require more specifically tailored datasets or systems. Lessons learnt from previous such systems indicate the following guiding principles:
• Supporting the clinical/care process is paramount • Keeping the dataset to a minimum encourages compliance • Minimising duplication (particularly with paper processes) is critical
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Of particular mention is the requirement to record & share patient assessments. MIDIS, FACE & EDMS have functionality to develop assessment forms and should be considered in the first instance.
Patient pathways following entry to the healthcare setting can be complex, involving onward referral internally or outwith NHSFV. Currently such referrals are often unstructured leading to clinical governance risks. NHSFV will look to structure these referrals using existing systems, predominantly SCI Gateway though other mechanisms will be considered if more appropriate. Not only will this improve clinical governance but also support the 18 week Referral-to- Treatment targets.
3.3.13 Telehealth/Telecare The use of telecommunications to improve health and healthcare directly is coming of age. No longer the preserve of the enthusiast, over the next 5 years telehealth will start to become more mainstream.
Already in NHSFV, video-conferencing supports clinical education, multi-disciplinary case conferences and, to a more limited extent, remote care in paediatrics, emergency and stroke services. In addition Dermatology Services use images to triage patients. Websites such as Beating the Blues and Moodjuice directly support patients whilst video links allow exercise classes to be viewed remotely. Many GP practices offer phone consultations, removing the need for patient travel, reducing risk of cross-infection and often leading to shorter more focussed consultation.
The recent Review of Telehealth in Scotland highlighted:
• “Targeted appropriately, telehealth offers the potential to help NHS boards deliver a range of clinical services more efficiently and effectively”
• “Patient experience is broadly positive and there are high levels of satisfaction”
• “The experience of NHS staff involved in telehealth initiatives is also positive”
• “Better-quality evaluations are required to provide reliable evidence on the overall effectiveness of telehealth and whether it offers better value for money than traditional patient care”
The Scottish Centre for Telehealth highlights the main strands of benefit as:
• Unscheduled Care. The use of video conferencing to support A&E centres and minor injuries units • Education. Junior doctor development and training regardless of location • Chronic Disease Management. The use of monitoring in the home, preventing unnecessary admission and thereby improving quality of life, particularly for those with long term conditions or learning disabilities. • Remote & Rural. Prevention of unnecessary and potentially distressing travel by enabling remote consultation
It is recognised that high-tech solutions are not always required – for example, a phone or email consultation may be as effective as full-blown video conferencing.
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The overall aim of telecare is to help more people to live at home, for longer with safety, security and quality through the use of telecare equipment. Resultant benefits include:
• Increasing support for self care • Developing & delivering anticipatory care • Reduced admissions to o Hospital o Care Home • Reduced time spent in o Hospital o Care Homes • Earlier discharge from hospital
NHS Forth Valley will look to maximise the benefits from these emerging technologies by matching needs with telehealth/telecare developments. There is a need to evaluate the role of assistive technology to support people’s quality of life and make it more mainstream, offering individuals choice.
NHS Forth Valley is one of the partner Boards in the DALLAS initiative looking to establish widespread use of telehealth/telecare. In addition NHS Forth Valley will look to build business cases to support mainstreaming telehealth and other enabling technology. Particular areas of interest include:
• Video links to reduce oncall cover (joint with other Boards) • Home monitoring for: o COPD o Hypertension o Diabetes • Online Clinical Advice • eConsultation – either online or via video link
3.3.14 Health Records/“Turning off the paper” NHS Forth Valley currently holds a colossal amount of paper case notes within secondary care amounting to over 13 kilometres. The storage, filing and transportation of these paper case notes has substantial associated costs.
The Health Records Department provide a critical support function within Forth Valley not only the provision of medical casenotes but also managing many essential administrative tasks from national data returns to compliance with the Mental Health Act. Currently the health records service manage multiple paper-based records and provide an advisory service to other departments who have implemented their own paper based records.
Recently the main medical casenotes storage has been centralised on the Falkirk Community Hospital site, though intermediate storage is required on other sites such as FVRH ahead of clinics, etc. It should be noted that the main storage of the Health Records library is not at the main location requiring records (ie FVRH).
Paper records are limited to one location and one person at a time. The opening of Forth Valley Royal Hospital (FVRH) and evolving Community Hospital model means an increase in transportation of casenotes.
As care pathways become more complex, the pressure on the health records service increases. The handling of paper casenotes adds little direct value to patient care.
The move towards a “Paperlight Hospital” will deliver key benefits:
• Access to patient information where and when required, both within and outwith NHSFV • Reduction of cancelled appointments • Audit of who has accessed the information • Reduction in transportation costs • Reduction in filing & storage costs
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It is essential that the health records service implement electronic health records in compliance with the National Health Records Strategy.
The challenge for Health Records and wider administration services can be summed up with the phrase “turning off the paper” – managing the transition from paper to electronic records. However before the paper can be “turned off” key questions must be addressed:
• Do we have an electronic system? • Is it adequate? • Is it used? • Is the infrastructure available & robust?
Already NHSFV has “turned off” paper laboratory results to GPs; paper immediate discharge letters; paper referrals from GPs; and radiology images. The Electronic Document Management system provides clinicians with online access to clinical correspondence.
Without moving towards a “paperlight Hospital” the ability of Health Record Services to provide a modern fit-for-purpose service will be severely compromised.
NHSFV believes that moving towards a “paperlight” health service is achievable, desirable and is central to this strategy.
Currently NHSFV has 3 Patient Administration Systems (PAS) covering Community/Mental Health, Acute Outpatients and Acute Inpatients respectively. This leads to unnecessary duplication, difficulties in tracking patient information/casenotes and does not provide a firm foundation for future developments. In addition support and maintenance of 3 systems is not cost-effective. NHSFV will move towards a single PAS/PMS as a priority.
3.3.15 Access to Records The development of electronic health records provides many security benefits including auditable access, password controlled access and role-based access rules. However there are also many risks including potential access to unauthorised information.
Defining access rules is difficult. Should a bank nurse working within an admission ward have access to laboratory results for patient X? The potential is for access rules to become complex and difficult to administer and monitor.
Access Rules will be reviewed regularly in consultation with data owners and users. Most importantly, as the ultimate data owners, the public will be engaged in the discussion over access to their records. Because system access rules are unlikely to be ever comprehensive, they will be backed up by clear, well-publicised and enforced confidentiality/access policies. NHS Forth Valley will work towards access only where the patient is on the member of staff’s caseload.
The use of mobile devices, such as clinical tablets, will further enhance the access to records where & when required. For example, access to the patient record at the bedside.
3.3.16 Service Information Healthcare processes and care pathways are increasingly varied, with new innovative approaches being regularly introduced. It is difficult for clinicians to be aware of all available services and the preferred care pathway. In the past GPs, for example, might be given care pathways documentation, however in paper form this is unlikely to be readily available or up to date.
The web-based Service Information Directory provides clinicians and, as a secondary priority, the public with a variety of information such as available services, agreed pathways, referral criteria, patient information leaflets, etc. This assists, supports and influences the decision making process for referring by providing accurate information on services and referral methods/criteria.
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3.4 Supporting Clinical Governance
A major benefit from the use of eHealth is improved patient safety. Many of the strands discussed in this strategy have a patient safety element to them, from the effective communication of diagnostic results through to protocol-based referral online, from standardisation of assessment forms/processes to formulary-based prescribing.
Put simply eHealth offers the NHS opportunities to significantly reduce clinical risk not possible using paper-based systems. NHS Forth Valley will embrace these changes and embed in the redesigned clinical processes by encouraging clinicians to consider how eHealth systems should be used.
The eHealth agenda is a patient safety agenda
3.4.1 Monitoring & Informing Service Provision Access to information is key to improving care and ensuring clinical effectiveness.
Information on clinicians’ service provision - benchmarked against that of colleagues, other Board areas and other practices - and in comparison with accepted good practice, allows clinicians and their peers to review and improve patient care. The translation of data into knowledge that leads to improved patient care will be supported by the development of information systems providing clinicians with relevant information on their own workload. In new systems development, clinical access to "useful" information will be an important part of eHealth functionality.
The introduction of electronic health records will provide, as a by-product, the information to inform the clinical governance agenda. Compliance with national guidelines, targets and other quality and effectiveness criteria can be monitored and areas for improvement identified.
3.4.2 Supporting Effective Care Understanding the most appropriate approach to caring for patients is increasingly confusing. The use of eHealth can support the clinician – either through an embedded protocol in the referral/transfer/discharge process (see section on clinical communications) or through decision support in the prescribing of medication.
The use of proven eHealth facilities is increasingly the norm for clinicians, with non-use being questioned not by eHealth professionals but by the statutory audit bodies. For example, Quality Improvement Scotland (QIS) now regularly challenges services whether electronic health records are used.
In addition, timely, easy access to high-quality clinical effectiveness information and reference material gives clinicians the tools to provide improved patient care. Current paper-based protocols and guidelines for clinical care are often out of date or not readily accessible. An online catalogue of agreed and draft guidelines provides clinicians with an up-to-date readily available resource centre. Online access to patient information leaflets supports both the clinician and patient.
The Library & Knowledge Services Strategy outlines a way forward to enable clinicians’ easy access to effectiveness information through increasingly online journals and other resources. The strategy also outlines how increased value can be gained from library services.
3.4.3 Performance Management Performance management is an essential element of ensuring value for money. To facilitate this appropriate information should be available when it is required, at the level of detail required. This will vary between users - however must be driven by users if analytical resources are not to be wasted.
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Performance management information is required at all levels of the organisation, from the clinician analysing their own workload through to Scottish Government Health Directorates HEAT indicators for the whole service. A key issue to be addressed by the Information Strategy is how to meet the majority of requirements whilst minimising the duplication of effort.
The supporting and monitoring of the 18 week referral to treatment target illustrates the NHS Forth Valley philosophy – the eHealth systems will primarily support the improved efficient processes, however accurate and timely monitoring information will be available to support effective management. The Patient Tracking List (PTL) will provide clinicians and service managers with near-real-time information, extracted from operational systems.
3.4.4 Data Quality With the introduction of electronic health records data quality will be an important consideration. By data quality, it is important that data recorded is:
• validated on entry, where possible, to ensure compliance with data standards • timely (eg clinical correspondence) • accurate • complete
By its nature, data quality is difficult to achieve involving, as it does, human intervention. NHSFV will seek to automate where possible.
Data quality is cyclical - increased use of the data will lead to improved data quality, improved data quality leads to increased use. Data Quality, including timeliness, will be audited on a regular basis.
Ultimately clinicians must be able to trust the information presented to them – but they need to realise that they also are responsible for that data quality.
Clear ownership of systems and data will be identified – this will ensure clarity over responsibility and decision-making.
3.4.5 Equality & Diversity NHS Forth Valley supports the Equality & Diversity principles, and commits to undertaking equality impact assessments where required/appropriate. In relation to the eHealth Strategy NHSFV will ensures that, where possible and appropriate, data relating to ethnicity, disabilities, interpreter requirements, faith/belief, sexual orientation & veterans’ eligibility will be collected in accordance with national guidance.
NHSFV has been incorporating disability, ethnicity and interpreter requirements information into eReferral protocols to enable suitable provision to be made in secondary care. This can have a significant effect on the care experience of the patient.
Public website development does and will continue to support use by visually impaired members of the public.
Of particular note for an eHealth Strategy, however, is the potential for “digital inequality” – this is further discussed in section 3.2
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3.5 Working in Partnership
It is important to recognise that NHS Forth Valley is only one of a number of partners involved in improving the health of the population. From an IM&T perspective, initiatives such as the Emergency Care Summary (ECS) allow partners within the NHS - the Scottish Ambulance Service & NHS24 – have potentially life-saving information about patients from Forth Valley.
3.5.1 National Bodies Over recent years NHS Forth Valley has led in the implementation and benefits realisation for many key national initiatives, including SCI Store, SCI Gateway, CHI, N3 and ECS. NHS Forth Valley will continue to support the national eHealth Strategy, recognising that a national approach to electronic health records and transfer of care is essential. This particularly applies to NHS Forth Valley as it borders six other NHS Board areas.
In compliance with the national strategy, where a nationally procured system is available or is planned to be available, NHS Forth Valley will look to choose that system. However there will remain a need for local evaluation of the national system with respect to “local fit” from a technical, process and financial perspective. In addition NHS Forth Valley will participate in national initiatives (eg procurements) where appropriate.
NHS Forth Valley also recognises the need for consistency of language, not just across Scotland but also internationally. Therefore NHS Forth Valley will work towards national data definitions & standards; and interoperability standards.
3.5.2 Sharing Information The public expects the appropriate sharing of information within and between care organisations29.
Exchange of information should be encouraged between partner organisations. However this exchange should be safe and secure, complying with the relevant legislation (eg Data Protection Act). A Information Sharing Group has been established including representatives from NHS Forth Valley, local councils, Police, Fire & Rescue, Forth Valley College, Stirling University and Scottish Enterprise. This partnership will oversee data sharing initiatives to ensure secure but effective data sharing. In addition there is an agreed overarching Information Sharing Protocol with Councils – this should be supported by specific protocol developed for each information sharing process.
Increasingly health services could be co-located with partner organisations (eg social work). In addition to the challenges mentioned above, consideration needs to be given to the sharing of IT equipment and networks. This will be addressed based on national guidance and local requirements.
Voluntary organisations can play an increasingly significant role in the care process. Consideration will need to be given to access to patient information by the voluntary sector.
Without electronic means, sharing care information can be cumbersome and bureaucratic. NHS Forth Valley will support processes, such as single shared assessment, through appropriate use of eHealth, enabling shared information subject to legislative constraints. In particular sharing will only be enabled following informed consent by the individual concerned.
Examples of current initiatives include single shared assessment, child protection (Getting It Right For Every Child), multi-agency public protection advice (MAPPA) and delayed discharge information.
NHS Forth Valley is, and will continue to be, an active participant in national programmes for modernising government in partnership with local councils, police and local enterprise companies to improve access to local services.
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3.6 Supporting Corporate Functions
IM&T has a role in improving efficiency of the day-to-day running of NHS Forth Valley. Already, Finance, Human Resources and Estates Management are heavily reliant on IT systems. Across the area, the systems supporting these functions should be the same. However, it would be inappropriate to replace existing systems that are meeting the requirements, unless substantial benefits can be demonstrated. Where system replacement is considered, harmonisation is strongly recommended.
3.6.1 Financial Services The introduction of electronic purchasing integrated with financial systems has led to improved efficiency, together with savings through controlled purchasing. Such developments should take account of national initiatives and potential partnership with local authorities. A single system for supporting financial services has been established.
As part of the national Shared Financial Services initiative, NHSFV, as a local “spoke” is required to have a “Fit for Purpose” IT infrastructure.
3.6.2 Human Resources Consideration has been given to improving recruitment, training & development and other workforce planning processes through the introduction of area-wide HR systems. These should, where appropriate, be integrated with financial systems and the national email & directory service to support consistency on staff details.
Ideally the HR systems should provide an effective staff identification – that is, feeding into the wider eHealth systems as a Staff Directory. This should support role-based access (RBA) to eHealth systems, thereby reducing the amount of system-specific user administration required.
The introduction of a Learning Management system will enable the scheduling and recording of training to be better monitored. However it is the potential of online training or “eLearning” that offers an innovative approach to delivery of staff education, particularly in mandatory areas such as data protection, health & safety, equality & diversity, etc. Staff can undertake training when & where is convenient for them and managers can monitor compliance.
The introduction of Knowledge & Skills Framework (KSF) is supported by a suite of systems which document job KSFs, staff Personal Development Plans (PDPs) and link to training information. Again this has supported the monitoring of compliance with Agenda for Change.
At a more basic level, online access to policies, procedures and forms such significantly reduce stationary costs and increase access/compliance
3.6.3 “Office” & Directory Services Administrative services are currently paper-rich. However by making use of existing electronic systems, many of the processes can be streamlined. Technology such as digital dictation, speech recognition and electronic document management can support the modernisation of support services, leading to increased efficiency.
At present there is significant duplication of e-storage of documents – it is unstructured and difficult to locate required information. Often one must contact the creator of the document to find a copy – this is inefficient. A more structured approach with increased shared filing will reduce duplication and improve co-operation within the organisation.
The introduction of document imaging for paper records will result in reduced storage costs and easier access to information. Applications within financial services, human resources and estates management should be considered, along with compliance with the Freedom of Information Act.
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The email culture is well established across NHS Forth Valley - it is the preferred method of written communication. Access to email is not restricted by the base of the user – remote access, including from home and via mobile devices, allows more flexible working, supporting innovation and increased communication. However this access should be secure, complying with national protocols and policies.
Like email, secure remote/mobile access to documents and systems will support more flexible and efficient working. Like clinicians, managers should have access to key information when and where required. The use of mobile technology and the virtual desktop – the user’s settings being available wherever the user logs on – will support this innovation.
The introduction of “social networking” style technology can support the next development, giving easy but appropriate access to documents and facilitating effective communication. Eventually the use of email may be superseded by this style of communication.
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3.7 Promoting the Benefits of New Technology 3.7.1 Education & Training Ensuring that staff have the right skills is considered an essential element of eHealth development, and NHS Forth Valley is committed to the provision of appropriate education/training to allow staff to maximise the benefit from eHealth. An area-wide approach, integrated with wider education and training initiatives, will be encouraged to efficiently deliver effective staff development.
The use of online training material and other distance learning approaches will be supported as a cost- effective approach to staff development. eHealth training, education and development will link closely with the Lifelong Learning initiative, Knowledge & Skills Frameworks (KSFs) and Personal Learning Plans (PDPs) development
NHS Forth Valley will also look to innovate in its approach to education and training. For example, the development of “role-based training” – the concept of training based on the requirements of a particular role (eg ward nurse) rather than simply running a course in the use of a particular computer system. Further, when doctors are trained in, for example interpretation of radiology images, this should be done using online images rather than film/printed images.
3.7.2 Benefits Realisation NHS Forth Valley recognises that simply installing computer systems does not deliver benefits. The development and implementation must be a shared experience with users and eHealth staff fully involved as a partnership. Further it is recognised that effective organisational development and process redesign are crucial to realising the benefits.
NHS Forth Valley has a proven record of adoption of systems based on the identification of benefits to the user as well as the wider organisation – for example, electronic referral, online access to lab results. Benefits realisation is embedded in the local implementation philosophy.
Proven approaches to benefits realisation, such as Managing Successful Programmes, identification of local champions and effective support mechanisms beyond the project implementation phase, will be employed. Where appropriate, use of eHealth will be mandatory to ensure ineffective processes are eliminated, however NHS Forth Valley believes persuasion is more effective than coercion.
To support effective realisation of benefits NHS Forth Valley has developed a supporting benefits management strategy, with strong links to the national benefits toolkit.
For a number of years, NHS Forth Valley has nurtured and encouraged an “eHealth culture” where clinicians and managers recognise the role that eHealth has
3.7.3 Innovation Change and innovation in clinical services and other health improvement initiatives often needs to be supported by improved or new information systems. NHS Forth Valley will look to support these innovations, however recognising that mainstream services are likely to be higher priority, where resources are limited.
NHS Forth Valley will encourage the concept of “trialability” – trials of innovative approaches rather than formal pilots. Where innovations adequately demonstrate cost-effective improvements to the service, rollout across the Forth Valley area will be considered. This approach is particularly applicable with respect to emerging technologies such as voice recognition, mobile devices and telehealth.
In particular, development of telemedicine has potential to improve the patient experience, whether through reducing travel, increasing home care/monitoring, or supporting nurse-led clinics and integrated community-based healthcare30 (see earlier section on Telehealth/Telecare).
The eHealth developments should complement and support more general redesign.
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3.8 Infrastructure 3.8.1 Availability The usefulness of an electronic health record will be restricted if it is not available to the clinical staff when and where they require it. Although which technology is not clear at this time, the need for remote access to integrated health records is apparent. NHS Forth Valley will explore the feasibility further with a preference for using nationally approved products.
Specifically NHSFV will provide network access where & when required. In addition it will explore the concept of “role-based devices”. For example, if a pharmacist working on wards requires a tablet PC, then that is what should be provided. However the pharmacist does not require a separate additional desktop PC. Staff should have one device that best suits their role’s requirements.
The key finding of the McClelland Review of ICT Infrastructure in the Public Sector in Scotland was that the public sector is lagging where it should be and there is an opportunity for benefits in radically changing how ICT is adopted and deployed and in how it enhances access to and improvements in the quality and value of services. Shared ICT platforms, a connection and spread of exemplar projects and enhanced engagement with the industry would reduce the proportion of cost invested in ICT by individual organisations and deliver local savings. It would deliver wider savings in public sector costs by providing a platform for the operation of other shared services and better support sustainability goals.
The current economic environment of a largely standalone and “self-sufficient” operating mode is no longer affordable and an era of sharing in ICT will not only offer better value, but also still meet the needs of individual organisations and their customers.
NHSFV will, through working with other NHS Boards and the Scottish Government, support initiatives that will lead to great efficiencies.
3.8.2 Security & Confidentiality The establishing of clear, unambiguous access rules is essential. These will be developed in line with national policies, the Data Protection Act 1998 and the Access to Health Records Act 1990 and based on a “need to know” – for example, what patient information does a consultant in obstetrics require to care for this patient? These access rules will evolve as the benefits, risks and safeguards emerge, however within these rules, access to the electronic health record will be as wide as possible amongst clinical staff. NHSFV will continually consult with clinical and public/patient advisory groups. NHS Forth Valley is committed to continually improving the monitoring of access to systems, both reactively to suspected breaches and proactively to preventing unauthorised access – this will be achieved through implementation of evolving technology (eg Fairwarning software), access policies and effective authorisation procedures.
As part of Single System Working, a single suite of information governance policies has been agreed and will be reviewed as required. The emphasis is on effective but practical rules, which safeguard identifiable information in line with national guidelines31 32 and the Data Protection Act 1998. Further NHSFV will introduce effective monitoring of access, or more specifically inappropriate access, of patient records.
All new and existing systems developed will have adequate, tested disaster recovery plans in line with the national IT security guidelines. In addition service departments will be encouraged to have robust contingency plans, should electronic systems not be available.
NHS Forth Valley recognises the risks surrounding the use of mobile electronic devices (eg USB memory sticks, laptops) and has locally adopted national standards and policies33.
Patient access to records/repeat prescriptions/booking of appointments (see elsewhere in the strategy) will provide new challenges. However NHSFV is committed to a Risk Management approach, recognising that risks cannot be eliminated. The benefits are assessed against the risks – the risks being minimised.
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The Caldicott Guardian will take the lead for progressing this element of the strategy as chair of the Information Governance Group. A more detailed Information Governance Strategy & Workplan is available.
NHSFV will seek to support the implementation of the national Information Assurance Strategy34
3.8.3 Identity Asset Management A key underpinning priority for the strategy is Identity Asset Management (IAM). This catch-all term which will result in only authorised people (staff) being given access to systems. IAM encompasses Single Sign-On but also needs to ensure that effective processes are put in place to allow authorised persons timely but controlled access to systems. This is not straight-forward – for example, how do we provide bank, agency and locum staff contracted at short-notice to access patient records to carry out their duties? Single Sign-On, underpinnined by IAM, improves security by “making it easy to do the right thing and harder to do the wrong thing” 3.8.4 Technical & Support Underpinning the developments highlighted in the strategy is the technical infrastructure. The usefulness of the electronic health record will depend on the technology being fast enough, reliable enough and easy to use. The Intranet will be monitored and upgraded to ensure adequate response and reliability is maintained. Wireless communications is already widespread with the acute hospital site. Use of mobile technology will increase based on the requirements of the staff role.
As the various public organisations work more closely together (care of the elderly, child protection, etc) then network security restrictions should not be a barrier. It is not sensible for staff to access separate public sector systems through separate PCs. Joined up approaches to support integrated services will be required – this is supported in the McClelland Report mentioned previously. However the security and integrity of the wider NHS infrastructure should not be compromised.
There is recognition that the services offered by eHealth initiatives require support 24 hours a day, 7 days a week. The criticality of these systems is recognised and the need for a responsive support service is essential. A particular challenge will be addressing support issues where IT systems are used in time-constrained patient encounters, for example outpatient clinics. There is also a requirement for clear contingency and disaster recovery procedures. Additionally, Service Level Agreements (as defined in ITIL) will be developed to clarify user responsibilities and targets for responsiveness from the support services. The Information Technology Infrastructure Library (ITIL) methodology will provide the basis for providing ICT services.
The Infrastructure Strategy will provide more technical details, including an assessment of the size and quality of the support function required.
NHS Forth Valley will look to work with National Framework agreements to provide and enhance existing IM&T/e-Health Services.
3.8.5 Standards NHS Forth Valley recognises the need for interoperability between organisations and will look to comply with national and international technical and data standards as required and where available. NHS Forth Valley will work, with partner organisations, towards the aims outlined in the national Application & Infrastructure strategy.
NHS Forth Valley supports the national convergence strategy, believing that this should deliver both economies of scale (particularly if hosting is shared) and cross-organisational benefits (eg clinician training and Managed Clinical Networks). However the business case for any national system or development must still be proven and accepted locally.
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4 Management Arrangements
4.1 Local strategy development eHealth development in NHS Forth Valley has been an evolutionary process. The strategy reflects this, outlining the general direction of travel.
This strategy was initially developed by the Area IM&T Strategy Group in 2000. The strategy was subsequently refreshed in 2003, 2005, 2007 and 2009 by the eHealth Programme Board.
Stakeholders within NHS Forth Valley, public representative bodies and local authorities were consulted at each refresh of the strategy. Membership of the eHealth Programme Board and groups involved in the 2011/12 refresh are listed in Annex A.
4.2 Taking the strategy forward
The eHealth Programme Board has responsibility for overseeing the implementation of the eHealth Strategy. Chaired by the Executive Lead for eHealth, the eHealth Programme Board reports to the Healthcare Strategy Programme Board. The remit of the eHealth Programme Board is included in Annex B.
The eHealth Programme Board is supported by a series of groups concentrating of particular aspects of the eHealth Strategy.
In addition the NHS Forth Valley is represented on the national eHealth Leads Group (see below) and has bi-annual review meeting with Scottish Government representatives.
The IM&T function(s) cannot deliver this strategy. The clinical and non-clinical units within NHS Forth Valley, supported by the IM&T function(s), must take it forward. Appropriate use of eHealth should be a key element of performance appraisal for managers and clinicians.
4.3 National Governance
NHS Forth Valley aims to work collectively, and in concert with other Boards nationally and regionally, to take forward the eHealth strategy on behalf of NHS Scotland, particularly focused on:
• Increasing value from existing systems; • Reducing inefficiency and waste across the service through improved eHealth uptake; and • Ensuring new systems and services are cost effective for all boards.
The Head of eHealth/ICT is a member of the national eHealth Leads group. This group has responsibility for the tactical and financial decisions impacting the national eHealth Strategy. This group will consider future direction for systems and services so they align with the national eHealth strategy and allows increased exploitation of functionality at local and regional Board level, within the agreed financial envelope.
As part of the eHealth Leads group, and other national groups, the Head of eHealth/ICT will keep the NHSFV Programme Board informed of decisions made within the eHealth Leads group and raise issues/concerns locally as appropriate. Likewise he/she will raise local and regional issues within the eHealth Leads group for consideration, decision making, and where appropriate escalation to the national eHealth Programme Board. The Head of eHealth/ICT will look to exert influence over the future development of key national applications, increasing the value for money in developments that will align closely with NHS Forth Valley needs, and the broader clinical and health community
4.4 Supporting Strategies
This overarching strategy outlines the general direction. It will be supported by more detailed and specific strategies/plans which will be developed and maintained. These are outlined in Annexes C to G.
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4.5 Resourcing
The resourcing of eHealth initiatives is problematical. Often the benefits are difficult to identify in monetary terms (eg electronic discharge) or the benefits are not realised by the implementing department (eg online access to laboratory results).
IM&T developments should deliver benefits either a reduction in costs to the service or a demonstrable benefit to the patient/population. In the first instance, funding should be identified from the existing service through re-design; however, non-recurring bridging finance can be identified to support the transition.
The recurrent funding of rolling out successful eHealth pilots becomes a financial pressure unless the ongoing funding is identified. Managers should consider the recurring costs, including marginal costs (such as increased IT support, data communications, systems administration) and capital charges, and identify potential funding before projects commence.
Through careful consideration an agreed approach to funding has been developed. This approach is consistent with the wider NHS Forth Valley approach to funding developments and is outlined in the Financial Framework annex.
From a procurement perspective, NHSFV supports the National Architecture Vision - ‘re-use before buy, buy before build’
4.6 Implementation
System implementation which is unplanned and inconsistent with the strategy causes significant problems for ICT services and can lead to wasted funding. NHS Forth Valley has an agreed local project lifecycle – see annexes – which looks to minimise such “left field” developments.
Also the annexes include the current project portfolio, an outline programme plan highlighting the key projects, with timescales and leads. The interdependency of projects within the portfolio must be recognised and planned for. A benefits management plan will support the realisation of benefits, rather than simply the implementation of systems. Timescales are dependent of availability of resources.
Where appropriate, PRINCE2 is the preferred project management methodology. The overall programme management will be based on Managing Successful Programmes.
4.7 A Responsive Strategy
The primary function of NHS Forth Valley is clearly not merely to deliver IM&T systems. IM&T is a support function. As such it must remain flexible and responsive to the needs of the service.
The NHS Forth Valley Healthcare Strategy outlines the direction of travel, however the detailed service requirements will alter as clinical evidence, service redesign, technology and other factors develop. The IM&T service must be responsive to these changes and, where appropriate, influence these changes.
Partnership for Care highlights this: “… Change and Innovation Plans …must ensure information systems support changing patterns of care”
IM&T services must work with Clinical Change, Redesign, Clinical Effectiveness and Organisational Development functions to ensure eHealth plays an appropriate part in the evolving provision of healthcare. Clinical champions will facilitate the realisation of the benefits from eHealth, contributing to improved care pathways and a more effective service to patients and the general public.
However there is need for clarity over approval processes for new initiatives to ensure developments are (a) in line with the general strategy and (b) are adequately resourced and supported. NHS Forth Valley will look to agree a clear project lifecycle to address this issue – this will be developed in conjunction with national Programme Management structures and processes.
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5 ANNEXES
Annex A Stakeholders Annex B Governance Arrangements Annex C Systems Architecture Annex D Information Governance Strategy Annex E Information & Statistics Strategy Annex F Health Records Strategy Annex G Infrastructure Strategy Annex H eHealth Learning Strategy Annex I Benefits Management Strategy Annex J eHealth Outcomes Plan Annex K Financial Framework Annex L Summary of Consultation Annex M Project Lifecycle Annex N Equality & Diversity Impact Assessment Annex O Glossary Annex P Document Ownership & History
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References
1 Delivering for Health 2 HDL(2005)46 eHealth: guidance for planning and development pending single record 3 Better Health, Better Care – A Discussion Document Scottish Executive 2007 4 NHS Scotland Efficiency & Productivity Framework (Feb 2011) http://www.scotland.gov.uk/Publications/2011/02/11144220/0 5 The Healthcare Quality Strategy for NHS Scotland (May 2010) http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf 6 NHS Scotland eHealth Strategy 2011-2017 (2011) 7 Review of ICT Infrastructure in the Public Sector in Scotland. Scottish Government, June 2011 8 Scotland’s Digital Future, Scottish Government (2011) http://www.scotland.gov.uk/Resource/Doc/981/0114237.pdf 9 Forth Valley Healthcare Strategy 2012 10 NHSFV 18 week RTT Strategy 2008 11 Stockdale A: Public understanding of genetics and Alzheimer disease. Genet Test, 1999. 12 Office of National Statistics, http://www.statistics.gov.uk/ 13 Ofcom http://stakeholders.ofcom.org.uk/market-data-research/market-data/communications-market-reports/cmr11/scotland/ 14 Ofcom http://media.ofcom.org.uk/facts/ 15 ONS Opinions Survey (August 2010) 16 Internet Access Quarterly Update (May 2011) http://www.statistics.gov.uk/articles/nojournal/internet-access-q1-2011.pdf 17 Social Justice … a Scotland where EVERYONE MATTERS. Scottish Executive, November 1999. 18 Freedom of Information (Scotland) Act 2002 http://www.itspublicknowledge.info/foiactcontents.htm 19 Ofcom http://media.ofcom.org.uk/facts/ 20 Data Protection Act 1998 http://www.hmso.gov.uk/acts/acts1998/19980029.htm 21 Access to Medical Records Act 1990 http://www.hmso.gov.uk/acts/acts1990/Ukpga_19900023_en_1.htm 22 Capturing The Impact of EPR: The Electronic Patient Record At Burton. NHS Executive, October 1997. 23 Jones, A: The Clinical Benefits of the Integrated Clinical Workstation Programme 1994-6. Winchester & Eastleigh HealthCare NHS Trust, October 1997. 24 Dr Nichola H Strickland, Case study from: Benefits of Using Clinical Information. IHCD, July 1997. 25 Computerised Drug Prescribing For In Patients. The Wirral Hospital NHS Trust, November 1995. Contact: Alan Spours. 26 Kaplan B & Lundsgaarde HP: Towards an evaluation of an integrated clinical imaging system: identifying clinical benefits. Methods Inf Med,1996. 27 Sujansky WV: The benefits and challenges of an electronic medical record: much more than a “word-processed” patient chart. West J Med, 1998. 28 General Practice Information Technology Options – Report to NHS Scotland eHealth Board (Deloitte) Nov 2006 29 Attitudes to electronic data sharing in the NHS: analysis of focus group discussion (Scottish Consumer Council) 2005 30 Wallace S, Wyatt J & Taylor P: Telemedicine in the NHS for the millennium and beyond. Postgrad Med J, 1998. 31 National IT Security Manual. 32 HDL(2006)41 NHSScotland information security policy 33 CEL(2008)45 NHS Scotland mobile data protection standard 34 CEL(2011)26 NHS Scotland Information Assurance Strategy
ANNEX A
MEMBERSHIP OF eHEALTH PROGRAMME BOARD (2011)
• Jonathan Procter Director of Strategic Access & Capacity, Executive Lead for eHealth (Chair) • Scott Jaffray Head of IT • Tony Morrison Stirling Council • Steven Kirkwood Senior Finance Officer • John Schulga Consultant Paediatrician/eHealth Clinical Lead • Oliver Harding Consultant in Public Health Medicine • Michael Fox Head of Capacity & Information Services • Deirdre Coyle Head of Information Governance • Eddie MacDonald General Manager, Stirling CHP/Chair of CHP eHealth Group • Dave Simpson eHealth Consultant • Mary Cameron eHealth Manager/Chair of eHealth Learning Group • Agnes Provan Head of Health Records • Iain Wallace Medical Director • Steven McGhie Staff Representative • Andrew McElhinney GP/eHealth Clinical Lead • Duncan Lamont GP/eHealth Clinical Lead • Katherine Callaghan Workforce Planning • Maggie Quayle Associate Director of Nursing • Ian Aitken General Manager, Medicine & ICR/Chair of Acute eHealth Group • Douglas Morrison Acute Consultant • Rosemary Fletcher Head of Occupational Health/AHP eHealth Lead • Stephen Nelson Systems Manager/Chair of Infrastructure Group • Beverley Finch Head of Corporate Services/Chair of Corporate IM&T Group • Gail Caldwell Director of Pharmacy • Derrick Douglas Asst Director of Finance • Nicola Henderson Senior Dietician
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ANNEX B - GOVERNANCE
The eHealth Programme Board provides support and accountability for the delivery of the eHealth/IM&T Strategy across NHS Forth Valley. The Programme Board reports into the NHS Board via the Executive Group.
The membership of the Programme Board includes:
• Executive Lead • eHealth Clinical Lead(s) • Caldicott Guardian(s) • Professional Lead/Head(s) of Service • Director(s) responsible for eHealth/IM&T Services • Chairs of subgroups (see below) • Financial representative(s) • Staff representative(s) • Local authority representatives • Public/patient representative • SGeHD representative
The Programme Board is supported by a number of subgroups. These subgroups contain, not only IM&T representation, but are user/clinician-rich as appropriate:
Information Governance Group This group has devolved authority to approve policies relating to information governance on behalf of the eHealth Programme Board and the NHS Board Clinical Governance Committee. The group co-ordinates awareness raising and incident monitoring.
This group, chaired by a Caldicott Guardian, includes the Caldicott Guardian(s), Head of Information Governance, Head of ICT/eHealth, public representative and technical representative
CHP eHealth Group The group provides devolved project leadership and monitoring for sector specific or cross-area initiatives, encourage innovation linking to the redesign initiatives and the management of allocated resources. The group also provides a forum to discuss/feedback the provision of eHealth/IM&T support to CHP services, enabling clinical input to the eHealth agenda. The group includes clinical representatives, practice manager representatives, CHP GM, Head of ICT/eHealth, other staff involved in IT support of primary care IM&T/eHealth.
Acute eHealth Group The group provides devolved project leadership and monitoring for sector specific or cross-area initiatives, encourage innovation linking to the redesign initiatives and the management of allocated resources The group also provides a forum to discuss/feedback the provision of eHealth/IM&T support to Acute services, enabling clinical input to the eHealth agenda. The group includes clinical representatives, General Manager(s), Head of ICT/eHealth, other staff involved in IT support of secondary care IM&T/eHealth.
Infrastructure, Information & Education Group This group provides governance for a series of education/learning, information/statistics and infrastructure,
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related projects. This group also oversees the development of the infrastructure strategy, the eHealth Learning Strategy and the Information & Statistics Strategy. Membership includes service representation, Head of Performance Management and OD/HR representation
Health Records Committee This group oversees the development of Health Records policy and strategy. It reports jointly to the eHealth programme Board and the Clinical Governance Committee.
Corporate IM&T Group This group ensures that the corporate services (including HR, finance & estates) needs relating to IM&T developments are being addressed. Membership includes service representation, Head of ICT/eHealth
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ANNEX C – SYSTEMS ARCHITECTURE
Purpose/Scope To detail which systems will provide which functions to support the eHealth Strategy, including:
• intended list of systems
• key interfaces
Authorised by eHealth Programme Board
Developed by eHealth Programme Office
Lead Head of eHealth
Current Status Latest available 2008 Strategy, though Systems Map is available via eHealth Programme Office
ANNEX D – INFORMATION GOVERNANCE STRATEGY
Purpose/Scope To detail how information governance will be taken forward across NHS Forth Valley, including:
• secure but effective access to person-based information, including the electronic health record
• integrity of systems and networks
• meeting Freedom of Information obligations
• compliance with Data Protection Act
Authorised by eHealth Programme Board & Clinical Governance Committee
Developed by Information Governance Group
Lead Head of Information Governance
Current Status Available
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ANNEX E – INFORMATION & STATISTICS STRATEGY
Purpose/Scope To detail how the information and statistical needs of NHS Forth Valley will be met, including:
• performance management at all levels (eg national, strategic, tactical, operational, clinical)
• statistical analysis and modelling support
• data management
• national data returns
Authorised by eHealth Programme Board
Developed by Information Management Group
Lead Head of Information Services
Current Status Available
ANNEX F – HEALTH RECORDS STRATEGY
Purpose/Scope To detail how health records will be managed, including:
• transition from paper to electronic
• access to records
• audit
Authorised by eHealth Programme Board & Clinical Governance Committee
Developed by Health Records Committee
Lead Head of Health Records
Current Status Available
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ANNEX G – INFRASTRUCTURE STRATEGY
Purpose/Scope To detail how the supporting technical infrastructure will be developed and maintained across NHS Forth Valley, including:
• secure but effective access
• reliability and integrity
• contingency planning & disaster recovery
• support arrangements
• voice and data integration
Authorised by eHealth Programme Board
Developed by Infrastructure (Telecomms) Group
Lead Head of ICT/eHealth
Current Status Available
ANNEX H – eHEALTH LEARNING STRATEGY
Purpose/Scope To outline how eHealth/IM&T training, education and learning will be delivered across NHS Forth Valley, including:
• Core requirements (eg MS Office, NHSmail Basic IT, Internet)
• Ongoing Systems training/learning
• Implementation stage system training/learning
• eLearning and other innovative approaches
• Joint working with other learning agencies
Authorised by eHealth Programme Board
Developed by eHealth Learning Group
Lead Head of eHealth Programme Office
Current Status Available
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ANNEX I – BENEFITS MANAGEMENT STRATEGY
Purpose/Scope To outline how NHSFV will manage the identification and realisation of benefits from the eHealth Programme
Authorised by eHealth Programme Board
Developed by eHealth Programme Office
Lead Head of eHealth Programme Office
Current Status Available
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ANNEX J - eHEALTH OUTCOMES PLAN
The national eHealth strategy has 5 strategic aims:
1. maximise efficient working practices, minimise wasteful variation, bring about savings and ensure value for money 2. support people to manage their own health and wellbeing, and to become more active participants in the care and services they receive 3. contribute to shifting the balance of care and support people to self manage, and to provide appropriate information for people with long term conditions and mental health problems 4. improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality 5. improve medication management as an essential part of peoples’ care
The highlight level mapping of the main initiatives with national priorities is below:
Alignment with National Strategic Objectives 123452011-12 2012-13 2013-14 2014-15 2015-16
Key Priorities Single PAS X Community eHealth (MiDIS) X XX Intelligent Test Requesting/Reporting X X Hospital Prescribing/Medicines Administration X XX TeleHealth (DALLAS) Shared Assessments X XX Patient Portal X Clinical Portal X XX Paperlight NHS Forth Valley X XXX
Other Significant Initiatives Stirling Community Hospital Infrastructure XX Falkirk Community Hospital Infrastructure XX Infrastructure Refresh X PC Refresh X Electronic Document Management X XX Single Sign-On X X Voice Recognition X Theatre Management System X X Prison eHealth Mental Health eDischarge & Bed Management (eWARD) X XXX EMISWeb - NHSB analysis X Community Eyecare Pilot X X SID - LTC XXX Record Culling X Palliative Care Summary XXX Key Information Summary (KIS) XXX Online Clinical Advice X XX eInternal Referrals X X eTertiary Referrals X X Self Check-in to Outpatient Clinics XX X Clinic Scheduling X eClinic Letter X XXX Neonatal System X X Child Health Systems X X Child Protection Messaging X
The table below shows how the eHealth Strategy/Programme initiatives map to the national eHealth priorities and suggested outcome measures/targets:
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Quality Outcome: The best use is made of available resources NHSScotland works efficiently and effectively, making the best possible use of available resources. Strategic eHealth Aim: To use information and technology in a coordinated way to maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money. OUTCOME: HEALTHCARE SERVICES ARE MORE EFFICIENT eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Reduce number of Patient Reduce number of PAS È number of PAS Currently 3 PAS – By Mar 2013 replace PiMS* Administration Systems to: PiMS, HelixPMS, È support costs By Mar 2013 Single PAS TOPAS - increase consistency of across NHSFV* È variation of admin process administration & process By Mar 2014 reduced PAS
- increase flexibility of workforce costs by £150k pa* - reduce support costs * dependent on BC outcome
More efficient & effective processes to Replace Out-of-Hours system Ç Use of ECS Currently NHSFV use By Jun 2012 NHSFV will be support out-of hours care, including Taycare OOH system fully utilising Adastra Ç Clinical Governance links with NHS24, ECS, etc
Increased use of digital dictation and Encourage effective use of È time taken to turn Turnround for OP clinic By Mar 2013 turnround for voice recognition technologies to: digital dictation system documents around letters in in excess of 6 OP clinic letters to be < 2 weeks weeks - improve efficiency of document Encourage effective use of production and availability. voice recognition software All OP clinic letters By Mar 2014 >90% OP clinic from consultant-led letters to be sent to GPs by - enable paperlight hospital services are now being SCI Gateway. delivered to GP Practices via post
Increase support for efficiency use of Build on existing use of È updating of eWhiteboards eWhiteboards in all By Sept 2012 updating of bed inpatient wards to: eWARD acute and community status will be <30 minutes È use of paper for nurse inpatient wards across NHSFV - improve bed management handovers
- improve nurse handover Updating of bed-usage By Mar 2013 all inpatient averages at 30 minutes wards will use nurse - improve clinical governance but wide variation handover functionality
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Improved use of electronic referrals to: Encourage use of “Referral Ç outpatients avoidance by 2 specialties currently By Mar 2014 majority of for Advice” increased use of referrals for offer “referral for secondary care services will - reduce the time taken to refer advice advice” offer “referral for advice” Provision of infrastructure to - improve the quality of referrals. support referrers Ç clinical governance Internal referrals are By Mar 2013 all dental Ç extension of electronic currently via paper or practices will refer via SCO referral capability to additional verbal Gateway professional groups (eg dental, ophthalmic) Cardiology referrals to By Mar 2014 all internal GJH are via SCI referrals will be via SCI
Gateway Outpatients
1 ophthalmic practice & By Mar 2014 all tertiary 50% of dental practices referrals will be via SCI currently refer via SCI Gateway (dependent on Gateway. tertiary centres ability to receive) Overall, >99% of referrals are received By April 2014 95% of and processed referrals from optometrists electronically. to hospital eye services will be done electronically with the necessary business changes in place.
By April 2014 95% of all optometry claims will be made electronically. Standard Ensemble integration Specification of adaptors for Ç use/reuse of Ensemble By Mar 2013 the default for adaptors and national information Ensemble adaptors all new systems integration standards are used to support will be the Ensemble Deliver clinical portal Ç adoption of eHealth integration and reduce duplication of integration engine. information via Ensemble standards effort. By Mar 2016 all systems integration will use Ensemble (unless specifically agreed by local infrastructure group)
Increased use of virtual desktop È energy costs To be confirmed technology to: eHealth Strategy 2012-2017 Annexes 3 of 40
- reduce energy consumption È support costs - simplify desktop standardisation and support - improve accessibility and versatility of desktop services.
Consolidate use of multi-function Further rationalisation of È cost of consumables Desktop printers (>200) To be confirmed devices (MFD) to: printers. have been removed È support and maintenance (Note significant savings unless a strong - reduce cost of printing / fax costs already achieved through business case can be introduction of MFDs) - increase accessibility of equipment È number of single-function made (eg staff through use of “follow-me” services. and dedicated devices disability). Ç ratio of people to devices 46 multifunction devices in place. Agreed end date for faxing
Introduce paperless processes in Rollout MiDIS Ç information sharing By Mar 2014 all community community health services to: between clinicians services will be using MiDIS - encourage multi-disciplinary working Ç standardisation of forms/assessments - support streamlining of clinical governance
Support efficient use of facilities by Introduce scheduling È unused facilities By Mar 2015 NHSFV will introducing effective clinic/theatre/bed system(s) have an integrated Ç capacity planning scheduling clinic/theatre/bed scheduling process
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Quality Outcome: Everyone gets the best start in life, and is able to live a longer, healthier life NHSS works effectively in partnership with the public and other organisations to encourage healthier lifestyles and to enable self care, therefore preventing illness and improving quality of life. Strategic eHealth Aim: To use information and technology in a coordinated way to support people to communicate with the NHSS, manage their own health and wellbeing, and to become more active participants in the care and services they receive. OUTCOME: PEOPLE HAVE THE OPTION TO COMMUNICATE ELECTRONICALLY WITH NHSSCOTLAND eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Electronic communications are used to Provide option of SMS or È number of DNAs Appointments provided By Mar 2013 NHSFV will support management of appointments. Email correspondence for by patient-focussed have decided if SMS/Email Ç level of sign-up to service appointments (including DNA booking service in communication provides support) È number of telephone calls consultation with value for money to GP practice patient. Pilot Kiosk check-in and By Mar 2013 NHSFV will demographics check and Check-in is via OP have decided if Kiosk check- change. reception in provides value for money
People can make GP appointments Encourage practices to Ç number of practices < 5 practices currently By Mar 2013 early adopters and request repeat prescriptions on implement EMIS patient offering electronic patient offer EMIS patient will have been evaluated line. services services services By Mar 2015 >90% of GP È number of telephone calls practices will offer online to GP practice services including:
- Appointment - Repeat Prescription - Results Service - Health & Wellbeing Advice
People have electronic access to their Develop ability to allow È patient requests to Health No current patient By Mar 2016 the mechanisms own information. people to have electronic Records Service electronic access to will be in place to allow access to: patients to access online their own information. patient record - Medical Correspondence
- Lab and Radiology reports - Emergency Care Record
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- Access to records summary
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OUTCOME: PEOPLE ARE BETTER ABLE TO MANAGE THEIR OWN HEALTH AND WELL BEING AND ARE MORE ACTIVE PARTICIPANTS IN THE CARE AND SERVICES THEY RECEIVE eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) High quality and trusted on-line local Promote use of online health Ç website hits NHSFV website By Mar 2013 NHSFV website information is available for use. and healthcare information will be refreshed Ç positive user feedback Service Information Refresh/Redevelopment of Directory (SID) NHSFV website provides clinical info but is available to public
Increased use of telemedicine such as Development of business È hospital admissions None at present None at present medical devices to enable health cases to support use of È complications due to early monitoring and management at home. telemedicine detection È number of home visits by healthcare workers
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Quality Outcome: People are able to live well at home or in the community NHSS plans proactively with patients and with other partners, working across primary, community and secondary care, so that the need for hospital admission is minimised. This is therefore reflected in the outcome indicators on emergency admissions and end of life care. Quality Outcome: Everyone has a positive experience of healthcare Patients and their carers have a positive experience of the health and care system every time, which leads them to have the best possible outcomes. This should be demonstrable across all equalities groups. Strategic eHealth Aim: To use information and technology in a coordinated way to contribute to care integration, and to support people with long term conditions. OUTCOME: CARE IS BETTER INTEGRATED eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Improved communication between Referral for advice Ç access to electronic By Mar 2014 majority of primary, community, secondary & systems by community staff secondary care services will MiDIS implementation tertiary care. offer “referral for advice” Effective bed management OP Clinic letters via SCI Gateway to practices & È use of faxing By Mar 2014 all internal community services referrals will be via SCI Outpatients Internal referrals to
community services via SCI By Mar 2014 all tertiary Gateway referrals will be via SCI Use of eWARD in Community Gateway (dependent on Hospitals & Mental Health tertiary centres ability to receive) Effective use of clinical email By Mar 2013 all inpatient wards will have effective bed management
Improved electronic communication Electronic Shared Ç number of electronic By Mar 2016 >90% of all of and information transfer between assessments between SSA SSA will be made health and social care sectors. sectors electronically
OUTCOME: PEOPLE WITH LONG TERM CONDITIONS ARE BETTER SUPPORTED eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates)
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Electronic access to anticipatory care Rollout use of Palliative Care Ç availability of care plans By 2014 the ePCS and KIS plans for patients that can benefit from Summary (ePCS) & Key will have been rolled out È hospital admissions them. Information Summary (KIS) nationally across Scotland Ç patient experience for those who need it
Public access to evidence, guidelines Extend use of Service Ç information to support Currently SID has & protocols Information Directory (SID) LTC patients clinically focussed LTC content to support information/guidelines patients /protocols
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Quality Outcome: Staff feel supported and engaged Staff throughout NHSS, and by extension, their public and third sector partners, feel supported and engaged, enabling them to provide high quality care to all patients, and to improve and innovate. Quality Outcome: Healthcare is safe for every person, every time Healthcare services are safe for all users, across the whole system. Strategic eHealth Aim: To use information and technology in a coordinated way to enhance the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality. OUTCOME: HEALTHCARE WORKERS HAVE BETTER ACCESS TO THE INFORMATION THEY NEED eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Clinicians that need it have ready Clinical Portal Implementation Ç clinical access to the “top By Sep 2012 clinicians across electronic access to clinical priority 14” priority clinical NHSFV will have access to Clinical Applications information items at the point of patient information items phase 1 clinical portal (single accessed direct from portal care. sign-on & basic clinical È number of physical Scan-on-demand for old system access). paper record pulls paper records (destruction on By Mar 2013 >50% of scanning) È data related clinical Outpatient clinics will be incidents. Paperlight hospital/healthcare paperlight (ie no paper system Ç clinician satisfaction with records communications By 2014 all territorial Health Boards will be using clinical portals (or electronic windows to information) and the priority information items agreed by clinicians will be available at the point of care
Electronic storage and access to ECG Procure & implement ECG Ç availability of ECG Currently printed and By Mar 2013 clinicians will be results system results circulated on paper able to access ECGs online
Introduce intelligent online test Implement order Ç legibility of requests Currently being evaluated By Mar 2013 all test requesting and reporting to: communications for labs, requesting will be online È repeat tests/ radiology & ECGs - improve clinical governance investigations eHealth Strategy 2012-2017 Annexes 10 of 40
- reduce administrative costs Ç appropriateness of requests È data entry
Increased use of mobile devices and Move towards a “role-based Ç access to electronic supporting applications allows device” model, including: records improved access to information. - desktops Ç clinician satisfaction - laptops/computers-on- Ç remote access to wheels information - tablets/iPads - PDAs - eWhiteboards
Access to information to information Encourage use of ePCS Ç practices recording >70% of practices record By Jun 2012 all practices end-of-life care ePCS ePCS recording ePCS and ePCS being accessed by OOH, Ç Access to ePCS in OOH, A&E and AAU at appropriate A&E & AAU levels
Access to neonatal care information Procurement & Ç clinical governance Currently maternity By Mar 2014 NHSFV will when & where required implementation of neonatal services use the Matsys have implemented a neonatal Ç regional working system system system
OUTCOME: PERFORMANCE DATA ARE READILY AVAILABLE TO PROACTIVELY IMPROVE SERVICE DELIVERY eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Availability of near real-time Expand the current Ç audit and benchmark Dashboards in place: Consolidation of existing dashboards/ information to measure dashboard service across all information • Practice Profiles dashboards – both quality and performance improvement NHS FV: (not real-time) availability, content & use Ç infection control at both individual clinician level and • Acute dashboards • Acute Profiles organisational level. • Practice Profiles Ç intervention options (not real-time) • Community Ç clinical management • Patient Tracking Dashboards List (not in wide use)
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OUTCOME: NHSS ORGANISATIONS DEMONSTRATE INCREMENTAL IMPROVEMENT IN RELATION TO INFORMATION ASSURANCE eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Privacy breach detection software and Planning and implementation Ç effective use of audit Manual audit of high-risk By Mar 2013, privacy breach associated procedures to provide of FairWarning systems. Limited or no detection fully implemented Ç number of systems greater assurance around information audit of other systems. and supporting business actively audited. use and its safeguards. processes in place. Ç awareness of professional obligations È incidents of inappropriate access È tolerance of poor practice Effective and appropriate use of Introduction of effective web- È inappropriate/non- Limited web-monitoring By Mar 2013 web filtering will internet and bandwidth filtering software business use of internet be in place. Internet Analysis of current effect browsing should be Ç bandwidth available to on bandwidth available predominantly to business- support clinical care related sites. Promote single system working Develop information sharing Ç Information that can be GP-Secondary care through agreed sharing of information agreements between key shared sharing is limited to across clinical areas. For example: clinical/partner groupings clinical correspondence Ç Patient safety through • OOH access to GP records and ECS appropriate access to • GP access to secondary care information records • Secondary care access to GP records • Information sharing with partner organisations Single Sign On to enable clinicians to implementation of Imprivata Ç systems able to be Majority of consultants By Mar 2013, Single Sign On access information from multiple OneSign product accessed through SSO have SSO used by all clinicians and sources without repeated log-ins, and available across the key È systems administration to allow self-service password reset. Other clinicians still using clinical systems. È password sharing multiple sign-on È passwords to remember Removal of generic logins eHealth Strategy 2012-2017 Annexes 12 of 40
Quality Outcome: Healthcare is safe for every person, every time Healthcare services are safe for all users, across the whole system Strategic eHealth Aim: To use information and technology in a coordinated way to improve the safety of people taking medicines and their effective use OUTCOME: MEDICINES RECONCILIATION IS SUPPORTED ACROSS ALL TRANSITIONS OF CARE eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates)
Electronic patient medication Encourage use of ECS by Ç Use of ECS Clinicians in OOHs, By 2014 we will have summaries are available to appropriate clinicians (subject to A&E and Acute Leading to: enabled an accurate and healthcare workers at any point of the nationally & locally approved Admissions have up-to-date electronic patient journey. access policy) È harm due to drug errors access to ECS, medication summary to be including pharmacists È number of missed doses of available to the appropriate Extend use of ECS to medicines administered healthcare workers Community Pharmacies to involved in a patient’s support emergency Ç advice on allergies prescriptions journey through the available at point of healthcare system prescribing
OUTCOME: THERE IS REDUCED VARIABILITY IN PRESCRIBING PATTERNS AND GREATER COMPLIANCE WITH BEST PRACTICE GUIDELINES eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Electronic ordering from wards to Procure & Implement È number of pharmacist Meds Rec on By Mar 2014 we will have a pharmacy to allow quicker access to ePrescribing & Medication interventions adminission recorded streamlined ePrescribing on medication. Administration on eWARD all inpatient wards È number of missed doses of
medicines administered Paper-based È pharmacist time wasted to prescribing travel to wards Ç Improved work patterns / flow È Variation in practice/process
Immediate transfer of medication Implement eClinic Letter Ç Clinical Governance Currently patients given By Mar 2014 a more changes from outpatient clinic to GP Ç Continuity of care paper note to pass to streamlined process will be in GP place with automatic “posting” eHealth Strategy 2012-2017 Annexes 13 of 40
to patient record
OUTCOME: PEOPLE ARE SUPPORTED TO TAKE THEIR MEDICATION APPROPRIATELY eHealth contribution to outcome Planned activity Measure/indicator Baseline Target (including dates) Electronic recording of medicines Procure & Implement È number of missed doses of Paper-based medicines By Mar 2014 we will have a administration on acute wards to ePrescribing & Medication medicines administered administration streamlined medicines provide effective patient safety and Administration Ç Improved work patterns / administration process on all audit flow inpatient wards È Variation in practice/process
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ANNEX K - eHEALTH STRATEGY – FINANCIAL FRAMEWORK
This paper will outline the eHealth Financial Plan for the years 2011 to 2014. It will detail the strategic direction, implementations and major risks connected with this plan. It will outline the plan for local capital and National Strategic eHealth funds for the years 2011-14 and how these align to the eHealth strategic outcomes as well as reviewing the process of prioritisation of local bids for developments.
Strategic direction and focus
The following proposals were prioritised by the eHealth Programme Board in 2011 using the following criteria:
• Directly supporting the NHSFV Healthcare Strategy • Directly supporting the National eHealth Strategy • Directly supporting the NHSFV eHealth strategy • Directly supporting HEAT or other national targets • Directly supporting significant savings • Directly supporting patient safety • Availability of recurring funds • Risk of not progressing (using NHSFV risk assessment matrix)
Below is an overview of the main “MUST DO” recommendations for 2011-14.
Core IT Infrastructure The top priority for infrastructure is the continual refresh of PCs, servers & networks is required to ensure a robust, secure and reliable platform for all systems. Computer systems are now essential to NHSFV business.
Clinical Portal The Clinical Portal will enable clinicians to seamlessly access different parts of the patient’s record online – clinical correspondence, lab results, radiology images, etc.
Patient Management System (PMS) Replacement With 5 Boards migrating to TRAK-PMS, there is a resulting cost pressure for NHSFV remaining with HELIX-PMS. Moving to a single PMS across NHSFV should release savings as well as simplifying our administrative processes. A business case is currently being developed to move to a single PAS/PMS across NHSFV.
Electronic Employee Support System All Board HR departments have committed to move to a national HR system, which will support various HR processes including recruitment staff governance, etc. NHSFV has agreed to be one of the early implementers
Single Sign On Clinicians will be enabled to sign-on once to all systems they have authorised access to. This is the rollout and enhancement of previous Single Sign On technology. The enhancement will include “chip’n’pin” style technology to make login fast and easy but still secure.
Additional Projects
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ePrescribing This involves the electronic management of prescribing. Essentially this involves the replacement of the paper based systems currently used and moves to electronic medicines management from prescribing through to supply and administration
Order Comms This project introduces online management of test requesting and test tracking for diagnostic services for both primary and secondary care .
Savings
As a general principle, developments should, as a minimum, have a zero cost sum. Savings from eHealth initiatives, though possible to identify are notoriously difficult to extract (for example, there is no doubt online access to laboratory results has resulted in real savings however these have been absorbed by clinical units).
Where a system/project is largely/wholly within a department (Electronic Employee Support System, PMS, Unscheduled Care, Cancer Waiting Times) recurring costs will be met within that department.
The Paperlight Hospital/EPR (Portal, EDMS, Single Sign-on) draft business case has already identified significant savings that should cover recurring costs. However extracting savings from one cost centre to cover costs in another cost centre remains challenging.
Strategic Fund
The National eHealth strategy is built on 4 main drivers: rationalisation, improving value for money, improving the capacity of NHS Scotland to respond flexibly and choosing solutions strategically.
The eHealth Strategy for 2011-17 has 5 Strategic aims; to use information and technology in a co- ordinated way to:
• Maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money. • Support people to communicate with the NHSS, manage their own health and wellbeing and to become more active participants in the care and services they receive. • Contribute to care integration and to support people with long-term conditions. • Improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality. • Improve the safety of people taking medicines and their effective use.
The new eHealth strategy focuses ICT/eHealth activity on the Scottish Government’s Quality Strategy through these 5 aims. In addition work is underway to develop a Citizen eHealth Strategy.
Alignment with NHS Forth Valley Priorities
NHS Forth Valley ‘MUST DO’ projects closely aligns with the outcomes highlighted above.
Focusing on the following projects over the next 3 years will allow NHS Forth Valley to ensure progress is achieved with each of these outcomes.
• Paperlight/EPR – This project has two initial key deliverables, EDMS and Clinical Portal, together they will deliver on most of the strategic outcomes. • Eward – extending the development and use of the Eward product • ePrescribing - ePrescribing can support the entire medicines use process, enabling medications to be managed electronically from prescribing through to supply and administration. • Order Comms – initially this involves the management of test requesting for diagnostic services for both primary and secondary care.
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In Principle the strategic fund would support the eHealth/ICT team deliver these projects. The above projects would also be subject to the appropriate business case and governance arrangements.
The attached financial plan outlines how this strategic fund would be utilised to support these initiatives, as well as the plans for the following years capital allocation.
Devolved Budgets
From April 2011 the SG eHealth department has devolved to NHS Boards on a NRAC basis the majority of eHealth budget for infrastructure (N3, NHS Mail) and Services (National systems, licences, development, services and software). The eHealth leads along with support from the various PMG Groups will actively manage these budgets to ensure value for money, and a balanced outcome.
Risks
Core Staffing Risk
In addition to the implementation of new systems both the ICT/eHealth departments provide core services and on-going development of existing systems. It is therefore necessary that stability be ensured within the staffing elements of the department to retain skills and experience, that if lost due to the reduction and whole scale termination of current fixed term posts will seriously impact the delivery of core services and the delivery of the national (&local) strategic outcomes
It is therefore recommended that the current fixed term posts within the eHealth/ICT department be extended where appropriate for the next two years.
A formal review of the fixed term positions within ICT/eHealth coinciding with the financial year 2014-15 onwards will be required to enable comprehensive planning to take place, with the possible implementation of the TRAK product having a significant impact on the shape of the project delivery teams. The review should also encompass the core service eHealth provides (in terms of the development of existing services, governance and training) as well the project delivery requirement.
Infrastructure
Core infrastructure refresh is a high-risk area that needs to be addressed. As the reliance on systems increases year on year and the existing asset base increases in line to support the entire eHealth Programme, NHS Forth Valley must ensure infrastructure refresh occurs on a continual basis and at an appropriate level. Infrastructure refresh has traditionally been funded through capital allocations. Over the last few years, this was split into two areas; General Infrastructure (Networks and servers) and Desktop Infrastructure, on average £200k is allocated for each of these areas, this is also the plan for the next two years. (This allocation has been topped up on occasion by either NHS Forth Valley or Scottish Government to assist this high-risk area).
PCs/Desktop • Essentially NHS Forth Valley has approx. 5800 Desktop PCs. The current funding allows for the refresh of approx. 300 PCs per year, at this rate we can replace every PC every 18 years. The aim is to try and replace PCs every 5 years. • We must also note that the desktop infrastructure strategy is changing, mainly due to the introduction of thin client technology, which may extend the lifetime of PCs and the increased use of mobile technology, e.g. Tablet, IPADs, etc. • Taking the above issues into account the capital allocation for desktops needs to be increased to £750k per annum. • The risk of not investing is high. PCs will fall behind in specification, they will not meet the on-going performance expectations, and access to critical systems will be affected.
Networks & Servers • Again these are key areas of infrastructure that support access to systems and provide platforms for all systems to be run from. These also need constant maintenance and replacement. We do currently manage to obtain on average 7-10 years for these components. However we do need to have a more robust replacement strategy.
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• An increase to the capital allocation of £350k per annum would provide a more resilient infrastructure estate. Failure of these core servers affects all users and all systems
NHS Mail
NHS Mail will be replaced over the coming two years. Although this is a National Program, the funding has now been devolved to NHS Boards. The eHealth Leads are acting on a National basis to ensure a collective approach and provide continuity of service. There will be a local requirement to support any move to a new email service. Although this requirement is not known at this time it will require implementation and change funding.
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NHSFV eHealth Programme Strategic Development Fund National Strategic Outcomes 1 Shifting the balance of care 2 Supporting people to manage their own health and wellbeing 3 Enhancing the availability of appropriate information for health care workers 4 Improving medication management 5 Maximising efficient working practices National Strategic Outcome 2011-12 2012-13 2013-14 12345 Priorities GMS System Replacement XXXX EMISWeb - NHSB analysis
PMS XXX X Acute £ 50,000 £ 100,000 Community OP £ 25,000 £ 50,000 MHA - PiMS Exit £ 10,000
Paperlight / EPR XXXXX Voice Recognition £ 228,019 £ - -£ EDMS £ 25,000 £ 70,000 £ 70,000 SSO £ - £ 30,000 £ 30,000 Portal Project Management £ 100,000 £ 120,000 £ 120,000 Portal Development £ 150,000 £ 100,000 £ 100,000 Clinical Lead £ 25,000 £ 25,000 eWARD - Mental Health & Phase 3 XXX Project Support & Development £ 70,000 £ 35,000 £ 35,000 ePrescribing XXX Project Support & Development £ 150,000 £ 200,000
Order Comms XX Project Support & Procurement £ - £ 125,000 £ 175,000
KIS XXXXX Project Lead £ 30,000 £ 30,000 £ 30,000
Patient Portal XX Project Development and support £ 60,000 £ 70,000
Other Misc Job scheduling System £ 30,000 Procurement dev tools £ 10,000 Muse £ 50,000
Total £ 778,019 £ 895,000 £ 855,000
Known Funding (non-recurring)
Moving Towards Electronic Casenote£ 228,019 £ - -£ Long term Conditions (KIS Evaluation)£ 40,000 -£ -£ Ensemble Integration £ 94,047 -£ -£ Strategic Development Fund £ 755,000 £ 755,000 £ 755,000
Total £ 1,117,066 £ 755,000 £ 755,000
£ 339,047 -£ 140,000 -£ 100,000
eHealth Strategy 2012-2017 Annexes 6 of 40
ANNEX L – SUMMARY OF CONSULTATION
The refresh of the strategy (2012-2016) was untaken by the eHealth Consultant. A series of presentations, workshops and discussions were carried out with representatives of the following groups:
Clinical Units Women & Children Surgical Medical Stirling CHP Clackmannanshire CHP Falkirk CHP
Associate Medical Directors/CHP Clinical Leads
Advisory Groups Area Clinical Forum Area Medical Committee GP Sub-committee Area Drug & Therapeutics Committee Area Pharmaceutical Commitee Area Optical Committee Area Psychology Committee
Exec Grp/PMG
Public Representative Groups Patient Public Panel Public Partnership Forum
Key Departments Information Services ICT/eHealth Info Governance Health Records Pharmacy eHealth Groups Acute eHG CHP eHG Corporate IM&T Health Records Committee Information Governance Group
Other Internal Audit Scottish Government eHealth Directorate eHealth Clinical Leads
In October 2011 a draft strategy was made available to all staff (via Staff News & Intranet website) for comment.
The draft strategy was shared with NHS Board members in January 2012, prior to formal agreement.
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ANNEX M - NHS FORTH VALLEY eHEALTH PROGRAMME - PROJECT LIFE CYCLE
OVERVIEW
The attached diagrams illustrate a lifecycle for projects within the NHS Forth Valley eHealth Programme.
The lifecycle is divided into 5 key stages:
• Concept • Business Case • Initiation • Implementation • End of Project
Each project will be registered on the project portfolio. The stage of each project will also be recorded.
Whilst the use of highlight reporting is explicitly mentioned during the implementation stage, it is expected that highlight reports will be produced at all stages.
Note that nationally agreed standard documentation/guidance will be followed where available (eg highlight reports, risk management). Where not available the Programme Office will advise on expected content.
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eHealth Strategy 2012-2017 Annexes 9 of 40
eHealth Strategy 2012-2017 Annexes 10 of 40
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ANNEX N – EQUALITY & DIVERSITY IMPACT ASSESSMENT
NHS Forth Valley Standard Impact Assessment Document (SIA)
Please complete electronically and answer all questions unless instructed otherwise.
Section A
Q1: Name of Document eHealth Strategy 2012-2016
Q1 a; Function Guidance Policy Project Protocol Service Other, please detail
Q2: What is the scope of this SIA
NHSFV Wide Service Specific Discipline Specific Other (Please Detail)
Q3: Is this a new development? (see Q1)
Yes No
Q4: If no to Q3 what is it replacing? eHealth Strategy 2008-2012
Q5: Team responsible for carrying out the Standard Impact Assessment? (please list) eHealth Consultant
Q6: Main SIA person’s contact details
Name: Dave Simpson Telephone Number: 01786 454659
Department: eHealth Email: Dave.simpson@nhs.
net
Q7: Describe the main aims, objective and intended outcomes To outline the direction of travel in the use of ICT and Information in supporting the delivery of healthcare in NHS Forth Valley. The eHealth Strategy provides a summary of the main aims for development of information and IT within NHS Forth Valley. Its purpose is to inform the development of information systems up to 2015/2016 and it encompasses the services delivered throughout the NHS Forth Valley area in order to:
• Investigate, measure and monitor the health of the population • Maximise public and patient health gain from information technology • Provide information electronically to support clinicians and our partners in direct patient care and in development areas of Managed Clinical Networks and Clinical Governance • Promote the benefits of new technology and encourage innovation, and support these with training
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Q8:
(i) Who is intended to benefit from the function/service development/other(Q1) – is it staff, service users or both?
Staff Service Users Other Please identify ______
(ii) Have they been involved in the development of the function/service development/other?
Yes No
(iii) If yes, who was involved and how were they involved? If no, is there a reason for this action? Clinical Units Women & Children Surgical Medical Stirling CHP Clackmannanshire CHP Falkirk CHP
Associate Medical Directors/CHP clinical Leads
Advisory Groups Area Clinical Forum Area Medical Committee GP Sub-committee Area Drug & Therapeutics Committee Area Pharmaceutical Commitee Area Optical Committee Area Psychology Committee
Exec Grp/PMG
Public Representative Groups
Key Departments Information Services ICT/eHealth Info Governance Health Records Pharmacy eHealth Groups Acute eHG CHP eHG Corporate IM&T Health Records Committee Information Governance Group
Other Scottish Government eHealth Directorate eHealth Clinical Leads
(iv) Please include any evidence or relevant information that has influenced the decisions contained in this SIA; (this could include demographic profiles; audits; research; published evidence; health needs assessment; work based on national guidance or legislative requirements etc)
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Comments:
• National eHealth Strategy • Various national and local strategies (see section 2) • Evidence relating to public use and availability of internet
Q9: When looking at the impact on the equality groups, you must consider the following points in accordance with General Duty of the Equality Act 2010 see below:
In summary, those subject to the Equality Duty must have due regard to the need to:
• eliminate unlawful discrimination, harassment and victimisation; • advance equality of opportunity between different groups; and • foster good relations between different groups
Has your assessment been able to demonstrate the following: Positive Impact, Negative / Adverse Impact or Neutral Impact?
What impact has your review Comments had on the following ‘protected Provide any evidence that supports characteristics’: Adverse/ Positive Neutral your answer for positive, negative Negative or neutral incl what is currently in place or is required to ensure
equality of access. Age 9 Whilst the emphasis on patient engagement with the service online may, at first glance, suggest a potential “digital inequality”, the strategy highlights the need to not to disadvantage patients/public who prefer not to access information online. The availability of ethnicity information will inform public health and service assessments Disability (incl. physical/ 9 Plans to improve disability information sensory problems, learning in e-referrals and communications with difficulties, communication patients needs; cognitive impairment) Gender Reassignment 9 Marriage and Civil partnership 9 Pregnancy and Maternity 9 Race/Ethnicity 9 The availability of ethnicity information will inform public health and service assessments Religion/Faith 9 Sex/Gender (male/female) 9 The availability of gender information will inform public health and service assessments Sexual orientation 9 Staff (This could include details 9 The eHealth Strategy puts a large
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of staff training completed or emphasis on training and process required in relation to service redesign delivery)
Cross cutting issues: Included are some areas for consideration. Please amend/add as appropriate. Further areas to consider in Appendix B Carers 9 Homeless 9 Involved in Criminal Justice 9 Prison eHealth will be a key area for System development over the next few years Language/ Social Origins 9 Plans to improve language information in e-referrals and communications with patients Literacy 9 Low income/poverty 9 The availability of gender information will inform public health and service assessments Mental Health Problems 9 Rural Areas 9 Increasing use of telecare/telemedicine will improve healthcare provision for people in rural areas
Q10: If actions are required to address changes, please attach your action plan to this document. Action plan attached?
Yes No
Q11: Is a detailed EQIA required?
Yes No Please state your reason for choices made in Question 11.
No high negative impact assessed
If the screening process has shown potential for a high negative impact you will be required to complete a detailed impact assessment.
Date EQIA Completed 27 / 09 / 2011
Date of next EQIA 2014 Review
Signature Print Name Dave Simpson
Department or Service eHealth
Please keep a completed copy of this template for your own records and attach to any appropriate tools as a record of SIA or EQIA completed. Send copy to [email protected]
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eHealth Strategy 2012-2017 Annexes 16 of 40
ANNEX O – Glossary
CHI Community Health Index – index of patients registered with General Medical Practices
CHP Community Healthy Partnership
DPH Director of Public Health
EHR Electronic Health Record
Email Electronic mail – messages between individuals exchanged using networks and computers
EMIS System used by all General Medical Practices in NHSFV
EPR Electronic Patient Record eICR Electronic Integrated Care Record
Firewall Device restricting access to networks
Forth Valley Intranet Network linking all NHS organisations within Forth Valley, with single access point to NHSnet
(SCI) Gateway Workflow system facilitating electronic transfer of clinical correspondence (eg electronic referral
GPASS General Practice Administrative Support System
HDL Health Department Letter
HEAT Health, Efficiency, Access, Treatment – Performance management targets for NHS Scotland
HEPMA Hospital Electronic Prescribing & Medicines Administration
HelixPMS Patient administration system used in acute services inpatients
ICT Information & Communications Technology
Identifiable An individual can be identified from the data/information provided
IM&T Information Management & Technology
IP Internet Protocol – standard method of exchange of information across networks
ISD Information & Statistics Division
IT Information Technology
ITIL Information Technology Infrastructure Library – Industry standard for managing ICT departments
KSF Knowledge & Skills Framework
LAN Local Area Network – network of computers within the same or neighbouring locations
MEL Management Executive Letter
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MS Office Standard package used in office environment for word-processing, spreadsheets and databases
MSP Managing Successful Programmes – methodology used to manage realisation of benefits from a programme consisting of one or more projects
NHSFV NHS Forth Valley
NHSmail Secure NHS web-based email system
NHSnet or N3 Closed national network linking local networks. Only available to NHS or NHS- sponsored organisations
NHS24 NHS Scotland call centre
PACS Picture Archive Computer Storage
PC Personal computer
PDA Personal Digital Assistant – handheld “PC”
PDP Personal Development Plan
PiMS Patient Information Management System – developed by iSOFT
PAS/PMS Patient Administration System/Patient Management System
PRINCE Project Implementation in a Controlled Environment – methodology used to manage project implementation
RMS Radiology Management System
Router Device directing electronic messages
Server Software that performs actions at the request of a client programme running on another computer
SCI Scottish Care Information – Generic term for national inhouse developed/commissioned products
SCCRS Scottish Cervical Call & Recall System
SG Scottish Government
SHOW Scottish Health on the Web – Website of Scottish NHS, accessible by the NHS and the general public
SIGN Scottish Intercollegiate Guidelines Network
SIRS Standard Immunisation Recall System – recall system used by Child Health department
SMR Scottish Morbidity Record – patient-based record collated nationally relating to health care provision
(SCI) Store System providing key demographics to variety of systems. Also provides clinical access to lab & radiology results
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TOPAS Outpatient Management System
WAN Wide Area Network – Network of LANs
WLAN Wireless Local Area Network
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Annex P – Document Ownership & History
Document Owner
The Executive Lead for eHealth is the owner of this document on behalf of NHS Forth Valley
The document should be reviewed every three years.
Document History
Version Description Author Date Approved 1 Area IM&T Strategy D Simpson 18 August 2000 NHS Board 2 Refresh 2004-05 D Simpson 16 March 2005 NHS Board 3 Refresh 2008-09 D Simpson March 2008 NHS Board 4 Refresh 2011-12 D Simpson
eHealth Strategy 2012-2017 Annexes 20 of 40 eHealth Strategy
Jonathan Procter Board Seminar
• Strategy Development • Patient Participation • Telehealth • Clinical Portal • Vision National eHealth Strategy
• maximise efficient working practices, minimise wasteful variation, bring about measurable savings and ensure value for money • support people to manage their own health and wellbeing, and to become more active participants in the care and services they receive • contribute to shifting the balance of care and support people with long term conditions and mental health problems • improve the availability of appropriate information for healthcare workers and the tools to use and communicate that information effectively to improve quality • improve medication management as an essential part of peoples’ care National eHealth Strategy
• Efficiency • Public/Patient use of eHealth • Long term Conditions (incl. Mental Health) • Electronic Health Record & Workflow • Medication Management Stakeholder Consultation (40-60 meetings) • Clinical Units • CHP Management Teams • Associate Medical Directors • NHSCHP Clinical Forth Leads Valley • Clinical Advisory Groups • Exec Grp/PMG • Public Representative Groups • eHealthKey Departments Strategy Computer• eHealth Groups Industry • eHealth Clinical Leads • Health2012-2017 Records Committee • Information Governance Group Trends• Local Partners & Predictions • Internal Audit • Scottish Government eHealth Directorate • All Staff eHealth in NHSFV
Protocol-based Referral Discharge Electronic Health Record Online Diagnostic Results Emergency Care Summary (Clinical Portal) Websites Referral Management Test Requesting & Reporting Practice & Community Patient Tracking (Order Comms) Profiles Bed Management Hospital Prescribing Internet Access Medicines Reconciliation Community eHealth GP Systems Patient Participation Out of Hours GPs Telehealth Mental Health Assessment Digital Dictation Partnership Working Barcoded Wristbands Nurse Handover Single PAS Service Information Infrastructure Activity Dashboards Self-care
Accessible, Up-to-date Limited & Out of date & Relevant Patient as a partner in care Primary & Community Care
Structured & Unsecure & Passive Decision Support Primary & Community Care
Shared Community Health Record
Shared Assessments Diagnostics
Limited & Expensive Flexibility Diagnostics
Labs Wards & Outpatients Requests
GPs
Results Radiology
A&E Clinical Communications
Slow & Unreliable Fast & Reliable All Majority of Clinical Communications
Slow & Unreliable Fast & Reliable Wards
Limited Access Cross-hospital Hospital Setting Infrastructure Infrastructure Health Record
Multiple locations Single Records Library The Paperlight Health System
Electronic Patient Record eHealth in NHSFV
Protocol-based Referral Discharge Electronic Health Record Online Diagnostic Results Emergency Care Summary (Clinical Portal) Websites Referral Management Test Requesting & Reporting Practice & Community Patient Tracking (Order Comms) Profiles Bed Management Hospital Prescribing Internet Access Medicines Reconciliation Community eHealth GP Systems Patient Participation Out of Hours GPs Telehealth Mental Health Assessment Digital Dictation Partnership Working Barcoded Wristbands Nurse Handover Single PAS Service Information Infrastructure Activity Dashboards eHealth in NHSFV
Protocol-based Referral QualityDischarge Electronic Health Record Online Diagnostic Results Emergency Care Summary (Clinical Portal) Websites ReferralStrategy Management Test Requesting & Reporting Practice & Community Patient Tracking (Order Comms) Profiles Bed Management Hospital Prescribing Internet Access Medicines Reconciliation Community eHealth GP Systems Patient Participation Whole Out of Hours GPs Telehealth Mental Health AssessmentPaperlight System Digital Dictation Partnership Working Barcoded WristbandsHospital WorkingNurse Handover Single PAS Service Information Infrastructure Activity Dashboards Acknowledgments
• Executive Team • 60 Consultant Review Groups • Non Exec Board Members – – Karen , Fiona & Vicky • Dave Simpson Summary & Next Steps
• Significant progress through effective benefits realisation
• Priorities consistent with local & national direction – Integration – Efficiency – Patient involvement
• NHS Board is asked to approve strategy Timelines
2011-12 2012-13 2013-14 2014-15 2015-16
Single PAS
Community eHealth
Intelligent Test Requesting/Reporting
Hospital Prescribing/Medicines Administration
TeleHealth
Shared Assessments
Patient Portal
Clinical Portal
Paperlight NHS Forth Valley
Forth Valley NHS Board
27 March 2012
This report relates to Item 6 on the Agenda
Health & Social Care Integration
(Paper presented by Professor Fiona Mackenzie, Chief Executive)
For Approval SUMMARY
1. HEALTH AND SOCIAL CARE INTEGRATION
2. PURPOSE OF PAPER
The purpose of this paper is to brief Board Members on progress both nationally and locally in relation to the Scottish Government’s plan to integrate adult health and social care.
3. BACKGROUND
For some years successive governments have been looking at ways to better integrate and deliver joint services across the NHS and Local Authorities. Most notably have been the Joint Future Agenda in 2003 and The NHS Scotland Reform (Scotland) Act 2004.which introduced the requirement for each health board to establish Community Health Partnerships. CHPs were intended to create a more consistent and enhanced role in the delivery of integrated services and to work towards making a measurable improvement to the health of the local population.
CHPs have developed differently across Scotland with some operating within a health only structure whilst others have adopted a more integrated health and social care structure. There has also been varying levels of duplication in roles and functions between the CHPs and other partnerships particularly in relation to the Community Planning Partnerships which were already in existence and established by local authorities.
CHPS have also shown variation on how clearly outcomes and objectives have been defined and agreeing measures in terms of each partners’ contribution to achieving overall performance improvement.
The Change Fund has now been made available to NHS Boards and Local Authorities to implement plans to make better use of combined resources and is directed towards older people’s services. The fund is expected to facilitate shifts in the balance of care and influence decisions on overall health and social care spend for this client group.
4. NATIONAL CONTEXT
In December 2011 the Scottish Government announced its plans for integrating adult health and social care. The plans are anticipated to herald a radical reform of Community Health Partnerships (CHPs).
The Cabinet Secretary for Health, Wellbeing and Cities Strategy, Nicola Sturgeon said the “aim [of the plan is] to improve the quality and consistency of care for older people and put an end to the ‘cost shunting’ between NHS and local authorities that too often ends up with older people being delayed in hospital longer than they should be and not getting the best standards of care.”
“Key elements of the new system will be: Community Health Partnerships will be replaced by Health and Social Care Partnerships, which will be the joint responsibility of the NHS and local authority, and will work in partnership with the third and independent sectors
Partnerships will be accountable to Ministers, leaders of local authorities and the public for delivering new nationally agreed outcomes. These will initially focus on improving older people's care and are set to include measures such as reducing delayed discharges, reducing unplanned admissions to hospital and increasing the number of older people who live in their own home rather than a care home or hospital
NHS Boards and local authorities will be required to produce integrated budgets for older people's services to bring an end to the 'cost-shunting' that currently exists
The role of clinicians and social care professionals in the planning of services for older people will be strengthened
A smaller proportion of resources - money and staff - will be directed towards institutional care and more resources will be invested in community provision. This will mean creating new or different job opportunities in the community. This is in line with the commitment to support people to stay at home or in another homely setting, as independent as possible, for as long as possible. The Change Fund for older people's services is already helping to deliver these improvements.”
In conjunction with the Scottish Government’s plans as outlined above, the Self Directed Support (Scotland) Bill was launched on 1 March 2012. This Bill aims to give people more choice and control over the support they receive. If these changes are to work well then it is essential that local authorities and NHS Boards improve the planning of how future care is delivered.
Following the Government announcement there has been wide ranging discussion across both health and social care, within the voluntary sector and amongst professional bodies.
There is a high level of commitment politically across all parties to the Government’s plans and all agree that what matters to people is that they receive quality services, delivered efficiently and effectively. The public are not concerned with the boundaries between health and local authority service delivery and the bureaucracy that exists as a result.
It is anticipated that consultation on the government’s proposals will commence post the local government elections in May 2011. The detail of that consultation document is being developed in collaboration with representatives from the NHS, Local Authorities, the Scottish Government and Independent Sector.
NHS Chief Executives have been discussing the implications of the Government’s proposals and held a workshop on 1 March and a development session on 14 March where a number of issues were considered which will inform the consultation document. The discussions focussed on what would be included, outcomes, workforce, governance, finance and other issues. In conclusion, NHS Chief Executives support the plan to integrate adult health and social care seeing this as a major opportunity to improve the quality and efficiency of services to users and carers across Scotland.
Nationally, an integration governance structure has been developed consisting of a Ministerial Strategic Group for Health and Community Care, chaired by the Deputy First Minister and Cabinet Secretary for Health Wellbeing and Cities Strategy, supported by the Health and Community Care Delivery Group. This Group has a number of sub groups, see below, each with membership from across the Scottish Government, NHS Boards, Councils, COSLA and others: -
Integrated Resourcing and Budgeting Joint Commissioning Workforce HR Governance and Accountability Locality Planning and Professional Engagement Outcomes / Indicators Implications for other areas of social care services
NHS Forth Valley is represented on a number of these groups by Fiona Mackenzie, Chief Executive, Fiona Ramsay, Director of Finance and Helen Kelly, Director of Human Resources.
Whilst the Cabinet Secretary has made it clear that proposals aim to initially improve services of older people, indications are that the first phase of implementation will be for all adult care.
The likely timetable for legislation is that a Bill will be launched in the spring of 2013 and could be passed into statute by the spring of 2014.
5 LOCAL CONTEXT
NHS Forth Valley has a good track record of working in partnership with local authorities. Since the establishment of CHPs Forth Valley has continued to seek opportunities for more effective joint working. Increasingly projects have been developed on a multi-agency basis for example the North West Stirlingshire project and the sharing of premises at the Clackmannanshire Healthcare Centre. Perhaps most notably in terms of the plans for health and social care integration is that NHS Forth Valley has the only pooled budget in Scotland for its Integrated Mental Health Service.
More recently existing CHP governance arrangements have been strengthened by the establishment of Partnership Boards with Stirling and Clackmannanshire Partnership Boards recently merging to create greater opportunities for partnership working and integration.
A Joint Executive Group has also recently been established across all three Council areas. This group brings together representative Executives from the Councils and NHS Forth Valley. The focus of this group is to develop and oversee joint working opportunities across the four agencies working in conjunction with the G5 and links closely with the work of the broader Community Planning Partnership agenda. Chief Executives are currently in the process of identifying a resource to support them with this agenda to augment operational delivery.
Discussions have taken place at the Healthcare Strategy Programme Board and the Performance Management Group will be reviewing implications of the Government’s plans at its meeting on 29 March. It is very important that the NHS Board also has an opportunity to take an active role in discussions and the purpose of this paper is to outline the current status of this fast moving agenda. The Board will continue to be kept informed on progress prior to the Consultation Document being published and thereafter to agree next steps.
6. RECOMMENDATION(S) FOR DECISION
The Forth Valley NHS Board is asked to: -
o Note the progress in relation to the plans to integrate adult health and social care services and that further updates will be provided to the Board as appropriate. o Note the Board will be fully involved in progressing this important issue.
7. AUTHOR OF PAPER/REPORT:
Name: Designation: Beverley Finch Head of Corporate Services
Approved by: Name: Designation: Fiona Mackenzie Chief Executive
Forth Valley NHS Board
27 March 2012
This report relates to Item 7.1 on the Agenda
Minute of the Area Clinical Forum meeting held on 19 January 2012
For Noting FORTH VALLEY NHS BOARD
DRAFT Minute of the Area Clinical Forum meeting held on Thursday 19th January 2012 at 6.15 pm in the Boardroom, NHS Forth Valley, Carseview House, Castle Business Park, Stirling.
Present Dr Allan Bridges (Chair) Ms Lindsay Cowan, Area Optical Committee Ms Kathleen Cowle, Area Pharmaceutical Committee Dr Leslie Cruickshank, Falkirk CHP Dr Stuart Cumming, Stirling CHP Dr Marie Grant, Area Psychology Committee Ms Morag Harris, Allied Health Professionals Committee Mr Graeme Inglis, Healthcare Scientists Forum Dr James King, Clackmannanshire CHP Ms Grace Love, Area Optical Committee Dr Keith Bowden, Area Psychology Committee Ms May Fallon, ANMAC Ms Allison Ramsay, ANMAC
In Attendance: Ms Fiona Mackenzie, Chief Executive Mr Tom Hammond, Senior Planning Manager
1/ WELCOME AND APOLOGIES FOR ABSENCE
Dr Bridges welcomed everyone to the meeting and apologies for absence were intimated on behalf of, Mr Robert Johnston, Area Dental Committee and Mr Ian Watt, Area Pharmaceutical Committee.
2/ QUALITY IMPROVEMENT AND PRODUCTIVITY IN GP PRACTICES
The Area Clinical Forum received a presentation, “Quality Improvement and Productivity in GP Practices”, presented by Dr. Stuart Cumming.
Dr. Cumming explained that this encompassed the work of the Whole System Working Project (including QIP and QOF), which recognised the role of Primary Care as a key stakeholder in service development. He out lined the work being undertaken. He noted the objective of the work as to “Provide GPs with information and evidence about key issues and activity in format that allows learning, reflection and appropriate informed changes of clinical behaviour” and described the specific aims as:
• Improving interface communication between primary and secondary care • Highlight primary care issues and enable primary care to recommend changes • Successful clinical engagement.
The outcomes that had been achieved covered admissions, referrals, prescribing and quality improvements.
The priorities for 2012 /13 have been prioritised as:
• Labs and radiology • Prescribing - QOF QIP - Polypharmacy • Long Term Conditions • Anticipatory Care Planning 2 FORTH VALLEY NHS BOARD
• Patient safety
In the discussion that followed the Committee agreed that the process could be allied to other professions and believed that similar gains could be made in ambulatory care. It was recognised that parts of the process were applicable to AHP and Nursing services and any area where there was reliable data and joint working. It was noted that the process had empowered those who had been involved.
The discussion concluded with Dr. Cumming emphasising that where a joint approach was needed, the process used evidence and data to redesign by agreement and often resulted in more efficient use of resources.
Dr Bridges thanked Dr. Cumming for informing the Forum of this important work in developing services in NHS Forth Valley.
3/ STRESS CONTROL
The Area Clinical Forum received a presentation, “Introducing Stress Control in NHS Forth Valley”, presented by Dr Marie Grant Head of Primary Care Adult Psychology.
Dr. Grant outlined how this new approach was structured, emphasising that it was not therapy but lecture based for people with mild to moderate stress. It had been developed by Jim White, (Psychologist in Glasgow) and consisted of a 6 week psycho-educational CBT course held in non NHS premises to reduce stigma. Patients were invited to bring someone with them and were viewed as students. It was a relapse prevention approach with up to 100 attendees at each session. In both Glasgow and Fife, where the approach had already been established, it had proved to be efficient and cost effective with no waiting list.
In NHS Forth Valley a pilot was completed in December 2011 and the recruitment and training of facilitators and coordinators is now being progressed. A pilot is also being planned to include staff via referral from the occupational health service.
The Forum welcomed this initiative and noted the sustained improvement the majority of participants made. The Forum also highlighted the way this project allowed the Psychologists to use their time more efficiently with those who needed 1:1 therapy. The discussion that followed indicated that there were many other areas where this approach could be used, including heart failure patients and carers.
Dr Bridges thanked Dr. Grant for informing the Forum of this important development in the treatment of stress.
4/ MINUTE OF AREA CLINICAL FORUM
The minute of the Area Clinical Forum meeting held on Thursday 17th November 2011 was approved as a correct record.
5/ MATTERS ARISING 3 FORTH VALLEY NHS BOARD
The venue for the ACF event on 22nd of March was confirmed as Forth Valley Royal Hospital.
6/ AGENDA ITEMS FOR NEXT MEETING
The next business meeting of the Forum will be on 17th May. It was agreed that Lindsay Cowan would present on the current issues for the Area Optical Committee and Kathleen Cowle would present on the current issues for the Area Pharmaceutical Committee. Additionally it was agreed that the Director of Finance, Fiona Ramsay, would be invited to present on the current NHS Forth Valley financial position. The Chairman indicated that changes to the NHS Forth Valley management structure were under discussion and it may be appropriate to discuss these at the meeting in May. Feedback from the event in March would also be on the agenda.
7/ ANY OTHER COMPETENT BUSINESS
Tom Hammond drew the attention of the Forum to CEL 01 (2012), ‘Health Promoting Health Service: Action in Hospital Settings’ that had been circulated earlier in the week. It highlighted Area Clinical Forums as champions. It was agreed to invite the Director of Public Health to a meeting later in the year to discuss this issue.
8/ DATE OF NEXT MEETING
The next Business Meeting of the Forum will be on Thursday 17th May 2012 at 6.15pm in the Boardroom, NHS Forth Valley, Carseview House, Castle Business Park, Stirling.
The ACF is running an event on 22nd March, ‘Delivering Quality through Engaging with Professional Advisory Committees and members were encouraged by the Chairman to do all they could to ensure a good turnout from all Advisory Committees.
4
Forth Valley NHS Board
27 March 2012
This report relates to Item 7.2 on the Agenda
Minute of Clinical Governance Committee meeting held on 20 January 2012
For Noting
1
DRAFT Minute of the Forth Valley NHS Board Clinical Governance Committee meeting held on Friday 20 January 2012 at 9.30 am in the Boardroom, NHS Forth Valley, Carseview House, Stirling.
Present: Mr B Clark, Non Executive Board Member (Chair) Dr S Cumming, Clinical Lead, Stirling CHP
In Attendance: Professor A Wallace, Director of Nursing Dr A M Wallace, Director of Public Health Mrs A Richmond-Ferns, Associate Director of Human Resources Dr I Wallace, Medical Director Professor F Mackenzie, Chief Executive Mrs I Graham, Personal Assistant (Minute) Mrs M Inglis, Head of Clinical Governance Mrs E Crosbie, NHS Forth Valley Public Partnership Forum Mrs H McGuire, Public Involvement Network
1/ APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of Ms F Gavine, Mrs G Caldwell, Ms M Duffy, Mr I Mullen and Dr A Bridges.
2/ MINUTE OF NHS FORTH VALLEY CLINICAL GOVERNANCE COMMITTEE MEETING HELD ON 14 OCTOBER 2011
The minute of the Clinical Governance Committee meeting held on 14 October 2011 was approved as a correct record with the following amendments:
Pg 3, final line should read - ‘target, and the use of acute occupied bed days …’
Pg 4, para 4 should read - ‘Dr Wallace reported on the two Healthcare Environment …’
Pg 4, para 5 should read - ‘from next year Forth Valley HAI Annual Report would …’
3/ MATTERS ARISING
3.1 Review of Actions
The Committee considered the actions from the previous meeting and noted the progress made to date.
Re Item 6.2 - Mrs Richmond Ferns advised that once the model of care had been agreed, the workforce plan would be taken forward.
2
4/ CLINICAL GOVERNANCE: STRATEGY AND OBJECTIVES
4.1 NHS Board Clinical Governance Committee Terms of Reference
The Committee received a paper - NHS Board Clinical Governance Committee Terms of Reference - presented by Dr Iain Wallace, Medical Director
Dr I Wallace advised that there had been no change to the terms of reference, however this would be reviewed once the new NHS Forth Valley structure was in place.
The Committee agreed an amendment to add one Member of the NHS Forth Valley Public Partnership Forum to the membership to the Terms of Reference.
5/ SAFE CARE
5.1 NHS Forth Valley Healthcare Associated Infection Reporting Template (HAIRT)
The Committee received a paper - NHS Forth Valley Healthcare Associated Infection Reporting Template (HAIRT) - presented by Dr Anne Maree Wallace, Director of Public Health.
Dr A M Wallace highlighted the Board reporting performance arrangements for Healthcare Associate Infection to the end of October 2011 in the new format.
The Healthcare Environment Inspectorate (HEI) had carried out their first unannounced inspection at Forth Valley Royal Hospital on 20 September 2011 and the feedback received had been very positive. All requirements and recommendations had now been signed off. A process to provide ongoing assurance was in place, with a range of HAI audits being reported to the Area Prevention and Control of Infection Committee.
Cases of Staphylococcus Aureus Bacteraemias (SABs) had increased; Dr A M advised that this was partially due to a significant increase in skin infections associated with intravenous drug use. The cause for this was still being investigated. The effect of the use of acute occupied bed days as the denominator for this indicator was noted and Dr A M Wallace advised that she had written to the Chief Nurse regarding this issue.
The Committee questioned why the graphs showed yearly activity and Dr A M Wallace advised that quarterly/six monthly updates could be circulated to the Executive Team if required.
The Committee noted the report.
5.2 NHS Forth Valley Corporate Risk Register
The Committee received a paper - NHS Forth Valley Corporate Risk Register - presented by Dr Anne Maree Wallace, Director of Public Health in the absence of Mrs Gail Caldwell, Pharmacy Director.
Dr A M Wallace highlighted:
3
ILHP 03 - Pandemic flu had been reinstated to the register as this was perceived nationally as a risk.
The Committee noted the report.
5.3 Health Improvement Scotland (HIS) Surgical Profiles
The Committee received a paper - Health Improvement Scotland (HIS) Surgical Profiles - presented by Mrs Monica Inglis, Head of Clinical Governance.
Mrs Inglis advised that the report was in draft format as further information was still required.
The following points were discussed:
Bariatric surgery was not currently undertaken in NHS Forth Valley. Review of the data had shown that the patient identified had had a surgical procedure for a different clinical indication other than bariatric surgery. The percentage of surgical terminations for 15-44 years in NHS Forth Valley was low. There were no concerns in Primary Care regarding accessing terminations.
Mrs Inglis proposed that Mr Clark approve the response to Healthcare Improvement Scotland.
The Committee approved the proposal.
6/ EFFECTIVE CARE
6.1 NHS Forth Valley Clinical Governance Performance Monitoring Template Summary
The Committee received a paper - NHS Forth Valley Clinical Governance Performance Monitoring Template Summary - presented by Mrs Monica Inglis, Head of Clinical Governance.
Issues the Committee were asked to note were:
Standards for neurological services - self assessment completed, review 3 February 2012 Unannounced inspection of Munroe House - Falkirk CHP would review report Audit Scotland Telehealth - this would be reviewed as part of the eHealth Strategy
The Committee noted the report.
6.2 Cervical Screening Programme
The Committee received a paper - Cervical Screening Programme - presented by Dr Rani Balendra, Public Health Consultant.
4
Dr A M Wallace reported that cervical smears were offered every 3 years for the 20-60 year age group. Numbers of cervical cancer mortality for the period 2005-2009 had reduced. The uptake for the lower age group however was not as high as expected but it was noted that this was a national trend.
The Human Papilloma Virus (HPV) immunisation programme had been rolled out in NHS Forth Valley but it was too early to report any impact on cervical cancer figures.
The Committee noted the report.
6.3 NHS Forth Valley Annual Medical Appraisal Report
The Committee received a paper - NHS Forth Valley Annual Medical Appraisal Report - presented by Dr Iain Wallace, Medical Director.
Dr I Wallace advised this retrospective report covered the period from April 2010 – March 2011. The GP appraisal scheme had been running for a considerable time but there had been difficulty developing a system for secondary care. It was noted that enhanced appraisal and revalidation was due to commence in 2013 and that a number of NHS Forth Valley clinicians had already been trained as enhanced appraisers.
In response to questions Dr I Wallace explained the process for revalidation. The General Medical Council (GMC) required doctors to be appraised yearly before they could be revalidated. Should an individual not be appraised then the GMC would refuse revalidation and investigate the reasons.
The Committee noted the report.
7/ PERSON CENTRED CARE
7.1 NHS Forth Valley Complaints Performance Report
The Committee received a paper - NHS Forth Valley Complaints Performance Report - presented by Professor Angela Wallace, Director of Nursing.
Professor Wallace reported that during November 2011 NHS Forth Valley achieved 40.26% response to complainants within 20 days.
It was highlighted that this was the first report since NHS Forth Valley had taken over responsibility for healthcare in the prisons and that prisoner complaints were reflected in the figures for the Falkirk Community Health Partnership. Members requested that prisoner complaints be noted separately in future reports and Professor Wallace agreed to action this.
The vacancy in the Patient Relations Department had now been filled and it was aimed to increase the response figures for the March report.
In response to a query from Mrs McGuire regarding the new patient service, Professor Wallace stated that there was no further information available on the tender for the new
5
patient service. The Independent Advice and Support Service (IASS) would continue to provide a service until March 2012.
The Committee noted the report.
8/ REPORTS FROM ASSOCIATED CLINICAL GOVERNANCE GROUPS
8.1 Minute of Patient Focus and Public Involvement Steering Group held on 8 September 2011
The Committee noted the minute of the Patient Focus and Public Involvement Steering Group held on 8 September 2011 as presented by Professor Angela Wallace, Director of Nursing.
8.2 Minute of Information Governance Group held on 28 October 2011
The Committee noted the minute of the Information Governance Group held on 28 October 2011 as presented by Dr Iain Wallace, Medical Director.
8.3 Draft Minute of Acute Clinical Governance Working Group held on 24 November 2011
The Committee noted the draft minute of the Acute Clinical Governance Working Group held on 24 November 2011 as presented by Mrs Monica Inglis, Head of Clinical Governance.
8.4 Draft Minute of the Area Prevention and Control of Infection Committee held on 8 September 2011
The Committee noted the draft minute of the Area Prevention and Control of Infection Committee held on 8 September 2011 as presented by Dr Anne Maree Wallace, Director of Public Health.
8.5 Child Protection Quarterly Report - October/December 2011
The Committee noted the Child Protection Quarterly Report - October/December 2011 as presented by Professor Angela Wallace, Director of Nursing.
8.6 Draft Minute of the Child Protection Action Group held on 1 August 2011
The Committee noted the draft minute of the Child Protection Action Group held on 1 August 2011 as presented by Professor Angela Wallace, Director of Nursing.
8.7 Draft Minute of Area Medical Equipment Committee held on 25 November 2011
The Committee noted the draft minute of the Area Medical Equipment Committee held on 25 November 2011 presented by Dr Iain Wallace, Medical Director.
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8.8 Draft Minute of the Joint Clinical Governance Working Group held on 24 November 2011
The Committee noted the draft minute of the Joint Clinical Governance Working Group held on 24 November 2011 as presented by Mrs Monica Inglis, Head of Clinical Governance.
8.9 Draft Minute of Research and Development Committee held on 29 September 2011 and 24 November 2011
The Committee noted the draft minute of the Research and Development Committee held on 29 September 2011 and 24 November 2011 presented by Dr Iain Wallace, Medical Director.
8.10 NHS Forth Valley CHI Project: End of Project Report
The Committee noted the NHS Forth Valley CHI Project: End of Project Report as presented by Dr Iain Wallace, Medical Director.
Dr I Wallace highlighted that CHI issue would continue, however when the new system was fully electronic the issue would improve.
The Committee noted the report.
8.11 NHS Forth Valley Guidelines and Policies Update
The Committee noted the NHS Forth Valley Guidelines and Policies Update for the period October to December 2011 inclusive presented by Dr Iain Wallace, Medical Director.
9/ TO NOTE ANY UNTOWARD INCIDENTS
There were no untoward incidents to report.
10/ ANY OTHER COMPETENT BUSINESS
Mr Clark belatedly welcomed Mrs Crosbie to the Committee and apologised for omitting her introduction at the start of the meeting.
11/ DATE AND TIME OF FUTURE MEETINGS
The next meeting of the NHS Forth Valley Clinical Governance Committee would be held on Friday 30 March 2012 at 9.30 a.m. in the Boardroom, Carseview House, Stirling.
There being no further business, the Chair closed the meeting at 11.45am.
7
Forth Valley NHS Board
27 March 2012
This report relates to Item 7.3 on the Agenda
Minute of Audit Committee meeting held on 27 January 2012
For Noting
1 AUDIT COMMITTEE
DRAFT Minute of the NHS Forth Valley Audit Committee meeting held on Friday 27th January 2012 in the Board Room, Carseview, Stirling.
Present: Mr James King (Chair) Cllr Scott Farmer Mr Charles Forbes Mr Tom Hart
In Attendance: Mrs Fiona Ramsay, Director of Finance, (Executive Lead) Prof Fiona Mackenzie, Chief Executive Mr Ian Mullen, Chairman Mr David Archibald, Regional Audit Manager, FTF Audit Services Mr Tony Gaskin, Chief Internal Auditor, FTF Audit Services Mr Peter Lindsay, Audit Scotland Miss Lynn Brown, Audit Scotland Mr Peter McIntyre, NHS Counter Fraud Services (Item 4.1 only) Mr Gordon Young, NHS Counter Fraud Services (Item 4.1 only) Mr Graeme Bowden, Capital Accountant
1/ APOLOGIES
There were no apologies for absence.
. 2/ MINUTES OF PREVIOUS MEETING
The Minute of the Audit Committee meeting held on 21st October 2011 was approved as a correct record.
3/ MATTERS ARISING
3.1 National Shared Services Review
Mrs Ramsay highlighted that there were currently two main areas of risk to NHS Forth Valley within the National Shared Services project. Mrs Ramsay advised that she had recently attended a meeting organised by the NSS team for Boards currently using the Capital Asset Register (CARS) System for the management of their Fixed Assets. The purpose of the meeting was to air concerns the CARS users had in moving to the Real Asset Management (RAM) system and this meeting highlighted that issues were still outstanding with User Acceptance Testing and the new system’s forecasting/modelling functionality. Mrs Ramsay also asked the Committee to note the risks associated with the National Single Instance (NSI) project timeframe. NHS Forth Valley, as a member of the Tayside Consortium, was due to move to a new single ledger platform from 1st April 2012. Mrs Ramsay indicated that there were ongoing concerns with interfaces of feeder systems, timescales to allow completion of User Acceptance Testing in advance of the planned ‘Go Live’ date, the Boxi reporting function and also the gaps in Technical Support that were causing a risk to the April timescale being met. Mrs Ramsay indicated that there were important meetings in the next week regarding interfaces with feeder systems
2 which would determine if the April 2012 date remained feasible. The risk highlighted could impact on the availability of April Finance reports and potentially beyond.
The Committee noted the update on the National Shared Services Review.
4/ COUNTER FRAUD SERVICES
4.1 The Role of Counter Fraud Services Mr King welcomed Mr Peter McIntyre and Mr Gordon Young who had been invited to attend the Audit Committee to give a presentation on the role of Counter Fraud Services (CFS). Mr McIntyre highlighted that CFS was committed to reducing fraud and corruption in the NHS in Scotland to an absolute minimum, and to building and promoting a culture in which staff, patients and the wider public regard fraud against the NHS as totally unacceptable. Mr McIntyre indicated that there was a CFS Strategy in place that outlined their universal principles for countering fraud, the core elements targeted and also the key partners that CFS worked with while providing their services. Mr Young also provided the Committee with an insight to the structure of CFS and highlighted that teams were in place and working together to prevent, deter, detect and investigate fraud. These teams contribute to the delivery of both national and local counter fraud policy and initiatives. Mr Young highlighted that there were two Investigation teams working on both reactive and proactive cases. The reactive teams investigated cases referred to CFS and the proactive team undertakes exercises that deter, prevent and detect fraud and financial loss. Mr Young also indicated that there was a communications team that delivered a national programme of counter fraud initiatives and fraud awareness campaigns. This team worked with Counter Fraud Champions to get anti-fraud messages across at local Board level.
Mr Mullen queried what the key performance indicators were for the Counter Fraud Service and whether they were being met. Mr McIntyre indicated that the performance of the service was basically measured against savings made, the number of investigations and the Health impact of successful investigations. Mrs Ramsay also asked the Committee to note that relatively straightforward cases appeared to take a considerable time to conclude.
Mr King thanked Mr McIntyre and Mr Young for attending and giving their very informative presentation and both then left the meeting.
4.2 Counter Fraud Services Quarterly Report
Mr Archibald presented the Counter Fraud Services Quarterly Report for period ending 30th September 2011 and highlighted that the report indicated there were currently two cases relating to NHS Forth Valley.
The Committee noted the Counter Fraud Services Quarterly report.
4.3 CFS – Local Cases Update
Mr Archibald provided the Committee with an update on the local cases that had been referred to Counter Fraud Services. Mr Archibald highlighted that Operation Basil had resulted from a statistical outlier case relating to an Optician’s Practice. No fraudulent issues were proven. Operation Dragonfly was a new case with matters ongoing. Mr Archibald also commented on another issue which had arisen following a CFS Alert in connection with an individual seeking to access treatment across primary care areas. 3 The Committee noted the update on the local cases referred to Counter Fraud Services.
5\ INTERNAL AUDIT
5.1 Internal Audit Progress Report
Mr Archibald presented the Internal Audit Progress Report that summarised the audit work achieved since the last Committee meeting. He informed the Committee that six reports had been issued from the 2011/12 audit plan and a further three draft reports were with management for comment. Mr Archibald also highlighted that work was underway in another six reviews from the audit plan that included areas that External Audit would be taking reliance on Internal Audit’s findings.
The Committee noted the Internal Audit Progress Report.
5.2 Internal Audit Mid Year Review
Mr Gaskin presented the Internal Audit Mid Year Review and advised the Committee that the review examined the framework in place for NHS Forth Valley to provide assurance to the Chief Executive that there is a sound system of internal control supporting the achievement of the Board’s objectives. The Mid Year Report allowed the opportunity to amend processes accordingly prior to the year end. Mr Gaskin asked the Committee to note that the review had established that there were no control weaknesses evident and indeed that NHS Forth Valley continues to develop and maintain its control framework effectively.
Mr Gaskin advised that there had only been one recommendation made within the report that will require further review relating to Financial Governance surrounding the annual updates to NHS Forth Valley’s Financial Operating Procedures. Mr Gaskin asked the Committee to note that the Statement on Internal Control, published annually within the statutory accounts, was being replaced by a Governance Statement. It was however anticipated that the content of the new statement would not change a great deal for 2011/12. Mr Gaskin also indicated that NHS Forth Valley has been proactive in making it clear how the current financial climate is adversely impacting on resources and working with the Scottish Government Health Department to establish appropriate remedial courses of action. The Mid Year Review report indicated that work in this area had resulted in an improvement in the rating for the component within Financial Governance relating to “Arrangements to ensure Resources are Used Effectively, Efficiently and Economically”. Mr Gaskin highlighted that NHS Forth Valley had completed the Best Value matrix for 2010/11 and indicated the Board had advised that an updated matrix would be submitted to the March 2012 Audit Committee meeting that would reflect the changes made to the Best Value guidance issued for 2011/12.
The Committee noted the Internal Audit Mid-Year Review report.
6/ EXTERNAL AUDIT
5.1 External Audit Plan 2011/12
Mr Lindsay presented the External Audit Plan for 2011/12 and indicated that the purpose of the plan was to summarise the key challenges and risks facing NHS Forth Valley, and sets out the work Audit Scotland propose to undertake during 2011/12. Mr Lindsay indicated that the planned work would include: 4 An audit of the financial statements and provision of an opinion on whether they give a true and fair view of the state of affairs within NHS Forth Valley; A review and assessment of NHS Forth Valley’s governance and performance arrangements in a number of key areas; and The provision of regular reports to the Audit Committee during 2011/12.
Mr Lindsay indicated that Audit Scotland’s approach would focus on the areas of highest risk such as the assessment of Equal Pay liabilities, the ongoing implementation of the Board’s Integrated Healthcare Strategy, effective partnership working and also NHS Forth Valley’s financial position in relation to the current global financial pressures and changes being initiated within the NHS in Scotland. Mr Lindsay also indicated that Audit Scotland would provide an Annual Report to NHS Forth Valley that would summarise all significant matters arising from the 2011/12 audit reviews and an overall conclusion about NHS Forth Valley’s management of key risks.
Mr King queried if the review of Performance Management would be considered as a key priority area and Mr Lindsay confirmed that Audit Scotland intended scrutinising the minutes and papers presented at the newly formed Performance and Resources Committee.
With regard to the External Audit Fee, Mr Lindsay advised that it had reduced by 9.2% from the level set in 2010/11. Mr Lindsay also indicated that, as a result of Audit Scotland’s cost reduction plans, it was anticipated that NHS Forth Valley would also receive a rebate equivalent to 8% of the 2010/11 indicative audit fee already paid in the last financial year.
The Committee noted the External Audit Plan for 2011/12.
6.2 Audit Scotland Reports
Mrs Ramsay presented a summary paper for information on three national performance reports issued by Audit Scotland and emphasised that none were specific to NHS Forth Valley. The reports covered
6.21 Overview of the NHS in Scotland’s Performance 2010/11 This report was issued in December 2011 and highlighted that the NHS has strategies to make the service more efficient and effective and to help improve the quality of services it provides. Information on hospital activity is good but the NHS continues to find it difficult to measure productivity due to weaknesses in data and difficulties in linking costs, activity and quality. This is needed to identify how to improve services and the nation’s health with the same or fewer resources. In addressing the challenges that lay ahead for the NHS in Scotland, the report highlighted some key pressures that Boards must address. 6.22 Priorities and Risks Framework – a national planning tool 11/12 This report was issued in November 2011 and is an update to the initial version of the Priorities and Risk Framework issued in 2008 and subsequently revised since. The Priorities and Risks Framework (PRF) for NHSScotland (NHSS) is intended to provide a common framework for the delivery of high-quality public sector audit across the health sector. The PRF is one element of an audit approach which has been designed to meet the requirements of the Code of Audit Practice and International Standards on Auditing. These standards require auditors to understand their client’s business and its environment.
5 6.23 The Role of Community Planning Partnerships in Economic Development This report was issued in November 2011 and looks at how community planning partnerships (CPPs) operate and in particular how CPPs contribute to local economic development. The report follows up on a previous audit report published in 2006 that highlighted a number of areas for improvement including the need for better performance reporting, a better understanding of the cost of delivering on priorities and a need to break down barriers to effective partnership working. The 2011 report highlights that, since that previous report, the development of Single Outcome Agreements has helped improve the way in which CPPs monitor and report their performance but judging performance is made more difficult than it needs to be because of the large number of performance measures for economic development being used across Scotland.
The Committee noted the summary paper on Audit Scotland reports and that there were no specific actions identified for NHS Boards in these Reports.
7/ AUDIT FOLLOW UP REPORTS
7.1 Internal Audit Follow-Up Report
Mr Bowden presented the Internal Audit Follow-Up Report and indicated that good progress had been made since the last Committee meeting in obtaining confirmation that outstanding recommendations had been reviewed. Mr Bowden asked the Committee to note that to date, no recommendations made and due for a response were outstanding. Mr Bowden indicated that one further issue remained part complete relating to Service Contract Expenditure at the new Forth Valley Royal Hospital, but this was anticipated to be completed by the end of February. With regard to Priority 2 recommendations, Mr Bowden advised that since the last meeting five had been issued of which four were due to be reviewed at a later date, with the remaining priority 2 recommendation now resolved. Mr Bowden also asked the Committee to note that Internal Audit had recently finalised their annual review of the follow-up process and awarded it a category “A” rating.
The Committee noted the Internal Audit Follow-Up Report.
7.2 External Audit Follow-Up Report
Mr Bowden presented the External Audit Follow-Up Report and advised that the review process was currently ongoing with five final External Audit Reports issued by Scott Moncrieff. Mr Bowden indicated that to date there were no recommendations currently due for a response outstanding and provided the Committee with a summary of the outstanding issues due to be reviewed later in the year.
The Committee noted the External Audit Follow-Up Report.
8/ GOVERNANCE ISSUES
8.1 Audit Committee Terms of Reference
Mrs Ramsay presented the Audit Committee Terms of Reference and highlighted that they had been reviewed against model Terms of Reference set out in the Audit Committee Handbook. This review had provided assurance that the business covered by NHS Forth Valley’s Audit Committee is in line with the requirements set out within this model. Mrs Ramsay also highlighted that the Audit 6 Committee Handbook contained a Self Assessment Checklist and it was proposed that this checklist would be completed with the input of the Audit Committee Chair and presented to the Committee at the March 2012 meeting.
Mrs Ramsay advised that there was only one amendment proposed to section 4.2.4 of the Terms of Reference to cover the role of the new Performance and Resources Committee in their review of the delivery of efficiency programmes.
The Committee approved the revised Audit Committee Terms of Reference and noted the proposed completion of the Self Assessment Checklist.
9/ RISK MANAGEMENT
9.1 Risk Management Process
The planned presentation on the Risk Management Process was deferred to the next meeting.
9.2 Corporate Risk Register
Prof Mackenzie presented the latest version of the Corporate Risk Register and advised that a great deal of work had recently been performed by the Risk Management Team to automate the system. Prof Mackenzie advised that one new risk had been added within this latest version relating to both recent and potential Industrial Action by staff.
The Committee noted the Corporate Risk Register.
10/ ANY OTHER COMPETENT BUSINESS
10.1 Change in Accounting Policy
Mrs Ramsay provided the Committee with some background to two recent changes in accounting policy that will require prior year adjustments and also require the restatement of prior year comparator balances within the 2011/12 statutory accounts as follows:
10.11 – Donated Assets & Similar Financing of Non-Government Sources - The value of financing Donated Assets has historically been charged against a Donation Reserve. With effect from 1st April 2011, NHS Bodies will no longer hold Donation Reserves and where assets are funded by donation, the financing element will be recognised as Income. 10.12 – Prison Healthcare Transfer - Responsibility for the Healthcare of Prisoners in Scotland officially transferred from the Scottish Prison Service (SPS) to NHSScotland on 1st November 2011. In order to comply with HM Treasury’s Financial Reporting Manual (FReM), the transfer of prisoner healthcare from the SPS to the NHS must therefore be accounted for using merger accounting, which means Boards must account for the full year costs of prisoner healthcare from 1st April 2011.
The Committee approved the changes in accounting policy for Donated Assets and the Prison Healthcare Transfer.
7 10.2 Primary Medical Services – Payment Verification Procedures
Mrs Ramsay advised the Committee that a letter had been issued by the Scottish Government Health Finance Directorate notifying NHS Bodies that amendments had been made to the protocol issued on Payment Verification Procedures for Primary Medical Services. The Committee were advised that copies of the full document could be obtained from the Scotland’s Health on the Web (SHOW) website or on request from the Audit Committee Coordinator.
There being no further business the meeting closed at 11.10am.
11/ DATE OF NEXT MEETING
The next meeting of the NHS Forth Valley Audit Committee will take place on Friday 23rd March 2012 in the Board Room, Carseview, Stirling commencing at 9.30am.
8 Forth Valley NHS Board
27 March 2012
This report relates to Item 7.4 on the Agenda
Minute of Endowment Committee meeting held on 27 January 2012
For Noting
1 ENDOWMENT COMMITTEE
Draft Minute of the Forth Valley NHS Board Endowment Committee meeting held on Friday 27th January 2012 in the Forth Valley NHS Board Headquarters, Carseview House, Castle Business Park, Stirling.
Present: Mr. James King, Chair of NHS Forth Valley Endowment Committee (Trustee) Prof. Fiona Mackenzie, Chief Executive, NHS Forth Valley (Trustee) Mrs. Fiona Ramsay, Director of Finance, NHS Forth Valley (Trustee) Mr. Charlie Forbes, Non-Executive Member (Trustee) Mr. Tom Hart (Employee Director) In attendance: Mr. Jonathan Procter, Director of Strategic Access & Capacity Planning, NHS Forth Valley (Executive Lead) Mr. Garry Wells (Treasury Services Manager) Mr. Craig Holden (Fundraising Manager)
1/ APOLOGIES FOR ABSENCE
There were no apologies for absence.
2/ MINUTE OF THE FORTH VALLEY NHS BOARD ENDOWMENT COMMITTEE ST MEETING HELD ON 21 OCTOBER 2011
The minute of the Forth Valley NHS Board Endowment Committee meeting held on 21st October 2011 was approved as a correct record.
3/ MATTERS ARISING
i) Revised Expenditure Policy – see item five below. ii) WRVS Gifting of Funds – see item six below. iii) Utilisation of Legacies – see item seven below. iv) Fundraising Managers Update – see item nine below
4/ FINANCIAL REPORT FOR THE 9 MONTHS ENDED 31st DECEMBER 2011
Mr. Wells presented a paper “Financial Report for the 9 months ended 31st December 2011”
Mr. Wells provided details of the movements in the receipt and disbursements of funds during the period together with an update on the projected year-end financial outturn.
Mr. Wells highlighted the receipt of a significant donation from the Larbert & Carron District Samaritans Trust and commented on other relevant matters arising from the report.
2 Following a brief discussion during which Mr. Wells answered a number of questions from Committee members, the Committee thanked Mr. Wells for his contribution and approved the Financial Report for the 9 months ended 31st December 2011.
5/ REVIEW OF ENDOWMENT COMMITTEE’S TERMS OF REFERENCE AND REVISED EXPENDITURE POLICY
Mr. Procter presented a paper “Review of Endowment Committee’s Terms of Reference and Revised Expenditure Policy”:
i) Endowment Committee Terms of Reference and Objectives – approved. ii) Bidding for Funds Policy – After a brief discussion, the Committee approved the Bidding for Funds Policy. iii) Investment Policy – approved. iv) Revised Expenditure Policy – Mr. Procter advised the Committee that this policy included the revisions previously agreed by the Committee to ensure the Expenditure Policy was now compliant with charities legislation. Mr. Procter also advised that this policy may require amendment following the outcome of the NHS Scotland Endowments Review Group. After this brief discussion, the Committee approved the Endowment’s Expenditure Policy. v) Charitable Development Group Terms of Reference – approved. vi) Bursary Committee Terms of Reference – the Committee agreed that it was not necessary for the Bursary Committee to be a formal sub-committee of the Endowment Committee and that it should only report to the Endowment Committee. The Committee also asked that the criteria used by the Bursary Committee when awarding grants be submitted to the next meeting of the Endowment Committee for review and approval. Mr. Wells agreed to provide this information.
The Committee thanked Mr. Procter for his contribution and approved the Review of Endowment Committee’s Terms of Reference and Expenditure Policy.
6/ WRVS GIFTING OF FUNDS
Mr. Procter presented a paper “WRVS Gifting of Funds”. Mr Procter advised that the proposals totalling £175,000 had been signed off by the committee via email, had been submitted to the Head of WRVS for Scotland prior to the Christmas recess.
Mr. Procter advised the Committee that the WRVS have given verbal confirmation that they intend to award the full £175,000 of available Gifting of Funds to the NHS Forth Valley Endowment Fund.
Mr. Procter further advised that this is the single largest donation received by the NHS Forth Valley Endowment Fund and that appropriate arrangements would be put in place to present and acknowledge this donation..
The Committee noted with pleasure the WRVS donation.
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7/ UTILISATION OF LEGACIES
Mr Wells presented a paper “Utilisation of Legacies. “
The Committee considered proposals received from the Director of Nursing and the General Manager for Women & Children for the utilisation of legacies bequeathed to their department.
After a brief discussion, the Committee agreed to the proposals for the utilisation of these legacies.
8/ REPORT ON SUB-COMMITTEES
Mr. Procter presented a paper “Report on sub-committees”
The Committee noted the Minutes of the Charitable Development Group held on 23rd August 2011 and the Draft Minutes of the meeting held on the 15th November 2011. The Committee also noted the minutes of the Bursary Committee held on 28th June 20011 and 15th September 2011.
Mr. Procter also advised the Committee that the donation from the Larbert & Carron District Samaritans Trust had now been received in full and this was reflected in the finance report previously reported.
The committee noted with pleasure the receipt of the donation from the Samaritans Trust and approved the Report on sub-committees.
9/ FUNDRAISING MANAGERS UPDATE
Mr. Holden gave a Presentation to the Committee, “Fundraising Managers Update”
Mr. Holden began with a brief summary of the content of the presentation and then provided further details on the following items:
1 Roles & Responsibilities: Mr. Holden provided a summary of the roles and responsibilities of the Fundraising Manager’s post.
2 Fundraising Plan Activities: Mr. Holden reported that the following tasks and activities had been carried out in support of the Fundraising Plan: 2.1 The continued development of fundraising opportunities and the increase in public awareness of Forth Valley Giving 2.2 Participation in the NHS Charities Forum in order to share best practices and develop new initiatives 2.3 The provision of support and advice to fundraising partners and groups
Mr. King asked whether any income had been received via the on-line website. Mr. Holden agreed to provide this information to the next Committee meeting.
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3 Income Generation: Mr. Holden updated the Committee on some of the significant donations arising from the implementation of the Fundraising Plan. Mr. Holden also provided details of the substantial amounts of grant income received as a result of his support of the implementation of the Arts Strategy.
4 Voluntary Income levels: Mr. Holden provided an analysis of the levels of voluntary income received since the implementation of the fundraising strategy. This analysis demonstrated that, despite a downward trend in charitable donations nationally, the levels of income received by the Endowment Fund had shown a slight increase during the last two years.
5 Fundraising in 2012: Mr. Holden provided details of a number of activities to be undertaken in 2012 in support of the Fundraising Plan. These included an events programme, the development of a staff payroll-giving scheme and corporate partners programme, and the implementation of the NHS Forth Valley Appeal.
6 Investing in Health: Mr. Holden presented some ideas on how this may be taken forward and linked in with developing criteria for award of funds to support schemes. Following some discussion it was agreed that a paper would be provided at a future meeting to review options.
In the discussion that followed, Mr. Holden answered a number of questions from Committee members relating to his presentation. Following this discussion the Committee thanked Mr. Holden for his contribution and a noted the Fundraising Managers Update.
10/ INTERNATIONAL ACCOUNTING STANDARD 27 – CONSOLIDATION OF ACCOUNTS.
Mrs. Ramsay advised the Committee that as part of the process of adopting Accounting Standard 27, “shadow” accounts will require to be prepared for the 31st March 2013 financial accounts. This requires a set of accounts to be prepared under the existing reporting arrangements and second set of accounts to be prepared reflecting the changes arising from the implementation of the new Accounting Standard. Mrs. Ramsay also advised that the Auditors timetable for the completion of the Endowment Fund’s accounts will need to be coordinated with the timetable for the completion of the Exchequer accounts to ensure consolidation is achievable.
11/ NATIONAL ENDOWMENTS REVIEW GROUP
Mr. Procter presented a paper “National Endowments Review Group”
Mr. Procter provided the Committee with an update on the work carried out to date by the NHS Endowments Review Group. Mr. Procter also advised that the Endowment Funds Expenditure Policy may require amendment following the outcome of this review group.
5 12/ DATE OF NEXT MEETING
The next meeting of the Forth Valley NHS Board Endowment Committee is to be held on Friday 23rd March 2012 in the Forth Valley NHS Board Headquarters, Carseview House, Castle Business Park, Stirling. The meeting is to commence at approximately 11.30am, following the conclusion of the business of the Audit Committee.
There being no other competent business the Chair closed the meeting at 12:45pm.
6
Forth Valley NHS Board
27 March 2012
This report relates to Item 7.5 on the Agenda
Minute of Staff Governance Committee meeting held on 3 February 2012
For Noting
1
STAFF GOVERNANCE COMMITTEE
DRAFT Minute of the Staff Governance Committee meeting held on Friday 3 February 2012 at 2pm in Boardroom A, NHS Forth Valley, Carseview House, Stirling
Present: Dr Karen Facey, Non Executive Director (Chair) Mr Brendan Clark, Non Executive Director Mr Tom Hart, Employee Director Ms Janett Sneddon, Staff Side Representative Mr Ian Mullen, Chairman Mrs Helen Kelly, Director of Human Resources
In Attendance:
Ms Linda Donaldson, Associate Director of Human Resources Mrs Morag McLaren, Associate Director of Human Resources Mrs Alison Richmond-Ferns, Associate Director of Human Resources Mr Peter Mackie, Head of Risk Management Mrs Lesley Yarrow, AHP Consultant for Older Peoples Services Mrs Pam McGlashan, Personal Assistant (Minute Taker)
1/ APOLOGIES FOR ABSENCE
Apologies for absence were received from Professor Fiona Mackenzie, Ms Margaret Duffy and Mrs Maureen Cornforth.
Dr Facey welcomed Mrs Lesley Yarrow to the meeting.
2/ MINUTES OF MEETINGS
2.1 Minute of Staff Governance Committee meeting held on 13 December 2011
The minute of the Staff Governance Committee meeting held on 13 December 2011 was approved as a correct record.
2.2 Minute of Staff Governance Remuneration Sub Committee meeting held on 13 December 2011
The minute of the Staff Governance Remuneration Sub Committee meeting held on 13 December 2011 was noted.
3/ MATTERS ARISING
Dr Facey asked Mrs McLaren to update the Committee on the NHS Scotland – Staff Experience Framework. Mrs McLaren advised that work is ongoing regarding the development of a National Staff Experience Framework. Forth Valley are one of 3 pilot Boards (with Tayside and Dumfries & Galloway). There will be a set of metrics agreed which will measure staff experience and these will be piloted locally before feedback to the National Staff Experience Framework Steering Group. In view of this it has been agreed nationally that the Staff Survey will be delayed until April/May 2013. This work also involves a review of best practice and several organisations in
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the Private and Public sector are being visited to gain their views and experience. A Project Manager and Analyst have already been appointed. There is an NHS Forth Valley Staff Experience Group and this will work on the local pilot. The project commenced in December 2011 and will continue until March 2013.
Mr Hart advised that the 3 Employee Directors from the pilot Boards are invited to attend the National Project Group meetings. Meetings have been organised until the end of the year and it has been agreed that there will always be at least 1 Employee Director present at each meeting. Mr Hart will keep the Staff Governance Committee updated on progress.
4/ STAFF GOVERNANCE
4.1 Health & Safety Update followed by presentation by Lesley Yarrow, AHP Consultant for Older Peoples Services on Slips, Trips and Falls
Mr Mackie presented the paper and advised that there was an increase in staff incidents by 9% from last quarter however the total number of patients involved in incidents reduced by 5%. He also advised that the organisation has moved from a paper based system to an electronic system of recording.
Needlestick Injuries have risen from the last quarter. The Health & Safety Team will now follow up every single injury to find out causation.
RIDDOR incidents are also up by 10.
The Fire Team are rolling out the Fire Strategy. Only one unsatisfactory report received and this was for Meadowbank and there is now an Action Plan in place NHS Forth Valley received a satisfactory report from the fire brigade and Mr Mackie will report this in the next Quarterly Report.
The Mental Health Zero Tolerance Group has been resurrected to address the issues of workplace violence and aggression.
He also reported that the Health & Safety Team have visited the 3 Local Prisons, Glenochil, Cornton Vale and Polmont following the TUPE transfer of healthcare staff.
Concerns have been raised regarding courses being cancelled due to poor attendance. Mr Mackie is working with the OD Team to find out the reasons for this. Dr Facey noted that later in the agenda the government response to the Self Assessment Audit contained a section on training and reminded the positive benefits of the Learning Management System which will provide reports on access, attendance and evaluation of all training. It was considered this will assist managing this issue.
There is a focus on targeting the highest reported areas, these being violence and aggression, slips, trips and falls. There is a focus on training in all these identified areas and work is ongoing with Units to help manage processes. There are folders in each area and a full audit will be carried out in the Summer.
Dr Facey stated that whilst it was reassuring to learn of the work that was being carried out in relation to needle-stick injuries this remains an area of concern to the Committee. A discussion followed on Sharps boxes, these should be taken to the site and the needle disposed of at this point, however it has been found that this is
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not the case. This issue will continue to feature in all future reports to this Committee.
Mr Mackie advised that discussions were taking place regarding taking training to the work site and also eLearning using a range of different ways to deliver training.
The Committee were asked to note that Paul Hopson intended to retire. In his role as RCN Health & Safety Representative he has played a significant part in the development of health and safety management processes and his contribution was acknowledged. Dr Facey thanked Mr Mackie for the update.
Mr Mackie then introduced Mrs Yarrow and invited her to give her presentation on Slips, Trips and Falls.
Key points from her presentation were:
• Slips, Trips and Falls are the highest reported incidents in Forth Valley. A Falls Prevention Improvement Plan has been introduced to ensure a better understanding and this will be shared at the highest level. Our aim by September 2013 is to reduce incidents by 30%. NHS Forth Valley is at the forefront on this work nationally.
• Currently looking at researching evidence and the tools to help implement this programme – the same tools are on eWard.
• Falls Prevention Champions have been identified and these are multi- disciplinary as this is everyone’s responsibility from patients to carers and relatives.
• A learning day was held for Falls Prevention Champions and leaflets have been produced which will be sent out to patients, their carers, families and friends to give advice about the measures which can be put in place to reduce the chance of patients falling whilst in hospital. A future learning day is planned for April 2012.
• There is also a Falls Challenge Poster which has a timeline in the middle section, the left side incorporate the cost to patients after a fall and on the right side what we can all do to help prevent falls.
• Chris Wright has been working with Lesley and others to develop an on line training programme and this has been taken on board by the national team and they wish to roll this out crediting NHS Forth Valley for developing this programme. The programme will be available to staff and there will also be public access for people involved in social care. The aim of the programme is to raise staff awareness. The Nurse Manager/Head of Service will decide what modules are appropriate for each group of staff.
Mr Mackie acknowledged the innovative work undertaken by Lesley Yarrow to date.
Following discussion Dr Facey thanked Mrs Yarrow for a very detailed presentation and asked that the Staff Governance Committee receives regular updates.
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4.2 Attendance Management – Refreshed Approach
Mrs Richmond-Ferns advised that time has been spent reviewing policies and this paper was initially submitted to the Performance Management Group in January 2012. The paper was approved at this meeting. It was highlighted that following a statement that Serco absence figures were lower than Forth Valley, this was followed up and it was found that Serco calculated absence rates differently which explained this outcome.
Work is in hand to implement an on-line referral to Occupational Health which will speed up referral of staff.
There is an Early Attendance Support Project which will see two pilot areas within Clackmannanshire Community Health Partnership and Medicine & Emergency Care and Rehabilitation being able to refer their staff on the first day of absences for telephone support from Occupational Health, to ensure that the member of staff is fully aware of and able to refer themselves into the support services available.
There is also a Stress Control Programme headed by Dr Marie Grant where in conjunction with NHS Forth Valley Psychology Services, Occupational Health will be referring appropriate staff to Stress Control. This is a programme of self help which is delivered in a lecture style format over a period of six weeks.
Absence Clinics were introduced in May 2011 and involve HR/General Managers/Staff Side Representatives to discuss complex cases. These will continue in 2012/2013.
Early referral to Occupational Health was previously 4 weeks this is moving to 3 weeks.
Information on progress and outcomes on each of these will be brought to a future Staff Governance Committee meeting.
Dr Facey on behalf of the Committee noted that there are a range of approaches being implemented, however asked that in future papers reference is made to external benchmarks and trend analysis.
Mrs Kelly advised that discussion at the Performance Management Group had reaffirmed support for this priority. Staff side are supportive of the early attendance pilot and it was acknowledged that we are continually raising awareness of attendance management policies and processes.
A discussion followed on whether the 4% target was achievable. It was acknowledged that we are continually looking at other Boards achievements and how we can emulate these in Forth Valley.
Dr Facey thanked Mrs Richmond-Ferns for a clear presentation of how Forth Valley are trying to address absence management issues.
4.3 Staff Governance Standard Self Assessment Audit 2012/2011 – Scottish Government Health Department Feedback
Mrs Richmond-Ferns presented this paper and updated on the organisations response to SGHD feedback. A meeting is taking place in February/March to discuss all the issues flagged by the SGHD feedback.
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Mr Hart commented on the report and advised that there were positives and there are areas where we need to make improvements.
Dr Facey asked if the implications of this and the outcome from the meeting with SGHD could be fed back to the Staff Governance Committee. Mrs Kelly agreed a further update would be provided at the next meeting.
5/ RESHAPING THE WORKFORCE
5.1 Workforce in Transition – Update
Ms Donaldson informed the Committee that the Draft Workforce Plan has been approved by the Area Partnership Forum and this will be shared with NHS Board members and published on the intranet and internet website. The 2012/2013 workforce plan will be completed in April 2012.
Consistent with the majority of other NHS Boards NHS Forth Valley determined that it was not realistic at this time to provide 5 year projections for our workforce.
Ms Donaldson also advised that the Cabinet Secretary has decided to reduce the overall commissioned student nurse and midwife intake for 2012/2013 by 10% therefore there will be 270 fewer places.
A discussion followed on the reduction in student intake and Ms Donaldson advised that currently the employment opportunities for trained midwives is limited overall, however NHS Forth Valley will be taking on 51 interns.
Ms Donaldson also reported that at the end of January 53 exits were approved for the Voluntary Severance Scheme.
In relation to the 25% Senior Management Reduction Target – there are 41 members of staff in scope and we have been tasked with carrying out this reduction by 2015 however by 31 March 2013 NHS Forth Valley will have achieved 99% with the remainder to be achieved by May 2013.
A Workforce in Transition Stocktake is being held on 27 February and a report will be brought to the next Staff Governance Committee meeting.
The Committee noted the update.
5.2 AfC/KSF Update including Prison Healthcare Services
Ms Donaldson advised that KSF monitoring is continuing monthly and a report will be brought to the next Staff Governance Committee meeting, meantime eKSF training is continuing 4 days a week until the end of March.
Job Evaluation – Ms Donaldson updated on the Community Psychiatric Nurse review which is ongoing. Discussions are continuing between NHS Forth Valley and Full Time Officers and it is hoped that this will be concluded by March 2012.
AfC – The Scottish Terms & Conditions Committee (STAC) recently issues a letter asking how NHS Scotland could best maintain expertise in Agenda for Change job evaluation now that the work of evaluating and reviewing posts has been concluded. Due to the level of change locally our experience is different from other Boards and we are still redesigning and refreshing jobs and panels are still ongoing (at least 1
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panel per week), so work is certainly not concluded. We receive a large number of Freedom of Information Requests and information is taken from the CAJE (Job Evaluation) system. All local information is held on this system. The preference for Forth Valley would be to maintain existing systems and processes at a local level with job evaluation being centrally co-ordinated and maintained in partnership. Ms Donaldson will respond to the STAC request for views and share this response with Committee members.
Prisons – Helen Kelly has taken over HRD leadership role for Prison Healthcare. Following lengthy discussions and utilising job evaluation rules and regulations around national profiles three posts are felt to be unsafe and there are six posts which require more robust evidence. Terms & Conditions – Ms Donaldson reported that the National on call negotiations are ongoing. It is hoped to have on call harmonised by April 2012. Ms Donaldson updated on a presentation which she gave to the Terms & Conditions Local Group and advised of the complexities in relation to AfC processes, local agreements and staff that are still on Whitley Terms & Conditions.
The Committee noted this update.
6/ RISK MANAGEMENT
6.1 Corporate Risk Register – Workforce Issues
Mrs Kelly advised that there had been a few minor amendments to the Corporate Risk Register. The Committee noted these amendments.
6.2 Industrial Action
Mrs Kelly advised that a Debrief Meeting had been held following the Industrial Action on 30 November, which outlined how overall agreed services were maintained. We are following the national scene with interest and BMA have recently written to the Cabinet Secretary requesting a Scottish response to pensions. This has been kept on the Risk Register as it has not been resolved yet.
Staff side remain in discussions with Ministers and the mandate each organisation has for Industrial Action is still live.
The Committee noted the position.
7/ REPORTS TO NOTE
7.1 HR Policy Update
Mrs Richmond-Ferns advised that the current focus is on the Attendance Management Policy locally and PIN Policies launched nationally in December.
7.2 Learning, Education & Training Strategy & IIP Update
Mrs McLaren advised that there was a meeting of the Learning, Education & Training Strategy Group taking place in the following week to look at reviewing the LET Strategy against the refreshed Integrated Health Strategy and Quality Strategy.
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The national revision of the Staff Governance Standard that is expected to be issued in May needs to be taken account of in this refresh and so may lead to a delay producing a refreshed LET Strategy for a few months.
The Committee was informed that there has been excellent uptake of places on the Leadership Management & Personal Development Programme and a second Trainer Development Programme commences this month.
7.3 Organisational Development Update
Mrs McLaren advised that the OD Team continue to be very busy and this is impacted by the retirement of a team member in December. The OD Team is continuing to deliver on stated priorities and is currently assisting in developing Quality and Improvement priorities.
Secondary Care Medical Enhanced Appraisal was formally launched in December 2011. Forth Valley has 23 trained appraisers. The BMA has now approved the process and documentation and a SGHD CEL is awaited to confirm this process.
8/ REPORTS FROM COMMITTEES
Mr Hart advised that most of the main issues have been dealt with on the Agenda.
8.1 Minute of Acute Services Partnership Forum held on 15 November 2011
The Committee noted the minutes of the Acute Services Partnership Forum
8.2 Minute of Health & Safety Committee meeting held on 14 December 2011
The Committee noted the minutes of the Health & Safety Committee.
8.3 Minute of CHP Partnership Forum held on 9 November 2011
The Committee noted the minutes of the CHP Partnership Forum.
8.4 Minute of Area Partnership Forum held on 16 December 2011
Following a question from Dr Facey, Mr Hart explained that it was felt that the Joint Area Partnership forum and clinical Advisory Forum Session at the Annual Review had not been successful. Mr Hart and Dr Allan Bridges have agreed to write to SGHD on behalf of both forums explaining their position and that they would wish to revert back to the original format for the next Annual Review.
9/ ANY OTHER COMPETENT BUSINESS
Mr Mullen advised that this would be Dr Facey’s last meeting and he wished to acknowledge that Dr Facey had brought a fresh perspective and energy to the work of this Committee and had changed the style of these meetings which had been beneficial. On behalf of the Committee he wished to thank her for her had work. Dr Facey acknowledged that Staff Governance had been a new area for her and she had learned a lot, found it very stimulating and thanked everyone for their openness.
There being no further business, the Chair closed the meeting at 3.50pm
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9
Forth Valley NHS Board
27 March 2012
This report relates to Item 7.6 on the Agenda
Minute of Acute Services Committee meeting held on 23 February 2012
For Noting
1
ACUTE SERVICES COMMITTEE
DRAFT Minute of the Acute Services Committee meeting held on Thursday 23 February 2012 at 9.30 am in the Board Room, Carseview House, Castle Business Park, Stirling.
Present: Dr Vicki Nash, Non-Executive Member (Chair) Mr Simon Dryburgh, Assistant Director of Finance, Acute Service Ms Margaret Duffy, Chief Operating Officer Mr James King, Non-Executive Member Mr Jonathan Procter, Director of Strategic Access and Capacity Planning
In attendance: Mr Ian Aitken, General Manager, Medicine, Emergency Care and Rehabilitation Mr David McPherson, General Manager, Forth Valley Surgery, Cancer Services and Facilities Ms Alison Richmond-Ferns, Deputy Director, Human Resources
Mrs Ann Duffy, Committee Administrator
1. APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of Dr Allan Bridges, Ms Maureen Coyle, Ms Fiona Gavine, Ms Gillian Morton, Dr Peter Murdoch, Dr Iain Wallace, Mrs Jann Gardner and Professor Angela Wallace.
2. MINUTE OF THE ACUTE SERVICES COMMITTEE MEETING HELD ON 22 DECEMBER 2011
The minute of the meeting held on 22 December 2011 was agreed as a correct record.
3. MATTERS ARISING
There were no matters arising of note.
4. FINANCIAL & PERFORMANCE REPORTS
4.1 Complex Therapies
The Committee were due to receive a presentation “Complex Therapies” from Mr Simon Dryburgh, Assistant Director of Finance, and Mrs Jann Gardner, Lead Pharmacist, Acute Services. Mrs Gardner was unable to attend the meeting due to
2 illness, however, the Committee agreed to receive the financial aspects of Complex Therapies from Mr Dryburgh. The presentation highlighted:
Surgical & Cancer Services Herceptin Lucentis Oncology Medicine Emergency Care & Rehabilitation Biologics Plasma (immunoglobulins) Woman & Children &Clinical Services & Sexual Health HIV Acute Services Complex Therapy – Expenditure 2008 -09 to 2011-12 In Month actual v budget – All Acute Complex Therapies Budget v Expenditure Acute Services Complex Therapies 2008-09 to 2011-12 Cognitive Enhancers Next Steps – Finance Budget build Activity Horizon Scanning
In the discussion that followed the presentation, Ms Margaret Duffy referred to the efforts made to manage these drugs and the benchmarking exercise carried out which included continued ongoing work with General Managers and Pharmacy colleagues.
Dr Vicki Nash thanked Mr Dryburgh for the very informative update on the financial implications of Complex Therapies and looked forward to Mrs Jann Gardner delivering the pharmacological overview update section of this presentation at the meeting to be held on 26 April 2012.
4.2 Finance Report to end January 2012
The Committee considered a paper “Finance Report” presented by Mr Simon Dryburgh, Assistant Director of Finance, Acute Services.
Mr Dryburgh reported that the Acute Services financial position as at 31 January 2012 reflected a cumulative overspend of £2.562m, a movement in January of £0.105m, which represented a return to the trend of reducing monthly spend. The key element of the change related to an increase in expenditure on complex therapies. Mr Dryburgh commented on the operational overspend and highlighted the Complex Therapies as set out in the Graph 1 in the report
The Surgical & Cancer Services Directorate had reported a reduction in the monthly overspend, largely driven by improvements in medical pays with the underlying trend remaining in line with expectations. The Medicine, Emergency Care & Rehabilitation Directorate had reported an increase in monthly overspend compared to December, although this was principally as a result of increased expenditure on complex therapies, as the majority of expenditure was incurred in this Directorate. The Woman & Children Clinical Services and Sexual Health monthly performance had continued
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Mr Dryburgh described the achievement of savings targets to date and noted that although there was some slippage in delivery, 80% of operational savings targets in Acute Services were being achieved. The Acute workforce savings however were reporting shortfalls due to the difficulties in implementing skill mix changes in the context of low staff turnover. Mr Dryburgh confirmed that General Managers, the Assistant Director of Finance and the Chief Operating Officer met regularly to identify and fully risk assess expenditure reduction plans.
In answer to a question from Mr James King regarding agency and locum costs, Mr Dryburgh set out the financial context and detailed how, with support from General Managers, work had been undertaken to project these costs forward building in the impacts of known recruitment and returns from sick leave. It was suggested that a presentation on medical bank and agency staff be delivered to the Committee at the meeting in April 2012.
Ms Margaret Duffy confirmed that a series of detailed financial meetings would be held with all General Managers over the coming weeks.
The Committee noted the Finance Report.
4.3 Director’s Report
The Committee considered the “Director’s Report” presented by Ms Margaret Duffy, Chief Operating Officer.
Ms Duffy reported on the highlighted issues, which included:
Attendance Management Board position - Absence increased by 0.02% from 5.56% in November 2011 to 5.58% in December 2011
Staphylococcus Aureus Bacteraemia (SABs) – The number of SABs for January 2012 was 5; 4 hospital and 1 healthcare acquired infection.
A&E attendance – Fairly static position overall. The gap between actual and trajectory up slightly on previous month. Year on year comparison fluctuating.
4 hour A&E target – End December 2011, 93.7% a 3.8% in-month deterioration from November however a 3% year on year improvement.
Daycase rates – Target 84% - December 2011 position was 84% in line with target.
Delayed discharge – January 2012 zero delays. Bed day lost increased 827 in January 2012 against 712 in December 2011.
4 Theatre under runs - 8% target for December 2011 with the actual position 13.5%.
Late starts – Position at December 2011 was 4.3% against a 3% target.
Cancellations – Local target of 5%. Actual position for December 2011 was 13%.
Did Not Attend (DNA) – The January 2012 position showed 7.8% which was in line with target.
Mr Ian Aitken reported on the key milestones set in place to deliver continuous patient care, in areas including Accident and Emergency and Mental Health.
He further reported on the issues that had arisen through patients attending Accident and Emergency department with minor ailments, largely due to the lack of GP appointments. He confirmed that discussions would be held with GP surgeries and the Scottish Ambulance Service to address these issues.
Ms Duffy advised the Committee that work was ongoing around the Acute model and integrated care and the importance of scheduling and rostering within this area.
Dr Nash suggested that an update on Scheduling and Rostering be presented to the Committee at the meeting scheduled for 28 June 2012.
4.4 Waiting Times Highlight Report to end January 2012
The Committee considered a paper “Waiting Times Highlight Report” presented by Mr Jonathan Procter, Director of Strategic Access and Capacity Planning.
Mr Procter advised that within 18 weeks Referral to Treatment, 92.1% of patients had been treated, representing the 5th consecutive month of National Target achieved and delivery of the National Target required at the end of December 2011.
Within cancer services, 95.1% of patients were treated within 62 days of referral and 95.1% of patients treated within 31 days of diagnosis for the period October 2011- December 2011, with the National Target for December 2011 achieved in both areas.
Mr Procter highlighted the significant achievement by all the clinical and managerial teams in delivering the Cancer and 18 weeks RTT targets. The Committee noted and the delivery of these important milestones and congratulated teams on this.
With regard to Stage of Treatment performance, Mr Procter reported that there were 741 Outpatients waiting over 12 weeks at the end of January 2012 and 256 Inpatients over 9 weeks. Within diagnostics, there were no patients waiting over 6 weeks at the end of January 2012.
In overall terms Mr Procter highlighted that there were still significant challenges in meeting the March quarter end targets within Outpatients and Inpatients and while there had been a lot of work and continued focus by clinical teams and others there were still a significant number of patients to be treated before the end of March. Mr
5 Procter went through in detail the current risk assessment as outlined within the report and highlighted the issues, challenges, action plans and current risk assessment.
In answer to a question from Mr James King regarding Rheumatology capacity issues, Mr Aitken advised that these specialities would be looked at on the chronic management process and managed within the 18 weeks pathway.
With regard to Accident & Emergency performance, Mr Procter further advised that 93.9% of patients waited less than 4 hours between arrival at the A & E unit to admission, discharge or transfer. This was 4.1% below target; however, the performance had improved by 4.4% on the previous year. Scotland has also seen a dip in performance for December with the national position moving from 96% in September to 94.4% at the end of December.
In Summary the Acute Services Committee: · Noted the overall performance as at 31st January 2012 · Noted the Exceptions Report · Noted the Risk Assessment and supporting actions for the period January- March 2012
Mr Procter congratulated the managers and clinicians on the key target achievements around Cancer and 18 weeks RTT.
The Committee noted the Report and the recommendations by Mr Procter.
5. Any Other Competent Business
There was no other business of note.
6. Date of Next Meeting
The next meeting will be held on Thursday 26 April 2012 at 9:30am in the Board Room, Carseview House, Castle Business Park, Stirling.
6
Forth Valley NHS Board
27 March 2012
This report relates to Item 8 on the Agenda
Taking Forward the Equality and Diversity Agenda in NHS Forth Valley
(Paper presented by Mrs Helen Kelly, Director of Human Resources)
For Noting TAKING FORWARD THE EQUALITY & DIVERSITY AGENDA IN NHS FORTH VALLEY
PURPOSE OF PAPER
The purpose of this paper is to provide Board members with an update on progress with the Equality and Diversity agenda within NHS Forth Valley.
During 2012 NHS Forth Valley will ensure that the Equality Duty 2010 General & Specific Duties continue to become mainstreamed into our work as service providers and employers.
We will continue to monitor our performance against equality and diversity criteria through the Fair for All Development Group chaired by Helen Kelly, Director of Human Resources and Dr Abu Arafeh, Fair for All Development Group Lay Advisor.
Achievements against key priorities to date are reflected within the enclosed report.
KEY ISSUES
NATIONAL ISSUES
Equality Act 2010
The Scottish Government completed its consultation on the Public Sector Equality Duty Revised Draft Regulations at the end of November 2011. Responses are available for viewing on the Scottish Government website
(www.scotland.gov.uk/Publications/2012/01/1910/downloads)
The revised draft regulations contain key elements such as
. Equality Outcomes . Mainstreaming Equality . Methodology for Public Bodies to consider regarding ‘Assessment and Review’ . Employment Information . Gender Pay Gap Information . Equal Pay Statement . Procurement . Scottish Ministers Duty . Publication Duty
Draft Regulations were first introduced to the Scottish Parliament in January 2011 and considered by the Parliament’s Equal Opportunities Committee in March 2011. The Committee did not support them. Scottish Ministers subsequently withdrew those draft Regulations and agreed to look at them again.
The outcome of the consultation and draft regulations will be laid before the Scottish Parliament in early 2012 (not completed at time of writing report). NHS Forth Valley made a positive response to the revised draft regulations proposed by the Scottish Government.
Forced Marriage (Protection and Jurisdiction) (Scotland) Act 2011- This Act came into force on 28th November 2011. The legislation will provide robust, solid protection for both men and women who are in a forced marriage or under threat of one. It introduced Forced Marriage Protection Orders, which will safeguard the rights of individuals being forced to marry and carries with it, a criminal offence, which if breached, could mean that perpetrators face a prison sentence and/or fine.
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Equal Marriage Consultation The Registration of Civil Partnerships Same Sex Marriage consultation paper sought views on the possibility of allowing religious ceremonies for civil partnerships and the possible introduction of same sex marriage. The consultation closed on 9 December 2011. The Scottish Government will take at least 12 weeks to consider the responses received.
Offensive Behaviour at Football and Threatening Communications Bill (Scotland) Act 2012 This was passed at the Scottish Parliament on 14 December 2011. Two offences will be created by the legislation, targeting sectarian behaviour in and around football matches and on the internet. Those convicted could spend as long as five years in prison and be banned from football grounds. This legislation will strengthen our effort in tackling hate crime in all sections of NHS Forth Valley and its respective communities.
Scottish National Stalking Group National working group met in January 2012. Lynn Waddell sits as an NHS representative. Several pieces of work are ongoing including 18th April 2012 being agreed throughout the UK as National Stalking Day At the National Scotland Stalking Group in January 2012, NHS Forth Valley were praised for our Gender Based Violence ‘Z’ cards and small information cards for service users. These are being considered for adaptation for stalking victims.
LOCAL ISSUES
NHS Forth Valley Equality Delivery Scheme (EDS) An NHS Forth Valley Draft Implementation Plan has been developed; implementation will be subject to approval by the Fair for All Development Group and Forth Valley NHS Board.
The Implementation Plan identifies actions to be taken throughout 2012 including public and staff involvement activities, structure of reporting and monitoring mechanisms and proposed timeline for actions subject to final confirmation of dates from the Scottish Government.
This implementation Plan is also supported by an NHSFV Equality and Diversity Communications Strategy.
Engagement and the Public Sector Equality Duty Case law from the previous equality duties states that public involvement is important in ensuring public authorities understand the impact of their decisions on different people. A failure to engage has been at the heart of findings that a public authority has not complied with equality duties.
The general equality duty requires public authorities to have an adequate evidence base for their decision-making, and engagement can help develop that evidence base.
To meet this requirement a series of focus groups and events will be held from May – August 2012. Lynn Waddell has agreed to speak at the next three Patient Public Forums during 12th – 26th June 2012.
Additional events will be arranged throughout this time period as well as presentations to specific groups. Engagement to seek a range of staff views will be completed via a range of meetings, an online survey and presentations.
What are the consequences if we don’t publish the relevant information?
3 The Equality and Human Rights Commission (EHRC) is responsible for assessing compliance with the duties. It has powers to issue compliance notices to public bodies that have failed to comply.
The Commission, or any individual or group of people with an interest can also enforce the general equality duty.
Patient Information: Improving collection of Diversity Information Work is ongoing in this area. The Equality Act Guidance to date highlights that data collection is a priority. Although the main focus to date has been on race and ethnicity, work will be undertaken to collate information on patients by the additional protected characteristic groupings.
It is proposed that a review will be completed over the next few months on record systems for patients to ensure that they have the specific equality monitoring fields and that they are fully aligned with all protected characteristics.
The willingness of staff and patients to gather and/or provide information limits how comprehensive our data can be as well as the quality of incoming information from the referring services. This can result in some inconsistencies and poses some challenges in being able to demonstrate information consistently for each of the protected characteristic groups.
Information on sexual orientation and transgender are the areas that currently pose the biggest challenges for the future in relation to data collection. The information we publish may not therefore have complete data sets, but what we can do is evidence that processes are in place to gain better equality monitoring information and publish action plans and use this as a key objective/outcome for our future actions in relation to meeting the equality duty.
E&D TRAINING
Equality and Diversity Training (E&D) NHS Forth Valley Equality and Diversity training will be reviewed for 2012 following the publication of the Public Sector Duties and respective codes of practice.
During 2011, 994 staff from a range of NHS Forth Valley services completed a variety of E&D training. Strand specific training was also delivered to staff throughout the year.
NHS Forth Valley Community Language Interpreting and Translation Services
A review is currently being completed as a priority for NHS Forth Valley on the current ‘Community Language’ interpreter service provision. Actions from this review will inform NHS Forth Valley’s Equality Delivery Scheme objectives and respective action plan for 2012 -16.
Sue Dow, Falkirk Community Health Partnership General Manager, is leading the review. Outcomes from the review will ensure consistency in quality of service, the streamlining of current service provision, appropriate usage of the service itself and value for money.
Actions to date: . Community Focus Groups – have taken place and key areas identified by communities have been recognised and will inform the work of the review team including the use of language line and satisfaction with services to date. . Review being completed of current contractors, interpreter usage and locations of highest users/languages . Proposal being developed to complete a pilot within Maternity services on the use of Polish interpreters. This pilot will focus on accessing NHS National Waiting Times current Interpreter staff bank to identify if this model of practice would work within NHS Forth Valley. 4 . Flow chart put in place to enhance staff’s knowledge about the use of telephone interpreting services.
NHS Forth Valleys spend during 2011/12 on Interpreters is £218,000.
A presentation was given to FFA Development Group in March 2012 on actions being taken. Appendix A indicates the current spend to date on interpreters during 2011/12.
NHS Forth Valley Equality and Diversity Board Training Training on the Equality Duty 2010 General and Specific Duties and NHS Forth Valley requirements is being delivered to Board members and senior managers on the 8th May 2012. It is proposed that the implementation plan as per 3.2.1 will form part of the discussion.
EQIA: Update NHS Forth Valley is developing a more robust database and EQIA online tool, which can be accessed by staff at source and information sent directly to a central database. A risk assessment was completed on the use of a ‘cloud based’ database; no significant problems identified. The final Data Base will be subject to approval by Information Governance prior to implementation.
DISABILITY SPECIFIC ACTIONS The following provides a summary of actions taken in regards to disability within NHS Forth Valley.
PAVE (Patient Advice, Volunteer, Education) Funding Progression with the PAVE project is currently slow; volunteers continue to support the Disability Service in relation to staff training and review of documents.
Disability Service has recently recruited a Disability Liaison Worker who as part of their remit will have links into the PAVE volunteer project. This individual commenced on Monday 13th February and will provide capacity and support to the PAVE Project.
Disability Equality Training As part of the recent collaboration of Prison Health Services within NHS Forth Valley the Disability Services is working in partnership with Polmont Young Offenders Institute. This work is specific to the needs of profoundly Deaf British Sign language users who become prisoners within the services there. During this process our sub contracted Interpreters have been able to benefit from several in-house prison training programmes. Work will be evaluated and further partnership discussions will take place regarding future developments.
British Sign Language (BSL) Interpretation Provision Current contact for NHS Forth Valley’s BSL and Translation Services is being reviewed and any amendments will be considered prior to further progression of the contract. In April 2012 the agreement will be signed, if appropriate, for a further three years with the current provider.
An audit of Interpretation and Translation service for British Sign Language was carried out in October 2011. The evaluation was positive from both staff and service users.
Access and Capacity The Disability Service continues to support the work being taken forward in relation to the SCI Gateway amended fields within Primary Care and the transfer of this information into the Secondary Care systems. There has been significant support from Primary Care for this work with meetings held with two of the GP Leads in early February.
5 The work being undertaken in NHS Forth Valley is being recognised at national level. There is much interest across Boards on how we can share the complexities of our patient pathways. At a national level there are shared concerns of Did Not Attend (DNA) numbers and patient concerns linked to broken journeys that were not conducive to increasing confidence in health services. If we considered the access and communication needs of clients at the right time during their pathway through health, efficiencies and satisfaction would increase hopefully leading to reduced DNAs, patient concerns and financial waste.
NHS Health Scotland NHS Forth Valley’s Disability Advisor and Quality Manager continue to attend national meetings chaired by NHS Health Scotland. The Translation, Interpretation and Communication Support Joint Action Group (TICS JAG). This group reviews what NHS Boards are providing to address legislative requirements in relation to translation and interpretation within the NHS and to consider possible national contracts.
NHS Health Scotland Equality and Data Monitoring Steering Group This group, working closely with ISD, is considering Boards data collection, how we, utilise and record the information to influence better service provision etc.
At the Public Health Inequalities Conference held in Aviemore in November 2011, Charlene Condeco, Disability Nurse Adviser, co presented with Michael Tornow, Project Officer Health Scotland, on the SCI Amendment work being carried out in NHS Forth Valley. Michael’s focus was the national inequalities agenda whilst Charlene focused on local work showing how inequality can be reduced during patient pathways when a patient’s access and communication requirements are considered and met.
Additional Actions . Accessible information – information continues to be provided about alternative accessible information as requested. Included in recent provision have been pre and postoperative guidance materials, consent forms and patient concern booklet and patient concern letters in Braille and Audio minutes for several NHS Forth Valley groups in which visual impaired service users participate. . NHSFV “Coffee Mornings” - to take place in April 2012. The content of the meeting will include update on Interpretation BSL provision, introduction of new Disability Liaison Worker and her role . 2012 Calendar - produced with drawings generally done by children from one of our local Primary schools and centred around their views on disability. The £418 from the sales of this year’s Calendar was used to purchase Christmas gifts for the Children’s Ward at Forth Valley Royal Hospital.
GENDER SPECIFIC ACTIONS
Gender Based Violence
Scottish Government CEL 41 (2008) – NHS Forth Valley Gender Based Violence (GBV) Action Plan . All actions completed as per action plan and the Gender Based Violence Policy is currently with Human Resource Team for review. . The programme of training on ‘Routine Enquiry’ to support Sexual Health Services, Community Nursing and Emergency Department Staff is now completed. . A programme of staff training will be developed for 2012 -16 with the proposal to develop additional awareness sessions for NHS Forth Valley medical staff and General Practitioners. . DRAFT GBV Equality Outcomes and Action Plan have been developed as part of our Equality Duty work for 2012-2016, with community consultation scheduled to take place during May – September 2012. 6 . Dental Staff Training – GBV Champions to commence training and meetings in March 2012. . Working with Interpreters, Training and Gender based violence -The Scottish Refugee Council delivered awareness sessions during December 2011 and March 2012 with a focus on working with interpreters and people who have experienced abuse, violence or are fleeing terror
NHS Forth Valley GBV Publications . ‘Z’ cards to be updated March 2012 for staff . Gender Based Violence guidance to be placed on Service Information Directory (SID) currently in draft format which should be available June 2012 . Discussions being held in April with Dr Roger Alcock, A&E Consultant, to develop young people GBV resource. . Partnership working being considered with Violence Against Women Falkirk. Actions to be reflected in next Board report.
Update from Caledonian System Reference Group meeting on 22/6/11 Meeting held with members of GBV Steering Group and Jim McCormack from Caledonian Service. Further to discussions with the short term working group, guidance and staff information being developed for dissemination via Service Information Directory (SID).
Criminal Justice Authority Domestic Abuse Liaison Group Meeting December 2011 Meeting held to discuss future development of a Multi Agency Risk Assessment Conference (MARAC) system within Forth Valley. Terms of Reference agreed and mapping exercise conducted. Update to be given at next meeting.
Men’s Advice Line The Men's Advice Line is a confidential helpline for male victims of domestic violence and abuse. They welcome calls from all men - in heterosexual or same-sex relationships. Service is accessible for people with hearing impairments as well as Language Line offering emotional support, practical advice and information on a wide range of services. Men’s advice line call report 2011 – Scotland - Figures for Forth Valley area 10 contacts were made within the Forth Valley area.
Draft Chaperone Policy DRAFT Policy developed which sets out guidance for the use of chaperones and procedures that should be in place for consultations, examinations and investigations.
Policy submitted for approval in November 2011; however concerns were raised about the practical implications of implementing the policy. The policy has therefore been re-circulated for further comments and amendment and will be reconsidered in Spring 2012.
RACE & ETHNICITY SPECIFIC ACTIONS
Stop Hate in Central Scotland NHS Forth Valley continues as a member of the local Multi Agency Hate Response Strategy (MAHRS) partnership with the last meeting held in February 2012.
There have been 8 reports of racist incidents (verbal abuse) and 1 report of religious bigotry (verbal abuse) in NHS Forth Valley in 2011 and one report of a racist incident in January 2012 (verbal abuse).
Work is nearing completion on a DVD resource to promote awareness of the importance of reporting hate incidents and the support available to victims of hate incidents.
Keep Well
7 Work is ongoing in developing the ‘extension plan’ for Keep Well for April 2012 and beyond. Part of this includes consideration of identifying and engaging specific vulnerable populations such as people from black and minority ethnic communities including gypsy travellers.
A very successful local planning event was held in November 2011 to identify health and wellbeing priorities of local people from black and minority ethnic communities. Almost 60 participants attended the event which was facilitated using Open Space methodology.
The output of the event is available and an associated Action Plan for 2012 and beyond is currently being developed. This event report and action plan will be fed back to the NHS Forth Valley Fair for All Development Group and the local Community Planning Partnerships and is available from Helena Buckley, Quality Manger.
DIVERSITY CALENDAR NHS Forth Valley has sponsored the Diversiton Diversity Calendar for 2012 which can also be found on the NHS Forth Valley public website. There is free and unlimited access to this resource electronically throughout 2012. http://www.diversiton.com/ForthValleyNHS2012.asp It is a practical diversity resource for all NHS Forth Valley staff, volunteers and colleagues in primary care; it includes details of all the main religious and secular dates and can help us to ensure that meetings and events are not planned for dates when key sections of our workforce and local community may not be able to participate.
Religion and Belief Specific Actions
Spiritual Care Steering Group meeting 1st November 2011
Areas discussed:
. Spiritual Care Centre Access – Lynn identified that an audit had been completed prior to the opening of the centre. Areas identified within SERCO issues log. Since the meeting discussions have been held with Maureen Coyle re same and actions identified. . Spiritual Care Policy under review. . During the meeting a table top exercise was conducted looking at 3 key areas; Faith Focus Group, Engagement Focus Group and Policy focus groups. From these discussions actions will be taken forward. Up date to be given at next FFA Meeting. . Community Listening Programme - This pilot project in Alva is ongoing. . Volunteers - The new group of volunteers had now finished their shadowing and are working well in mental health, the hospice and Community Hospitals. . Chaplains National Conference “Exploring your Shadows”, was held on Wednesday 25th January 2011 at Forth Valley Royal Hospital o Reverend Collin spent a week teaching in the Palliative Care Unit in China focusing on compassion and communication skills. Eighty people attended the workshops which were very successful. o Shifting the Balance of Care -The Spiritual Care Team is aware of the moves into Community. Reverend Collin continues to work in the GP Surgery. Reverend Collin stressed that as a team they are making sure that they are able to offer Spiritual Care both in the acute hospital and community hospitals. They are also providing home visits as necessary. o Accessible Languages - Dr Multani raised concerns at the meeting that the language used on the back of some policies was academic Punjabi and stressed that this required to be changed. It was noted that the new form of policies does not include the range of languages but suggested that it would be beneficial to have as an agenda item for the next meeting about “equality issues and accessible languages
8
SEXUAL ORIENTATION
Lesbian Gay Bisexual & Transgender (LGBT) Youth Scotland Evidence was submitted for LGBT Youth Scotland Charter Mark and feedback to date is that additional evidence is required regarding how training has improved service delivery. This remains work in progress.
Stonewall Best Practice Programme - Meeting held February 2012 on progress to date: a) Network Group - NHS FV ‘Blue Light’ LGBT staff network proposal developed with Central Scotland Fire and Rescue, Central Scotland Police is currently with local partnership forums for discussion. b) Staff Monitoring - Discussions held with Stonewall about monitoring staff profile. Stonewall are holding an event for NHS Boards in March 2012 to discuss best practice in this area. Human Resource department invited to attend. c) Community Engagement - Work is ongoing with Scottish Health Council, LGBT Youth Scotland and Stonewall Scotland to support LGBT community engagement. d) Staff Training NHS Forth Valley will support Stonewall in Knowledge and Skills training through their online Learning Resource (OLR) and in supporting implementation of training surrounding it.
LGBT/Gender Based Violence Training Being initially offered to staff that have completed the ‘routine enquiry training’. Propose to deliver this training from mid 2012
9 FINANCIAL IMPLICATIONS There may be some financial implications associated with meeting the requirements of the Equality Act, due to changes in service delivery and training for employees.
Directorates will need to consider equality implications when prioritising funding for service delivery and training. This should be addressed as part of the Equality Impact Assessment process to be completed by service areas.
WORKFORCE IMPLICATIONS The NHS Forth Valley workforce is key to the delivery of the Equality and Diversity agenda both in terms of delivering services for our population which are fair for all, but also as recipients of our work to promote equality of opportunity for all staff.
RISK ASSESSMENT AND IMPLICATIONS This paper outlines progress and highlights any issues associated with taking forward the Equality & Diversity agenda within NHS Forth Valley.
Evidence of upheld complaints based on breach of equalities legislation is a stark and often expensive reminder that services are not meeting their Public Duty and not functioning as they should. As public awareness of legal protection grows, there is a greater likelihood that breaches will be more noticeable to an informed patient population and acted upon personally or through a legal intermediary, bypassing the standard NHS complaints process.
Ideally, every service should be in a position to confidently demonstrate compliance through the Equality Impact Assessments completed on their service area or within financial or service delivery reports completed.
RELEVANCE TO STRATEGIC PRIORITIES Equality and Diversity work streams form an integral part of NHS Forth Valley’s Local Delivery Plan and Patient Focus, Public Involvement Framework.
RELEVANCE TO DIVERSITY AND/OR EQUALITY ISSUES NHS Forth Valley is required to comply with the duties of the:
The Equality Act 2010
Impact Assessment: - The E&D Progress report is a factual summary of actions completed in relation to equality and diversity and as such does not require an impact assessment.
RECOMMENDATIONS FOR DECISION
Forth Valley NHS Board is asked to – . Note the content of this report.
AUTHOR OF PAPER/REPORT
Name: Designation: Lynn Waddell Equality & Diversity Project Manager
Approved by: Name: Designation: Helen Kelly Director of Human Resources
10 Appendix A NHS Forth Valley Interpreting cost 2011/12 Language Ratio 2009/10 2010/11 YTD Polish 40.69% 94857.46 84108.46 88752.39 Sign Language 23.55% 41749.96 61124.85 51371.43 Arabic 7.77% 23798.98 10687.82 16950.4 Mandarin 6.39% 19278.46 9064.75 13938.11 Indian 4.03% 8653.94 9009.67 8779.48 Russian 3.68% 7098.35 9017.75 8032.41 Cantonese 2.95% 6880.81 6111.42 6443.38 Slovak 2.10% 5416.70 3859.21 4586.05 Lithuanian 3.61% 5282.32 10429.28 7876.45 Urdu 1.70% 4578.78 2931.45 3707.01 Hungarian 1.03% 3170.37 1402.88 2247.77 Thai 0.26% 1011.32 148.85 564.94 Czech 0.43% 941.32 939.37 934.66 Latvian 0.38% 875.37 796.70 829.96 Turkish 0.31% 689.23 673.70 676.18 Italian 0.25% 451.07 648.04 548.58 Spanish 0.18% 237.39 553.75 396.99 Indonesian 0.06% 212.58 67.47 137.42 Bulgarian 0.03% 138.01 0 66.53 Romanian 0.19% 122.17 688.54 410.07 German 0.02% 104.62 0 50.17 French 0.14% 89.09 517.32 306.46 Japanese 0.07% 86.42 204.91 146.14 Amharic 0.08% 69.42 258.26 165.77 Portuguese 0.01% 50.54 0 23.99 Nepalese 0.08% 335 171.23 Somalian 0.0000 20 9.82 100.00% 225844.68 213599.45 218123.80
Notes 2011/12 year-to-date spend is for the period April 2011 to January 2012. Information is no longer held to allow 2011/12 expenditure to be accurately analysed by Language. Instead, spend by language is estimated, based on historical spend by language over 2009/10 & 2010/11.
Language Line Interpreter services
Sum of Amount Department Total V70000 A&E Nursing 355.2 V45354 Stg Locality Gen Hhv 109.6 V72082 Gum Health Advisor 106.4 V43310 Falkirk Locality Resources 80.8 V79040 Endoscopy FVRH 48.8 V44002 Locality Admin - Alloa Hc 27.2 V45425 Non Pract Attach Loc 4 Dn 14.4 V20725 Ward 3 Mh FVRH 6.4 Grand Total 748.8
The language figures are the YTD payments we have made to the company, not the YTD cost FV has occurred. 11