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Self Assessment of Risk Factors for TB ANNUAL REVIEW 2007/08 SELF-ASSESSMENT JULY 2008 ` ` NHS LOTHIAN ANNUAL REVIEW 2007/08 Agenda 1: Executive summary 1.1 2007/08 highlights 2: Progress on 2006/07 Annual Review Action Points 2.1 Phasing out Availability Status Codes (ASC) 2.2 Waiting times 2.3 Financial performance 2.4 Management of three acute hospitals 2.5 Rezoning medical admissions 2.6 Extended opening times for primary care services 2.7 Edinburgh BioQuarter 2.8 Royal Hospital for Sick Children Business Case 3: Improving health and reducing inequalities 3.1 Increasing healthy life expectancy in Lothian 3.2 Drugs, alcohol and tobacco 3.3 Coronary Heart Disease (CHD) and Stroke 3.4 Sexual Health and HPV vaccination programme 3.5 Improving health for children and young people 3.6 Immunisation programmes 3.7 Screening programmes 3.8 Health Impact Assessment 3.9 Keep Well Project 3.10 Community planning 3.11 Working with other organisations 4: Shifting the balance of care towards primary and community care 4.1 Primary Care Modernisation Strategy 4.2 Mental health services 4.3 Management of long term conditions 4.4 Pharmacy 4.5 Prescribing 4.6 Optical and Dental Services 4.7 CHP/CHCP development 4.8 Anticipatory care ` 5: Access to services 5.1 Waiting times and progress towards 18 weeks referral to treatment 5.2 Diagnostic waits 5.3 Cancer waits 5.4 A&E waits 5.5 Access to primary care 5.6 Access to NHS dental services 5.7 Delayed discharges 6: Service change and redesign 6.1 Sites and services vision 6.2 ICIC 6.3 Lean in Lothian 6.4 Patient Focus and Public Involvement 6.5 Carer’s Information Strategy 7: Improving treatment for patients 7.1 Enabling and supporting patients to be partners in their care 7.2 Making healthcare safer 7.3 HAI and Infection Control 7.4 Modernising services through better use of technology 7.5 Spreading best practice 8: Finance, efficiency and workforce 8.1 Financial performance and planning 8.2 Efficiency savings and efficient Government targets 8.3 Workforce issues and workforce planning 8.4 Aligning workforce, financial and delivery plans 9: Local service issues 9.1 St John’s campus visioning 9.2 MMC repatriation of funding from NES 9.3 Capital support for Lothian large schemes Agenda Item 1: Executive Summary 1.1 2007/08 Highlights ` ` NHS Lothian Annual Review 2008 Agenda Item 1 1: Executive Summary Key Points • NHS Lothian has continues to provide high quality services and care to the 809,764 people who live in Lothian and many more in the South East of Scotland • Although we are working hard to meet – and exceed – targets, we are committed to continual improvement and modernisation to achieve the levels of Scotland and the world’s best • We can show improvements in key clinical areas, such as cardiac services and care for people with long-term conditions • We are making more use of new technology to improve our patients’ experience of healthcare and at the same time are striving to make care more patient-centred • We remain committed to health improvement and tackling health inequalities and are, for example, targeting stop smoking services in deprived areas • We continue to work across boundaries – organisational and geographic – to provide high quality care and make the best use of resources Below are some stand-out examples of our achievements 1.1 2007/08 highlights Immunisation programmes Primary immunisation rates remain very high at over 98%, exceeding the Scottish Government target of 95%. Significant improvements have been made in Measles, Mumps and Rubella (MMR) uptake at 5 years. Three out of four CH(C)Ps now exceed the 95% target for MMR1 at 5 years. In 2007/8 flu vaccination uptake for over 65s is positive at 77%, above both the Scottish Government target and national average. Drugs alcohol and tobacco The Lothians and Edinburgh Abstinence Programme (LEAP) is a treatment and rehabilitation programme for clients wanting to achieve a substance free recovery. LEAP was launched in September 2007 and 22 patients have already graduated. The two-year pilot programme operates seven days a week and provides aftercare support as well as access to self-help groups. During the year we improved access to Stop Smoking services. We put additional support into the acute sector, targeting maternity services and we developed a pharmacy-based scheme. In the first quarter of 2008, 1,430 people were recorded as setting quit dates, up from 1,051 in the same period the previous year. 1 NHS Lothian Annual Review 2008 Agenda Item 1 Sexual health NHS Lothian’s Healthy Respect has continued to deliver a multi-faceted approach combining education, information and services. The HIV Comeback Tour campaign increased awareness of HIV and testing and demonstrates the strength of partnership working. The campaign won the award for best photography and the Gold Award in the Communications in Business (CiB) awards for 2007. Prescribing NHS Lothian continues its excellent track record in primary care with the lowest cost per patient per annum (£149) in Scotland. This means a saving to NHS Lothian of £28.1m compared to the Scottish average prescribing costs for 2007/08. In addition, the Lothian Joint Formulary (LJF) is recognised as one of the most highly developed formularies in Scotland, encouraging safe, effective and economical prescribing. Dental services More than three quarters (75.5 per cent) of children in Lothian were registered with an NHS dentist by the end of December 2007, notably above the Scottish average of 71.7 per cent. This was achieved by working closely with general dental practitioners. Waiting times and progress towards 18 weeks referral to treatment By the end of December 2007, NHS Lothian achieved all of the HEAT targets set by the Scottish Government for waiting times. No patients waited more than 18 weeks for inpatient, day case, or outpatient treatment. No cataract outpatients waited over 11 weeks and no inpatient / day cases waited over 7 weeks. Treatment was delivered for all patients in need of cardiac intervention within the required target timeframes. Finally, the target of a maximum 9 week wait for key diagnostic scopes and scans was met six months ahead of schedule and has continued to be maintained. Patient Administration Systems throughout Lothian have been upgraded to support New Ways. The model and level of training and awareness raising undertaken in NHS Lothian during the transition has been commended by ISD as a standard to be attained by other boards. NHS Lothian has also been selected as national partner board for the 18 weeks target from referral to treatment for routine patients, which is to be achieved by 2011. Cancer waits During 2007 NHS Lothian steadily improved compliance with the headline 62- day target. The combined total for all tumour groups increased from 80.4% in the first quarter of 2007, to 94.5% by the end of the year. Provisional data for the first quarter of 2008 shows an improvement to 95.6%. Delayed Discharges NHS Lothian, in partnership with local councils, has again met all its delayed discharge targets. The April 2008 census reported the best results since ISD begun collecting the data in 2000. Overall, 50 patient discharges were delayed in comparison to 89 for the previous year, and zero delays were 2 NHS Lothian Annual Review 2008 Agenda Item 1 reported in short stay and over six weeks categories. All members of the Lothian Partnership are committed to maintaining the zero standards for short stay and over six week delays and to maintaining the overall numbers of patients delayed, in line with the 2007/8 target figure. Lean in Lothian Lean in Lothian, in partnership with GE Healthcare, has used Lean methodologies to achieve substantial improvements in mental health, primary care, acute services and key support services. The project involves training staff to spot opportunities for change and gives them the power to make improvements in patient care. The 14 projects delivered in 2007/8 have had significant immediate impacts on staff and patient experience by improving efficiency, reliability, and greater equity of response. Better use of resources has led to reductions in the number of patients who don’t attend (DNAs), targeting of staff time to delivering direct care, reduced waiting times, and faster turnaround time for results. Examples include: • One-stop new patient clinic in place in the breast service, allowing most patients to get an outcome at first appointment • Breast service follow-up process has been redesigned, reducing patient visits to hospital and focusing clinical staff time where needed • 40% reduction in pathology laboratory turnaround times, and average 30% reduction in turnaround time for essential theatre instruments • Same day sorting, triage and appointing of outpatient referrals in gastro- intestinal and general surgery at RIE • increased therapeutic activities and staff skills development programme in acute mental health wards HAI and Infection Control Good progress has been made on the overall HEAT target. Since 2005 there has been a fall of 11.24 per cent in the number of Staphylococcus Aureus Bacteraemia episodes. This equates to a reduction in numbers from 498 in 2005-06 to 442 in 2007-08. Other areas of good work include average compliance of above 95% on national monitoring and audit requirements for cleaning services; more than 670 trained Cleanliness Champions, above the target of 461 set by NHS Education; reductions in infection rates for hip arthroplasty (0.78%) and caesarean section (2.9%) which are below the national averages (1.64% and 8.24% respectively). Financial performance and planning NHS Lothian delivered its financial targets in 2007/8 while also achieving early pay back of brokerage of £3m.
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