NHS Greater Glasgow & Clyde
Glasgow City Community Health Partnership
South Sector
Implementation Plan 2011/12
1/28 – South Sector Implementation Plan 1 Contents
Page
Foreword by Director 3
Structure of Plan 3
Background and Details of Glasgow City Community Health Partnership 4
Section 1 – Our Population and its Health 6
Section 2 – Key Challenges 8
Section 3 – Key Actions 9
• Children & Families 9 • Health Improvement 10 • Adult Mental Health Services 12 • Primary Care 13 • Alcohol and Drugs 16 • Older People and Disability Services 17 • Unpaid Carers 17 • Improving the Quality of Health Care 18 • Addressing Health Inequalities 18 • Sexual Health 19 • Workforce, Finance and other Resources 20 • Community Planning Arrangements 20
Appendices
• Appendix A – South Sector Staffing Detail 21 • Appendix B – South Sector Geography 22 • Appendix C – Sector Finance Summary 23 • Appendix D - Draft Action Plan – 2011/12 24
2/28 – South Sector Implementation Plan 2 Foreword by David Walker, South Sector Director
2011/12 will be a challenging time for all public sector services. Our intention is to deliver a range of high quality services, focussing on our priorities from the Board’s planning framework and to work closely with partner agencies and stakeholders to achieve these.
This Sector plan will provide a summary of the key areas of work for 2011/12 and will form the basis for discussion with stakeholders for work beyond that point.
The Sector will be responsible for implementing a number of key objectives including;
1. Involving and engaging staff around responsibilities for Staff Governance Standard Delivery including Staff Governance Action Plan, Health and Safety, and communication. 2. Establish meaningful engagement with GPs and other independent contractors across South sector 3. Achieve financial balance for 2011/12 and deliver savings plan for 2012/13 and 2013/14. 4. Delivery of HEAT targets to improve performance in service access and delivery and population health. 5. Delivery of Development Plan for the CHP and Implementation of this Sector Plan. 6. Support Shifting the Balance of Care for older people including use of the Change Fund 7. Review and progress use of Integrated Assessment Framework (IAF) and implementation of Healthier Wealthier Children. 8. Review future options for streamlining learning disability management and professional leadership. 9. Develop service quality and performance arising from integration of new Adult Rehabilitation Teams 10. A focus on quality and equality of Service provision.
Structure of the Plan
In Section 1 there is an outline of the characteristics of the population within the South Sector and the health issues which affect our local residents.
Section 2 explains some of the key challenges and opportunities which the sector faces in taking forward our plans.
Section 3 contains the details of our key actions for 2011/12.
I hope you find this document useful and if you need further information please contact Hamish Battye, Head of Planning & Performance. Telephone 0141 276 2612. Email [email protected]
3/28 – South Sector Implementation Plan 3 Background and Details of Glasgow City Community Health Partnership, South Sector
The South Sector is one of three areas of the Glasgow City Community Health Partnership (CHP). The CHP was formed in November 2010 following changes to the arrangements for the five Community Health & Care Partnerships between Glasgow City Council and NHS Greater Glasgow & Clyde. Although the CHP is managed as a National Health Service organisation, it retains strong links with Glasgow City Social Work, Education and other services and partners.
The Sector has a Management Team responsible for service delivery and co-ordination, as well as ensuring implementation of CHP policies and plans at a local level. The overall leadership for the CHP is provided by the CHP Management Team, which includes the three Sector Directors, and is accountable to the CHP Committee.
The Sector involves residents in planning services through the Public Partnership Forum and through a wider network of service user and carer groups. We also engage with staff through the Staff Partnership Forum and through involving them in key re-design and planning groups. At a local level we work in partnership with a wide range of statutory and voluntary organisations to ensure that our planning and service delivery operate in joined up ways. We are improving our links with General Practitioners to engage on a regular basis with general practice, which will include the development of more local based arrangements, to promote good partnership working with all primary care contractors in the South Sector.
The CHP manages the following NHS Services and functions at sector level:
• community nursing, health visiting and school nursing; • relationships with primary care contractors; • local older people and physical disability services – including Rehabilitation and Discharge teams for adult and older people. • chronic disease management programmes and staff; • allied health professionals; • palliative care; • learning disability services; • Community Addiction Services • mental health inpatient services at Leverndale and Southern General hospitals • community adult mental health services • primary care mental team services and a range of specialist mental health services including early intervention; • homeless and asylum services; • health improvement and planning; • resource transfer arrangements with the City Council; • specialist community children’s services and child and adolescent mental health; • Adult Rehabilitation
The sector also has City / Board Wide responsibilities for issues such as:
• Reshaping care for Older people – including the Change Fund • Care Homes Medical Practice • Continence Services • Health at Work • Employability and Health
4/28 – South Sector Implementation Plan 4 The South Sector covers the geography of the former South East and South West Community Health & Care Partnerships. (See maps in appendix B). The population of the area is around 220,000. The sector provides mental health hospital services and community services for a population of approximately 370,000
The sector employs over 1500 staff and has an annual budget for 2011/12 of just over £171m. Details of staffing can be found in appendix A and a financial summary is included in Appendix C. The Sector assumed responsibility for adult mental health in-patient and specialist services and in May 2011, with staff transferred from acute services as part of the formation of integrated adult rehabilitation teams. The latter is yet to be fully included within the service budget.
5/28 – South Sector Implementation Plan 5 Section 1: Our population and its health 1
The total resident population of South Glasgow is 220,489 people. A breakdown of the population by age is shown in the table below:
Age Bands No. of people % of population % of this age band in Scotland 0-15 years 38,743 17.6 17.6 16 -64 years 151,602 68.6 65.7 65-74 years 15,622 7.1 9.0 75+ years 14,522 6.6 7.7
The South Sector is noted as having a higher than average population of Black and Minority Ethnic Communities. 8.9% for the South Sector compared with 6.2% for Glasgow City. This is based on data from the 2001 census as well as work undertaken by the Scottish Refugee Council, reviewing the numbers of people living in rented accommodation and other surveys including reviews of UK Border Agency data. (A Study of Black Minority Ethnic (BME) Service User Distribution by Integration Network Area. October 2010 – Scottish Refugee Council). There are significant levels of BME populations in the Govanhill area with both established second generation populations as well as migrant workers. There are also Asylum Seekers concentrated in the Greater Govan area.
There are a number of factors affecting the health of the people living in South Glasgow. The recent Health and Wellbeing Profiles for Scottish Community Health Partnerships highlighted a number of issues for South Glasgow.
Life Expectancy and Mortality: Male and female life expectancy is significantly lower than the Scottish average, although it has been rising over time. Mortality rates from all causes (all ages), coronary heart disease, cerebrovascular disease and cancer (all under 75s) are all significantly higher than the Scottish average.
Behaviours: An estimated 32% of adults smoke in the Council area, compared to 25% in Scotland as a whole. In South Glasgow there have been 801 deaths from alcohol conditions in the last five years and the death rate is higher than the Scottish average. The proportions of the population hospitalised with alcohol conditions and with drug related conditions are also higher than the Scottish average. Levels of sporting participation in the Council area are 5% lower than the Scottish average.
Ill Health and Injury and Mental Health Cancer registrations and the proportions of the population hospitalised for coronary heart disease, COPD, cerebrovascular disease, emergency admissions and multiple admissions (65 years and over), are all significantly higher in South Glasgow than the Scotland average. The prevalence of diabetes is also significantly high. Rates of hospitalisation for asthma are higher than the Scottish average although those hospitalised after a fall in the home (65 years and over), are significantly lower than the Scottish average. The road traffic accident casualty rate is lower than the Scottish average. Drug prescribing for mental health problems is significantly higher than average. Suicide death rate (19.5 per 100,000 population) is also higher that the Scottish average (15.1 per 100,000).
Social Care and Housing South Glasgow has a significantly higher percentage of adults claiming incapacity benefit/severe disability allowance than the Scottish average. The percentage of single adult dwellings is significantly higher than the Scottish average whilst within the council area, both
1 Health and Wellbeing Profile for South Glasgow, Scottish Public Health Observatory (2010)
6/28 – South Sector Implementation Plan 6 homelessness and the rate of children looked after by the local authority are also significantly high. Extreme fuel poverty is significantly lower in the council area than Scotland (6.5% of households compared with 7.5% respectively).
Education and Economy Primary and secondary school attendance rates in South Glasgow are lower than the Scottish average. Levels of income and employment deprivation, the percentage of working age population claiming Job Seeker’s Allowance, dependence on out of work benefits or child tax credit, and people claiming pension tax credits are all significantly higher than the Scottish average.
Crime and Environment The crime rate (63.9 per 1,000 population) is significantly higher than the Scotland average (49.5 per 1,000 population). Rates of referrals to the Children’s Reporter for violence-related offences, and rates of patients hospitalised following an assault, are also high. The percentage of the population living within 500 metres of a derelict site (46.9%) is higher than the Scottish average (30%)
Women and Children’s Health Breast screening uptake is lower than the Scottish average. The prevalence of pregnant mothers who smoke is lower than the Scottish average whilst the rate of teenage pregnancies (under 18s) is higher than average. Although an increasing figure in the South Sector, the percentage of babies exclusively breastfed at 6-8 weeks at 22% is lower than the Scotland average, and the immunisation uptake at 24 months of vaccines other than MMR is also lower. Child dental health in primary 1 is worse than the Scottish average with 49% of children with no obvious signs of decay.
7/28 – South Sector Implementation Plan 7 Section 2: Key Challenges
Issues and Challenges and Opportunities
The Sector is presented with a range of challenges including:
• Severe pressures on our finances next year (and for a number of years thereafter) with an annual reduction in the NHS budget of between 2% and 4%. • High levels and concentrations of deprivation, poor health and health inequalities which place significant demands on our services. • Listening to our staff and other partner services around the effectiveness and performance of our services. • Continuing to manage the transition from the CHCP to the CHP sector arrangements and the need to establish and embed new management and governance arrangements. • Implementing changes to our workforce over the coming year through changes to the mix of skills and practitioners within our team. We will need to collaborate with other parts of the NHS system in these re-design programmes as our staff turnover is low and is likely to slow even further as the recession in the public sector takes hold over the next few years. • Putting a greater emphasis on improving the productivity of our services in order to make the budget savings and to re-invest in service improvement. • Demonstrating a shift from crisis management to early intervention approaches within these financial constraints and increasing demands for services. • The need to maximise the benefits of the wider physical regeneration which is taking place in the area as a consequence of large scale housing re-developments and the 2014 Commonwealth Games. • The importance of working with our partners to ensure that we maximise the benefits of public services for local people and to ensure that services operate in an efficient way. • Integrating new services and their staff into the CHP structure, such as acute hospital staff who will become part of the Community Rehabilitation and Enablement Teams. • The progression of a plan for the relocation of hospital wards for mental health from the Southern General hospital to new and improved ward accommodation
The major strengths and opportunities for the CHP over the coming year include:
• Voluntary and community networks operating throughout the area.
• The strong history of partnership working between the public and voluntary organisations operating in the South Sector.
The major change and development programme within the sector will be supported by expertise from the Change and Development Manager and Service Improvement staff. Aspects of this work will be included in the overall Sector Action Plan. In addition, the Sector will be supported by Organisational Development resources to support the development of leadership skills, local learning plans and a range of other interventions to support the Sector at a time of significant change.
8/28 – South Sector Implementation Plan 8 Section 3: South Sector Plan – Key Actions
The Glasgow City Community Health Partnership (CHP) Plan focuses on the key actions to be taken forward across Glasgow City and will be underpinned by the Sector Plans developed for North East, North West and South Glasgow. The following section provides information on the key activities and actions that will be taken forward by the South Sector during 2011/2012.
Children and Families
• We will implement the Review of Speech and Language Therapy and ensure an effective interface with local education department. • We will implement the recommendations of the review of Community Paediatric Services and in each sector we will establish integrated paediatric teams.
• This will include implementation of “Looked After and Accommodated Children – We Can and Must Do Better” • We will implement the Child and Adolescent Mental Health Service (CAMHS) redesign through implementation of:
• The workforce model for CAMHS • The Choice and Partnership approach. • A suite of clinical outcome measures including service users’ views of outcome and service received. • Prescribed evidence-based interventions delivered by CAMHS teams. • An equality impact assessment • We will implement a consistent approach to the use of the Integrated Assessment Framework (IAF)
The Glasgow City CHP Development Plan includes a range of re-designs and programmes, which will be implemented across both the City and at a Health-Board wide level and this reflects the CHP’s role as the host organisation for specialist children’s services. These include:
• Implementation of the Triple P parenting programme • Health improvement programmes to promote breastfeeding, reduce smoking in pregnancy and by young people and improving oral health • Re-designs of Child and Adolescent Mental Health, Community Paediatrics and Speech and Language Therapy services • Review of School Nursing • Improving access for young peoples to mental health services • Embedding the Integrated Assessment Framework into practice and implementing actions from Child Protection inspection by HMIE • Roll out of the Special Needs in Pregnancy Services to support vulnerable women and their babies • Support for Young Carers • Implementation of Releasing Time To Care for Health Visiting staff • Developing a Workforce Plan for Children and Families • Implementation of the Healthier Wealthier Children programme to provide financial inclusion advice and income maximisation.
9/28 – South Sector Implementation Plan 9 Specific actions which will take place within the South Sector include:
Healthy Children Programme We will undertake pilot work to support the development of the Healthy Children Programme, including the 30 month assessment and referral processes prior to the programme being launched across the Health Board area.
Non Offence Referral Management (NORM) This was established in the former South West CHCP area and we will ensure that this project is established on a Sector basis to ensure that children affected by domestic abuse are picked up at an early stage to prevent unnecessary involvement with the Children’s Reporter.
Routine Sensitive Enquiry We will train all Health Visitors in Routine Sensitive Enquiry (where patients are asked if they have experienced domestic abuse and, if necessary, provided with and/or referred to appropriate care and support). We will also ensure that more Children and Families support staff access and complete the e-KSF module. Routine sensitive enquiry training will also be offered to mental health staff in hospital and community settings.
HEALTH IMPROVEMENT ACTIVITY
Smoking Cessation
Black & Minority Ethnic • We will adapt our smoking cessation services to offer a more culturally sensitive and accessible service for the BME population and break down barriers to engagement. Appropriate resources in various languages will be available along with bilingual support to all clients either face to face or via an interpreted telephone call. This approach arises from the findings from last year’s Needs Assessment.
Champix (Varenicline) Clinics • We will offer additional support to smokers through pilot Champix (Varenicline) Clinics to encourage attendance at support services, and to ensure easy access to Champix. The pilot programme will also have Independent Pharmacy Prescribers available at support sessions to arrange the prescribing of Champix which evidence shows can improve success rates.
GP Pilot • We will deliver a pilot programme within a GP practice to improve patient contact to encourage more practice patients, who are smokers, to access our smoking cessation service. The GP’s involved in the pilot will letter all adult patients who are registered as smokers within the practice.
Mental Health • The ongoing delivery of smoking cessation services and no smoking policy at leverndale and southern general mental health hospitals
Youth Health • We will pilot smoking cessation services and other tobacco prevention programmes with local young people in a community setting.
10/28 – South Sector Implementation Plan 10 • We will deliver youth health services within a community setting to enable young people to get support on a wide range of health related issues e.g. sexual health, drugs & alcohol etc.
Oral Health • We will support the implementation of the fluoride varnishing programme and the Smile Too programmes within our pre-five establishments to reduce the incidents of dental decay.
• We will continue to link with the Bookbug out reach programme to provide information and raise awareness of oral health and other health improvement issues.
Men’s Health
• We will develop a strategy to improve men’s health across the South Sector, including hard to reach men
Healthy Eating and Tackling Obesity • We will deliver a range of Healthy Eating Programmes including: Get Cooking / Get Shopping to encourage local residents to develop a range of cooking skills.
• We will implement the “Active Children Eating Smart” (ACES) and Active Choices programme to prevent childhood obesity. The programmes will encourage young people to eat healthier and become more active.
• We will support the development and implementation of Walking Programmes to encourage local residents to become more physically active.
• We will through our Weaning Fayres offer advice to local parents on a range of nutritional issues by staff who have gained the competency/training on dietetics’.
• Implementation of health eating programmes at Leverndale hospital and the Southern General mental health hospitals
Mental Health • We will support the implementation of a range of services to encourage positive mental health including: stress and counselling services within the community.
• We will support the development of a range of services to improve young people’s mental and emotional wellbeing inc. expansion of youth counselling services, training for those who work with young people and arts based programmes.
• Implementation of health improvement programme for mental health including hospital programme .Continuing to be part of the national health promoting hospital programme
Healthy Weight Communities • We will develop a range of health programmes and activities to improve the health of local residents in Priesthill/ Nithshill/ Househillwood and encourage them to be more physical activates e.g. jogging groups, cycling scheme, allotment development and nutrition programmes.
11/28 – South Sector Implementation Plan 11 Healthier Wealthier Children • We will support the development and implementation of Healthier Wealthier Children Programme to work towards reducing child and family poverty by offering a range of financial and money advice services to families.
Adult Mental Health Services
The recent proposed changes to the arrangements for the management of Adult Mental Health Services will become clearer this year but the strategic priorities for mental health will remain the same. Key areas for action within the South Sector are detailed below.
• The progression of a the plan for the relocation Southern General mental health wards to new and improved ward accommodation
• We will continue to work on improvements relating to managing patients at home and meeting their needs .Preventing unnecessary admission to hospital and managing patients discharge with community and hospital services working together for continuous improvement.
• We will continue to work through a programme of service improvement with our community hospital and community staff and patients representatives and user and carers.
• Implementation of a programme of improvements to continue to meet the standards for hospitals in regard to hospital environmental standards
• We will improve the interface between Addiction Services and Learning Disability Services
• We will implement a clinical governance workplan for Mental Health Services in relation to patient safety and strengthen links between Primary Care and Addictions and Learning Disability
• We will maintain waiting times for accessing Primary Care Mental Health Teams across the South at four weeks
• We will maintain waiting times for access to Psychiatry and Psychology to less than 12 weeks
• Mental health staff will work closely with the voluntary sector, Mental Health User & Carer Network, and community planning partners.
Links to employment • We will work with local employability services and partners to ensure that our patients can access the range of available services for them to move towards and possibly into work. This will continue to be done through our work development programme for mental health
12/28 – South Sector Implementation Plan 12 Depression & Anti-depressant Prescribing • We will work with General Practitioners, Mental Health professionals and voluntary providers to offer support to patients and alternatives to anti depressants where this is appropriate.
Psychological Therapies • We will implement a plan and a programme to meet the requirements of the National HEAT target on access to psychological therapies
Community Mental Health Teams & Primary Care Mental Health Teams • We will continue to deliver community mental health services which meet the needs of patients in the South. We will also be reviewing the work of teams to ensure that they are supported in delivering community mental health services recognising that these services have performed well.
Crisis Service • We will be bringing forward a plan to reconfigure Crisis Services to ensure that we can continue to deliver the services effectively, recognising that these services have performed well.
Productivity & Financial Improvements • The Mental Health Services will be seeking to achieve operational efficiencies, including meeting the financial savings targets while maintaining good service provision.
Primary Care
The Sector has a role to work closely with primary care contractors across the South of Glasgow. Within our boundary there are 52 GP practices, 50 dental practices, 58 Community Pharmacies and 44 optometry practices. The particular priority areas for action in 2011/12 for the South Sector are listed within this section.
General Practice.
• We will work with local General Practitioners to form, develop and support an elected GP Committee in the South Sector, built on locality representation
• We will support work around referral management, including an analysis of outpatient and emergency admissions from Practices through the Quality and Productivity element of the Primary Care Quality Outcomes Framework (QoF)
• We will continue to implement the Primary Care Framework and to promote the development of the Scottish Patient Safety Programme which is a key improvement intervention set out in the National Action Plan for Delivering Quality in Primary Care. This work plan aims to deliver a comprehensive programme for primary care which will be ready to be launched in 2013. The work plan will cover the following themes:
• safer medicines, for example high risk medications and medicine reconciliation in the community • improving communication between secondary and primary care, for example information relating to discharge from inpatient care
13/28 – South Sector Implementation Plan 13 • develop a programme which aligns with the work of the Long Term Condition Collaborative e.g. develop care bundles to implement reliable care for CCF (Congestive Cardiac Failure) • develop a programme to take forward the HAI (Healthcare Acquired Infection) element of the Quality Strategy in the community, for example develop community based interventions to improve antimicrobial prescribing.
This will compliment ongoing work through the Prescribing Team auditing safe use of Methotrexate and monitoring and reducing antibiotic use associated with HAI in the community. This work will help to reduce unscheduled admissions to Hospital and links to the service redesign agenda (through the Change Fund) to deliver high quality sustainable care to older people in the community. The Caring To-gether Programme for ' Better End of Life Care for Heart Failure Patients' which we are contributing to also links strongly to this programme. . Developing joint work with our Primary Care Contractor
Prescribing
The 2010/11 prescribing budget for South Sector is around £42M. The South Sector Prescribing Support Team will continue to promote the delivery of safe, clinically effective and cost effective prescribing through a range of multifaceted activities and will endeavour to keep prescribing costs within the designated budget allocation. In order to achieve this, the team will continue to complete the following core activities:
• Completion of 100% of annual GP practice prescribing visits (MED 6 visits) in the South Sector by the end of August ‘11 • Analyse polypharmacy – use of multiple prescriptions • Deliver cost savings for the Sector from the NHSGGC Prescribing Indicators (MED10, Rational Prescribing Incentive Scheme and QP1-5) by March 2012 • Provision of prescribing support & advice for a wide range of healthcare service providers across the Sector e.g. District Nurses, Community Pharmacists • Deliver prescribing education and training where appropriate • Support local and national prescribing targets (e.g. HEAT targets) • Develop and implement local prescribing initiatives
The Prescribing Support Team will also continue to promote links and better understanding between all members of the primary healthcare team across the South Sector in relation to prescribing matters. This will be achieved through a number of strategies including the development of a Sector wide Prescribing Group, Non Medical Prescribing/Practice Nurse group(s) and the provision of prescribing support and advice to a range of service providers across the sector.
Community Pharmacy
• We will work with Community Pharmacies to maximise the benefits from the new Contract, in particular the Public Heath element. The Chronic Medication Service commenced in community pharmacies across Scotland in May 2010 but implementation has been slow. Within NHSGG&C six GP Practices and seven Community Pharmacies have been identified (including one in South Glasgow) and have agreed to participate in an Early Adopter process. All the sites will have enhanced support from IT facilitators and Community Pharmacy Development Team to explore the journey of a serial prescription, facilitate communication between GP Practice and pharmacy, develop a shared list of patients suitable for CMS serial prescriptions and develop governance pathways once process has been established.
14/28 – South Sector Implementation Plan 14 Feedback will be crucial to the success of this process to enable local and national modifications if necessary.
Dentists • We will work closely with the Oral Health Directorate and local dentists to take forward local initiatives to improve services and dental health in the Sector
Optometrists
We will develop Ophthalmology -supported Optometry Learning Networks whose purpose will be to enhance the clinical skills of the participating Optometrists. There will be a modular accredited training course made available to all interested optometrists. Thus all NHSGG&C GPs will be able to confidently refer their patients to Community Optometry.
• Within South Sector we will work to support Community Optometrists and GPs during this period of transition.
South Glasgow are working with the Royal National Institute for the Blind (RNIB) to stop people losing their sight unnecessarily. RNIB have developed a number of sight loss prevention projects across the UK called 'Community Engagement Projects' (CEP) to develop effective ways of targeting priority communities. The aim is to develop learning from these pilot projects that can be utilised with priority populations across the UK. An Eye Health Equity Profile has been created within NHSGG&C and at present RNIB have commissioned Shared Intelligence to support project partners in: • working more closely with local communities to understand awareness of eye care and experiences of, and views about, accessing and using optometrist and ophthalmic services • reviewing findings from this community based research to make specific evidence- based improvements to the local eye health prevention and care pathways.
Within Glasgow the focus is on Diabetic Retinopathy within the Pakistani population.
Governance • We will ensure patient safety and clinical effectiveness via our clinical governance group, developing this locally and ensuring links are made with the Glasgow City CHP and NHS GGC Board governance arrangements.
Early Intervention
Keep Well is a national pilot programme aimed at increasing the rate of health improvement (ages 45-64 years) amongst Scotland’s poorest residents. The programme works through primary care, particularly focussed on reducing coronary heart disease amongst this target population.
• From 2008 to 2010, Keep Well has been available to patients aged 45-64 yrs registered with GP Practices whose patient population is within the worst 15%. SIMD. 2011/12 is an extension year during which all patients 40-64yrs in all eligible practices will be targeted. In South Sector we will work with a maximum of 25 eligible GP practices to deliver on Keep Well, including those involved in the initial SW pilot.
• One of the key aims of Keep Well is to support patients to look at their health from a wider social and economic perspective and to address inequalities. Patients will be supported to access a wide range of services to address their health needs and to get support on issues such as money advice, healthy weight, smoking and
15/28 – South Sector Implementation Plan 15 employability. Outreach workers will be available to support GP practices to encourage patients to undertake their health checks and access key services.
Joint work between Primary and Secondary Care
Using joint work developed at Board level, we will improve relationships with secondary care by • supporting the referral management arrangements between GPs and hospital services • Ensure that the Health Board achieves the 18 week RTT Target and also the 62- and 31- day cancer Waiting Time targets • Reduce avoidable admissions and re-admissions and reduce bed days occupied by in-patients including by exploring service redesign opportunities presented by the Change Fund • Develop and implement care pathways • Reduce repeat attendances at Accident & Emergency. • Contribute to the reduction of Did Not Attends (DNA’s) at outpatient or other appointments within acute using learning from Keep Well experience.
Alcohol and Drugs
The Glasgow City Alcohol and Drugs Partnership (ADP) continues as an integrated service with the City Council and has a key responsibility to develop and drive forward the need to tackle alcohol and drug issues across the City. This will include supporting the City wide Alcohol and drug prevention and recovery strategy.
• The CHP is a key partner of the ADP and Glasgow City Council and the NHS currently deliver joint alcohol and drug community based services in the city to over 11,500 clients. In the South Sector, we will continue to develop our services to meet the needs of the local population.
Community Based Clinics and Improvements in access to Services • We will develop our four local community addiction teams to ensure an equitable service is delivered across the sector and ensure that we achieve 21 and 14 day targets for service access
Health Improvement Activity
Alcohol Brief Interventions (ABIs) • We will continue to deliver ABIs across the area with further emphasis on supporting GPs and targeted staff sessions. Furthermore, we will train staff from other public organisations and the voluntary sector so that they can deliver ABIs to the local people who they come into contact with.
Off Sales Campaign • We will work with the Police to continue with the off sales campaign to reduce under age drinking.
Boozebusters
16/28 – South Sector Implementation Plan 16 • We will support partners to deliver Boozebusters programme within local schools to raise awareness of alchol and other related issues. GRAND • We will continue to support the Getting Real for Alcohol and Drugs week.
Pathways Project • We will lead the 'Pathway's' project which aims to join up addiction services with wider social, cultural and educational activities. Client access to these services will be supported by service users trained to be peer mentors. A key feature will be supported access to Glasgow Life Welcome Visits.
Extend the Role of Service User Involvement
• We will extend the remit of Service User Involvement to ensure service meets the needs/aspirations of the client group
Introduction of Recovery Based System of Care
• We will review the work undertaken by Community Based Services to ensure these facilitate the full opportunities for Recovery with South.
• We will define Recovery and use these definitions to drive positive outcomes at all stages of care.
Older People and Disability Services
There are significant change programmes being developed and implemented at both a health board wide and Glasgow City level in relation to older people’s and disability services to which the South Sector will contribute towards. This includes;
• the implementation of the Change Fund programmes to support the Re-Shaping Care for Older People; • the implementation of the Rehabilitation and Enablement Team structures: • Releasing Time to Care for District Nurses • improvements in support for people once they have been diagnosed with dementia • the review of the Equipu Aids and Adaptations Service.
Unpaid Carers
Unpaid carers are vital to the many people in the South of Glasgow who rely on their family and friends to provide support. The CHP Development Plan includes a series of actions to identify carers, to provide them information and support so that they can perform their caring roles and to involve them in our decision making and planning structures. In the South Sector over the coming year we will:
• Develop actions to support Carer’s as part of the Change Fund bid.
17/28 – South Sector Implementation Plan 17 • Develop a South Carer Reference Group to promote engagement with Carer Centres and Carers • Publish a Young Carer strategy for South Glasgow and prioritise implementation of recommendations
Improving the Quality of Health Care
The CHP Development Plan categorises quality under the headings of public involvement, patient experience, person centred care and safety. The sector will contribute to a range of CHP and Board wide initiatives in relation to quality and at a local level our energies will be focused on:
• Re-launching our public partnership forum to ensure that it reflects all of the neighbourhoods and communities located in the South Sector.
• Continuing to support and develop the existing service user fora and groups in connection with addictions and mental health.
• Working with a range of partners to ensure that health improvement programmes are delivered in communities and are accessible to the community.
• Re-design of the specialist continence service
• Implementing Equality Impact Assessments (EQIAs) for all major service re-designs and service changes.
• EQIA’s will be undertaken in a range of areas including within the Continence project, Addictions and Primary Care Services
Addressing Health Inequalities
The South Sector has specific issues around deprivation and ethnic minority groups which require us to focus on improving equality of access to services or provision of services. This will include;
• We will develop an Inequalities Action Plan and a range of Equality Impact Assessments for the South Sector. • We will develop and implement the Roma Pilot programme to support the local Roma population to access services and improve their health. • We will develop the Equally Well model within the Govanhill population targeting a broader population
Financial Inclusion and Income Maximisation
• We will work with partners to maximise access to money advice and welfare rights services for patients and carers
Health Improvement Activity
Older People
18/28 – South Sector Implementation Plan 18 • We will work with our local partners to ensure older people maximise their income and have access to money and financial advice services.
Mental Health Patients • We will work with our local partners to ensure mental health patients in Leverndale get advice on money and other financial matters which in return and help reduce our hospital bed times for the patient group.
BME / Pollokshields Health Shop • We will deliver a range of health services and health improvement programmes through the Pollokshields Health Shop to our local BME population to reduce barriers in accessing services and work towards reducing inequalities e.g. health visitor drop- in’s, alcohol counselling, smoking cessation, Get Cooking / Get Shopping and group work around mental health and wellbeing.
Employability • We will work closely with partners to promote employment opportunities for patients within the Sector
Health, Housing and Homelessness Continuing to deliver on our Health and Homelessness action plan which includes:
• Providing appropriate “one point of access” to our services for housing providers who have concerns about the health of their tenants.
• Engage with service users through a variety of means such as Shared Solutions, focus groups and links with housing colleagues.
• Re-launching our Essential Connections Forum as a strategic meeting to include representatives from housing providers across the South Sector as a key vehicle for delivering on joint housing and health priorities.
• Continuing with our partnership working with a range of specialist support providers located in the South Sector through the Vulnerable Household Forum.
• Mainstreaming of specialist homelessness health services as appropriate using agreed protocols
Sexual Health
The South Sector will contribute to the work being delivered via Sandyford and primary care services to deliver on the CHP Development Plan priorities in relation to improving sexual health. This will include: optimising use of diagnostics; increasing the provision of LARC and HIV testing; improving sexual health and relationship education; increasing the provision of free condoms for those most at risk.
Specific South Sector Actions will include;
• Through SHRE (Sexual Health Relationships Education) we will work with our partners in education to provide training for staff and parents on relationships and other sexual health issues e.g. through our Talk 2 seminar programme. • Provision of youth sexual health services in the local community.
19/28 – South Sector Implementation Plan 19 Our Workforce, Finance and other Resources
Our Workforce The CHP’s workforce is our main asset as it is our employees who deliver the care and support for the residents of South Glasgow. It is vital therefore that we continue to invest in the development of the skills and knowledge of our staff, so that they can operate professionally in a constantly changing environment. Over the coming year we will:
• Work towards achieving the Healthy Work Lives – Silver award • Using the findings from the staff survey to improve how we support staff in their work • Contribute to the city wide workforce planning activities • Implement a learning and education plan to ensure staff have the appropriate skills and knowledge • Putting in place organisational development plans to support the re-design and change programmes, which are taking place within the Sector or where we have lead responsibilities • Ensure that we achieve our targets in relation e-KSF and absence.
Finance The sector has a budget of over £171m, which primarily covers expenditure on staff and prescribing and accommodation. The South Sector will be required to contribute to the achievement of the Board’s savings’ target of 3% during 20011/12. These savings will be initiated through initiatives at Health Board, Glasgow wide and South Sector levels. However, from a solely local perspective we will be required to initiate savings totalling £211,000
• In addition to achieving the savings targets for 2011/12 the South Sector will also be required to roll forward those savings we were not able to make during 2010/11. At the time of writing these figures remain to be confirmed.
Accommodation In the face of diminished capital resources, the South Sector has a number of strands of work to rationalise its properties and ensure that the use of buildings is maximised. These include: • Reviewing our current leases and reducing the number of these (where possible) as a way of making efficiency savings. • Provision of a new Sector Headquarters facility by December 2011 removing a further leased property • Reviewing the future use of Cardonald Clinic • Ensuring we maintain quality and maximise the usage of the accommodation and clinical space in our health centres and other NHS facilities.
Community Planning Arrangements
The Sector will continue to contribute to the community planning structures. These are currently going through a period of change but we would hope that the new arrangements will be in place during 2011/12. Opportunities exist to develop new and improved ways of delivering services in partnership as part of the One Glasgow and Total Place initiatives.
20/28 – South Sector Implementation Plan 20 Appendix A – South Sector Staffing Detail
Care Group South Number of Staff Addictions 49 CD 16 Health Improvement 47 Mental Health 667 Primary Care Sector Services 680 Other 43 Planning 15 Hosted Services 22 Executive 3
Total 1542
Breakdown of Primary Care Sector Services: Number of Staff District Nursing Staff (DN) 160 Health Visiting Staff 158 Dietetics 7 Physiotherapy 20 Podiatry 25 Older People’s Mental Health – In-patient 72 Older People Mental Health 24 Rehab (Community Rehabilitation Team) 28 Out of Hours (DN) 69 Diabetes 14 Learning Disability 24 Other 44 Care Homes Medical Practice 35 Total 680
21/28 – South Sector Implementation Plan 21 Appendix B - South Sector Geography
22/28 – South Sector Implementation Plan 22 Appendix C
Budget Summary – South Sector
Service Area Budget Addictions £1.8 M
Family Health Services – GP’s / Dental / £63M Optometry
Mental Health – Community & Primary Care £6M
Mental Health In-Patient Services £24.7M
Primary Care Sector Services £22.7M
Planning £500,000
Accommodation and Administration £3.5M
Prescribing £43M
Hosted Services – Continence / Older people / £3M Employment
Health Improvement £2.8M
Other – Executive / Development Funding / £270,000 Clinical Director
Total £171 Million
23/28 – South Sector Implementation Plan 23 Appendix D – Draft Action Plan 2011/12 Glasgow City Community Health Partnership South Sector
DRAFT ACTION PLAN 2011/12
Progress Codes
On Target/Complete Green
Slightly Behind Target (will be completed by end of reporting period) Amber
No Progress Red
24/28 – South Sector Implementation Plan 24 Priorities Lead Officer Progress Comments CHILDREN AND FAMILY SERVICES Implement the Review of Speech and Language Therapy Implement the recommendations of the review of Community Paediatric Services Implement the Child and Adolescent Mental Health Service (CAMHS) redesign Undertake pilot work to support the development of the Healthy Children Programme, including the 30 month assessment and referral processes prior to the programme being launched across the Health Board area. Establish Non Offence Referral Management (NORM) project across South Sector Train all Health Visitors in Routine Sensitive Enquiry
HEALTH IMPROVEMENT ACTIVITY
Offer a more culturally sensitive and accessible Smoking Cessation service for the BME population Offer additional support to smokers through pilot Champix (Varenicline) Clinics Deliver a pilot programme within a GP practice to improve patient contact to encourage more practice patients, who are smokers, to access our smoking cessation service Pilot smoking cessation services and other tobacco prevention programmes with local young people in a community setting Deliver youth health services within a community setting to enable young people to get support on a wide range of health related issues e.g. sexual health, drugs & alcohol etc Support the implementation of the fluoride varnishing programme and the Smile Too programmes within our pre-five establishments to reduce the incidents of dental decay
25/28 – South Sector Implementation Plan 25 Priorities Lead Officer Progress Comments Develop a strategy to improve men’s health across the South Sector, including “hard to reach” men Deliver a range of Healthy Eating Programmes Implement the “Active Children Eating Smart” (ACES) and Active Choices programme to prevent childhood obesity Support the development and implementation of Walking Programmes to encourage local residents to become more physically active Support the implementation of a range of services to encourage positive mental health including: stress and counselling services within the community Develop a range of health programmes and activities to improve the health of local residents in Priesthill/ Nithshill/ Househillwood Support the development and implementation of Healthier Wealthier Children Programme
INDEPENDENT CONTRACTORS – PRIMARY CARE / PRESCRIBING / PHARMACY / OPTOMETRY
Reduce pressure on prescribing budget through audit, liaison, training and specific prescribing initiatives Work with Community Pharmacies to maximise the benefits from the new Contract Develop Ophthalmology -supported Optometry Learning Networks Work with RNIB to develop targeted Community Education Programmes to reduce sight loss Deliver Keep Well programme in up to 25 GP practices Improve communication with Secondary Care provision
ADDICTIONS
Develop our four local community addiction teams to ensure an equitable service is delivered across the sector and ensure that we achieve 21 and 14 day targets for service access Deliver Alcohol Brief Interventions across the area with further emphasis on supporting GPs and targeted staff sessions
26/28 – South Sector Implementation Plan 26 Priorities Lead Officer Progress Comments Work with the Police to continue with the off sales campaign to reduce under age drinking. Support partners to deliver Boozebusters programme within local schools to raise awareness of alchol and other related issues Support the Getting Real for Alcohol and Drugs week Introduction of Recovery Based System of Care
PRIMARY CARE SUPPORT SERVICES
Implementation of Community Rehabilitation Teams Implementation of Change Fund Programmes Support “Releasing Time to Care” – Review of District Nurses
UNPAID CARERS
Develop actions to support Carer’s as part of the Change Fund bid Develop a South Carer Reference Group to promote engagement with Carer Centres and Carers Publish a Young Carer strategy for South Glasgow and prioritise implementation of recommendations
IMPROVING THE QUALITY OF HEALTHCARE
Re-launching our public partnership forum to ensure that it reflects all of the neighbourhoods and communities located in the South Sector Continuing to support and develop the existing service user fora and groups in connection with addictions and mental health Re-design of the specialist continence service Equality Impact Assessments will be undertaken in a range of areas including within the Continence project, Addictions and Primary Care Services
ADDRESSSING HEALTH INEQUALITIES
Develop an Inequalities Action Plan and a range of Equality Impact Assessments for the South Sector
27/28 – South Sector Implementation Plan 27 Priorities Lead Officer Progress Comments Develop and implement the Roma Pilot programme to support the local Roma population to access services and improve their health Develop the Equally Well model within the Govanhill population targeting a broader population Work with partners to maximise access to money advice and welfare rights services for patients and carers Deliver a range of health services and health improvement programmes through the Pollokshields Health Shop to our local BME population
HOUSING AND HOMELESSNESS
Engage with service users through a variety of means such as Shared Solutions, focus groups and links with housing colleagues Re-launch Essential Connections Forum Mainstream specialist homelessness health services as appropriate using agreed protocols
WORKFORCE
Achieve Healthy Working Lives Award Use finding from Staff Survey to improve how we support staff Develop and implement a learning and education plan Deliver on targets for E-KSF and staff absence figures
FINANCE
Deliver on savings targets for 2011/12 (Including carry forward of any 2010/11 outstanding issues)
28/28 – South Sector Implementation Plan 28