WEST DUNBARTONSHIRE

COMMUNITY HEALTH PARTNERSHIP

DEVELOPMENT PLAN

2007/08 – 2009/10

Table of Contents

Table of Contents...... 2 Introduction...... 4 West Dunbartonshire Community Health Partnership ...... 5 Acknowledgements:...... 5 Glossary of Terms...... 6 The Health of West Dunbartonshire ...... 7 Local Profile...... 7 Health Outcomes: An Overview...... 8 Comparative SMR 2003 – 2005 ...... 8 Health Inequalities: Wider Determinants...... 9 Health Inequalities: Lifestyle Risk Factors...... 10 Priorities for Local Action ...... 11 West Dunbartonshire CHP: Roles and Responsibilities ...... 13 Local Services...... 13 Health Improvement – A Corporate Approach to Tackling Health Inequalities.14 Promoting Participation: Staff, patents and the public ...... 15 CHP Committee...... 16 Professional Executive Group...... 16 Public Partnership Forum ...... 17 Local Partnership Forum...... 17 Community Based Services ...... 18 Partnership Working ...... 18 Integrated Joined Up Services ...... 18 Shifting the Balance of Care...... 18 Investing in and supporting our Staff...... 19 Delivering in Partnership ...... 20 GG&C Acute Directorate ...... 20 GG&C Rehabilitation and Assessment Directorate (RAD)...... 20 GG&C Mental Health Partnership...... 21 GG&C Managed Clinical Networks (MCNs)...... 21 West Dunbartonshire Council (WDC)...... 21 West Dunbartonshire Community Planning Partnership (CPP) ...... 22 Worklessness and Employability...... 22 Strengthening Local Services: Primary Care...... 23 The General Practice Contract...... 24 Tackling Long Term Conditions...... 24 Developing Community Services ...... 25 Community Older Peoples Teams ...... 25 Primary Care Mental Health ...... 26 Palliative Care...... 26 Dental Services ...... 26 Optometry ...... 27 Community Pharmacy ...... 27 Working with Care Homes ...... 27 Supporting Carers ...... 28 Working with the Acute Sector...... 28 Hosted Services: Diabetes Retinal Screening Service...... 28 Strengthening Local Services: Older People ...... 30 Strengthening Local Services: Mental Health ...... 32 Capital investment on the Ailsa Ward (Dumbarton Joint Hospital)...... 32 Integration of Services ...... 32 Reprovision of IPCU Beds...... 32 2 24 hour access...... 32 Mental wellbeing ...... 33 Addictions...... 33 Services for People with Learning Disabilities...... 34 Services for People with Acquired Brain injury...... 35 Services for People with a Sensory Impairment...... 35 Physical Disability ...... 36 Health and Homelessness ...... 36 Homelessness Nurse ...... 37 Strengthening Local Services: Children’s Services...... 38 Universal Services ...... 38 Specialist Children’s Services...... 38 CHP Children’s Plan...... 39 Child and Adolescent Mental Health Services (CAMHS) ...... 39 Psychology Services ...... 39 Looked After and Accommodated Children. (LAAC) ...... 39 Allied Health Professional Services (AHP) to Clydebank and alignment of appropriate services within Clydebank...... 40 Additional Support for Learning Act...... 40 Child Development Centres and Paediatric Clinics...... 40 Specialist Children’s School Nursing ...... 41 Child Protection Inspection, HMIE Action Plan ...... 41 Tackling Health Inequalities: The Health Improvement Team ...... 42 Tobacco Control...... 42 Alcohol...... 42 Breast Feeding ...... 42 Oral Health...... 42 Services for Young People...... 42 Sexual Health...... 43 Strengthening Human Resources...... 44 Workforce Planning...... 44 Staff Governance ...... 45 Absence Management...... 45 Learning & Education...... 46 Induction ...... 46 Management Development ...... 47 Qualifications...... 47 Continuous professional and personal development...... 47 Organisational Development ...... 48 Fostering a healthy culture...... 48 Single Equalities Scheme...... 49 Targeting Gender Inequalities...... 49 Finance...... 50 Indicative Revenue Annual Budgets for Financial Year 2007/08 ...... 50 Cost Pressure 2007/08...... 51 Cost Savings Plan 2007/08 ...... 52 Capital Programme 2007/08 ...... 52 Investment Priorities 2007/08...... 53 Appendix 1 - Finance...... 54 Appendix 2 - Board Corporate Objectives...... 60

3

Introduction

As we move into the second full year of operation for West Dunbartonshire CHP, it is appropriate that we take this opportunity to set out for all the interested stakeholders in the area – agencies, staff, patients, carers and the public at large - the objectives and priorities that we intend to deliver.

The first year of the Partnership has seen the CHP at the forefront of a major assessment of the health needs of the whole population. Much of the content of this Plan sets out clear goals that we in the CHP, working with our Community Planning partners and with the support of our communities, intend to achieve in addressing the huge challenge to improve health in West Dunbartonshire.

West Dunbartonshire now has the second highest all cause death rate of any local authority area in Scotland with the clear contributory factors of smoking, excessive alcohol consumption, drug abuse, poor diet and lack of physical activity at the core of the lifestyles challenges that confront our community. These factors when considered alongside other issues such as high unemployment set an obvious context within which our priorities must be set.

However on a more positive note, the reality is that the CHP is already beginning to address many of these issues and our first year of operation has seen us firmly establish the support infrastructure and processes that will enable to tackle, with others, these major population health challenges.

We should at this point recognise the successes that have already been achieved in this year: for example • A successful and positive Inspection of the multi agency child protection arrangements in West Dunbartonshire • Further investment in community mental health services – particularly in the Dumbarton and Alexandria locality • Action to integrate the two former NHS Board areas into a single system of working

It is acknowledged that much remains to be done – particularly in respect to the last point– to deliver equal access to all in the area to a comprehensive range of NHS services. This plan for the next three years will hopefully see us move significantly towards delivering that service equity.

At the same time as we set out these objectives and priorities, we must also set out our commitment to delivering them in away that enjoys the full support of the community that we serve. The CHP has from its inception endeavoured to work in a way that restores and adds to public confidence in the broader health system and in the CHP specifically. We recognise that public trust and confidence needs to be earned and hopefully by delivering what we set out in this development plan we will be able to enhance and improve the public perception of what we do – not just at the times when they may be unwell – but how we are working with others to improve the overall feeling of health and well being of everyone in the West Dunbartonshire area.

R Keith Redpath – Director

4

West Dunbartonshire Community Health Partnership

Chair: Rani Dhir

Director: R. Keith Redpath

Clinical Director: Dr Patrick Trust

Head of Planning & Health Improvement: Soumen Sengupta

Head of Health & Community Care: Christine McNeill

Head of Children’s Services: Annie Hair

Head of Mental Health & Partnerships: David McCrae

Head of Finance: Jeanne Middleton

Head of Human Resources: Serena Barnatt

West Dunbartonshire Community Health Partnership Committee Members:

Dr Alan McDevitt GP Clydebank Health Centre

Dr Fiona Coulter Consultant Psychiatrist, Lomond

Ms Margaret Hastings Head of Physiotherapy, Lomond

Ms Selena Ross Dunbartonshire CVS

Mr Ross McCulloch Local Partnership Forum

Ms Muriel Robertson Public Partnership Forum

Ms Rose Hutchison Public Partnership Forum

Mr Keith Redpath Director

Acknowledgements:

We would like to thank all those staff and colleagues who have worked so hard throughout the last year. A great deal of effort and commitment has been demonstrated to produce this plan and we would like to record our thanks accordingly.

If you have any enquiries, please contact: Mr Soumen Sengupta Tel: 01389 812 301 Head of Planning & Health Improvement E-mail: [email protected] Hartfield Latta Street Dumbarton G82 2DS

5 Glossary of Terms

ABI Acquired Brain Injury AHP Allied Health Professional APF Area Partnership Forum ASL Additional Support for Learning BMI Body Mass Index CAMHS Child and Adolescent Mental Health Services CATS Community Addiction Teams CHCP Community Health and Care Partnership CHD Chronic Heart Disease CHP Community Health Partnership CMHT Community Mental Health Team COPD Chronic Obstructive Pulmonary Disease CPN Community Psychiatric Nurse CPP Community Planning Partnership DAP Domestic Abuse Prevalence GG&C Greater Glasgow and Clyde GIES Glasgow Integrated Eye Service GIRFEC Getting it Right for Every Child GMS General Medical Services GP General Practitioner HIME Her Majesty’s Inspectorate of Education HISG Health Improvement Strategy Group IPCU Intensive Psychiatric Care Unit IT Information Technology LAAC Looked after and accommodated children LPF Local Partnership Forum MCN Managed Clinical Network MI Myocardial Infarction MMRG Medicines Management Resource Group NHS National Health Service OD Organisational Development OHAT Oral Health Action Team OT Occupational Therapist PEG Professional Executive Group PMS Primary Medical Service PPF Public Partnership Forum PPP Public Private Partnership QIS Quality Improvement Scotland QOF Qualities and Outcomes Framework RAD Rehabilitation and Assessment Directorate RAH Royal Alexandria Hospital SIMD Scottish Index of Multiple Deprivation SIT Sensory Impairment Team SMR Scottish Morbidity Rates SNAP Scottish Needs Assessment Programme SOE Scheme of Establishment SPARRA Scottish Patients at Risk of Readmission and Admission WDC West Dunbartonshire Council

6

The Health of West Dunbartonshire

Local Profile

West Dunbartonshire is located in the West of Scotland, and has 22 electoral wards: • 11 located in Clydebank (Whitecrooks, Dalmuir/Central, Mountblow, Parkhall, Linvale/Drummy, Kilbowie, Kilbowie West, Faifley, Hardgate, Duntocher, Bowling/Milton/Old Kilpatrick). • 5 located in Dumbarton (Dumbarton East, Barloan/Overtoun, Dumbarton North, Dumbarton Central, Dumbarton West). • 6 located in the Vale of Leven (Renton/Alexandria South, Alexandria, North/Tullichewan, Balloch, Haldane/Jamestown/Kilmarnock, Ronhill East and Riverside).

The population estimate in 2005 was 91,400: 7.67% of the NHS Greater Glasgow and Clyde population.

West Dunbartonshire population projection 1996 – 2015, all ages

West Dunbartonshire has a similar age structure to the rest of Scotland. In 2005, there were more deaths than live births among West Dunbartonshire residents (1,153 deaths compared to 1000 births giving a natural fall of 153.) In addition there has been a net migration of people out of West Dunbartonshire in the recent period. Falls in the younger age groups outweighed gains in the older age groups and the population structure will increasingly become elderly in the future.

Currently 23% of all households in West Dunbartonshire are pensioner households, which is about the same as the Scottish average. According to the 2001 census figures, 14.37% of West Dunbartonshire households are lone parent households compared to the Scottish average of 10.5%. West Dunbartonshire is predicted to increase its percentage of lone parent households as a percentage of all households with children from 29% in 2002 to 39% in 2016: this would be above the Scottish averages of 23% in 2002 and 33% in 2016, and the third highest in the West of Scotland Council areas after Glasgow City and North Ayrshire. It has also been reported that 17% of West Dunbartonshire residents consider themselves to be carers. 7

Health Outcomes: An Overview

A boy born in West Dunbartonshire in the period 2000-2002 could expect to live on average 71.2 years and a girl 77.7 years. As in Scotland, life expectancy has tended to increase over time. However the life expectancy is consistently below the Scottish average by between two and three years for males and over a year for females. . It is estimated that on average a West Dunbartonshire male could expect to live for over 22 years with a limiting, long-standing illness and the average female nearly 22 years.

The perinatal mortality rate in West Dunbartonshire varied between 6.5 and 12 per 1,000 live births since 2004 (higher than the Scottish rate in 2004 and 2005, but below the Scottish rate in 2006). The proportion of babies with low birth weight (i.e. under 2,500 grams) born to West Dunbartonshire residents varied between 6.4% and 8.2% of live births and remained higher than the overall Scottish proportion

SMRs for West Dunbartonshire show an overall death rate of 12-15% higher than Scotland. These figures reflect significantly higher death rates in all periods for coronary heart disease and acute myocardial infarction and digestive diseases. Deaths from digestive diseases and alcoholic liver disease, cirrhosis, increased between the time periods, reaching statistical significance.

Comparative SMR 2003 – 2005

8 Health Inequalities: Wider Determinants

West Dunbartonshire is the second most deprived of thirty-two councils in Scotland for income-deprived population and third for employment-deprived population. The Carstairs deprivation scores for West Dunbartonshire indicate a greater level of deprivation than in Scotland in both 1991 and 2001. In addition, between the two censuses West Dunbartonshire has become slightly more deprived relative to Scotland. In 2001, one in three people living in private households in West Dunbartonshire were in households that did not own a car, compared to one in four Scotland-wide. Using the SIMD 2004, compared to Scotland, West Dunbartonshire has a similar percentage of the population in the most deprived 5% of data zones across Scotland (all around 5%). However it has nearly twice the proportion in the most deprived 20% of data zones across Scotland (37% in the council area compared with 20% Scotland-wide).

Twenty one percent of the working-age population in West Dunbartonshire have no educational qualifications (marginally less than the Glasgow City figure of 22%); 51% of the working age population have three or more Highers (which is lower than the Glasgow City figure of 52%; and 8% of the working age population have a degree (which is the second lowest of the West of Scotland councils).

Around 15% of West Dunbartonshire households have an occupancy rating of -1 or less this is measure of overcrowding. This is the fourth highest in Scotland after Glasgow, Dundee and Inverclyde. West Dunbartonshire has an estimated proportion of properties with rising/penetrating damp of 6.5% and an estimated proportion of properties with mould in any room of 9.5%, compared to Scottish averages of 6% and 11% respectively.

The West Dunbartonshire economy has performed below that of the West of Scotland and Scotland as a whole over the last ten years. The mean gross weekly pay for all employees in West Dunbartonshire is £348 which is the lowest of the West of Scotland councils and 12.3% lower than the Scottish average. In 2004, approximately 58.2% (circa 18,205) of total employee jobs in West Dunbartonshire were based on full-time employment (this figure is lower than that of the national average of 67.8%). It has the second highest percentage of people who are ‘employment deprived ‘of the 9 West of Scotland Councils, with a figure of 19.8% compared to the Glasgow City figure of 23.1%. It has been estimated that 16,000 West Dunbartonshire residents were economically inactive in 2005 (economic inactivity refers to people who are not in work and are not seeking work; this group includes students). This level of economic inactivity is higher than the percentage for Scotland. 23.6% of West Dunbartonshire residents had all their income from state benefits compared to 26.8% in Glasgow. The proportion of working age people in receipt of out of work benefits is estimated to be 23% in West Dunbartonshire which is the third highest in Scotland. Furthermore 17.8% of working age households are in receipt of working family and child tax credit. More than twice as many people are in receipt of guaranteed Pension Credit in West Dunbartonshire around 27%, which is the third highest in Scotland after Glasgow and Eilean Siar. 60.3% of residents experience difficulty meeting household expenses compared to 42.3% in Glasgow. 24% of primary school pupils and 21% of secondary school pupils in West Dunbartonshire are entitled to free school meals. Of the economically inactive residents in West Dunbartonshire, 8,000 are claiming sickness or disability related benefits, i.e. 1 in 8 of the working-age population.

West Dunbartonshire has the second highest rate of overall crime per 10,000 population of in the West of Scotland with a figure of 120 compared to Glasgow City’s rate of 157. 87.8% of West Dunbartonshire residents have reported feeling safe in their own home compared to 92.1% in Glasgow; and 53.9% have reported feeling safe walking alone even after dark compared to 58.4% in Glasgow. Only a third of people stated that they didn’t feel safe walking in their neighbourhood alone after dark in West Dunbartonshire (which was the same percentage as Glasgow City residents). West Dunbartonshire has the highest rate of domestic abuse incidents per 100,000 population in Scotland, with a rate of 1,409 compared to 1,339 for Glasgow.

Health Inequalities: Lifestyle Risk Factors

In 2005, a substantial Health and Wellbeing study was undertaken both within West Dunbartonshire and across GG&C. Its aim was to measure core health indicators associated with the Public Health White Paper. This work has provided us with valuable information on self-reported lifestyle behaviours of local residents. The findings are also comparable to the findings of the Health Survey of the West Dunbartonshire Community Planning Partnership’s Citizen’s Panel.

Currently smoking rates for West Dunbartonshire are estimated as being 39.8%, compared to 37.2% in Glasgow. 18% of people reported smoking everyday and 4% reported smoking some days. The proportion of 13 and 15 year olds classed as ‘regular smokers’ by gender in 2002 was 10% of boys and 17% of girls compared to 6% of boys and 11% of girls in Glasgow City. It is estimated that 62.5% of West Dunbartonshire residents are exposed to second-hand smoke most or some of the time compared to 54.9% in Glasgow.

24.8% of West Dunbartonshire residents are estimated to exceed recommended weekly units of alcohol compared to 17.7% in Glasgow. 13% of men and 11% of women reported drinking above the recommended weekly units of alcohol in the last week. The proportion of 13 and 15 year olds who had drunk alcohol during the last week by gender in 2002 was 26% of boys and 30% of girls.

10 West Dunbartonshire has the lowest breastfeeding rates in Scotland at first visit with 28.3%; and a rate of 25.8% at 6-8 week review compared to a Scottish average of 36.5%.

36% of West Dunbartonshire residents report taking at least 30 minutes of moderate exercise 5 or more times per week compared to 50.4% in Glasgow, with 49% of residents reportedly taking part in moderate exercise on most days of a typical week. 20.6% of West Dunbartonshire residents report taking at least 20 minutes of vigorous exercise 3 or more times per week compared to 28.1% in Glasgow, with 13% of residents reportedly taking part in vigorous exercise at least three times a week.

23.3% of West Dunbartonshire residents are reported to consume at least 5 portions of fruit and/or vegetables per day 23.3% compared to 30.2% in Glasgow; a separate survey found that a comparable 26% of residents reported consuming 5 or more portions of fruit and vegetables a day.

52% of West Dunbartonshire residents are estimated to have a BMI of 25 or over, compared to 42.2% in Glasgow. Among 3 year olds in West Dunbartonshire who were born in 1999, 23% were classed as overweight, including 11% obese, which in turn included 7% classed as severely obese.

64.4% of West Dunbartonshire residents who participated in the Health and Wellbeing stated that they perceived that their health was excellent or good (compared to 68.2% for Glasgow); and 74.9% reported a positive perception of general mental or emotional wellbeing (compared to 83.8% for Glasgow).

Priorities for Local Action

A substantial health needs assessment of the West Dunbartonshire populace was undertaken in 2006/07 by the Department of Public Health, Greater Glasgow and Clyde Health Board and the CHP. While the final report will be published during early 2007/08, the initial findings were made available at the end of February 2007 and substantiated the results of other local work. Key messages included:

• CHD, stroke, COPD, hypertension and diabetes are all more common in West Dunbartonshire than for Scottish counterparts • Smoking, drinking and obesity are major public health problems • Smoking in pregnancy and low breastfeeding rates have major implications for future health • All agencies and groups need to prioritise health improvement work locally • A key NHS priority is to manage chronic diseases in primary care

11 In order to tackle these effectively locally, all local stakeholders have to work collectively to make best use of their available resources to drive forward evidence- based action.

Service changes and developments in the coming years within West Dunbartonshire, CHP will reflect these priorities across all areas of work including:

ƒ Tobacco control

ƒ Obesity (increasing physical activity and improving nutrition)

ƒ Tackling alcohol misuse

ƒ Increasing breastfeeding

ƒ Reducing preventable repeat admissions to hospital

12

West Dunbartonshire CHP: Roles and Responsibilities

The West Dunbartonshire Community Health Partnership (CHP) Scheme of Establishment was formally approved by the Scottish Executive in July 2005. This outlined the arrangements for the new organisation to enable it to develop a more consistent health service framework across West Dunbartonshire.

Local Services

The delegation of services now managed by the CHP includes a wide range of primary care and other community based services including:

• Community Nurses • Health Visitors • Relationships with primary care contractors • Local Older People and Physical Disability Services • Mainstream school nurses • Chronic Disease Management programmes and staff • Specialist Children’s and Child Development Services • Oral Health Action Teams • Allied Health Professionals • Palliative Care • Addiction Services • Learning Disability Services • Community Mental Health Services • Health Improvement

The CHP holds contractual budgets for:

• General Practice • Dentists • Optometrists • Community Pharmacy

The CHP also:

• Hosts the Diabetic Retinal Screening Service • Has a lead role on behalf of CH(C)Ps in relation to the Diabetes Managed Clinical Network • Has a lead role on behalf of CH(C)Ps in relation to the Glasgow Integrated Eyecare Scheme (GIES) • Hosts the management responsibility for the Clyde Condition Management programme.

13 Health Improvement – A Corporate Approach to Tackling Health Inequalities

The Scottish Executive has tasked CHPs with improving the health of the populations they serve. Health Improvement is a cross-cutting priority for CHPs and the degree to which they can accomplish this will be a key measure of their success. Reducing the disparity of health outcomes between those from the poorest communities and those from the most affluent areas remains a key priority for the CHP.

West Dunbartonshire CHP is committed to effectively and pro-actively meeting its broader role in improving the health of the population and closing the inequalities gap. It does this as both:

• An effective partner within the Community Planning Partnership and other local multi-agency fora/networks.

The CHP recognises it key local leadership in working with local stakeholders, principally as through the Health Improvement Strategy Group (HISG). Within the context of the Community Planning Partnership’s wider development, over the course of the next three years, we will work with partners to:

ƒ Strengthen the HISG as an effective driver for strategic multi-agency change ƒ Support the HISG to provide a greater focus for local evidence-based action, principally by its developing a new Joint Health Improvement Strategy.

• Embedding health improvement as a core characteristic of all its services.

The CHP recognises that while significant health improvement in West Dunbartonshire cannot be delivered by any one organisation alone, CHP services and staff can and should make a significant contribution. In addition to the health improvement activity led within individual services and the work of its specialist Health Improvement Team, in year one we will:

ƒ Begin a process of introducing a defined corporate health improvement objective into the work programmes of all practitioner staff

It has recently been announced that West Dunbartonshire is to be part of the second wave of the Scottish Executive’s Keep Well (formerly Prevention 2010) preventative care programme. The aim of Keep Well is to increase the rate of health improvement in deprived communities by enhancing primary care services to deliver anticipatory care: identifying and targeting those at particular risk of preventable serious ill-health; offering appropriate interventions and services to them; and providing monitoring and follow-up. The focus will be on cardiovascular disease and its main risk factors (e.g. smoking and blood pressure).

In year one, we will:

ƒ Develop an appropriate and co-ordinated suite of Keep Well services, building on the learning from the first wave areas.

14 Promoting Participation: Staff, patents and the public

The CHP is also charged with establishing robust and constructive relationships with staff working within the area; and patients, carers and communities from across the area. The principal mechanisms for doing this are:

• The CHP Committee • The Professional Executive Group (PEG) • The Public Partnership Forum (PPF) • The Local Partnership Forum (LPF)

These Groups are now well established and working closely within the CHP in the delivery and development of services in West Dunbartonshire. Minutes from these key committees/groups are made available on the CHP website.

In year one we will work with them to:

ƒ Develop their role and contribution to service and corporate development prioritisation, planning and implementation (with a particular focus on action to tackle health inequalities).

15

CHP Committee

The CHP Committee is a formal Committee of NHS GG&C, and has a significant role in the provision of local health services. Membership of this Committee is broad and inclusive, including:

• Representation from the PEG • Representation from the PPF • Representation from the LPF • Representation from WDC

This enables the Committee to consider community needs and service issues within a wide context taking account of local authority, community representation, clinical leads and service staff contribution to the discussions.

The Committee has a governance and overall management role. Certain papers are presented to the Committee routinely (e.g. minutes from the PPF, LPF and PEG), with representatives highlighting issues for the particular attention of the Committee. In addition, there are routine finance reports, reports on complaints and also reports on service performance (e.g. on waiting times). The Committee also has a clear strategic role in determining the nature of local services and is well placed to address this responsibility within this broad context. Papers, including consultation issues and service proposals are presented and considered by this wide Committee representation thereby promoting involvement in developing the strategy for health care provision in West Dunbartonshire.

The Committee meets a minimum 6 times per year, details of which are advertised widely. The venues are alternated for each meeting between Clydebank area and Lomond area and are held in public. The Committee Minutes are presented to NHS GG&C by the CHP Chairperson, and again any significant issues arising may be further discussed at that point.

Professional Executive Group

The PEG acts as an advisory body to the CHP, and is the primary mechanism for clinical engagement. The PEG has advised on all aspects of service design and development including:

• Mental Health Re-Design • Immunisation Review • Hall 4 • Clinical Governance • Risk Management • Prescribing Policy • The CHP Development Plan

The PEG meets every six weeks and has become an integral part of the planning process. It will continue to provide clinical expertise and advice to the CHP in all aspects of service re-design in the coming months and years. 16 Public Partnership Forum

The PPF is the primary mechanism for the CHP to engage with local service users, carers and members of the public on service developments and plans. The PPF meets every two months and has become a critical friend to the CHP, contributing to discussions on key areas including:

• The Vale of Leven Integrated Care Pilot • Clyde Maternity Review • The Mental Health Strategy for West Dunbartonshire • The CHP Annual Development Plan

Over the coming year a training needs analysis of PPF members will be carried out and a training programme will be drawn up to ensure the members are able to develop their skills and confidence to participate fully in dialogue with the CHP.

Local Partnership Forum

The LPF provides a mechanism for ensuring fair and consistent application of the Staff Governance standard for staff working within the CHP.

The LPF meets every two months, with the types of issues addressed including operational issues which will impact on staff, and the broader development agenda within the CHP. Examples of items discussed are:

• Agenda for Change • Workforce planning • Local compliance with the NHS Staff Governance Standards • The CHP Development Plan

Future items include the Learning and Education Plan, the Organisation and Development Plan and the local Single Equalities Scheme Action Plan.

17

Corporate Themes

The following sections in the Plan will outline our key priorities and future plans for 2007/08 2009/10 around the seven corporate themes for Greater Glasgow and Clyde NHS Board. These are summarised below:

• Focus resources on areas of greatest need • Shift the balance of care • Improve our use of resources and ensure we provide a professional service • Modernise services and ensure they are full integrated • Improve the health status of individuals • Improve access to our services to ensure they are fully inclusive • Create an effective organisation

Key Themes

Community Based Services Developing Community based approaches which focus on anticipating needs earlier and putting resources into preventing problems, many of the proposed service developments outlined in primary care and community services reflect these objectives

Partnership Working Championing partnership working both with the CHP and other stakeholders. The CHP will continue the strong tradition of partnership working with the Local Authority and other stakeholders, including the Public Partnership Forum

Integrated Joined Up Services The Plan outlines plans for further integration of services across Mental Health, Learning Difficulties, Addictions and Older People across West Dunbartonshire.

Shifting the Balance of Care Hospitals and CHPS have a joint responsibility to plan and deliver good quality care and services for people. The CHP and Acute Divisions in West Glasgow and Clyde have shared objectives including reducing multiple admissions, and delayed discharges. We will ensure the mechanisms and Forums are established to enable us to set shared goals and objectives.

Involving service users and carers in the planning re-design and delivery of Services We will ensure service users and carers are fully involved in the planning and delivery of services by working in partnership with the West Dunbartonshire Public Partnership forum and by consulting with a broad a range of community organisations and Patients Groups.

18 Investing in and supporting our Staff The CHP is committed to involving staff in the change process and will work through the Local Partnership Forum and the Organisation and Development group to ensure the necessary training and development opportunities are available and that they are empowered to effect and influence change.

Developing an effective Performance Management System We will improve our performance management system and ensure we use the information we collate to improve and develop our services. We will also promote and support the streamlining of our systems with other Partners including the Acute Divisions in Clyde and West Glasgow and our Local Authority partners.

19

Delivering in Partnership

Much of what the CHP is charged with delivering is dependent on good communication and honest co-operation with colleagues and services within other service deliverers (both within and outwith the NHS).

There is a continuing need to develop stronger understanding and joint working between the distinct operational entities that make up NHS GG&C. On behalf of GG&C-wide CH(C)Ps, West Dunbartonshire CHP has been “twinned” with a number of specialist areas so that together we can take forward this process:

• Unscheduled (emergency) care (Acute Directorate) • Oral Health Directorate • Mental Health Partnership • Diabetes MCN

In addition to that work, over the course of the next three years, we will take forward developmental work with the following:

GG&C Acute Directorate

We will work with both Clyde and Greater Glasgow Acute divisions to:

ƒ Provide shared input into the MCN planning process. ƒ Develop and consult on the Vale of Leven strategy ƒ Develop strategy in relation to integrated children’s services ƒ Explore opportunities for health centres in Clydebank and Alexandria for reviewing patient pathways between the acute sector and community services ƒ Reduce multiple admissions via the use of SPARRA and other information sources ƒ Improve discharge planning arrangements across all sites ƒ Ensure a joint health improvement agenda across acute and community services

GG&C Rehabilitation and Assessment Directorate (RAD)

We will work with the RAD to:

ƒ Agree joint areas of activity and cross system planning for rehabilitation services ƒ Undertake a comprehensive review of arrangements for hospital discharge including Discharge Planning Agreement, the function of integrated discharge teams and the elimination of delayed discharge ƒ Develop a community rehabilitation model, including plans for the integration of health and social care and of primary and secondary care services.

The Balance of Care work which is ongoing with WDC through the Older People’s Strategy group (which includes analysis of SPARRA data and repeated admissions) reflect the priority attached to developing comprehensive models of care in the community for older people in conjunction with colleagues in the RAD.

20 GG&C Mental Health Partnership

We will work with the Mental Health Partnership on:

• Health improvement within specialist mental health services, including those directly managed by the Partnership and those in CH(C)Ps • Health improvement within other health and social care services including general medical services in primary care • Health improvement with broader operational providers e.g. employment dimensions of service provision, a wide range of community and voluntary organisations and settings • Strategic influence on broader policy areas e.g. regeneration, public sector as employees • Developing a framework for delivery and an agreed regime for monitoring performance, including identification of appropriate indicators

Through the development and implementation of the Clyde Mental Health Strategy the CHP will continue to develop a framework for community mental health services which will connect with a wide range of initiatives across different agencies to improve the wellbeing of the population.

GG&C Managed Clinical Networks (MCNs)

The roles, remit and membership of each of the respective clinical networks have been revised in order to reflect the single system working across GG&C. During 2006 both the Diabetes and CHD MCNs have come together to form a merged Greater Glasgow and Clyde MCN under one clinical lead. Work will continue over the coming year and beyond on the harmonization programme and unified working across the new health board area. Workstreams have arisen out of that harmonisation work to be taken forward throughout 2007/08 (detailed within MCN Development Plans).

We will work with the MCNs to:

ƒ Take forward these workstreams through the appropriate subgroups.

West Dunbartonshire Council (WDC)

There is a strong history of local joint work with WDC: through joint planning structures and joint futures arrangements to improve service outcomes for community care; established children’s services planning arrangements; and established committee arrangements through the Health and Social Justice Partnership Committee.

Key areas of joint work include the Balance of Care activity through the Older People’s Strategy Group, and the development of Joint Performance Frameworks for community care services. There has been successful development of a number of joint health and social care services, including Addictions, Learning Disability Services, Clydebank Community Older People’s Team, and the Goldenhill Resource Centre.

21

In year one we will work with WDC to:

ƒ Further integrate and develop these services and others across West Dunbartonshire with a clear emphasis on best value

West Dunbartonshire Community Planning Partnership (CPP)

Social deprivation and poverty are key indicators of ill health, and these are matters that demand collective responses. It is recognised locally that a holistic approach to tackling health inequalities is vital to improving the well being of people living in West Dunbartonshire.

Improving wellbeing and challenging inequalities are part of the vision of West Dunbartonshire CPP, of which the CHP is an active member. In addition to the CPP Board, the CHP contributes to number of its strategic sub-partnerships (notably the HISG, the Community Safety Partnership and the Business Growth and Employability Strategy Group).

Over the course of the three years, we will work with and through the CPP to:

ƒ Ensure agencies within West Dunbartonshire co-operate to ensure greater efficiency and sustainable services to improve the lives of the local population

Worklessness and Employability

‘Workforce Plus’ has been established by the Scottish Executive as part of its commitment to reducing disadvantage and inequality in Scotland. It aims to provide additional support to assist people move from welfare back into work. At the local level, CPPs have been charged with the task of designing and implementing a comprehensive Action Plan that will be used in taking forward the Workforce Plus Framework within their respective Local Authority area. West Dunbartonshire CPP has prioritised employability as a key and cross-cutting theme, i.e. all other planning should contribute to the delivery of targets that focus on reducing worklessness (including supporting those on incapacity benefit back into meaningful activity or employment) . The Business Growth and Employability Strategy Group has led on the preparation of this Action Plan, which was submitted to the Scottish Executive on the 31st January 2007. As part of this process, the CHP has given considerable thought to how it can best play a role in contributing to this agenda; and consequently pro-actively proposed a range of potential activities to be implemented through the Action Plan, namely as:

• Partner • Investor/procurer • Service provider • Care provider • Health improver • Volunteering opportunity • Portal ƒ Progress the local Action Plan, particularly those elements relating to the NHS.

22

Strengthening Local Services: Primary Care

Primary Care is an integral part of the delivery of community-based health and social care services within West Dunbartonshire. There are 20 Practices in the CHP area which between them register almost exclusively all of West Dunbartonshire’s residents. The Practices range from single-handed practices with 2,500 patients to much larger multiple practices with as many as 9,000 patients. Of these 20 practices, 19 deliver their services under the new GMS Contract, with one delivering its services around the PMS (or 17C) Contract. All of them are required to undertake the basic provision of care, with many opting to undertake additional work. There are nine practices covering the Clydebank area; four practices are based at Alexandria Medical Centre; six provide services form Dumbarton Health Centre and a further practice operates from its own premises in Alexandria.

A number of professions and staff work alongside GPs to deliver services to patients in multiple settings. In partnership with our Community Care colleagues we provide the following services:

• Assessment and Care Management • Rehabilitation and Enablement • District Nursing • Allied Health Professional Services such as Podiatry, Dietetics, Physiotherapy and Occupational Therapy • Older Peoples Services in partnership with WDC • Chronic Disease Management Programmes • Sensory Impairment Services • Palliative Care • Management of Long Term Conditions

The Primary Care Role in Improving Health

In response to the health needs assessment carried out in West Dunbartonshire which highlighted that smoking, drug and alcohol misuse and lack of exercise are major factors in causing disease [including Chronic Heart Disease(CHD), Stroke and Chronic Obstructive Pulmonary Disease(COPD)], we will ensure we develop our services to tackle theses health issues.

A new contract and priorities for improving the health of our patients means that we are now able to identify patients who have risk factors associated with many common chronic conditions. These include CHD, cancer and Type 2 (non-insulin dependent) diabetes. General Practice now has a leading role in identifying and screening patients with risk factors.

23 In year one we will: ƒ Provide information to GPs and other contractors on the range of health improvement activities that we are developing to help them to refer their patients (including exercise referral, weight management and smoking cessation) ƒ Use the information about levels of disease to plan and develop our services

The General Practice Contract

The level and type of service provided by GPs is described in their contract with the NHS. The contract sets targets and priorities for general practice in providing access, identifying patients with long term conditions and difficulties such as being a carer or being housebound.

In year one we will:

ƒ Assist with monitoring these contracts and the performance of practices ƒ Support practices to meet the target of providing access to appropriate services within 48 hours ƒ Use the information which practices gather about levels of disease to develop our services

Tackling Long Term Conditions

Shifting the balance of care from hospitals to the community is a key theme over the next 3years. In the following sections we will outline our specific service changes and developments in primary care which will achieve this aim.

Diabetes

Most patients with Type 2 Diabetes are now cared for within Primary Care. Patients have access at their review to a range of services provided by GPs, Practice Nurses, Dietitian and Podiatrists.

In year one we will:

ƒ Continue to work with General Practice to deliver models of multi-disciplinary care, and look to extend this model to all GP practices in the area

Coronary Heart Disease (CHD)

In year one we will:

ƒ With the Coronary Heart Disease MCN to develop services, and work to develop exercise referral, weight management and smoking cessation. ƒ With the Heart Failure Team to deliver services locally

24

Stroke

In years two and three we will:

ƒ Develop services in support of the specialist stroke units in the Acute Sector and the management of patients following stroke in communities. In particular we will work with the Physical Disability Team in partnership with our Older Peoples Teams and our Physiotherapy Service. ƒ Review our joint provision of OT services with WDC

Chronic Obstructive Pulmonary Disease (COPD)

ƒ Work with General Practice and with Asthma UK to improve our services for people with asthma ƒ Pilot a COPD programme with a local practice. ƒ Continue to develop links with Community Pharmacy to provide support for patients with COPD

Developing Community Services

There are a range of services provided by the CHP in the Community. These include Nursing, Physiotherapy, Dietetics and Podiatry.

In year one we will:

ƒ Support the ongoing training and education of staff particularly to develop multi-disciplinary working ƒ Develop their role in case/care management and continue to role out Single Shared Assessment and data sharing information systems ƒ Develop the role of all professions in anticipatory care ƒ Continue to audit caseloads and refine skill-mix ƒ Monitor and improve waiting times for access to community services and meet our waiting time targets ƒ Develop our direct access to Podiatry, Physiotherapy and Treatment Room services

Community Older Peoples Teams

Two models of Older Peoples Teams were developed prior to the unification of services across West Dunbartonshire. We intend to address this in accordance with our commitment to further integrate and join up services.

In year one we will:

ƒ Develop these teams as a single structure to work in partnership with WDC Social Work Services in providing time-limited assessment, rehabilitation and enablement. The teams will support community services to maintain older people at home and provide quick direct access to comprehensive packages of care.

25

ƒ Review the current care models ƒ Agree common care pathways and working arrangements. ƒ Agree unified management structure. ƒ Develop services out of hours in partnership with WDC

Primary Care Mental Health

In line with the corporate approach within the CHP to health improvement we will ensure health improvement is embedded within our mental health services and older people’s services including links across all areas of Mental Health provision.

In year one, we will work with colleagues in Mental Health to:

ƒ Continue to develop Primary Care Mental Health Services (including Direct Access and Advice), and as part of the Mental Health Strategy for West Dunbartonshire look to develop these services across the CHP.

Palliative Care

Most patients and their families have Palliative Care services provided to them at home by their GP and local nursing teams.

In year one we will:

ƒ Continue to work with our colleagues in Marie Curie Cancer Care and the Macmillan Nursing Service to enhance our delivery of Palliative Care ƒ Provide additional training on symptom control and management to Community Nurses and General Practice ƒ Support the development of the Gold Standards Framework and pilot the Liverpool Care Pathway for patients requiring Palliative Care. ƒ Continue to develop links between the Community Service, Older Peoples Service and WDC Social Work ƒ Expand responsibilities for case management ƒ Review the delivery of Out of Hours Services in partnership with the Lomond Care Team and the Clydebank Community Older Peoples Team

Dental Services

The introduction of a new Dental Contract shortly will provide NHS Dentistry with the opportunity to work within a new framework to support dentists in the delivery of more pro-active oral health improvement and dental health care. These new arrangements for dentistry bring an increased emphasis on quality in terms of the process and the outcome of care. There will be a requirement for quality and contract visits to all practices on a more regular basis and the CHP will contribute to these reviews.

26 In year one we will:

ƒ Support local dentists to provide access to patients within the NHS ƒ Provide additional support and training particularly for Dental Practice Staff

Optometry

The introduction of the new General Ophthalmic Services contract provides an opportunity to develop Community Optometry Services; and for them to work in partnership with Community Pharmacy and General Practice to develop primary eye care services.

In year one we will:

ƒ Work with colleagues in the Acute Sector to develop a local network providing primary eye care services within West Dunbartonshire ƒ Develop a Local Optometry Network ƒ Provide information to the public on the role of Community Optometrists in providing primary eye care services ƒ ƒ Support optometry with additional training ƒ Work with WDC and the Sensory Impairment Strategy Group to develop a network providing early access to Social Care Services, the Voluntary Sector and Social Care Networks, and to the Low Vision Aids Service.

In years two and three we will: ƒ Pilot a partnership with the Acute Sector to deliver a primary eye care service, shared care and care pathways for anterior eye disease and some chronic conditions

Community Pharmacy

Community Pharmacy has an important role to play in providing primary care services to the public, and the introduction of a new Pharmacy contract presents opportunities for development. They provide support for the self management of conditions and support to General Practice in their prescribing.

In year one we will:

ƒ Develop multi-disciplinary training around choice of medicines ƒ Develop a CHP prescribing web page for advice and newsletters ƒ Work with Community Pharmacists to support supplementary prescribers such as Optometrists, Nurses and Dentists

Working with Care Homes

Care Homes provide a home for many people in West Dunbartonshire and we currently provide General Medical Services, Nursing Services and services such as Podiatry and Physiotherapy. Many of these residents have complex needs and we will work with local Care Homes to provide improved services in the future.

27 In year one we will:

ƒ Work with the Nursing Homes Medical Practice to provide support to local care homes ƒ Include Local Care Homes in our CHP network and our training sessions ƒ Work with Local Care Homes to enable them to manage their patients effectively

Supporting Carers

Carers play an enormously important role in helping people to live with illness and disability at home. The new GP contract asks Practices to identify patients who have a role as a carer and recent legislation has entitled carers to have a Carers Assessment. We need to ensure that carers have access to good quality medical care and support. As part of our work of identifying patients at risk of admission (SPARRA) we need to identify those carers who are critical to supporting family members at home.

In year one we will:

ƒ Identify carers ƒ Support carers to receive a Carers Assessment. ƒ Pilot the identification of at risk care arrangements and what measures we could take to develop short- notice contingencies

Working with the Acute Sector

To properly integrate care we need to bring together all aspects of the patient’s journey, including diagnosis, treatment, care, rehabilitation and health promotion.

In year one we will:

ƒ Improve the early diagnosis and treatment of bowel cancer ƒ Provide alternatives to admission for patients (particularly the elderly) by improving our services to care homes and out of hours.

In years two and three we will work with colleagues in the Acute Sector to:

ƒ Provide services that are easier to navigate, and improve communication and access ƒ Develop networks which will improve access to Primary Eye Care services using Community Optometrists, shared care protocols for long term eye conditions (e.g. glaucoma) and ensure rapid access to hospital services for sight threatening conditions

Hosted Services: Diabetes Retinal Screening Service

West Dunbartonshire CHP hosts the management of the Diabetic Retinal Screening Service on behalf of CHPs across Greater Glasgow and Clyde. This is an important Service to assess and manage potential eye disease for people with diabetes.

28 In year one we will:

ƒ Integrate the current Clyde service with the Glasgow Eye Screening Service

In years two and three we will: ƒ Complete our migration to a new IT system for the call/recall and management of patients ƒ Screen patients at a rate that would see them being called/recalled for examination on a yearly basis (32,000 patients per annum at current prevalence rates) ƒ Develop clinics across hospital sites in Glasgow ƒ Introduce a mobile service with mobile vans providing access to digital photography in Health Centres across Greater Glasgow and Clyde ƒ Work with the Acute Sector to ensure rapid access to ophthalmology where a clinical diagnosis merits it ƒ Continue to develop the service to meet QIS Standards.

29

Strengthening Local Services: Older People

The CHP is part of the West Dunbartonshire Older People’s Strategy group and brings together representatives from:

• The CHP • WDC • Voluntary Sector • Service users and Carers

The Capacity Planning group (a sub group of West Dunbartonshire Older People’s Strategy group) produced a Balance of Care report which outlines a number of recommendations for the future of Older People’s Services in West Dunbartonshire. These include a review of current services across residential care, homecare, augmented homecare and rapid response services. The Report acknowledged the current configuration of services for older people may no longer match the needs and preferences of the population.

Current investment in long-term care must be targeted at people whose needs can only be met by that model of care, freeing investment to provide care from both services to people in their own homes and communities. We need to redress the balance of provision to ensure adequate homecare balanced against appropriate residential solutions.

In year one, with WDC we will:

ƒ Work with Joint Improvement Team to analyse health data (including SPARRA) which, when allied with the Balance of Care Report, can help us move forward on key themes ƒ Analyse of unplanned and repeated hospital admissions through the Delayed Discharge Sub Group ƒ Develop an Action Plan to tackle poverty and isolation among Older People

In years two and three we will: ƒ Work with Lomond Care Team and Clydebank Older People’s Team to identify gaps and modernise older people’s services across the Authority ƒ Put in place Joint Care Management Models

The above will involve plans to:

ƒ Develop community based rehabilitation models ƒ Develop anticipatory care models and early identification systems within Primary care in conjunction with Social Work partners ƒ Develop support for Nursing homes ƒ Develop the Critical Carers Scheme ƒ Complete our Partnership Agreement for Aids and Adaptations with the Independent Living Service

30 Much of this work is ongoing and the Partnership is committed to developing a comprehensive joint commissioning strategy for older people’s services. A major component in this has been the development of the Capacity Planning Report and the detailed work plans we have produced in conjunction with Joint Improvement Team and the Older People’s Strategy Group.

Health Improvement is also a key component in developing services for Older People. Working through the Older People’s Strategy group.

In year one we will:

ƒ Develop an action plan to tackle poverty, isolation and benefit issues which impact on the lives of older people in our communities. The Welfare Benefits Officer is part of a pilot scheme to roll out the Single Shared Assessment for Older people and will be a key link in getting older people access to services and wider activities within their local communities

Over the next year the interface between the CHP, Rehabilitation and Assessment Unit, Acute Divisions Operating Divisions will be a key element of promoting and supporting service planning, delivering change and improvement.

In line with the CHP’s commitment to reducing multiple admissions we will work with Partners to :

ƒ Establish clearer patient pathways to reduce admissions to hospital and delayed discharges

The development of CHP Development Plans and Acute Divisions Operating Plan will provide an opportunity to establish robust working arrangements and effective links with the common objective of improving outcomes for service users and developing services that optimise value for money. A particular issue facing West Dunbartonshire concerns the future of the Vale of Leven Integrated Care Model, which will be decided upon in the light of the final report on the health needs assessment.

31

Strengthening Local Services: Mental Health

West Dunbartonshire Mental Health Strategy Group brings together representatives from:

• The CHP • WDC • Service user and carer representation • Voluntary organisations

In year one, the Group will support:

Capital investment on the Ailsa Ward (Dumbarton Joint Hospital)

Resource has been allocated to re-furbish and refit the former Ailsa Ward at Dumbarton Joint Hospital site to establish a significant Adult Mental Health community base for West Dunbartonshire CHP. The Community Mental Health staff from Bank Street Medical Centre and Dumbarton staff will be based at the new Dumbarton Joint Hospital site. The site will become the base for Dumbarton and Alexandria Adult Community Mental Health Services.

Integration of Services

The joint future agenda in Scotland is a major driver for co-location and integration of local authority and health adult mental health services. Adult Mental Health services currently provided from Goldenhill Resource Centre offer a multi-disciplinary service. However to date services in Dumbarton and Alexandria have been unable to progress a co-location and integration process due to unsuitable accommodation.

The CHP will be working in partnership with colleagues from WDC and Argyll and Bute Council with the aim of achieving formal agreement regarding the co-location and integration of all adult community and mental health staff working within the Local Authority and West Dumbarton CHP.

Reprovision of IPCU Beds

The Greater Glasgow and Clyde Mental Health Partnership has agreed to the transfer of IPCU bed provision for the Dumbarton/Alexandria/Helensburgh area from Lochgilphead to the Greater Glasgow IPCU Network. An Implementation plan for this work has been developed in partnership by the CHP and the WDC. Negotiations are ongoing with NHS Highland to identify the resource available to GG&C Mental Health Partnership.

24 hour access

The CHP crisis team will operate a 24 hour crisis response service. The aim of this service will be to prevent hospital admissions and provide short term case management during a period of acute relapse. The Team will remain involved until the crisis is resolved and the person is linked into the appropriate services.

32

Mental wellbeing

The promotion of good mental health and wellbeing is an area which is relevant to all the partners including community planning. WDCHP will work to extend an integrated approach to mental health through the Choose Life initiative, the Stress Network and proposed primary care mental health services. The development of the Mental Health /Addictions protocol will ensure that very vulnerable people with complex needs can access the appropriate services when they require them.

The CHP is responsible for managing and delivering community health services and our key aim will continue to developing an infrastructure of community based mental health services across the Authority.

In years two and three we will:

ƒ Develop a robust joint information framework including jointly agreed local targets with local authority partners ƒ Develop a joint commissioning strategy for adult mental health services ƒ Continue the development of integrated health and social work services at the point of delivering services throughout West Dumbarton including jointly agreed protocols ƒ Develop the primary care mental health network for the whole of West Dunbartonshire ƒ Review and develop care pathways for specialist mental health services. ƒ Develop a referral protocol between addictions and mental health services.

Addictions

The CHP works in partnership with the West Dunbartonshire Addictions Treatment and Care Group, the key strategic group for the implementation of the West Dunbartonshire Corporate Action Plan for Drugs and Alcohol. The group has representation from a wide range of agencies including

• CHP • WDC • Voluntary Sector • Police

The West Dunbartonshire Community Addiction team has had a Joint Manager in place for some time and a fully integrated multi agency service operates in Clydebank. A key priority for the CHP will be to continue to develop the Community Addiction Team model across the authority and to co-locate health and social work staff in Dumbarton/Alexandria. The provision of equitable accessible inclusive Addiction Services across the authority is a key outcome for 2007/08.

There is clear evidence from the Health Needs Assessment that we must tackle the problem of drug and alcohol misuse and support people to lead active and productive lives.

33 We will work with WDC to ensure key targets identified in the Corporate Action plan for Drugs and Alcohol 2007/08 are met including:

ƒ Increasing the numbers of drug users in contact with services ƒ Improving the range of service choice for individuals. ƒ Develop integrated care pathways between CATS and Community Mental Health Teams and Homeless Services. ƒ Co-location of Health and Social Care staff throughout West Dunbartonshire

In accordance with the recently published National Plan for Alcohol, we will contribute to discussions about and work towards local targets regarding alcohol misuse over a range of different areas including:

• Cultural change • Healthy lifestyle choices • Protection and control • Access to services • Prevention • Education.

Meaningful activity including employment is crucial in achieving health improvement outcomes directly related to poverty and poor mental health. A high number of people on incapacity benefit are under 25; this is due mainly to reasons of substance misuse. Worklessness is a key target for all partners and in order to meet the needs of people considered to be furthest from the Labour market a range of services and supports need to be in place to help them move towards employment.

In year one, we will work with and through the Treatment and Care Group , the West Dumbarton Drug and Alcohol Forum and Workforce Plus to:

ƒ Ensure access for people on incapacity benefits to meaningful activity including training and employment opportunities.

Services for People with Learning Disabilities

Learning Disability Services within West Dunbartonshire are provided by Social Care and Health Care. West Dunbartonshire CHP will work closely with West Dunbartonshire Council to provide develop and support an integrated Learning Disability Service throughout our area.

In year one we will:

ƒ Co-locate Health and Social Care staff throughout West Dunbartonshire ƒ Create a Management Structure to support the implementation and development of an integrated Learning Disability service ƒ Increase the access to Clinical Psychology services by increasing capacity ƒ Explore transitional issues for Adolescents moving on to Adult Learning Disability Services ƒ Continue to work closely with Partners to maximise the independence of people with Learning Disabilities enabling them where possible to live within their local community

34

Services for People with Acquired Brain injury

Issue and challenges affecting people with Brain Injury can be enormous. The CHP is part of the West Dunbartonshire ABI Strategy group which brings together representatives from:

• The CHP • WDC • Voluntary sector • Service Users • Carers

The CHP along with Partners in the West Dunbartonshire ABI Strategy group will work to develop efficient interfaces and care pathways between the Brain Injury Project and specialist services such as the Acute services, including the Vale of Leven Southern General, the RAH and the Community Treatment centre.

West Dunbartonshire was represented at the recent seminar with the Rehabilitation and Assessment Unit to develop these interfaces and to discuss the local implementation of the Greater Glasgow and Clyde Strategy for ABI.

In year one, we will work within the ABI Strategy group to develop:

ƒ Awareness of ABI services among other services ƒ Support the development of supported care through housing providers ƒ Establish a baseline of the numbers of people receiving service provision for ABI. ƒ Improve carepathways between ABI project and Specialist Services

Services for People with a Sensory Impairment

The CHP is committed to a Partnership approach through the Sensory Impairment Strategy group to developing services for people with a sensory impairment through a range of supports which offer a quality of life that might not otherwise be possible. Health Services include Audiology provided within Dumbarton Health Centre, RAH and Gartnavel Hospital

The Sensory Impairment Team, NHS Greater Glasgow and Clyde and Lomond Care and Repair provide an equipment advice and information service to hard of hearing people as yet unknown to Specialist Services. The CHP and the SIT provide outreach services to people with a sensory loss within a clinic setting in Clydebank Health Centre.

In year one we will:

ƒ Continue to review and develop local services to meet the changing needs of people with a sensory impairment within the Sensory Impairment Strategy group ƒ Support primary care service developments in relation to retinal screening and community optometry services.

35 Physical Disability

The CHP works within the West Dunbartonshire Physical Disability Strategy group to ensure the implementation of the West Dunbartonshire Physical Disability Strategy. The Group has representation from the relevant agencies including social work and health and community representation.

The Partnership recognises the many barriers that are faced by people with disabilities, providing better services can make a big difference in tackling inequalities, for example improvements in physical access to buildings, changing attitudes and better access to specialist services where appropriate.

Working with our partners on the Strategy Group, we will:

• Ensure a wide range of local services exist for people with disabilities • Continue to develop and evaluate the specialist single shared assessment tool • Improve the care pathways with Community Disability Teams through joint work with the Rehabilitation and Assessment Directorate (RAD)

We will also work in partnership through community planning structures and the Workforce Plus Programme to maximise access to employment and training for disabled people.

Health and Homelessness

The CHP works in partnership within the West Dunbartonshire Homeless Strategy Forum which consists of various agencies including:

• The CHP • WDC • Voluntary Sector

The CHP’s responsibility for community health services mean that we provide a range of services to people who are homeless because of the complexity of the difficulties they experience. Many of the health problems experienced by homeless people relate to addictions, drugs and alcohol and mental health difficulties. Early intervention to prevent health problems developing is a key objective of work with homeless families in West Dunbartonshire.

The Health and Homeless Action Plan was agreed in partnership with the Homeless Strategy Forum, and a number of initiatives have been put into practice including:

• Local referral protocols and care pathways between Homeless Services and Addiction Services • Direct Referral process in place to refer homeless families to the Homeless Health Visitor • Protocol agreed to refer homeless families to mainstream HV/School Nurse 5- 16years

In year one, we will work with partners to:

• Put in place Referral Protocols between the Adult Community Mental Health Team and Homeless Services

36 • Develop a Service User Involvement model • Raise awareness of prevention and early identification of homelessness among NHS staff • Further develop accessibility and support services for homeless people across West Dunbartonshire

Homelessness Nurse

Funding is being extended to continue this key Nurse Post, which is co-located within West Dunbartonshire Homeless Services.

This post has been successful in ensuring that health needs among homeless people presenting to West Dumbarton Council are identified and that they are referred on to the appropriate health services.

The post was originally funded as a pilot, with Scottish Executive monies, through Argyll and Clyde Health Board; however it is now the intention to fully integrate the Post within the CHP structure.

37

Strengthening Local Services: Children’s Services

Universal Services

Universal Children’s Services are provided in the community of West Dunbartonshire by a team of Public Health Nurses/ Health Visitors based in the three Health Centres of Alexandria, Dumbarton and Clydebank. They provide child health services to children and families at home and in community clinics. Services include child health surveillance, child development, immunisations, and parenting, health promotion support for parents and families and child protection.

Within primary care settings, specialist teams have been developed in partnership with our Social Work and Voluntary Sector colleagues to provide support for young families’ children and young people. Specific reviews and innovations have recently taken place include:

• Immunisation review of Health Visiting and Primary Care December 2006 • Health Visiting Case Record Reviews in Child Protection November 2006 • Introduction of West of Scotland Child Health Record Health Visiting and School Nursing November 2006 • HMIE Integrated Child Protection Review 2006/07 • Planned Pilot of Integrated Assessment with WDC March-June 2007

In year one we will:

ƒ Work to increase MMR immunisation uptake by 2% to 94.6 by 2008/09

This will involve:

• A team approach to primary care: redesign of immunisation clinics timings and clinical and administrative support • Investments to assure safe storage of vaccines in primary care settings

ƒ Work with WDC and Acute Sector partners develop actions to improve the health of pregnant women; and support vulnerable young families ƒ Develop further the School Nursing Service, with a single team approach across the CHP in 2007, accompanied by the implementation of the Framework for School Nursing 2007/08 and the targeting of resources at vulnerable children ƒ Create a record store at Clydebank and commence transfer of complete HV records to School Health for P1 children and identified vulnerable children. ƒ Introduce a pilot of IAF for children in need and review prior to full implementation. ƒ Review Young families Support Services with a view to providing future mainstream services from 2008 onwards.

Specialist Children’s Services

The new single system arrangements have created the opportunity to deliver appropriate coterminous services to children across West Dunbartonshire.

38 In year one we will:

ƒ Work with WDC and other CH(C)Ps to redesign appropriate co-terminous services locally

CHP Children’s Plan

The CHP Children’s Plan is comprehensive across generic and specialist children’s services. Many actions can be achieved within the CHP with partners, however significant actions are co-dependant on close working across Greater Glasgow and Clyde Health Board to deliver safe sustainable local services within West Dunbartonshire.

Child and Adolescent Mental Health Services (CAMHS)

CAMHS services in Clyde are currently under review and discussion across GG&C. The management of CAMHS within the CHP does not include services to Clydebank and there are variances in access, waiting times and communications with referrers and Partnerships. The planning and solutions to these issues are GG&C-wide.

The Child Health Strategy Group will consider these issues and have appointed a team to explore these at a Development Day planned in May 2007. The CHP Children’s Services Joint Strategy Group will also consider initiatives funded by the Change Fund and explore mainstreaming where viable for these projects

In year one we will:

ƒ Redesign CAMHS to provide a more linked network service across the CHP and GG&C-wide, addressing on-call; access to specialist services; provision for 17/18 year olds; access to acute beds; assertive outreach; and pathways of care for transition and use of adult beds.

Psychology Services

With the appointment of a Psychology Consultant, we will:

• Develop local Psychology service for WD children • Undertake a scoping of needs for a local service and identify resource requirements to develop an improved service. • Mainstream services developed in Ben Ledi Project with WDC Education for target groups of children in school setting • Work with Psychology, CAMHS and Child Development to utilise services previously funded by ECR and Notre Dame to plan appropriate care packages in ECR funding • Provide Consultancy for referrers and promote work in Primary Care in line with framework for Children’s Services

Looked After and Accommodated Children. (LAAC)

During 2005-2007 a comprehensive needs assessment project has been undertaken to research the health needs of LAAC children in Clyde. Findings demonstrate that both the health and mental health needs of these children are not being met by mainstream services; and they are often lost in both the health and social care system. There is a

39 need for health improvement activity with carers in both residential and foster settings to assist in meeting these needs for younger children at an early intervention stage

In year one we will:

ƒ Be actively pursuing potential funding available for a G Grade Nurse Specialist Post for the CHP to provide services for LAAC children in all areas linking to WDC Social Work, universal health services and specialist health services for LAAC. The current proposal is for a fixed term post 2007-2008; however partnership funding is being sought to ensure this becomes a substantive partnership post.

Allied Health Professional Services (AHP) to Clydebank and alignment of appropriate services within Clydebank

The Service Development group in West Dunbartonshire led by specialist Children’s service manager is working with counterparts in West CHCP to identify AHP services where 80% or more is delivered in West Dunbartonshire and Services with a contract from the Local Authority.

In year one we will:

ƒ Scope these services, followed by developing a plan with West CHCP and individual service manages to transfer services to be wholly managed within the CHP during 2007-2008.

In years two and three we will: ƒ Explore utilization of staff over the whole area, and introduce pathway and referral guidelines to address inequity during 2008-2009.

Additional Support for Learning Act

The Joint Strategy Group for Children’s Services West Dunbartonshire will explore opportunities to address and invest in services redesign and training to meet the Additional Support for Learning Act definitions and need for the child population of West Dunbartonshire.

In year one we will:

ƒ Develop planned care pathways for AHPs and onward to more specialist services in Greater Glasgow and Clyde wide. The aim will be to improve equity of access and management of waiting lists to children. This will assist in meeting national targets for ASL and GIRFEC.

Child Development Centres and Paediatric Clinics

Paediatric General Consultant services are delivered in a different way in Clydebank, Alexandria and Dumbarton.

40 In year one we will:

ƒ Progress redesign to deliver what is local and appropriate within the CHP in line with the recommendations of delivering a Health Future Action framework

The scoping of potential redesign will commence in 2007-2008 and future configuration agreed 2008-2009.

Specialist Children’s School Nursing

The work of specialist child school nurses based in Kilpatrick SEN School, in year one will be scoped and management transferred to the CHP while the service still links to a GG&C-wide specialist school nursing service.

Vulnerable Children

HMIE inspection took place in West Dunbartonshire in December 2006 and January 2007. A verbal report has been provided and a full written report will be available by June 2007. Work has already proceeded and will address key points intimated to the Chief Officers Group.

Child Protection Inspection, HMIE Action Plan

In year one we will:

ƒ Work with WDC and the Child Protection Committee to prepare and implement a detailed action plan which will include ƒ reviewing records availability, storage and shelving in WDCHP and wider GG&C. Ensure appropriate management and availability of School Health Records ƒ Ensuring information management in EDIS is resolved within GG&C ƒ Develop with Yorkhill CPU a Pathway of care for forensic medicals ƒ Continue good practice of inter- agency training in Child Protection

In addition, in year one we will:

Review respite services for children with complex needs to scope future provision across all of the area and explore funding for future provision.

41

Tackling Health Inequalities: The Health Improvement Team

The Health Improvement Team provides specialist support to the CHP around gathering and interpreting data from a wide variety of sources (e.g. the Public Health Resource Unit). The ‘public health’ role of the team also involves linking Health Improvement practice to the evidence base: linking ‘what works’ with improving health outcomes locally. The team also carries out Programmes of Work around ‘life stages’ and around ‘topics’. Where a need has been identified, the Health Improvement Team may also ‘commission’ pieces of work from other agencies (e.g. the provision of fruit for primary schools). Finally, an emerging key role for the Health Improvement Team is ‘building capacity’ - supporting and facilitating others both within and out with the CHP to contribute effectively to health improvement.

The Health Improvement Team has already embarked upon a process of re-structuring and realignment, and the year ahead will see further developments to ensure that they are best placed to appropriately target action on those areas of need that can most benefit from it. The year ahead will build on demonstrated local successes and the strong preparatory work initiated by the Team.

In year one we will target:

Tobacco Control

Working with partners to develop a comprehensive approach to tobacco control; introducing a consistent approach to smoking cessation services across West Dunbartonshire, including specific work with pregnant women and support within mental health services; and rolling out the Stay Fresh programme in community pharmacies.

Alcohol

Working with partners to develop a comprehensive approach to tackling binge drinking and the incidence of problematic drinking behaviour.

Breast Feeding

Appoint an officer with lead responsibility for infant feeding to take forward work with local groups to develop a range of approaches aimed at increasing initiation and maintenance of breastfeeding.

Oral Health

Rolling out the Oral Health Action Team approach across West Dunbartonshire, with an emphasis on pre-5 dental health.

Services for Young People

Initiate and lead a comprehensive review of Youth Health Service provision across West Dunbartonshire, to inform the subsequent development of a consistent and equitable approach to addressing the needs of young people locally (especially the most vulnerable and at-risk). 42 Sexual Health

Working with partners to roll out a comprehensive range of local sexual health services through the introduction of Sandyford Initiative “hubs” (including counselling and sexually-transmitted infection screening).

43

Strengthening Human Resources

In order to be successful West Dumbarton CHP must ensure that the resources available to the organisation are utilised efficiently and effectively. Given that our workforce constitutes one of our primary resources it is essential that the CHP establishes a platform to plan for service and workforce changes in the short, medium and long term.

Clearly a major issue in the early months of the Partnership has been the dissolution of Argyll and Clyde Health Board and the transition to the new operational arrangements for planning and service delivery within the new Greater Glasgow and Clyde Health Board which was established in March 2006.

Since March 2006 the CHP has had a significant focus and involvement in the review of the previous Clyde clinical and financial plans:

Throughout this period key areas of work have been:

• The Review of Clinical Strategies for both Acute and non Acute services • The development of proposals that will return the Clyde elements back into recurring financial balance by the start of 2009/10. • Vale of Leven Integrated Care Model • Developing Service Level Agreements with Highland Health Board

Workforce Planning

In year one we will:

ƒ Develop a Workforce Plan which is affordable within current resources, available within our local labour market and we will furnish this workforce with the skills to adapt to the inevitable changes which will face a modern health service. This will require the establishment of closer links between financial, corporate planning and workforce planning professionals.

The CHP has embarked on a pilot to develop a workforce plan. A CHP workforce planning group will be established consisting of representatives from finance, service and workforce planning as well as relevant managers, trade union representation from CHP service areas.

The initial workforce plan will focus on identifying those national, regional and local drivers for change which will impact on the West Dunbartonshire CHP workforce over the next 3 years and beyond. The initial plan should be completed by November 2007. As an evolving organisation it will be necessary to ensure that existing sources of workforce data are merged to ensure that the information used to plan our future workforce requirements is robust and accurate.

44

Staff Governance

Staff Governance is defined as ‘a system of corporate accountability for the fair and effective management of all staff’ 1. It makes up the third pillar of the governance framework alongside clinical and financial governance. Staff Governance is incorporated into NHS (reform) Act 2004, thereby making it a statutory obligation placed upon boards. The CHP is required to implement staff governance standard for all staff working within the CHP.

In year one we will:

ƒ Implement the Staff Governance Standard for all staff working within the CHP through the SPF ƒ Establish a Staff Governance subgroup within the CHP specifically to progress staff governance action plan for the CHP. ƒ Ensure that Staff Governance issues will be reported to the Board through operational line management and via SPF links to APF

Absence Management

Efficient Government objectives require NHS boards have to achieve a target of 4 percent target for sickness absence by 31 March 20082. The CHP will achieve this target by:

ƒ Maintaining appropriate and up to date records to support management and monitoring of sickness absence. ƒ Ensure implementation of attendance management policy within the CHP ƒ Make sure appropriate mechanisms are in place to support staff during periods of ill health in line with positive and supportive practices around Staff Governance implementation and Healthy Working Lives.

1 Revised Staff Governance Standard 2 Efficient Government NHS HDL (2005) 51 45

Learning & Education

The Learning & Education Team for GG & C focuses on making learning opportunities inclusive and accessible to all staff. Learning and Development plays a major role in preparing staff to deliver effective and high quality services including supporting the achievement of personal aspirations to meet employment and professional requirements.

In year one, the Learning and Education Advisor will:

• Work with the CHP to identify the Learning and Education needs that will support them in achieving service priorities and national initiatives. • Work with managers and staff in identifying their learning and education needs to support KSF/PDP, Career Management, Personal development, and Continuing Professional Development and Governance. • Work with partnership organisations across the CHP and Greater Glasgow and Clyde to develop joint learning opportunities and enhance learning provision. • Develop and maintain a Learning Plan that details support and learning opportunities available. • Provide expert advice and support to staff and external agencies wishing to develop learning resources and programmes.

The Learning and Education Team has a number of priorities for 07/08, which include;

Induction

The induction process is critical in supporting and motivating new employees. A review of the induction processes will take place resulting in a harmonized approach. This will ensure all employees are given a sound foundation of information and awareness, which will support them in their role. This will include highlighting the behaviors and attitudes expected of NHS employees.

KSF & PDP

This plays a critical part in personal and career development as well as redesign of new and enhanced roles. To support the mainstreaming of KSF, L& E Advisors will continue to support managers and staff as they develop KSF outlines and will provide training on the personal development review process. The L&E Team will also map the KSF to current and future learning programmes to support Managers and Staff to identify appropriate development to meet the demands of the post.

46

Management Development

Designing and establishing a Management Development Framework, which will support all levels of management. This will identify robust development programmes to support new, existing and potential managers in meeting the demands of their role.

E-Learning

Begin to develop the enormous potential and capacity of e-learning resources, utilising Open Learning Centres, library facilities and the existing IT structures to support organisational and individual learning.

Qualifications

Identify the qualification activity within Greater Glasgow and Clyde ensuring that appropriate links are made across disciplines and functions. We will work with internal and external partners to develop and provide individual qualification pathways, which will address the learning needs of the service and create new opportunities for groups of employees and individuals.

Continuous professional and personal development

Developing new and improved ways to deliver services is crucial to the modernisation of health care services. We will work closely with managers and staff to identify the learning & education needs of new and enhanced roles. This will include supporting front line staff to develop the vital communications skills they require in their role. We are also aware of the significant changes in roles, particularly of our clinical staff, and we are working with service representatives to develop learning programmes, which support these changes.

47 Organisational Development

Organisational development (OD) focuses on developing the structures, systems, and processes to improve organizational health and effectiveness. It should be managed from the top through planned interventions in the organisation's processes. Leaders, managers, staff and our key partners all have an important role in shaping and implementing the OD activity for West Dunbartonshire CHP.

The West Dunbartonshire CHP OD plan will aim to continue the establishment of the new organisation and further improve the overall effectiveness of the organisation. Our objectives will be:

• To be clear what our purpose is • To identify how we can continuously improve the quality of the services we provide • To be more efficient, effective and focus on best value • To ensure staff are supported to do their job • To ensure that the services provided, and the way in which we provide them are user-focused, incorporate equalities-sensitive practice and implement key legislation/ national and local imperatives.

Fostering a healthy culture

Recognising the importance of both what we do/deliver and how we conduct ourselves in delivering high quality health services.

In year one we will:

ƒ Support partnership working/ collaboration across all services with key partners ƒ Develop effective team working across all services ƒ Work with Human Resources and Learning & Education to assess the learning and development needs of CHP staff ƒ Explore, define and undertake the joint OD and learning agenda with key partners ƒ Support the established CHP communication and engagement structure and processes ƒ Support the process of ensuring key legislation and national/local imperatives are reflected in how we deliver health services, such as: ƒ health improvement and health inequalities ƒ the engagement and involvement of patients, carers and communities ƒ child protection ƒ clinical governance ƒ staff governance ƒ equality & diversity

This activity will ensure the CHP will be working towards the corporate requirement to embed the NHS GG&C transformational themes.

48

Single Equalities Scheme

Ensuring equalities and diversity is not just about adhering to the legislation, but actively promoting exclusive ways of working and challenging discriminatory practice. We already participate in a multi-agency equalities group with our Community Planning partners. In collaboration with East Dunbartonshire CHP, we are working with OD and Human Resources colleagues to develop an Action Plan which will incorporate a training plan for new and existing staff.

In year one we will:

ƒ Ensure that we have and implement a robust local action plan that concentrates on embedding the Equality Scheme across the constituent parts of the CHP.

Targeting Gender Inequalities

Domestic Abuse is recognised nationally as a gender based issue. The CHP is a member of West Dunbartonshire Violence Against Women Partnership. As a partner the CHP aims to contribute to achieving the objectives outlined in West Dunbartonshire Violence against Women Strategy and Action Plan 2006-2008. We have committed to carry out specific actions an integral part of which will be training for staff. The CHP is committed to implementing the recommendations from Domestic Abuse Prevalence Argyll and Clyde (DAP) study in terms of health service response to domestic abuse.

In year one, with partners, we will: ƒ Support the roll out of a training programme in relation to the Scottish Executive ‘s Domestic Abuse Guidelines for Health Care Workers ƒ Contribute to the National Training Strategy through membership of West Dunbartonshire Domestic Abuse Training Consortium Sub Group ƒ Build on the “Freedom from Violence and Abuse” Objectives within the Joint Health Improvement Plan and ensuring linkages with other local relevant plans and strategies. ƒ Support the implementation of West Dunbartonshire Domestic Abuse Education Pack. ƒ Participate in the Scottish Executive Getting it Right for Everyone’s Children (GIRFEC) domestic abuse pathfinder project (Clydebank D division Police 2007/2009).

49

Finance Indicative Revenue Annual Budgets for Financial Year 2007/08

The Partnership has prepared a draft budget plan for 2007/08 pending confirmation of the overall NHS Greater Glasgow & Clyde Health Board financial plan for 2007/08.

At this stage the main elements of the indicative budgets are as follows:

West Dunbartonshire CHP INDICATIVE BASE BUDGETS 2007/08

Clydebank Lomond TOTAL £000s £000s £000s

2006/07 Budget by Care Group (as at 31/12/06)

Mental Health – Adult Community 1,341.7 2,858.2 4,199.9 Mental Health – EMI 0.0 1,927.8 1,927.8 Addictions 204.0 811.4 1,015.4 Learning Disabilities 0.0 601.5 601.5 Health & Community Care 1,742.0 2,485.9 4,227.9 Children & Families 700.9 3,151.2 3,852.1 Planning & Health Improvements 746.9 320.0 1,066.9 Family Health Services (FHS) 9,071.7 10,946.4 20,018.1 Prescribing 8,708.8 9,219.9 17,928.7 Executive & Admin, Accommodation costs & Other 846.3 1,367.9 2,214.2 Hosted Services 945.8 0.0 945.8 Resource Transfer and Income 0.0 262.3 262.3 TOTAL 24,308.1 33,952.4 58,260.5 2006/07 Budget by Cost Headings

Pay 0.0 0.0 0.0 Supplies 0.0 0.0 0.0 FHS 0.0 0.0 0.0 Capital Charges 0.0 0.0 0.0 TOTAL (1) 0.0 0.0 0.0 Add Inflation

- Pay Inflation (3.5 %) - indicative allocation 0.0 -General Supplies Inflation (1%) indicative allocation 0.0 - Primary Care Prescribing Costs Inflation (6%) 0.0 - Capital Charges Inflation – indicative allocation 0.0 - Energy costs growth – indicative allocation 0.0

TOTAL (2) 0.0 0.0 0.0 Add Programme Budgets Approvals

Approved service developments 0.0

TOTAL (3) 0.0 0.0

Minor Works etc (4) 0.0

Cost Savings Initiatives (5) 0.0

TOTAL 2007/08 Budget (1+2+3+4+5) £24,308.1 £33,952.4 £58,260.5 50

It should be noted work is ongoing to ensure that the appropriate resources are devolved to the Partnership and budget information will be updated routinely as information is made available.

Cost Pressure 2007/08

Pressures and Issues

The most significant cost pressure currently relates to the recurring overspend within ‘Clyde’ areas on GMS. This issue is currently under review on a Boardwide basis.

Hosted Services/ Local Managed on Behalf

The West Dunbartonshire CHP is responsible for hosting services on behalf of other CHCPs. Where this arrangement applies, the responsible Partnership will be expected to manage overall service expenditure within available funds.

Where expenditure remains within +/- 5% of the overall service budget, the Partnership will be expected to manage this within the context of its overall devolved service budget with no supplementary recharge/ reimbursement required. Where expenditure is greater than or less than budget by in excess of 5%, then it will be appropriate for the Partnership to take action to manage expenditure back into line with budget during the remainder of the year, and as a last resort recharge/reimburse the difference pro rata to each CH(C)P.

The West Dunbartonshire CHP has management responsibility for the following service budgets:

• Retinal Screening Service • Glasgow Integrated Eye Service • Clyde Condition Management Programme

Risk Sharing Arrangements

A risk sharing arrangement has been established whereby all CH(C)Ps have agreed to adopt a joint approach to the management of the Primary Care Prescribing Budget in 2007/08. All CH(C)Ps are responsible for managing expenditure within the allocated prescribing budget, which is governed by NHSGG&C standing financial instructions. The MMRG recognise the requirement for the risks associated with the devolved CH(C)P prescribing budgets to be managed jointly within the service partnerships to ensure the prescribing service is delivered within the total envelope of resources available to the CH(C)Ps for this service area. As a result of this the CH(C)P Directors have agreed to collectively share the financial risk on the prescribing budget under the agreed financial framework.

An equivalent risk sharing arrangement is being prepared for the management of overspends and underspend relative to budget for points achieved by GP practices in connection with the QOF section of the new GMS contract.

51 Cost Savings Plan 2007/08

Greater Glasgow & Clyde Health Board

NHSGG&C have a responsibility to address the £30 million inherited deficit for Clyde by the middle of 2009.

The Board has agreed at this stage that no ‘Clyde’ general targets’ will be allocated to service budgets with the exception of GP Prescribing Services. The Board approved a ‘Clyde’ Prescribing Cost Saving Plan of £5m during 2006/07, covering the three year period to 2009/10. The following savings targets for WD CHP GP Prescribing Services of £0.679m will be introduced from 2007/08 with planned savings achieved over a 3 year period.

The following information provides a detail breakdown to support the planned savings within GP Prescribing Services for WD CHP:

ƒ General Savings - £0.070m ƒ Formulation change - £0.130m ƒ Therapeutic changes - £0.162m ƒ Medication Review Clinics - £0.317m

In addition to the above savings outlined the CHP has proposed an approach to develop service redesign to fund locally and system wide the following CHP Investment Priorities over the next 3 years:

ƒ Addictions Tier 4 services ƒ Learning Disability - Psychology and Nursing post ƒ Community Mental Health Team efficiency savings ƒ Crisis Resolution Service ƒ Extending CPN Out of Hours Service ƒ Primary Care Mental Health Service ƒ C&F – Starting Well Model ƒ C&F – LAAC Nursing post ƒ Respite Services for Children with Complex Needs ƒ Redesign AHP and School Nursing Services ƒ Service Development Manager posts ƒ Out of Hours and overnight nursing – Admission avoidance ƒ Case Management Model – Older people and Carers ƒ AHP Professional Leadership redesign

Capital Programme 2007/08

Capital Planning

Discussions are ongoing with NHSGG&C to ensure that the WD CHP capital plans are prepared and submitted for consideration alongside capital plans by other divisions of NHSGG&C.

52

The CHP is currently preparing a 3 year capital plan following the outcomes of a strategic review of CHP service priorities. The plan will contain an itemised list of proposed capital spending, set out in priority order. The timeframe for finalising the plan is agreed and the final report will be submitted to the Capital Planning Group for consideration. Following review by the CPG the CHP Capital Plan will be taken forward within the appropriate NHSGG&C Capital Planning processes.

Formula Capital

There will be an annual process led by the Head of Capital Planning and Procurement and involving all CH(C)P Directors or designated representatives to reach agreement on an allocation of formula capital funding to each individual CHCP. The Formula Capital funding will be allocated for minor works and minor equipment.

Capital Plan Proposals

The following table highlights the proposed aspirations and capital spend within the West CHP over the next three years.

West Dunbartonshire CHP 2007/08 2008/09 2009/10 TOTAL Aspirations £'000 £'000 £'000 £'000

Alexandria Medical Centre - essential upgrade 250 250 Alexandria Health Centre - Reprovision 200 6,000 7,300 13,500

£450 £6,000 £7,300 £13,750

Investment Priorities 2007/08

The attached table highlights West Dunbartonshire CHP service changes and development proposals for the three year period to 2009/10 and captures key financial information relating to each proposal and has been set out in priority order, starting with the proposal which is given the highest priority for investment. The appropriate cross reference is highlighted within the table and links to the detailed investment proposal under the relevant care group section of the plan.

53

Appendix 1 - Finance INVESTMENT PRIORITIES & RESOURCE SHIFTS

(1) (2) (3) (4) (5) (6) (7) No. Description of Investment Proposal Start Recurring Non-Recurring Funding Funding Source(s) Funding Source(s) or Resource Shift Date Revenue Funding (Recurring Revenue) (Non – Recurring Revenue) 2007/08 2008/09 2009/10 Brief Capital Revenue Internal Cost New Funding Internal New Description Savings Cost Funding £’000 £’000 Savings £’000 ’000 £’000 £’000 £’000 £’000 £’000 Dec 2007 Access to Tier 4 Services for £80k £80k £80k 1 Dumbarton and Alexandria localities £80k Funded by internal redesign Redesigning Creation of Consulting rooms and Nov 2007 Consulting rooms £73k - 2 change of base for Addiction and changing services usage of rooms at Funding from Dumbarton Joint SE - £30K Hospital Funding from West Dun Council - £25k

Funding from West Dun CHP - £18K

Appointment of Health Improvement May 2007 £19,600 £19,600 £19,600 Officer (Infant Feeding) Post/

54

New Psychology post for Learning May 2007 £40k £40k £40k 3 Disability Team £40k Funding from the closure of Merchiston Hospital

September £42k £42k £42k 4 Charge Nurse (Band 6) post 2007 £42k Funding from the closure of Merchiston Hospital June 2007 Creation of suitable accommodation Refurbishment of 5 to house an integrated and Ailsa Ward, £535K £90K £90K Nil comprehensive Community Mental Dumbarton Joint Clyde From pulling Health Team at Dumbarton Joint Hospital to house Transitional existing service Hospital comprehensive Funding or revenue costs and integrated Capital and making CMHT Formula efficiency savings Changing the Pathway to IPCU for Dumbarton/Alexandria/Helensburgh June 2007 £135k £135k £135k £135k 6 from Lochgilphead Hospital to Disentangling Gartnavel Hospital Lomond MH Services investment for IPCU from NHS Highland Implementation of a West 7 Dunbartonshire Crisis Resolution September £510k £510k £510k 300k –from £155 k from Service in line with Service 2007 Redesign of Resource Function Paper current Transfer (West Intermediate Dun Council) services, CMHT and Day £55K From Services Argyll and Bute CHP

55 £100k from 8 Extending CPN out of Hours Service September £100k £100k £100k Clyde to cover Dumbarton and Alexandria 2007 Transitional localities as an integral part of the funding Crisis Resolution Service

Further Invest in Psychology services September £55k £55k £55k £55k from 9 within Clydebank Primary Care 2007 Resource Services and Goldenhill CMHT Transfer – West Dun Council £80k investment 10 Implementation of Primary Care November Nil £80k £80k from the Mental Health Service within 2007 redistribution of Dumbarton/Alexandria Clyde funding following Benchmarking exercise.

11 Current funding from Changing 2008/09 Children’s services Fund Supporting Parent Training Young Families. Project in for support £5k £80k £176k £5k partnership with West Dumbarton £249k £256k workers and Council a social work and investment in PPP education, previously one plus to for Health visitor provide support staff. Delivery Coordinator Early intervention in Staring well model.

12 Current Funding from Changing 2007/08 £25k £95k £100k £100k Children’s Services Funds Young People in Mind. Provision of Psychology and CAMHS support to Looked after and Accommodated Children. Provide 1 wte Psychologist.

56

13 Current Funding from Changing 2007/08 £70k £70k £70k £70k Children’s Services fund ends 2007 Ben Ledi Conduct disorder intervention project and SNAP Intervention approach. Psychologist. Provide SNAP Intervention in partnership with Education provision of Clinical Psychologist coordinator

14 CAMHS service redesign. Provide 2008/09 - £180k £180k Internal room £50k £180k Services in line with Framework for adaptations Capital Mental Health services and 16 to 18 within Acorn formula year olds. Scope with GGCHB for Centre and provision for Clyde Services. Patient waiting Additional Consultant and CPN x2. area to create additional clinical capacity

15 LAAC Nurse Post to provide 2007/08 £35k £35k £35k £35k £35k comprehensive nursing service to (year 1) LAAC in WDCHP including Residential units and Foster Care

16 Psychology Services as with SAMHS 2007/08 - £70k £70k £70k redesign: Identify resource to provide service in WDCHP with new appointment of consultant Psychologist. Appoint A Grade and clerical support for whole team.

17 Respite services for Children with 2007/08 - £95k £95k £30k Home is £95k Complex need. Currently provided where help is by CAN CARE Changing Services Yorkhill(yr 2) Fund. In Alexandria and Dumbarton. Include service within Clydebank

57

18 Redesign coterminous AHP and 2007/08 £60k £120k £120k £120k Special School Nursing Services. Resource shift Transfer Staff and resource from SW CHCP for South West and West CHCP to school nursing WDCHP for services delivering (West CHCP 80% within WDCHP. still scoping service to Clydebank). 19 Recruit Service Development 2007/2010 £40k £40k £40k 20k from current 20k Manager to support joint service joint post development with contractors and LA 20 Redesign and integrate Community 2007 £40k £40k £40k 24k from LCT 16k Older Peoples Team and Lomond Team Vacancy Care Team and recruit service manager 21 Invest in avoidance admission 2007/2008 £60k £60k £60k 20k from 40k particularly in out of hours and reorganisation of overnight nursing current services 22 Develop case management model to 2007/2008 £60k £60k £60k In addition to identify at risk older people and 30k from 30k their carers reorganisation of community nursing in Clydebank 23 Redesign and unify professional 2007 30k leadership in AHP services £45k £45k £45k Resource shift from transfer of £15k resources from hosting CHCP

24 Support Contractors to participate in 2007/2010 £40k £40k £40k clinical networks in Dentistry, £40k Pharmacy, Optometry, General Practice

25 Develop in partnership with the RAD 2007/2008 £30k £30k £30k services to support care homes to £30k manage patients at risk of admission: From the review of Nursing Homes Med Team (nk)

58 26 Develop training in Palliative Care 2007 £5k £5k £5k £5k 27 Introduce Carers Assessment 2007 £2k £2k £2k Training for CHP Staff £2k

28 Develop additional Clinical space at 2008 Adaptations to Clydebank Health Centre CHC to provide £200k additional Capital clinical space Formula 29 Provide additional IT equipment for 2007 community clinical staff £20k £20k

NOTE:-

1. Proposals are still not in priority order – to be agreed by the Senior Management Team 2. Some revenue cost’s are indicative at this stage and based on 2006/07 budgets 3. Start Dates to be confirm

59 Appendix 2 - Board Corporate Objectives

The following table outlines Greater Glasgow and Clyde NHS Board Corporate Clyde objectives and local actions to achieve them in West Dunbartonshire.

Board Corporate Actions Objectives Improving Services Reduce Barriers Develop networks which will improve access to primary eye Between Primary and care services using community optometrists, shared care Secondary care protocols for long term eyes conditions to ensure rapid access to hospital Work with the Hospital Sector to improve the early diagnosis and treatment of bowel cancer Work with RAD, neighbouring CHPs the VOL to develop rehabilitation and assessment services Dev effective care co-ordination and care pathways Work with the PEG to agree service re-design programmes with colleagues in primary and secondary care

Reduce Delayed Develop the role of all professionals in anticipatory care Discharges Develop case management role Roll out single shared assessment Develop CPT and LCT as a single structure Carry out analysis of repeat admissions Agree joint planning model with Acute Divs and RAD

Implement final Co-location of health and social work staff Dumbarton joint phase of mental Hospital health strategy Develop 24/7 service that treats people at point of least restriction Establish assertive outreach approach for CMHTs Establish Primary care mental health Services across WD Co-locate Health and social work staff throughout Create a new management structure to support the implementation and development of an integrated LD service Increase access to clinical psychology services by increasing capacity Explore transitional issues for adolescents moving on to Adult LD services Develop plans for Continue to deliver multi-disc care to people with type 2 chronic disease diabetes in primary care linked to GMS Work with CHD MCNS to develop services and work to dev exercise referral, weight management and smoking cessation Work with heart Failure teams to deliver local services Pilot a COPD scheme in the community Dev links with smoking cessation and community pharmacies

Improve Stroke Develop services in support of specialist stroke units in Services and hospital sector and management of patients in the community. Prevention Work with PDTs and OPTs. review joint provision of OT services across WD

60 Improve cancer Work with hosp sector to improve early diagnosis and services and treatment of bowel cancer prevention Integrate health improvement with service delivery and planning

Acquired Brain injury Ensure awareness of ABI services through CHP service Dir Cont to develop specialist assessment tool Work with RAD/ABI Strategy grp to dev efficient carepathways with Specialist services and CPDs.

Sensory impairment Develop a local optometry Network Provide info to public on role of Community Optometrists in providing primary care eyecare services Pilot a partnership with the acute sector to deliver primary eyecare services, shared care and care pathways for anterior eye disease and some chronic conditions Support optometry with additional training Work with the LA SI Strategy group to dev a network providing early access to social care services, the Vol Sector and social care networks and to the Low Visions Aid Service

Reduce health inequalities Deliver OHAP and Continue to support and develop Smile 2 programme increase number Develop and support the P1&2 oral health toothbrushing of 5yr olds without programme dental disease Develop a framework Ensure defined health improvement objective are incorporated of priorities for in work programmes of all practitioner staff tackling health inequalities Develop a Provide leadership for the Health Improvement Strategy programme of action group to become a key driver for change and to develop a greater focus for local evidence –based practice

Develop a framework Participate in local Community Planning Equalities group to meet legislative requirements and monitor compliance Ensure compliance Collaborate with East Dunbartonshire CHP OD and HR to with legislative identify key elements of Action Plan standards Raise awareness of SES amongst existing staff develop induction programme for new staff

Develop and Continue to support peer approaches to breastfeeding e.g. implement plan to Healthy Haldane and Breaststart reduce inequalities Continue to support the Breastfeeding Friendly Nursery among women and Initiative children Support the delivery and implementation of nutritional guideline training in pre-5 establishments in collaboration with our partners

61

Develop and Roll out staff Scottish Executive’s Domestic Abuse implement plan to Guidelines for Healthcare workers training across the CHP reduce inequalities Implement the recommendations from the Domestic Abuse among women and Prevalence Argyll and Clyde (DAP) children Support the implementation of West Dunbartonshire Domestic Abuse Education Pack

Contribute to the Explore the role of the CHP and wider NHS in relation to delivery and employability as a development of a Partner/investor/procurer comprehensive range Service provider of actions to improve Care Provider employability and Volunteering opportunity worklessness Portal Health Improver

Improving Health Status Establish corporate Utilise findings from the health needs assessment to inform health improvement local priorities framework and priorities Develop and See actions on Tobacco Control, Sexual Health, Alcohol, implement prog of Breastfeeding, Oral Health, and Services for Young People action to improve health status Reduce inequalities Utilise the findings of the health needs assessment to identify in CHD mortality specific local target groups e.g. women Link actions on tobacco control, problematic drinking behaviour and physical activity Deliver alcohol Collaborate with partners to deliver a comprehensive approach strategy and reduce to tackling binge drinking and problematic drinking excessive behaviour. To explore the evidence base in relation to specific consumption. Deliver groups e.g. young people Corporate action plan for drugs/alcohol Deliver Physical Work with partners to develop comprehensive approach to Activity Strategy sports development and physical activity for a wide range of abilities Identify priority areas for action Utilise the findings of the health needs assessment and health and well-being survey to target least active groups e.g. older people

Implement tobacco Pilot a model of smoking cessation which incorporates good strategy and practice from both areas to develop a consistent approach. reduction in smoking Work with partners to ensure a comprehensive approach to tobacco control Support development of specific services for vulnerable groups e.g. people suffering mental ill health Collaborate with Acute Sector to deliver more integrated services and develop joint approaches e.g. for pregnant women 62 Reduce suicide rate Explore with partners evidence –base around ‘What Works ‘ to reduce suicide rates

Dev plans to improve Disseminate and Consult on draft Quality of Life Strategy for health of older people Older People Work with partners and older people to identify priorities from draft strategy Develop action plan from identified priorities

Healthy food strategy Continue to support peer approaches to breastfeeding e.g. Healthy Haldane and Breaststart Continue to support the Breastfeeding Friendly Nursery Initiative Support the delivery and implementation of nutritional guideline training in pre-5 establishments in collaboration with our partners

Implement sexual Initiate and lead comprehensive review of youth health service health action plan and provision to inform development of equitable service which dev strategy for meets the needs of local young people reducing teenage Work with partners to roll out a comprehensive, accessible pregnancy range of services Based on the Sandyford Hub model Implement sexual health action plan and dev strategy for reducing teenage pregnancy Develop consistent approaches to condom distribution and emergency contraception access Support review of sexual health education & relationships education Contribute to delivery of ‘9months after’ programme Support the Speakeasy parent support programme on sexual health

Exercise Leadership and achieve positive organisational development Establish effective OD Group to develop Organisational and Development Plan. organisational CHP Development Day 20/3/07 leadership and developmental arrangements Implement revised CHP will develop a workforce plan to enable staff to develop individual skills of staff to adapt to change. performance and Ensure a process is in place to have a PDP for each member of development staff arrangements Develop and The CHP will continue to work in partnership with the LPF implement and ensure appropriate representation on the CHP Committee partnership arrangements Integrate Clyde Financial framework agreed SLAs under implementation responsibilities into NHS Glasgow

63 Improve engagement PPF meets regularly and is supported by the Public and involvement of Involvement officer. patients carers and Support the WD Carers Forum and ensure carers perspective is communities fed into the CHP structure Support the WDCVS as a mechanism to involve the voluntary sector in the CHP Support Community Planning structures and public involvement mechanisms such as the Citizens Forum, Youth For a etc

Implement staff governance standard for all staff through governance sub group and staff partnership forum Cont to ensure good communication structures in operation, including CHP web site, newsletter, staff development days, contribute to publications across the WD Partnership through the new Partnership wide Communications Group

Improve Systems and Processes Reduce staff sickness Maintain appropriate and up to date records absence Ensure implementation of attendance management policy within the CHP Ensure mechanisms are in place to support staff during periods of ill health in line with positive and supportive practices around staff governance implementation and Health Working Lives

Establish clear Support the development of an effective Clinical Governance management and system and structure processes and governance Ensure budget setting and budget control processes for the arrangements CHP are robust and potential cost pressures and service developments are identified and quantified

Effective NHS Ensure appropriate and active participation in WD community contribution to planning structures from the CHP at all levels Community Planning Contribute to the collective CP agenda in particular health improvement Ensure Health Improvement is prioritised as part of the Community Plan Support broader planning themes e.g. worklessness

Establish functional Ensure joint areas of work identified are taken forward and Performance monitored through local targets and Board corporate objectives Management Management Team to develop individual Personal (PM)arrangements: Development Plans (PDPs) Acute Work to embed a PM culture at all levels of the CHP Mental Health; CHP

64 Effective and clear corporate plan, policies and priorities Establish effective Financial framework developed budget setting processes Improve the NHS Fully support the collective integrated children’s services contribution to the through active participation in WD Joint Children’s Planning protection of Structures vulnerable children Implement the WD HMI Inspection of Child protection of Services Action Plan Implement the West of Scotland Family Health Assessment record Work with WDC to develop Integrated Assessment tool for children

Set and deliver Contribute towards implementation of AFC agenda for change Support assimilation of CHP staff to new pay bands requirements Deliver annual plans Joint areas of work agreed. Discussions ongoing with including joint RAD/ACUTE Directorates Acute/CHP Plans Develop proposals Review Clydebank Older People’s Team & Lomond Care for the integration of Team models of care with a view to re-design children's, older Develop effective interfaces with Acute/RAD Directorates people and disability Implement Children’s Services Action Plan services Develop equity of children’s services across WD including CAMHS, School Nursing, Allied Health Professionals, Child development and paediatric services Develop WD Physical Disability Strategy Improve interfaces between Specialist and community based services

65