Pan Highland Page No

APPENDIX 6 Visible, Accessible and Integrated Care: Draft v2 for June NHS Highland Board The Review of Nursing in the Community Implementation Plan - DRAFT

Pan Highland Page no . Updated Project Initiation Document (PID) ………………………………………………………………..1 . Overall Pan Highland Key Tasks and Actions in Transition Planning including Gantt chart …………7 . Pan NHSH Communication & Engagement Strategy ……………………………………………………12 . Pan NHSH Communication & Engagement Action plan …………………………………………………18 . Communication Framework …………………………………………………………………………………21 . Pan NHSH Change Management / Organisational Development (OD) plan…………………………..22 . CHP local Implementation plans: not included in this draft Argyll & Bute ……………………………………………………………………………………. Mid Highland ……………………………………………………………………………………. North Highland …………………………………………………………………………………. South East Highland ……………………………………………………………………………. R.A.G Progress status: The following is used to assess progress on some sections: R – Red alert = timescale/deadline missed or major issue encountered Key A – Amber = unexpected delay, issue arising or on horizon . RONC – Review of Nursing in the Community G – Green = activity running to plan, no problem with timescale . SGrp – Steering Group . LIG – Local Implementation Group . CHP – Community Health Partnership . SGov – Scottish Government . PID – Project Initiation Document . Board - NHS Highland Board . AAHPC - Area AHP Committee . APF - Area Partnership Forum . ACF - Area Clinical Forum . CPG - Clinical Planning Group . CGC - Clinical Governance Committee . DHS - DHS Management Team . HMa, Heidi May, Board Nurse Director . HMo, Helen Morrison, Associate Director, Clinical Workforce Development . RC, Ruth Cleland, Head of Internal Communication . FS, Fiona Sharples, Project Manager, RONC . Quarto: External OD consultants, commissioned by Scottish Government

File: Pan NHSH RONC Implementation plan DRAFT v2 APPENDIX 6 Visible, Accessible and Integrated Care: The Review of Nursing in the Community

Updated Project Initiation Document (PID) Version: April 2008 Project Title: Visible, Accessible and Sponsor: NHS Highland Board Integrated Care Project In November 2007, the Scottish Executive launched its report of the Review of Nursing Background: in the Community. The Review concluded that a new service model for community nursing in Scotland is required, to ensure community nurses are fit for purpose and make maximum contributions to meeting the health needs of Scotland’s population in the 21st century. It introduces a new practice framework for all nurses working in the community and a new service model to support nurses to work to the new framework.

The Executive invited NHS Boards to become Development Sites to implement and shape the new model and take part in an evaluation of its fitness for purpose. NHS Highland has been established as one of four Development sites. The others being NHS Lothian, NHS Tayside and NHS Boarders.

The Executive have established a Programme Board to steer and oversee the project, commission the development of educational packages and commission the evaluation. The NHS Highland Nurse Director sits on the National Programme Board.

This PID: o describes the approach NHS Highland plans to take to implementing the New Community Nursing model in NHS Highland o defines the accountability and governance structure it will adopt o outlines the implementation phase that will test and develop the model within the 7 core elements of practice by maximising nurses’ contributions in the community setting Project The project provides NHS Highland with an opportunity to: Benefits: o shape and influence the final model and related education programmes and methods of delivery o to plan the future community nursing workforce in NHS Highland with a informed understanding of future workforce needs based on public health analysis o address the twin challenges of the changing population and workforce demographics o contribute to implementing national policy on shifting the balance of care, e.g. Better Health , Better Care Project Aims: The project aims are to: 1. Implement, test and develop the new service model in NHS Highland with the aim of this model being safe and effective 2. Contribute to the National Programme, including the Capability Frameworks, Job Descriptions, Education packages and Evaluation 3. Plan and steer the transition from the current service model to the new service model, which will include the professional development of those in post 4. Ensure service sustainability throughout the transition process 5. Ensure clinical, staff and financial governance responsibilities and accountabilities are met throughout the life time of the model 6. To provide and receive advice, guidance and support to/from the Scottish Government Programme Board 7. To provide and receive advice, guidance and support to/from the Local Implementation Groups in the Community Health Partnerships (CHPs) and Sub Groups of the Steering Group. 8. To develop in the context of other national and local policy drivers such as

File: Pan NHSH RONC Implementation plan DRAFT v2 Getting It Right For Every Child and Long Terms Condition Management Project The project will deliver: Deliverables: 1. Base-line workload, workforce and community health needs information and workforce plans to support the testing and development of the new service model 2. Initial risk analysis and ongoing risk register 3. Transition plan for approval of the NHS Board and national Programme Board, including financial costings 4. Communication/Engagement Strategy and ongoing action plan 5. Implementation of the New Model in accordance with the transition plan 6. Regular progress reports to NHS Board (min. 6 monthly), Programme Board (monthly) and Area Nursing & Midwifery Advisory Committee (monthly), and regular updated to other Boards, e.g. DHS Board. 7. Final Project report incorporating - a. Recommendations for future model to NHS Board and Programme Board b. Full costs associated with recommendations This project will include: This project will not include: Analysis of the interface between the New Review of Mental Health Nursing Community Nursing Service and other key The project will interact closely with work on Telemedicine services eg: Social Care, Children’s but will not lead that project. services, Community Hospitals, General Practice and SSU services. Constraints: The project impacts on many services and individuals; engagement with all the stakeholders will be important and the ability of the project to deliver will be influenced by their co-operation throughout.

While the final model will need to provide improved services within financial budgets available, the transition process will require resources. If these resources are not forthcoming, progress will be constrained.

The new service model is being tested in Scotland during a 2 year project from April 07 to March 09. A final decision about roll out, based on the evaluation of this will be made in Spring 2009 by the Scottish Government.

During the lifetime of the project involvement of many stakeholders is vital to the success, the project involves cultural and individual change. Governance Structure

NHS Highland Board

National Programme Board

Education & Training Organisational NHS Highland Subgroup Change Subgroup Project Steering Group

North CHP South East CHP Argyll & Bute CHP Mid Highland CHP Local Implementation Group Local Implementation Group Local Implementation Group Local Implementation Group

Locality Groups in some CHPS

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 3 of 25 Project Manager: The key responsibilities of the Project Manager are:  S/he will be responsible for co-ordinating and managing the planning and implementation of the Review of Nursing in the Community across NHS Highland.  S/he will work with the Project Steering Group and other Groups, will be directly accountable to the Board Nurse Director and will ensure that the project meets its milestones as agreed at the outset.  S/he will highlight risks to the success of the project implementation and ensure that solutions are identified and implemented.

Project Sponsor: The NHS Board will sponsor the project. Their responsibility is to support the project’s aims and promote its value both within the organisation and with key stakeholders outwith NHS Highland eg: Highland and Argyll and Bute Councils, SEHD, and the Public.

Project Steering Group: The Steering group is responsible for the project being delivered on time, within resources available.

Should any difficulties be identified that could cause clinical, financial or staff governance issues, the Steering group will bring these to the attention of the Scottish Executive Review of Nursing in the Community Programme Board and, when necessary, NHS Highland Board.

CHP Management The Management Team Groups are responsible for implementing and testing and Team Local developing the new model in their own CHP in line with the Implementation plan, Implementation and contributing to the national evaluation. Groups: They have a responsibility to provide regular progress reports to the steering group and raise any divergence from the Implementation plan with the Steering group

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 4 of 25 Visible, Accessible and Integrated Care: The Review of Nursing in the Community

Overall Pan Highland Key Tasks and Actions in Transition Planning

Version: April 2008

The following is extracted from a Proposal paper on the Implementation Phase by Susan O’Rourke taken to the March Programme Board:

1. The Principles Principles for determining the approach to implementation should include:

Implement testing the project in natural logical order, locally driven to meet local challenges and circumstances and centrally supported. Communication and involvement of key stakeholders such as staff, patients, public and partners. Ensure an integrated and co-ordinated approach to implementation both locally and nationally with a common vision and commitment to achieving results. Address areas identified most in need of service change first, driven by local need and by setting out how these will be addressed, by whom and within agreed timescales. Maintain and improve patient care through integrated service planning with key stakeholders Improve the flow of patient pathways through integrated planning with key stakeholders and in collaboration with NHS QIS Maximise use of IT in collaboration with e-health care and local IM&T strategies Drive a pace that delivers results quickly but safely and effectively within a risk framework Identify change processes to be used for transition to the new service model Adopt a flexible approach to reflect new learning, new developments and service outcomes. Monitoring and review of project activities and timescales within a structured reporting system to local steering groups and National Programme Board.

2. Factors required for successful implementation: The development of a national transitional planning tool as a guide to enable project managers in pilot sites to develop, plan and manage their local implementation plans The national tool will ensure the stages; key actions and terminology used are the same, across the pilot sites. This will enable implementation to be achieved more effectively, reduce risks and enhance realisation of benefits of the service change. Monitoring and review of project activities and timescales within a structured reporting system Project management team clear of roles and responsibilities in order to achieve successful implementation. Pilot sites have completed; organisational readiness assessment, all relevant transitional activities and are ready to commence local implementation. Required approvals and support have been obtained from NHS Boards, Steering groups and the National Programme Board

File: Pan NHSH RONC Implementation plan DRAFT v2 Pilot Sites Implementation Plans Each pilot site will draw up an implementation plan for the local area. The plans will set out the actions required to ensure a co-ordinated joint approach to implementing and testing the new service model. The Plan should link to CHP/ LHP plans and involve key stakeholders such as staff, patients, public and partners.

Content of local implementation plans Implementation Plans should include:

Organisational readiness assessment Updated Project Initiation Document (PID) Updated Communication strategy Updated Risk Register Financial plan Resource plan Change management plan Education and training plan Process for review of standards, policies , procedures and patient pathways. Lessons Learned log

The plans would be signed off by the NHS Boards, Area Partnership Forums and National Programme Board.

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 6 of 25 GANTT chart

Key Tasks Key Actions Lead (s) Apr May Jun Jul Aug Sep Communication & Engagement Strategy & Action plan 1 Pan NHSH Communication & Engagement . Integrate current plan into revised Comms. Project Manager Strategy and plan updated template 2 Pan NHSH Communication & Engagement . Review and monitor Pan NHS Action plan Project Manager Strategy and plan reviewed and updated as . Materials to support communication required 3 CHP local Implementation plans to include . Ensure all stakeholders identified and Lead Nurses local Communication & Engagement addressed in local Implementation plan actions See CHP Local Implementation Plan . Review and monitor local Plan Change Management / Organisational Development 4. Development of pan NHSH Change . Identify Change Management support & Nurse Director / Management plan solutions OD lead / . What support is needed by whom and Project Manager See Change Management Plan / OD Plan for when and how to resource it, e.g.: / Quarto pan NHSH actions Maintaining momentum in non pilot sites Establishing opportunities to share learning and experiences across NHSH 5 CHP local Implementation plans to include . Identify Change Management support & Lead Nurses / Change Management plan solutions e.g. OD lead / Support to pilot sites from non pilot sites Project Manager See CHP Local Implementation Plans for local Maintaining momentum in non pilot sites actions Facilitation of teams to understand how to operationalise new service model Examination of ways in which duties, responsibilities, roles and team relationships may be defined and structured to best meet the needs of the new service model and current service delivery and stakeholders Establish opportunities to share knowledge amongst staff 6 Establish CHP local support for pilot sites . Agree role and remit of Local Facilitator Nurse Director / . Identify local Facilitators / Change Leaders Lead Nurses / Project Manager 7 Ensure Local Implementation Group / . Review ToR Lead Nurses Locality Group has appropriate representation and is fit for purpose

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 7 of 25 Key Tasks Key Actions Lead (s) Apr May Jun Jul Aug Sep Capability Framework / Job Descriptions (JD) . Ensure documents are circulated widely and Lead Nurses/ 8 Consult on Draft of Capability Framework in good time Project Manager for Advanced Practiice though LIGs, local . Encourage staff to provide feedback groups, meetings . Collate NHSH response and circulate and send to NES 9 Development of KSF outlines for family of . Continue with work on CHN outline and Project JDs circulate pan NHSH and complete Manager/KSF . Develop for SN, HCSW Group . Confirm process for Advanced Practitioner . Process outlines through NHSH Education & Training 10 Development of individual PDP and LDPs . Utilise NES LDP/PDP and 5 step Work based Lead Nurses based on learning needs learning process, and fit with NHSH PDP process, and using Capability Frameworks, See CHP Local Implementation Plans for KSF outlines (if ready) to identify any gaps in local actions knowledge & skills . Identify capacity locally to facilitate this E&T Subgroup process . Identify capacity of HEIs to provide Education Supervisor and confirm arrangements 11 Development of Education & Training . Education & Training Subgroup established, E&T Subgroup plan workplan being developed . Develop Education & Training plan 12 Ensure delivery of Education & Training . Monitor Education & Training plan Chairs of E&T plan . Provide updates on workplan at each Subgroup/Project Steering Group meeting Manager 13 Training delivery for staff . Identify cost of education and training and of Chair of E&T backfill Subgroup . Develop Education & Training plan . Inform Programme Board of projected costs Nurse Director Organisational Change 14 Organisational Change process followed . Organisational Change Subgroup established Chair of group - and meets regularly to support the RONC Head of See CHP Local Implementation Plans for Steering Group with matters concerning Personnel/ local actions organisation change Project Manager

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 8 of 25 Key Tasks Key Actions Lead (s) Apr May Jun Jul Aug Sep Risk Management 15 Ensure risks are identified and actions . Review and monitor Pan NHSH project Risk Project taken to minimise risks – maintain NHSH Risk Log Manager Risk Log/Register and review locally . Local Implementation Groups/Locality groups to review and localise Risk Register and Lead Nurses agree local actions Workforce and Workload Planning 16 Understand baseline of current workforce . Complete WF report of pilot sites and share AD Clinical in pilot sites information as appropriate Workforce Dev. / Lead Nurses . Micro detail re current workload and 17 Community health needs & workload population data – e.g. caseload activity and Lead Nurses/ requirements identified and understood complexity AD Clinical . Review view outputs of Professional Workforce Dev./ See CHP Local Implementation Plans for judgement tool and Census Project local actions . Health Needs Assessment Actions agreed at Manager Public Health (PH) workshop on 2/4: Feed comments from attendees on PH indicators to National Group Establish date of national Road show on PH indicators and organise invites to workshop invitees Utilise role of PHP’s in supporting pilot sites Clarify named PH specialist lead for each pilot site Organise small working group with approp. representation to agree info needed to be collated/interpreted for pilot sites, ensure consistency across NHSH . Use National Community WL tool when ready 18 Understand skills in current teams . Collate team skills – e.g. Child Health (child Lead Nurses/ protection, development, preschool and school Project Identify and understand skill set required health), Parenting, Family health, Health Manager for CHN teams in pilot sites promotion (anticipatory care, illness prevention), Disease management, Promoting self-care, See CHP Local Implementation Plans for Mental health / well-being, End of life care, local actions Communication skills, Leadership, IT, Resilience, Prescribing

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 9 of 25 Key Tasks Key Actions Lead (s) Apr May Jun Jul Aug Sep 19 Agree workload transitional arrangements . Based on above actions agree nursing Lead Nurses/ service within pilot sites and fit with the wider AD Clinical See CHP Local Implementation Plans for multidisciplinary and agency integrated teams Workforce Dev./ local actions . Ensure practitioners feel capable and Project prepared for practice Manager Other 20 Ensure fit with other national and local . Explore opportunities and how new service Lead Nurses/ initiatives model fits Project Manager 21 Develop and maintain ‘lessons learned’ . Implement lessons learned log to capture Project Manager log what has gone well & provide recommendations of how things could be done differently . Maintain log locally in pilot sites and feed into Lead Nurses overall Pan NHSH log 22 Develop Financial plan . Identify financial implications of service Financial lead/ changes and how resources will meet this Project Manager 23 Develop Resources plan . Identify resource implications of service changes, e.g. WF/WL actions See CHP Local Implementation Plans for . Analyse resource needs of team for practice Lead Nurses local actions e.g. IT, equipment, premises etc 24 Pathways of Care for new service . Develop new referral pathways in line with Head of Service model principles laid out in Visible, Integrated and Redesign/Lead Accessible Care Nurses 25 Establish what changes are needed to . Follow progress of Borders work on leading Project Manager Documentation – primarily Assessment – documentation and feedback and how this fits with existing documentation . Agree opportunities for testing documentation Lead Nurses/ and Getting It Right For Every Child during the pilot, e.g. the Assessment process Project Manager 26 Policies, standards and procedures . Review existing policies, standards and Lead Nurses/ review - ? fit for purpose for new service procedures to identify if fit for purpose for new Project Manager model service model and agree appropriate actions 27 IT requirements identified for testing . Scope current IT in pilot sites and identify Lead Nurses/ phase of project gaps and opportunities Project Manager . Scope how project fits with IT initiatives 28 Pilot sites/LIGs to develop local Review pan NHSH overall plan and develop Implementation plans appropriate local plans Lead Nurses See CHP Local Implementation Plan .

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 10 of 25 Key Tasks Key Actions Lead (s) Apr May Jun Jul Aug Sep Evaluation 29 Assist Research team in establishing . Identify existing data sources for the baseline Lead Nurses baseline in CHPs . Assist with questionnaires as requested Project Manager . Organise Focus groups, Interviews with / AD Clinical patients and operational managers in May Workforce Dev /June as required 30 Influence measurement of new service . Steering group and Local Implementation Board Nurse model group members to discuss locally and feed in Director/Project suggestions to Board Nurse Director/Project Manager Manager for May Programme Board . Continue to influence via Evaluation AD Clinical Subgroup Workforce Dev

Communication & Engagement Strategy ~ Pan Highland Version: April 2008 Development & Testing of the new Service model

1. Why? This Communication Strategy has been updated to support NHS Highland as one of 4 NHS Boards to lead the way in testing the national recommendations in Visible, Accessible and Integrated Care: Report of the Review of Nursing in the Community in Scotland (Scottish Executive, Nov, 2006). The Minister for Health and Community Care accepted the recommendations of the Review for a new service model and this is being tested in Scotland during a 2 year project from April 07 to March 09 by NHS Highland, Lothian, Borders and Tayside. A final decision about roll out, based on the outcomes of these projects will be made in Spring 2009 by the Scottish Government.

In the Action Plan for Better Care Better Heath (Dec, 2007) it states ”We want to see a model of nursing in the community that delivers effective nursing support to individuals, families and communities. This, we believe, will support community based services that are proactive, modern, safe and which help people to realise their potential for health and wellbeing...”

The new service model will see District Nurse, Health Visitor, School Nurse and Family Health Nursing disciplines absorbed into a single Community Health Nursing discipline.

The change required by staff as their role alters to embrace the Community Health Nursing model is demanding and communication is fundamental to the success of this project. In December 2007, NHS Highland Steering Group agreed to identify 3 to 4 areas in Highlands to test and evaluate the new Community Health Nursing Model and criteria was suggested for choosing areas. Possible areas were discussed at December Local Implementation Group workshops and were discussed locally. Possible areas were then discussed at the January RONC management team where further criteria were developed and the areas assessed against these with discussions continuing locally. A number of areas expressed an interest in taking part, and these were assessed against a range of criteria, including willingness of staff to be involved. A shortlist of proposals were taken to and discussed at the February Steering Group. It was agreed that the implementation process for the agreed pilot sites should commence immediately aiming for an official “Go Live” date in June. The following five areas were chosen and these reflect geographical spread and diversity of rurality, urban and delivery challenges:  Badenoch and Strathspey  Helensburgh  Kintyre and Mid Argyll  Tain  Thurso

The intention of this strategy is to ensure that everyone is aware of the testing process as well as have the opportunity to continue to influence and inform the shaping of the model. The Communications Action Plan is a live document which will require regular updating. Communication is a key risk area of the Project.

In the lead test areas the many stakeholders outlined below need to be included as part of the local Implementation Plan to ensure that they are aware of changes that will affect them or their colleagues. Also it is vital the momentum and engagement across all of NHS Highland continues. Stakeholders in the non test areas will need to continue to have opportunities to be involved and influence the testing although they are not directly participating as well as being kept informed about progress and lessons learnt in the lead test areas.

In NHS Highland the project is overseen by a Steering Group chaired by the Board Nurse Director. The Steering Group links to the National Programme Board. The Steering Group is supported by Local Implementation Groups in each CHP, chaired by the Lead Nurse, and in some CHPs there are Locality Groups. Membership is wide-ranging including community nursing staff, GPs, practice nurses, service

File: Pan NHSH RONC Implementation plan DRAFT v2 users and union representatives among others. Sub groups are set up when a need is identified. In December it was agreed to establish an Organisational Change Sub group, prior to this there was an ad hoc meeting to focus on Patient and Public Involvement. In February it was agreed to an Education & Training Sub group.

2. Who? Primary Stakeholders: District Nurses, Health Visitors, School Nurses and Family Health Nurses will feel the most direct impact, with big changes to their roles, work and training. Secondary Stakeholders: Those staff who work directly with the Community nursing staff- GPs, social work, CHP management teams, Lead Nurses, GPs, CPNs, Midwives, Practice Nurses and AHPs, hospital staff and specialist nurses. Tertiary Stakeholders: Patients, carers, partners and public - The Community Health Nurse will be the visible access point for people to the nursing service, providing care through a team of appropriately trained and skilled nurses with a broad range of experience. (Social work, education and voluntary groups)

Nursing staff, patients and carers, and other service partners will be fully involved in the development and delivery of the changes.

Who will do the communicating? Key spokespeople are Director of Nursing and Lead Nurses. Implementation of the communications plan will be integral to the Project implementation and a key role for the Project Manager. Also Key Groups are the Steering Group, CHP Local Implementation Groups and Locality Groups. Team Leaders have a key role as well as other staff delivering care directly to patients.

Values The Steering Group is supported by CHP Local Implementation Groups and in some CHPs there are Locality Groups. The communications plan will be in accordance with appropriate governance standards: e.g. Staff Governance standards (governing Well Informed Staff and Treated Fairly and Consistently) and Patient and Public Involvement requirements.

 Face to face communications will take place where possible  Openness  Staff involvement in the process and development and implementation of the model  Pro-active and timely information to staff ahead of media  Accessible staff briefings, workshops and information exchanges  Project milestone and timetables will be made clear  Identify hard-to-reach audiences (patients and carers) with special needs for communicating change to services

3. What?

Benefits What is going to better – opportunities? (taken from Team Leaders workshop in Dec 07)  Integrated working (credit and acknowledgement to remote and rural areas who are already working across boundaries)  Develop skills to meet the needs of the community/population and a better knowledge of the community  Single point of nursing contact  Right person, right care, right time  Reduce health inequalities  A&C Staff  Career structure  One stop shop for families  Consistency in roles and titles  More holistic and patient centred

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 13 of 25  Opportunities to develop areas of special interest in response to community needs  Opportunities for health improvement to be everybody’s business  Child protection everyone’s responsibility  Benefits to patients reduce complexity  Fluidity of staff between disciplines  Reactive v proactive  Increased understanding of each others roles

How will the new service model for nursing in the community benefit patients?  The Community Health Nurse will be the single point of contact to access community nursing services for people throughout the community: available to patients, carers, children, families and the community. This will be non-age or illness/condition specific and available across the life span.  The model builds on the best elements of nursing practice in the community to provide a means to support nurses to deliver a modern, flexible and responsive service within a multi-disciplinary and multi-agency context. Seven core elements were identified and considered relevant to underpin the activity of nurses in the community to enable their contribution to Delivering for Health: - working directly with individuals and their carers - adopting public health approaches to protecting the public - co-ordinating services - supporting self-care - multi-disciplinary and multi-agency team working - meeting health needs of communities - supporting anticipatory care

Key Messages ~ October 2007

What is the rationale for the changes & Why are we making the changes now?

1. The changes will support the long term strategic vision within the NHS in Scotland to provide care closer to home, to support self care, prevent illness and to anticipate health needs, thereby improving health and avoiding unnecessary hospital admissions. Community nurses are ideally placed and experienced and skilled to do this. The changes will be around developing and supporting this highly skilled and experienced workforce to do this.

2. Our population is ageing, with increasing associated conditions e.g. chronic disease. Recent National Policy has an increased focus on health promotion, ill health prevention, anticipatory care, supporting self care and providing care closer to home. This new nursing model provides us with an opportunity to modernise community health care to meet these challenges, especially in the context of the needs of remote and rural communities.

3. Our community nurses are very highly skilled and experienced and much valued, particularly in Highland communities. This is a very important opportunity for NHS Highland to lead the way in developing the new national recommendations for community nursing roles to meet future needs.

4. The model enables us to achieve a sustainable workforce with career and skill development opportunities in NHS Highland.

5. The new arrangements will see District Nurse, Health Visitor, School Nurse and Family Health Nursing disciplines absorbed into a single Community Health Nursing discipline. The Community Health Nurse will be the visible access point for people to the nursing service, providing care through a team of appropriately trained and skilled nurses with a broad range of experience.

How will the changes be implemented?

6. Nursing staff, patients and carers, and other service partners will be fully involved in the development and delivery of the changes. As a development site it means that we will have the

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 14 of 25 chance to influence how this new model is to work and to use the skill and expertise of our nursing workforce to inform key aspects of it.

In a Nutshell - Community Nurses with their broad range of skills and experience are pivotal to anticipating health needs and preventing ill health – especially in remote and rural communities. Changes are around making best use of these skills and experience within this highly valued resource

7. This whole Project is an evolutionary process – it will not be a BIG BANG change approach, nor is it a “done deal”. Your needs and your requirements will be embraced. Your choices will also be embraced – as far as they can be. You will have an opportunity to influence change – to help shape it rather than have it “done to you”

8. Everyone will get appropriate support. There is a Communication & Engagement Strategy and a Change Management plan developed to ensure staff are informed, supported and involved in the changes. Local Implementation Groups will ensure that staff at a local level have every opportunity to be involved in the implementation of the new model, influencing directly how it works. NHS Highland and the other Early Implementer sites are currently working with our local Universities to look at the educational support that will be needed for the new role.

What is involved in being a CHN?

9. There will be CHN’s, perhaps one of a number, working within a team environment, supported by all of the knowledge, skill and expertise required to undertake the role. Staff have already provided feedback about the Capability Framework for the role developed by NES, in addition to the visioning work done to look at the role of the CHN. This information is now being used to develop the CHN Job Description which is now out for comments.

10. As a CHN you will NOT be expected to deliver everything – you will be part of a team which together will have the knowledge, skills and experience to deliver all of what happens now – all aspects of care to all group

4. How & When?

Briefings / Established Forums  Get WISE format of staff briefings across NHS Highland. General messages, inviting feedback, face to face opportunity to give information and staff to ask questions.  Review of Nursing in the Community is an agenda item on all nurse team meetings  The Board Nurse, Lead Nurses, Project Manager, Team Leaders, Chairs of Locality Groups, and other staff as appropriate will continue to contribute to local briefings and update a range of stakeholders as appropriate pan Highland and within CHPs. This could be through existing Forums such as team meetings, CHP Board meetings as well as ‘specific’ meetings to inform and engage.  Regular reports by either Board Nurse, Lead Nurse, Project Manager to the following NHS Highland Key Groups, Committees, Nursing Fora: NHS Highland Board ANMAC – Area Nursing & Midwifery Advisory Committee AAHPC - Area AHP Committee HPF - Highland Partnership Forum ACF - Area Clinical Forum CPG - Clinical Planning Group CGC - Clinical Governance Committee DHS - DHS Management Team

Linking to other Agendas  The Board Nurse, Lead Nurses, Project Manager, Team Leaders, Chairs of Locality Groups, and other staff as appropriate will continue to contribute a Review of Nursing in the Community perspective to other agendas as appropriate pan Highland and within CHPs.

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 15 of 25  Agendas where the Review of Nursing in the Community is an opportunity / vehicle to deliver: o Better Health, Better Care “Shifting the Balance” o Anticipatory care o Direct Enhanced Service: o COPD o Carers o Cancer and Cancer Strategy o Rheumatology o Getting It Right For Every Child o KCND (child birth) o Strategy for Community Hospitals / DGH’s / Remote & Rural o Learning Disability – Same As You o Managed Clinical Networks o Long Term Conditions o Integrated Care Pathways o Mental Health – Rights, Responsibility and Recovery o OOH / Unscheduled care o Public health promotion o Palliative Care o Rehab Framework  Enabling factors o Role change – PDP’s / KSF o Senior Charge Nurse Review o Careers Framework o Modernising Nursing Careers o Non Medical prescribing o Workload measurement, workforce planning

Open workshops o Pan Highland workshops (e.g. Inverness, Golspie, Inveraray) led by the Board Nurse Director, supported by a Lead Nurse and Project Manager. General messages, inviting feedback, face to face opportunity to give information and staff to ask questions directly to Board Nurse Director and Lead Nurses.

Presentation  A single generic power point presentation should be updated regularly for use with groups such as DHS, Board, ACF, HPF, CHP & SSU Cttees, Nursing Fora, and an adapted one for use with the public.

Monthly Team Update  As part of Highland’s Monthly Team Update information is included that enables staff and other stakeholders to be informed about progress and developments, and planned appropriate local and national events.  This is distributed by the Comms dept in PDF  A word version is sent to the Lead Nurses for the Local Implementation Groups  They are also available on the intranet and circulated to HealthVOICE members

Web-based Communications Web-pages have been developed for the Review of Nursing in the Community as part of the NHS Highland intranet and the public website. The former includes the following and helps to ensure that all NHS Highland staff have access to up-to-date information on the progress of the development of the model:

 Background to the review  Monthly Team Updates

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 16 of 25  Scottish Government Newsletters and relevant publications  Presentations and outputs from workshops and meetings  Information on members of the Programme Board and minutes from these meetings  Information on members of the Steering Group and minutes from these meetings  Information on members of the Local Implementation Groups and minutes from these meetings  Information from other appropriate meetings, e.g. Team Leaders workshops  Updates from short life working groups as agreed by the Steering Group  Information on national and local events  Link to the Scottish Government website on the Review of Nursing in the Community and NES

Media  Use of the media through press releases and features for public/patient groups  When the lead test areas are agreed then a planned approach as part of Local Implementation plans should include articles for local newspapers in both test and non test areas

Key Messages Aide Memoir  General corporate clear and consistent “Key” messages for staff, and wider public audience. Updated and added as the project progresses

Question & Answers  Questions generated from staff during workshops, events and consultations are collated and Q&As are developed in liaison with the national project team to help to address people’s concerns and identified risks. These are now printed in the Scottish Government Newsletter that is published alternate months. These will be available on the intranet.  Questions and answers are being developed by the national Public & Patient Involvement Group for the public and these will be in the leaflet referred to below and will be on the public website.

Feedback Opportunities  An email address is available for staff to email queries and comments to - [email protected] and this is linked to the webpage  A log of Themes arising from this is maintained – with responses and feedback  Feedback is also invited via contacting the Project Manager, and at any events organised and meeting.

Patient and Public Involvement  A national information leaflet is being prepared and will be ready imminently  A national working group, chaired by Jane Walker from the Scottish Government, of Patient Public representatives is established. Gill Keel attends on behalf of NHS Highland.  A series of events will need to be organised locally in the lead test areas as part of the Implementation plan  A member of Highland HealthVOICE Network is on the Steering Group

Establishment of Short Life Working Groups or Workshops These will be agreed by the Steering Group and will undertake specific pieces of work to inform Steering Group and the project such as:- Patient and Public Involvement Organisational Change Sub group Children’s Services Public Health Education & Training Subgroup

Communication & Engagement Action Plan ~ Pan Highland Version: February 2008

Communication & Engagement Key Messages Timescale By whom To whom Status 1 Communication/ engagement processes: meetings Consistent key messages to all Ongoing HMa/Lead with estab. forums, workshops, road shows, events as stakeholders Nurses/FS/ All staff and per Change Management Plan & Communication & LIGs/ RC partners Engagement Strategy 2 Incorporate vision, values and principles of service Ongoing Fiona Sharples model into Communication Plan / Ruth Cleland 3 Monitoring & review of Communication Actions Ongoing FS/SGrp/ LIGs 4 Review and further develop Comms & Engagement Consistent key messages to staff and Update by FS/RC/ Susan strategy and Action plan, incl Pan NHSH one against the public and the media April Rose national one (being updated in Dec). LIGs/Lead Nurses 5 Monthly Team Update News on project and timescales Ongoing Fiona Sharples All staff and Addressing arising themes partners 6 Circulate bi monthly Scottish Government RONC Update on project, timescales, Ongoing Fiona Sharples All staff and newsletters, etc Addressing arising themes, Q&As partners 7 Report to Key Groups, Committees, Nursing Fora: All plus updates on project and Ongoing Heidi May / Key groups Board paper to Board every 6 months timescales and arising themes Fiona Sharples Arrange for DHS Board, ACF, SSU, AAHPC, / Lead CPG, CGC Nurses / LIGs Arrange for presentation to APF regularly Ensure all CHP specific Forums / Committees/ Groups identified and incl in LIGs local plans 8 Ensure patients and public are able to contribute at Ongoing Heidi May / Steering Group and CHP LIG/Locality groups Lead Nurses 9 Review of Nursing in the Community - item on all Update on project Ongoing Lead Nurses/ staff team agendas Team Leaders 10 Get WISE staff briefings All plus arising themes Revised – HMa, Lead Update RONC slide as part of this presentation, update April Nurses, GMs, arrange for Jan-Mar Comms Team 11 Circulate info to community councils and voluntary Ongoing Heidi May/FS/ groups e.g. MS Society, Help the Aged, Community PFPI Team Care Forum etc 12 Circulate information to HealthVOICE members Ongoing Isabel Rogers

File: Pan NHSH RONC Implementation plan DRAFT v2 Communication & Engagement Key Messages Timescale By whom To whom Status 13 Maintain Website Ongoing Fiona Sharples - Update website – intranet and webpage 14 Project Manager to be trained to maintain website tba Niall page Henderson/FS 15 Log of themes from website, respond to all emails. To Ongoing Lynn Lynes/ local lead Nurses as approp. Any emails via website Fiona go to Lynn Lynes, forwards to FS and HM for action. Sharples/ Lead Ongoing collation of themes by FS Nurses

16 FAQ/Q&A prepared from key themes and questions- Answers to arising Questions and Ongoing FS/HMa/RC/ Staff themes Lead Nurses nd 17 2 Media Release about project and Patient Reminder of key messages and Revised – Susan To inform Information Leaflet - Plan was to time media release purpose of project , to offer May Rose/Fiona public & with national Patient Info Leaflet, this now due Feb reassurance Sharples staff about project 18 Day in the life of existing staff roles – DN, HV, SN, To enable better understanding of Revised – To inform FHN, and new CHN role - what new role would look existing roles to April 08 Ruth Cleland staff and like. public 19 In-touch article Day in the Life of a DN Feb 08 RC All staff and Day in the Life of a HV March 08 public 20 Reassure and reduce fear of uncertainty Key messages, update on project Revised to HMa/FS Letter to all staff from Heidi May milestones and timelines and May 08 recognition of staff input to so far 21 Aide Memoir of Key messages Reminder of key messages and Update FS/RC Staff and - Update when Lead test areas agreed purpose of project. Importance of April public test/non test areas 22 Develop and maintain Issues Log Staff opportunity to log questions, Finalise use Fiona Sharples Staff All questions and concerns collected concerns. Answers to arising of form by / RONC Draft Issues form to January LIGs Questions, issues and themes 30 April Mgement team 23 Public & Patient involvement approach - NHSH Raise awareness and understanding, Feb - Mar FS/Gill Keel/ public & approach developed linking with national approach – reassure public SGrp/Lead patients review and include in Local Implementation plans Nurses/LIGs 24 Develop supportive feature for use in local press, Increase awareness & understanding Mar - June HMa/FS/ Lead Staff, include key messages, Contact local press in lead of opportunities, reassure Nurses / public, pilot areas patients

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 19 of 25 Communication & Engagement Key Messages Timescale By whom To whom Status 25 Local Implementation plans to include specific local April Lead Nurses/ Staff communication & Engagement actions LIGs 26 Develop resource pack for staff who directly deliver April FS/RC/Lead service to use to help them to feel comfortable and Nurses/local confident delivering key messages during transition Change leaders 27 Local sessions for staff in lead test areas to increase End of staff awareness and understanding of the impact of Apr /early RC/FS messages to public May 28 Agree on name change of RONC to ? Community Revised – Steering group Health Nursing project. Agree actions to launch name. 18 Apr FS/RC 29 Project Manager to receive media training tba FS/SoR/SR 30 National Events supported by Scottish Government Inform, engage, involve Sept 08 FS/RC/Scot Gov/LIGs 31 Context of other agendas e.g. Clinical Framework, Context of change and April 08 HMay/RG Steering Rural General Hospitals etc – Roger Gibbins invited to implementation plan of key work in Group present to Steering Group around RGH project 32 Staff from lead implementation sites to attend Shifting What can be learned from best May 08 Lead Nursing the Balance Conference practice in nursing and anticipatory Nurses/FS staff from care, health improvement etc lead sites elsewhere

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 20 of 25 Communication framework for Review of Nursing in the Community (RONC) •National communications to Board Nurse Director & Project Manager to Steering group members who circulate to reps and Implementation groups. Project Manager to local website / intranet, monthly Team Update. National comms. to Communications lead to GP circulation andto HealthVOICE members. •Minutes of the Steering group circulated by Director’s PA to Implementation groups for local circulation, and from Project Manager to Intranet and Website. Local mgrs and lead nurses to ensure hard copies. •See ‘Established Forums, Committees and Groups for RONC to engage and inform’ Scottish National Trade unions Government Other Development sites: Borders, Lothian, Tayside Website NES Programme Board (see National http://www.Scotland.gov.uk/Topics/ www.nes. Terms of Reference [ToR] Project Managers Group level Health/NHS-Scotland/nursing/review scot.nhs.uk for membership)

Subgroups Board Nurse Director, (PA) & Intranet Public website: Deputy RONC Lead email: [email protected] www.nhshighland.scot.uk. NHS Board /hottopics Steering Group level (see ToR for membership & Project Manager Appropriate Forums / Governance/Accountability) Committees / Groups Communications Lead

Appropriate Forums / Local Union Community CHP Local Implementation Groups Committees / Groups Reps level (see ToR for membership) Locality groups (A&B CHP)

District, School & Family Health nurses, Health Visitors

CHP management teams Midwives Practice nurses Specialist nurses CPNs/ AHPs Social workers GPs CLDNs Health VOICE HEI’s Patients Carers Public Council Voluntary sector File: Communication Framework V4 Oct, Last updated: 11/10/07

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 21 of 25 Change Management plan ~ Pan Highland Version: April 2008

Overall aim: To ensure all stakeholders are involved, engaged & supported through the changes that Review of Nursing in the Community brings to NHS Highland. This working document outlines pan NHSH interventions as part of managing change and organisational development, CHP Local Implementation plans will include specific CHP interventions. This plan is flexible and can be revised as new information is gathered through events and from the rediagnostic work (timeline to be agreed with Quarto). The events are part of the overall Implementation Plan and supports the Communication & Engagement Strategy.

Stakeholder Purpose of Intervention April May June July August Sept Lead (s) RONC Steering Create cohesion in the group. Group What is our role? What do we ½ day ½ day ½ day See ** Heidi May/ actually need to do? What Workshop Workshop Workshop Fiona support do we need? Empower Sharples group. Reviewing and strengthening responsibilities & accountabilities. Establish shared vision / common understanding. RONC Energise, build and maintain Management momentum. Establish shared Monthly Monthly Monthly Monthly Monthly Monthly Heidi May/ team vision / common understanding. meeting meeting meeting meeting meeting meeting Fiona Explore the issues together & Sharples agree solutions. CHP Local Create cohesion in the group. Implement Review Lead Implementation What is our role? What do we ation organisati Tba within LIGs & Locality groups Nurses/ Groups / actually need to do? Parallel workshop on and during April/May meetings Locality Locality Groups the Steering group. Empower If not in delivery to Chairs / FS group. Establish shared vision / March Vulnerable common understanding. groups Local Change Energise, build and maintain Leaders / momentum in pilot and non pilot Review Review Review role Lead Facilitators (1) sites. Establish shared vision / role and role and and support Nurses common understanding. support support needed / FS Explore the issues together & needed needed agree solutions. Get buy-in to See ** the plan. Provide Change ? EFS* by Management Tools. Quarto File: Pan NHSH RONC Implementation plan DRAFT v2 Page 22 of 25 Stakeholder Purpose of Intervention April May June July August Sept Lead (s) Team Leader Energise, build and maintain Action Learning momentum in pilot and non pilot W ‘shop W ‘shop W ‘shop W ‘shop W ‘shop RONC Set (TL ALS) sites and share learning across every 6 every 6 every 6 every 6 every 6 Management for pilot and non NHSH through testing phase. weeks weeks weeks weeks weeks team pilot sites Establish shared vision / common understanding. Explore the See ** issues together & agree solutions. Support process of change. Lead Pilot sites Maintain & build momentum in W ‘shop – ** Open lead pilot sites. Explore the issues explore space RONC together, share learning, establish options for events - Management shared vision / common ongoing Inverness & team understanding during the testing ways of Inveraray of the model. coming together Non pilot sites Maintain & build momentum in See ** Lead Nurses/ (see also TL non pilot sites, share learning Local events - tba CHP Local ALS above) from lead test sites. Facilitators Staff Groups - Involve, inform and Public Conference ? Open Lead Nurses/ Front line staff - support/reassure. Key Health – organise space See ** CHP Local members of Messages. Continuous feedback Wkshop wkshop Wkshop Facilitators new teams & from them. Co-creation. (4) post with BND / FS Specialists (3) Conf. CHP specific events to be Local events – see CHP local implementation plans Lead Nurses planned through LIGs General Establish understanding of the Lead Nurses/ Practice (7) model and its benefits. Engage Local events – see CHP local implementation plans See ** CHP Local them in shaping the detail. Facilitators / FS Medical Lead Get leadership buy-in. Act as Agenda HMo/FS Team champions. Make decisions item on See ** about competing objectives Leads meeting tba Pre-retirement Involve, inform and people support/reassure. Key Local 1:1 discussions Involve in local events See ** Lead Nurses Messages. Continuous feedback from them. Co-creation. (4)

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 23 of 25 Stakeholder Purpose of Intervention April May June July August Sept Lead (s) Get leadership buy-in. Act as ? Use some champions. Make decisions of DHS See ** HM/Lead CHP about competing objectives. meeting or Nurses/ FS Management CHP Dev Teams (5) day CHP specific events to be agreed Local events – see CHP local implementation plans Lead Nurses with Committee Highland Board Engagement, Involvement and Presenta Further presentation to be agreed See ** FS Partnership Championing. Key Messages tion to Forum (6) Forum HEI’s Engagement, Involvement and See ** Lead Nurses/ Championing. Key Messages. Local events – see CHP local implementation plans CHP Local Facilitators Head Engagement, Involvement and See ** Lead Nurses/ Teachers/PSE Championing. Key Messages. Local events – see CHP local implementation plans CHP Local staff Facilitators Health Voices Engagement, Involvement and See ** Lead Nurses/ Championing. Key Messages Local events – see CHP local implementation plans CHP Local Facilitators Highlands Get leadership buy-in. Act as Board HM/FS/ Board champions. Make decisions paper about competing objectives Patient/Public Engagement, Involvement and See ** Lead Nurses/ Forums Championing. Key Messages. Local events – see CHP local implementation plans CHP Local (incl Young People/Youth Facilitators workers, Argyll & Bute Citizen Panels) Engagement, Involvement and See ** Lead Nurses/ Social Workers Championing. Key Messages Local events – see CHP local implementation plans CHP Local Facilitators Staffside Reps/ Partners in the changes Workshop See ** Heidi May/ Unions Lead Nurse/ Fiona Sharples

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 24 of 25 Footnote 1.) A group who are keen to play a role not necessarily within their own regular role – the role of Local Facilitator is being developed. Champions for change in their locality. 2.) Plus periodic evaluation: “Where is my team in the change curve?" 3.) Including but not limited to Own teams: Allied Health Professionals (AHPs), Child Protection Advisors (CPA), Community Hospitals, Community Paediatricians, Community Psychiatric Nurses (CPNs), Midwives, Practice Nurses, Specialist Nurses (inc. McM). 4.) Each individual touched by the changes will have the opportunity every few months to express their emotional engagement with the process of change. "Where am I on my personal change curve?" 5.) GMs are key players 6.) Includes Trade Union and HR representatives 7.) To include Engagement of GPs, Practice Nurses, Practice Managers.

* = Equipping for Success (EFS), name of a course developed by Quarto

** Open space events - Inverness & Inveraray

File: Pan NHSH RONC Implementation plan DRAFT v2 Page 25 of 25