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NHS Shetland Written Submission

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NHS Shetland Written Submission HS/S5/18/16/6 Evidence for the Scottish Parliament Health and Sport Committee 15 May 2018 Ralph Roberts Chief Executive NHS Shetland April 2018 Page 1 of 293 HS/S5/18/16/6 1 Context Community Planning and the Islands (Scotland) Bill As the Islands (Scotland) Bill says, “island communities face challenges around geographic remoteness, declining populations, transport and digital connections...”. The Government has stated a commitment to supporting the island communities and improving outcomes by creating the right conditions for growth. Specifically, we consider a strong health service in Shetland to be a pre-requisite of a thriving economy. A strong emergency care response, at the Gilbert Bain Hospital and through other emergency service providers, is essential to businesses being able to invest in, locate to and operate in these islands. It goes without saying that the 200 miles of sea between us and the mainland means that we must have skilled and competent people on the island to deal with any emergencies, as well as a providing a good level of general health care which enables people to feel safe to live in these islands. The concept of community planning is inherent in the way of life for islands. All elements of public, private and voluntary sectors work together, especially in emergency situations, to address issues. Natural connections exists between organisations and individuals which helps build resilience and a flexible approach to making things work at a local level. It is difficult therefore to see Health and Care services in isolation from other essential public services (such as transport, housing and education). Services are intrinsically linked and care needs to be taken not to consider the movement of one service in isolation of others, as inter-dependencies may not be immediately evident. The provision of relatively well paid professional health and care posts has a significant positive benefit on the islands economies. Health and care jobs are vital to the local economy and maintaining, and growing, the isles populations through a range of attractive jobs is an important consideration. In essence, every job counts as it has a disproportionately positive socio-economic impact. The more remote and rural the area, the more essential health and care jobs are to their continued existence and sustainable future. Evidence: Isles Factor Paper Submitted to North of Scotland Regional Plan development, 01 H&SC NHSS Isles Factors (page 11) Page 2 of 293 HS/S5/18/16/6 Collaboration through Regional Planning The Island Boards face challenges in being able to continue to provide safe and effective health and care services. Support to island boards from mainland boards is well established and an essential part of Health provision for our community. There is an opportunity to further strengthen these arrangements to help both sustain services at a local level and also ensure access to more specialist services that are not available locally. The island hospitals need a level of activity to maintain an adequate level of workforce and skills so that appropriate emergency services are available. The staff need a broader range of skills than in most other Health services and are often required to undertake both generalist and specialist tasks. The Regional Plan provides a commitment to treatment as close to patient’s home as it is possible and safe to do and this, alongside effective use of technology, will help to minimise the time which island patients spend travelling to/from treatment. There is an emphasis on the e’Health agenda, and the focus on technology being used as an enabler to avoid patients, and their families, having to travel unnecessarily for appointments or treatment and in providing appropriate specialist advice to staff across Shetland. This needs to be underpinned by robust infrastructure and we are already working across agencies in Shetland to make the case for further investment, where there is a gap in provision. Scenario Planning NHS Shetland, in keeping with Health services across the world, is reaching a ‘tipping point’ in our ability to continue to meet current and future demand and performance levels. Our ability to identify and implement savings and efficiency targets, while maintaining our current performance, has become increasingly challenging. This is compounded by the challenges in attracting staff to fill key posts. From a financial perspective, rather than continue to look for a percentage of savings and efficiencies from each Department, we recognise the need to see if we were investing in the right mix and balance of services overall. Page 3 of 293 HS/S5/18/16/6 We have therefore started a ‘Scenario planning’ process as a way to progress a structured conversation with staff and stakeholders about the future of Health & Care services in Shetland. The process is developing a small number of scenarios— or stories about how the future might unfold and how this might affect an issue, or issues, that confronts us. The work has been started in partnership with our staff, service users and other community planning partners. 2 Performance and progress of Shetland's Integrated Joint Board To provide evidence on the performance and progress of Shetland Islands Health and Social Care Partnership, the following reports are presented. Final Accounts 2016-17 (page 18) Evidence: 02 H&SC NHSS IJB Final Accounts 2016-17 1 a, b Annual Performance Report 2016-17 (page 55) Evidence: 02 H&SC NHSS IJB Annual Performance Reports 2016-17 2 a,b Sample Quarterly Performance Reports, March 2018 (page 86) Evidence: 02 H&SC NHSS Sample Quarterly Performance Reports, March 2018 3 a,b Page 4 of 293 HS/S5/18/16/6 3 The most recent Annual Review self-assessment and feedback letter from the Cabinet Secretary or relevant Minister - At a Glance LDP Standards 2016-17 - At a Glance Outcomes 2016-17 - Update from 2015-16 Action Points - Everyone Has the Best Start in Life 2016-17 - Safe Healthcare 2016-17 - Everyone has a positive experience of healthcare 2016-17 - Available Resources 2016-17 - Staff Supported and Engaged 2016-17 - People able to live well at home or in the community 2016-17 - Area Clinical Forum Report 2016-17 - Area Partnership Forum Report 2016-17 - Annual Review Letter 2016-17 Evidence: as above tagged in bundle as ‘03’ (page 108) The key issues highlighted by the Minister for NHS Shetland’s Annual Review 2016-17 are as below. Main Action Points: - Continue to review, update and maintain robust arrangements for controlling Healthcare Associated Infection, with particular emphasis on C.Diff and SABs. - Continue to deliver on its key responsibilities in terms of clinical governance, risk management, quality of care and patient safety. - Keep the Health and Social Care Directorates informed on progress towards sustainable achievement of access performance standards. - As a minimum achieve the same elective waiting time performance at the 31 March 2018 as the Health Board delivered at the 31 March this year. Page 5 of 293 HS/S5/18/16/6 - Continue to keep the Health and Social Care Directorates informed of progress in implementing the local efficiency savings programme and plans in place to meet financial targets. - Continue to work with planning partners on the critical health and social integration agenda and the ky objective to significantly reduce delay in general and particularly patients experiencing delayed discharge. - Continue to make progress against the staff sickness absence standard. - Keep the Health Directorates informed of progress with redesigning local services. 4 Progress in delivery of your LDP Progress in delivery of the Board’s performance is captured in regular reports to the Board. Evidence: LDP 2017-18 (page 148) Evidence: 04 NHSS LDP LDP Feedback Letter (page 218) Evidence: 04 NHSS LDP Feedback Letter 2017-18 Page 6 of 293 HS/S5/18/16/6 5 NHS Shetland Performance Reports. NHS Shetland recently approved an updated planning and performance Annual Cycle, attached at Appendix 1. - Sample Quality performance report - Sample Healthcare Infection performance reports - Sample Performance reports Evidence: Sample Quality Assurance, Cover and Report, April 2018 (page 229) Evidence: 05 1 a,b,c,d NHSS Quality Assurance Sample Cover, Report & Data Appendices April 2018 Sample Healthcare Infection, Cover and Report, April 2018 (page 256) Evidence: 05 2 a,b NHSS HAI Assurance Sample Cover and HAIRT Template Report April 2018 Sample Performance, Cover and Data Report, February 2018 (page 269) Evidence: 05 3 a,b, NHSS Performance Cover and Data Report February 2018 Page 7 of 293 HS/S5/18/16/6 Evidence Register Section Evidence Reference Page 0 Evidence Pack Evidence Pack and Register 0 Evidence Pack 1 Context Islands Factors for Regional Planning 01 H&SC NHSS Isles Factors 11 2 Integration Joint Final Accounts 2016-17, Covering Report 02 1 a H&SC NHSS IJB Final Accounts 2016-17 18 Board Final Accounts 2016-17, Accounts 02 1 b H&SC NHSS IJB Final Accounts 2016-17 23 Annual Performance Report 2016-17 Covering 02 2 a H&SC NHSS IJB Annual Performance Report 2016-17 55 Report Annual Performance Report 2016-17 02 2 b H&SC NHSS IJB Annual Performance Report 2016-17 64 Quarterly Performance Report to March 2018 02 3 a H&SC NHSS Sample Quarterly Performance Reports, 86 March 2018 Quarterly Performance Report for Year to March 02 3 b H&SC NHSS IJB Annual Performance Report 2016- 98 2017: Complaints 17 Complaints 3 Annual Review At a Glance LDP Standards 2016-17 03 At a Glance LDP Standards 2016-17 108 At
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