FORTH VALLEY NHS BOARD
A meeting of FORTH VALLEY NHS BOARD will be held on TUESDAY 24TH JANUARY 2012 at 9.30AM in the BOARDROOM, FORTH VALLEY NHS BOARD HEADQUARTERS, CARSEVIEW HOUSE, CASTLE BUSINESS PARK, STIRLING.
Please notify apologies for absence to Debbie Innes, Corporate Services Assistant, Tel 01786 457247 Email [email protected]
AGENDA
1/ APOLOGIES FOR ABSENCE
2/ MINUTE OF FORTH VALLEY NHS BOARD MEETING HELD ON For Approval 29 NOVEMBER 2011
3/ MATTERS ARISING
4/ FINANCIAL & PERFORMANCE ISSUES
4.1 NHS Board Executive Performance Report to end December 2011 For Noting (Paper presented by Professor Fiona Mackenzie, Chief Executive)
4.2 Finance Report for the period ended 31 December 2011 For Noting (Paper presented by Mrs Fiona Ramsay, Director of Finance & Planning)
4.3 Corporate Plan Mid Year Update For Noting (Paper presented by Mrs Fiona Ramsay, Director of Finance and Planning)
5/ NHS FORTH VALLEY INTEGRATED HEALTHCARE STRATEGY 2011-2014 For Approval (Paper presented by Professor Fiona Mackenzie, Chief Executive))
6/ REPORTS FROM SUB COMMITTEES
6.1 Minute of Area Clinical Forum meeting held on 17 November 2011 For Noting
6.2 Minute of Acute Services Committee meeting held on 22 December 2011 For Noting
6.3 Minute of Clackmannanshire and Stirling Community Health Partnership For Noting Board held on 13 December 2011
6.4 Minute of Staff Governance Committee meeting held on 13 December For Noting 2011
7/ NHS FORTH VALLEY ENVIRONMENT STRATEGY 2009- 2014 For Approval (Paper presented Mr David McPherson, General Manager – Forth Valley Facilities & Surgical Services)
8/ ANY OTHER COMPETENT BUSINESS
FORTH VALLEY NHS BOARD
DRAFT Minute of the Forth Valley NHS Board meeting held on Tuesday 29 November 2011 in the Forth Valley NHS Board Headquarters, Carseview House, Castle Business Park, Stirling.
Present: Mr Ian Mullen (Chairman) Mr Brendan Clark Dr Stuart Cumming Ms Margaret Duffy Councillor Scott Farmer Mr Charlie Forbes Ms Fiona Gavine Mr Tom Hart Mrs Helen Kelly Mr Jim King Professor Fiona Mackenzie Dr Vicki Nash Mrs Fiona Ramsay Dr Iain Wallace Professor Angela Wallace Dr Anne Maree Wallace
In Attendance Mr Tom Steele, Director of Strategic Projects and Property Mr Jonathan Procter, Director of Strategic Access & Capacity Planning Ms Elsbeth Campbell, Head of Communications Ms Kerry McGinley, Senior Performance Manager Mrs Florence King, Corporate Services Manager (minute) Mr David McPherson, General Manager, Forth Valley Facilities (Item 5) Dr Aileen Holliday, Health Effectiveness Co-ordinator (Item 8)
1/ APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of Dr Karen Facey, Councillor Janet Cadenhead and Councillor Linda Gow.
2/ MINUTE OF FORTH VALLEY NHS BOARD MEETING HELD ON 27 SEPTEMBER 2011
The minute of the Forth Valley NHS Board meeting held 27 September 2011 was approved.
3/ MATTERS ARISING
There were no matters arising for discussion.
4/ FINANCIAL & PERFORMANCE ISSUES
4.1 Executive Performance Report to end October 2011
The NHS Board considered a paper “Executive Performance Report to end October 2011”, presented by Professor Fiona Mackenzie, Chief Executive.
Professor Mackenzie highlighted the following, as detailed within the report:
1 Review of the Healthcare Strategy The Annual Review of NHS Forth Valley Transfer of responsibility of prison healthcare services Meeting of the Chief Executives of the three Local Authorities and NHS Forth Valley on 17 November 2011 to agree an approach in relation to joint working. Financial position and projections The NHSScotland Chief Executive Annual Report published in November 2011 First unannounced Health Environment Inspection (HEI) at Forth Valley Royal Hospital Winter Planning Arrangements New Arts projects across Forth Valley The Scottish Health Awards where six finalists from NHS Forth Valley were shortlisted for an award Investing in Volunteers Award, awarded to NHS Forth Valley volunteers Speech and Language therapists from NHS Forth Valley voted the best team in Scotland for the way they supported the national Giving Voice campaign The award of the Facilities Management Excellence in a Major Project Award to Serco and partners Forth Valley NHS Board and Forth Health for the innovative approach to facilities management at Forth Valley Royal Hospital Launch of a DVD entitled Moving Forth launched by television personality Sally Magnusson Industrial action across the public sector on Wednesday 30 November 2011
The NHS Board discussed in detail the following:
Meeting of local Chief Executives held on 17 November 2011 Hand hygiene and ongoing audit through Scottish Patient Safety In patient survey Delayed Discharges Accident and Emergency waiting times and public partner events Industrial action, possible revenue savings from this, timescale for staff pay deductions and what services would be disrupted/delivered on the day Change Fund Scottish Health Awards
There was also a considerable discussion about the issues involved in absence management within NHS Forth Valley. The matter had been raised by the Cabinet Secretary at the Annual Review, and, while there was no doubt that a strong managerial focus continued to be applied, it was clear that a fresh approach was required.
After detailed discussion, the NHS Board noted the Executive Performance Report to end October 2011.
4.2 Finance Report for the period ended 31 October 2011
The NHS Board considered a paper “Finance Report for the period ended 31 October 2011”, presented by Mrs Fiona Ramsay, Director of Finance and Planning.
Mrs Ramsay highlighted that the operational overspend in-month had reduced from an average £0.926m in the first three months to £0.409m for October 2011. The decrease confirmed that the position was on track to achieve the planned financial balance in-month for operational services by April 2012.
2 To date 47 staff had been approved for the Voluntary Severance Scheme at a cost of £2.560m and producing recurring savings of £1.863m.
Dialogue had been ongoing with Scottish Government representatives regarding the NHS Forth Valley financial position. including the particular issues faced during implementation of the Healthcare Strategy. Agreement had been reached as reported to the November meeting of the Performance and Resources Committee. This funding combined with ongoing savings delivery allowed confirmation that financial balance could be achieved. Repayment of this transitional funding was planned over a five year period using proceeds from the sale of assets. The repayment was incorporated into the 2012/2013 Five Year Financial Plan scheduled for NHS Board approval in March 2012.
Mrs Ramsay reported that a capital meeting with the Scottish Government Health Directorate (SGHD) was arranged for mid December 2011. Issues included for discussion were the projected costs for Community Hospital Plans, top slice for reversionary interest and projected property sales. Based on the current projections and proposed allocation adjustments a breakeven capital position was anticipated.
The NHS Board discussed cross boundary flow and associated risks, Primary Medical Services (PMS) and in particular Golden Hellos. Mrs Ramsay explained that this was a national programme which been in place for around 6/7 years and involved a one-off payment of £5,000 over which NHS Forth Valley had no control.
After discussion, the NHS Board:
Noted the revenue overspend of £4.884m to 31 October 2011 Noted that following conclusion of discussions with the SGHD and based on current risks and ongoing delivery of savings in-year financial balance was achievable Noted that detailed work ongoing to support savings programmes to cover underlying financial gap of £11.244m Noted that work to prepare savings plans to meet financial pressures anticipated in 2012/2013, was in progress Noted the balanced capital position projected, and that discussion with the SGHD was required.
4.3 Terms of Reference – NHS Forth Valley Pharmacy Practices Committee
The NHS Board considered a paper “Terms of Reference – NHS Forth Valley Pharmacy Practices Committee”, presented by Professor Fiona Mackenzie, Chief Executive.
Professor Mackenzie advised that the changes to the Terms of Reference of the Pharmacy Practices Committee resulted from the introduction of the National Health Service (Pharmaceutical Services) (Scotland) Amendment Regulations 2011, effective from 1 April 2011.
The NHS Board approved the Terms of Reference – NHS Forth Valley Pharmacy Practices Committee.
5/ NHS FORTH VALLEY WINTER CONTINGENCY PLAN 2011-2012
The NHS Board received a presentation and paper “NHS Forth Valley Winter Contingency Plan 2011-2012”, by Mr David McPherson, General Manager, Forth Valley Facilities and Mrs Elsbeth Campbell, Head of Communications.
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Mr McPherson and Mrs Campbell highlighted the following:
Methodology Year on Year development This year Forth Valley Royal Hospital Communications - ‘Be Ready for Winter’ launch - New winter website zone - Joint working with Local Authorities - Winter features local media - Follow up briefings - Social medial
Mr McPherson provided information on the background and origin of the plan. Two regional events had been held, one of which was held in June 2011 and reflected on the winter past and the lessons learned, giving an opportunity to help shape the National Guidance.
Capacity management continued to evolve with robust escalation plans being developed. Contingency plans with regard to pandemic flu and severe weather were now embedded within the plan.
Mr McPherson highlighted the lessons learned from the severe weather during the last winter and the Civil Contingency Tactical Group “Polar Storm” exercise undertaken recently. The small but significant fleet improvements put in place were a huge improvement from last year with NHS Forth Valley having a greater understanding of how to flex the use of the 4 x 4 vehicles available.
Mrs Campbell reported on the launch of the new winter website zone that linked to national resources. In respect of social media, NHS Forth Valley was making the best use of this, taking account of the lessons learned from last year.
The NHS Board discussed social media, Facebook and Twitter, the accuracy of predictive capacity planning and escalation plans. In response to a question with regard to who would use Digital Media, Mrs Campbell explained that digital media was being used in addition to existing means of communication.
After discussion, the NHS Board approved the NHS Forth Valley Winter Contingency Plan 2011- 2012 and thanked Mr McPherson and Mrs Campbell for their informative presentation.
6/ REPORTS FROM SUB COMMITTEES
6.1 Minute of Area Clinical Forum meeting held on 15 September 2011
The NHS Board noted the minute of the Area Clinical Forum meeting held on 15 September 2011.
6.2 Minute of Acute Services Committee meetings held on 25 August and 27 October 2011
The NHS Board considered the minute of the Acute Services Committee meetings held on 25 August 2011 and 27 October 2011.
4 Dr Nash highlighted the following:
The beneficial impact of the move to Forth Valley Royal Hospital New model of reporting and governance changes Finance and Performance Reporting Impact of double running costs and clinical change Reduction in Nurse Bank spend Phase 3 Move and the Clinical Model Patient Experience 2010 survey
The NHS Board noted the minute of the Acute Services Committee meetings held on 25 August 2011 and 27 October 2011.
6.3 Minute of Stirling Community Health Partnership Board held on 13 September 2011
The NHS Board considered the minute of the Stirling Community Health Partnership Board meeting held on 13 September 2011.
Mr Mullen highlighted the following:
Delayed Discharge Reshaping Care for Older People Discussion with regard to proposed Care Village planned for former Stirling Royal Infirmary site Primary and Community Services Development Plan/Health Improvement Priorities The role of Partnership Boards Land Transfer – premature statement in minute with regard to nil cost. This item to be discussed in further detail at future meeting First joint meeting of the Clackmannanshire/Stirling Clackmannanshire Partnership Board to take place in December 2011
The NHS Board noted the minute of the Stirling Community Health Partnership Board meeting held on 13 September 2011.
6.4 Minute of Falkirk Community Health Partnership Board held on 20 September 2011
The NHS Board considered the minute of the Falkirk Community Health Partnership Board meeting held on 20 September 2011.
Mr Mullen highlighted the following:
Budgets and future financial plans Delayed discharge and change fund Public Social Partnership – Older People Performance report and future focus Asset Management
The NHS Board noted the minute of the Falkirk Community Health Partnership Board meeting held on 20 September 2011.
5 6.5 Minute of Clackmannanshire Community Health Partnership Board held on 11 October 2011
The NHS Board considered the minute of the Clackmannanshire Community Health Partnership Board meeting held on 11 October 2011.
Mr Mullen highlighted the following:
Health Improvement Priorities Joint Management Team update – Performance report Way Forward – Clackmannanshire/Stirling Partnership Boards First joint meeting of Clackmannanshire/Stirling Partnership Board to take place in December 2011
The NHS Board noted the minute of the Clackmannanshire Community Health Partnership Board meeting held on 11 October 2011.
6.6. Minute of Clinical Governance Committee meeting held on 14 October 2011
The NHS Board considered the minute of the Clinical Governance Committee meeting held on 14 October 2011.
Mr Clark highlighted the following:
South East Scotland Local Supervising Authority Annual Report to the Nursing and Midwifery Council April 2010 – March 2011 Significant reduction in Staphylococcus Aureus Bacteraemia (SAB) NHS Forth Valley Complaints Performance Report
The NHS Board noted the minute of the Clinical Governance Committee meeting held on 14 October 2011.
6.7. Minute of Audit Committee meeting held on 21 October 2011
The NHS Board considered the minute of the Audit Committee meeting held on 21 October 2011.
Mr King highlighted the following:
New internal auditor – Mr David Archibald Follow up of Audit Scotland’s Improving Public Sector Purchasing National Report Review of Telehealth
The NHS Board noted the minute of the Audit Committee meeting held on 21 October 2011.
6.8. Minute of Endowment Committee meeting held on 21 October 2011
The NHS Board considered the minute of the Endowment Committee meeting held on 21 October 2011.
Mr King highlighted the following:
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Annual visit from Mr Russell Crichton and Mr Craig Baxter, Investment Advisors, Speirs and Jeffrey, Stockbrokers Review of expenditure policy – Charity Test WRVS gifting of funds Utilisation of Legacies
The NHS Board noted the minute of the Endowment Committee meeting held on 21 October 2011.
6.9 Minute of Staff Governance Committee meeting held on 16 September 2011
The NHS Board considered the minute of the Staff Governance Committee meeting held on 16 September 2011.
Mr Hart highlighted the following:
Health and Safety Update – Quarterly Report Workforce in Transition – TUPE transfer to Serco Organisational Development Framework and Priorities 2011-2013 Transfer of Prison Healthcare Services – Workforce Issues Attendance Management
The NHS Board noted the minute of the Staff Governance Committee meeting held on 16 September 2011.
7/ TAKING FORWARD THE EQUALITY AND DIVERSITY AGENDA IN NHS FORTH VALLEY
The NHS Board considered a paper “Taking Forward the Equality and Diversity Agenda in NHS Forth Valley” presented by Mrs Helen Kelly, Director of Human Resources.
Mrs Kelly reported on the Equality Act 2010 which included instruction for legal compliance for public sector organisations. This was a split between a General Duty and a set of Specific Duties. The content of the Specific Duties was subject to consultation by the Scottish Government. A draft response had been prepared by the Equality and Diversity Project Manager to the Scottish Government Consultation on the Equality Act Specific Duties, and this had been circulated to Board Members, General Managers and Service Leads for additional comments prior to submission on 25 November 2011.
Mrs Kelly reported that Dr Cumming had kindly volunteered to join the Fair for All Development Group. She reported on the summary of progress and achievements on the Equality and Diversity agenda put in place since the last report highlighting the following:
The Equality and Diversity Annual Report which was a national requirement and demonstrated openness and transparency Improving collection of diversity information Equality and Diversity e-Learning package Gender based violence Transgender and the research completed by Engender Lesbian Gay Bisexual and Transgender (LGBT) Youth Scotland
7 The NHS Board noted the paper Taking Forward the Equality and Diversity Agenda in NHS Forth Valley.
8/ LAUNCH OF THE REDESIGNED PUBLIC HEALTH SECTION OF THE NHS FORTH VALLEY PUBLIC WEBSITE
The NHS Board considered a paper “Launch of the Redesigned Public Health Section of the NHS Forth Valley Public Website” presented by Dr Anne Maree Wallace, Director of Public Health and Dr Aileen Holliday, Health Effectiveness Co-ordinator.
Dr Wallace presented a live demonstration of the new Public Health section of the NHS Forth Valley public internet website. Regular updates to the website would provide information on developments within Public Health, providing an alternative to the Director of Public Health’s Annual Report.
The website provided links to a range of documents produced within Forth Valley covering many aspects of Public Health, in addition to links to other websites containing key information and statistics on Scotland’s health such as the Information Services Division and the General Register of Scotland. From next year a greater focus on NHS Forth Valley statistics would be included.
Dr Wallace highlighted the following topics covered:
Alcohol Screening programmes Dental Health – childsmile programme Emergency Planning and Health Care (Business) Continuity Work Prevention of Health Care Associated Infection (HAI) Obesity
NHS Forth Valley was currently making improvements to the software supporting its website. This was a major piece of work and would take place between November 2011 and January 2012. The full potential of the new website would be realised in early 2012.
In response to a question of the number of visits or “hits” to the new public health section of the website, Mrs Campbell advised that she would be able to provide a set of figures for the Board.
The NHS Board noted the paper Launch of the Redesigned Public Health Section of the NHS Forth Valley Public Website and thanked Dr Wallace and Dr Holliday for the informative presentation.
9/ ANY OTHER COMPETENT BUSINESS
There being no other competent business the Chairman closed the meeting at 12.45 p.m.
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NHS Forth Valley Board Executive Performance Report December 2011
1 Contents Page
Purpose of report 3
Chief Executive’s Summary 3
Performance Summary 6
Corporate Risks 10
Recommendation 12
Appendix 1 - Communications Update 13
Appendix 2 - Healthcare Associated Infection Reporting 16 Template
Appendix 3 - Performance Dashboard & trend information Attached
2 1. PURPOSE OF REPORT
The purpose of the Board Executive Performance Report (BEPR) is to provide assurance to the NHS Board of the overall performance of NHS Forth Valley against aims relating to the continued development of the Quality Improvement agenda, which includes national Health, Efficiency, Access and Treatment (HEAT) targets, local priorities and significant risks.
2. CHIEF EXECUTIVE’S SUMMARY
2011 has been a challenging year however we have achieved a great deal thanks to the hard work and sustained efforts of staff across the organisation.
Internal site reconfiguration is underway at both Falkirk and Stirling Community Hospital sites and key service moves will be completed by the summer of 2012 in line with the commitments set out in the Integrated Healthcare Strategy. Services transferred successfully from Bonnybridge Hospital to Falkirk Community Hospital at the end of last year and the site has now been declared surplus to requirements. Demolition of the older parts of Falkirk Community Hospital is underway and the few remaining services still to transfer to Falkirk Community Hospital, including the Ophthalmology service from Stirling Community Hospital and the Park Medical Practice from Falkirk town will do so in the next few months. At Stirling Community Hospital the Minor Injuries Unit will be re-locating to the ground floor of the former Maternity Unit on 26/27 January 2012. The Queen Elizabeth Wing will then be completely vacated to enable demolition preparations to be carried out. Demolition is expected to begin in February 2012. A comprehensive Communications Plan supports the programme of changes taking place.
Board Members will recall the widespread industrial action that took place on 30 November 2011. Management and staff side representatives co-operated to ensure the impact was kept to a minimum. As a result, all essential and urgent services continued to be provided but a number of non urgent and routine appointments were re-arranged.
Severe weather conditions on the 8 December put our Winter Contingency Plans to the test and some disruption occurred to non urgent and day hospital services. There was no disruption to services as a result of further bad weather on the 3 January 2012 as normal public holiday arrangements were in place and services were operating on a reduced basis. On both dates co- operation across the Forth Valley area was co-ordinated through the usual emergency processes. I wish to record my appreciation to staff who made sure that disruption was kept to a minimum.
The final Annual Review letter has been received following the Annual Review of Performance which took place on 7 November 2011. A number of Action Points have been detailed focusing on the Quality Strategy, Healthcare Associated Infection / Healthcare Environment Inspections, HEAT targets and the financial position. The letter will be circulated to Board members and is published routinely as part of the Annual Report.
3 The review of governance and management arrangements is reaching its final stages and is being considered at a Special Performance and Resources Committee on 17 January 2012. The Board will have an opportunity to review the detail of these arrangements in March 2012.
In December the Deputy First Minister and Cabinet Secretary for Health Wellbeing and Cities Strategy set out the Government’s plans to integrate adult health and social care. Legislation will be introduced, following consultation, which will herald a radical reform of Community Health Partnerships. These will be replaced by Health and Social Care Partnerships responsible for delivery against nationally agreed outcomes.
As previously reported NHS Forth Valley has now established a Joint Executive Group which includes all three local authority partner agencies. The focus of this group is to strengthen the role of Partnership Boards and support delivery of jointly agreed outcomes. The first formal meeting will take place on 30 January 2012.
The operational overspend to the end of December is £5.563m with an in- month overspend of £ 0.311m. The in-month operational overspend continues to reduce and based on the current trend which is broadly in line with anticipated reduction the target of achieving operational in-month balance by April 2012 will be achieved. It is important that savings delivery continues to be pursued to ensure delivery of in-month financial balance. Discussions with SGHD have concluded and agreement reached about a package of support in 2011/12 to be repaid over a five year period through the proceeds from property transactions. This allows confirmation based on current trend and risks that financial balance will be achieved this year.
Work on further cash savings is split into two categories as follows:-
Savings to meet the underlying financial gap of £11.244m – plans have been prepared and an initial risk assessment completed. Detailed planning is now in progress and every effort is being made to ensure these savings are delivered as quickly as possible
Savings requirements for 2012/13 and beyond have been identified and the October Meeting of the Performance Management Group (PMG) focussed solely on this topic. A range of ideas were generated and these are currently being assessed for deliverability including timeframes.
An initial draft of the Financial Plan 2012/13 to 2016/17 will be considered at the January Performance and Resources Committee
On 25 January 2012, NHS Forth Valley will be hosting a delegation, led by Mantoan Domenico, Regional Health Secretary, from the Veneto region of Italy as part of a programmed visit to Scotland. As well as discussing the Scottish and local healthcare system, including the integration agenda, delegates will receive a tour of Forth Valley Royal Hospital.
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As a consequence of a change in the political administration at Clackmannanshire Council, Councillor Janet Cadenhead has stood down from the NHS Forth Valley Board and a nomination has been received for her replacement. Approval is currently being sought from the Cabinet Secretary.
Key areas are highlighted in the following performance summary with further specific detail contained in appendix 3.
The current chair, Mr Ian Mullen OBE, DL reaches the end of his term of office on 29 February 2012 and arrangements are in place to seek a replacement. Since 2002 Mr Mullen has led the development and implementation of the Forth Valley Healthcare Strategy culminating in the Royal opening of Forth Valley Royal Hospital marking a significant milestone towards implementation of our Strategy. Mr Mullen has had a long and distinguished career in Forth Valley and elsewhere in the Scottish health service, the extent of which is unprecedented. On behalf of the Board I wish to convey my deepest thanks and appreciation for the leadership and support he has given over the years.
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Performance Summary
NHS Forth Valley continues to deliver strong performance overall. Key highlights are noted below with the supporting appendix 3 showing trend information against developing quality measures which include all Key and several Standard HEAT targets.
3. HEALTH - Modernising Services
Integrated Healthcare Strategy Work continues to oversee progress with the implementation of the Strategy in respect of Falkirk and Stirling Community Hospitals and other accommodation moves across Forth Valley.
The Integrated Healthcare Strategy has been reviewed and is being presented to the NHS Forth Valley Board in January 2012 for approval.
4. EFFICIENCY - Ensuring Effective Use of Resources
HEAT Key Measure Efficiency - Absences Absence management continues to provide challenges for NHS Forth Valley with a target of 4% by March 2009 unmet. Management focus continues. The November position of 5.56% is an increase of 0.27% against the October 5.29% position and remains above the trajectory. The year to date rolling average is 5.35%. The overall Board position is aggregated from Acute 5.18%, CHP 6.82%, Corporate 4.24%, and Forth Valley Facilities (FVF) 5.65%. The newly formed Allied Health Profession Care Groups, which no longer sit within Stirling CHP, are currently being reported separately under the heading ‘AHP Delivery Unit in accordance with Financial reporting. Acute and FVF showed decreased absence in month; Acute (-0.24%), Forth Valley Facilities (-0.22%). CHPs and Corporate showed increased absence; CHPs (0.82%), Corporate (1.33%).
5. ACCESS - Modernising Services
HEAT Key Measures Access - Inpatients, Outpatients, A&E, Diagnostics and Cancer
Inpatients At the end of December 2011 there were 90 patients waiting over 9 weeks. Taking into consideration the ‘day of action’ this number is at the low end of the estimated range.
6 Within orthopaedics the impact of an overall reduced level of activity over previous months coupled with a significant capacity requirement going forward puts pressure on the service over the next quarter. Plans are in place to address this however there is still a challenge within the more complex patient group. Consultant vacancies and long-term leave continue to have an impact on available specialist General Surgery capacity. The service continues to review additional capacity opportunities while plans developed to address the challenges are implemented.
Out-patients At the end of December 2011 there were 453 patients waiting over 12 weeks which taking account of the ‘day of action’ is at the lower end of the forecast but represents a decline in the overall position. Pressure remains on the Ophthalmology and Rheumatology services due to consultant vacancies and increased referrals. Work is on-going with General Managers to address the issues however on-going challenges remain. Gastroenterology services have been experiencing an increased level of demand over many months coupled with challenging workforce issues. Whilst there have been measures put in place to address the requirements on a short term basis there continues to be pressure on sustainability.
Cancer Monthly assessment (MMI) New 62 day target - In November 2011, 95.7% of eligible patients were treated within 62 days of referral. This is in line with target. New 31 day target - In November 2011, 95.1% of eligible patients were treated within 31 days of diagnosis which is in line with target.
Quarterly assessment - published statistics In the period July 2011 to September 2011, 95.9% of patients, including screening patients, were treated within 62 days of referral. This is ahead of the 95% national target In the period July 2011 to September 2011, 95% of patients were treated within 31 Days of diagnosis which is in-line with the national target
8 Key Diagnostic Tests 18 patients waited over 6 weeks at the end of December 2011
4 Hour A&E Wait In December 2011, 93.7% of patients waited less than 4 hours between arrival at the A&E unit and admission, discharge or transfer. This remains below the national target of 98% by 4.3% and is a 3.8% reduction on the previous month. This is a 3% improvement against the December 2010 position.
7 Work with the Scottish Government reviewing emergency pathway has been carried out. This is expected to help provide some of the sustainable solutions going forward.
18 Week RTT Performance In November 2011 91.5% of patients were treated within 18 weeks. This remains ahead of the December 2011 target of 90%
Substance Misuse By March 2012, 90% of clients will wait no longer than 5 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery The end December position for Alcohol Misuse is 98.6% with the position in respect of Drug Misuse 98.2%, with the combined position 98.4% A combined trajectory in respect of the 90%, 3 week waiting time by March 2013 has been submitted to Scottish Government and agreed
Child and Adolescent Mental Health (CAMHS) By March 2011 no client will wait longer than 52 weeks from referral to treatment for specialist CAMHS Services - target achieved. This will be reduced to 39 weeks by March 2012 and 26 weeks by March 2013 The trajectory was submitted to Scottish Government in November 2011 At December 2011, no patients waited over 39 weeks from referral to treatment
Audiology By December 2011 no one will wait longer than 18 weeks from referral to treatment Following implementation of a detailed action plan designed to support achievement of the target, the December position is 97% of patients seen within timescale.
6. TREATMENT - Improving the Quality of Patient Care
Healthcare Environment Inspectorate Inspection (HEI) On September 20th 2011, Forth Valley Royal Hospital (FVRH) had its first unannounced inspection by the HEI Inspectorate. Overall, the report was positive and highlighted only 4 requirements and one recommendation. These have been addressed and are routinely monitored to ensure compliance.
Examples include: HEI-Type mock inspections: The Infection Control Manager and a representative from SERCO inspect two wards on a monthly basis using the inspection tools used by the HEI Inspectorate. The wards are chosen by the Chief Executive and are reported to her directly. Infection Control Compliance audits: These are performed on a monthly basis and are carried out by the Infection Control Support Officer and members of the Patient Panel. All clinical areas are audited across FVRH
8 and Community Hospitals. Reports are sent to the Charge Nurse, Service Manager and General Manager. A database has been developed to monitor compliances and non-compliances and the first quarterly report will be presented at the Area Prevention and Control of Infection Committee (APCIC) this month. Ward Visit Programme: A database has been developed to capture all issues highlighted during the Infection Control ward visits on a weekly basis. The data captured includes adherence to standard infection control procedures, use of isolation rooms, linen management, personal protective equipment (PPE), waste and sharps management. This allows for the rapid identification of training requirements to ward areas to help adherence to various infection control policies and procedures. Leading Better Care Audits: Audits performed by managers to give them assurance of compliance at ward level. Infection Control and environment checks for managers: Audits performed by ward staff including peer audit carried out on a monthly basis. All results are escalated through management lines and are overseen by the Area Prevention and Control of Infection Committee. Learnpro training database was implemented across NHSFV which will enable continual monitoring of staff attending mandatory training events. Health Protection Scotland will soon be implementing a National Infection Prevention Manual to all NHS Boards. This will be monitored locally and reported nationally for adherence. Contents of the manual include hand hygiene, linen management, waste disposal, PPE, Management of blood and body fluid. This will ensure a consistent approach across NHS Scotland.
Healthcare Associated Infection (HAI) HAI remains a priority in Forth Valley.
Heat Targets The number of staphylococcus aureus bacteraemia (SABs) for December 2011 was 8. New denominator and target for 2011/12 with a target of 0.26 or less per 1000 occupied bed days. The position for December 2011 is 0.4. The number of Clostridium Difficile Infections (CDI) in patients 65 years or over in October was 1. The rate of CDIs for patients 65 years or over was 0.2 per 1000 occupied bed days. Hand hygiene compliance was 98% for November 2011.
A&E Attendance This target continues to provide challenges for many Boards across Scotland with NHS Forth Valley activity fluctuating against the agreed trajectory points. In December there were 1613 A&E attendances per 100,000 population. This is 115 above the agreed trajectory of 1498 and a slight deterioration against the November position of 1574 with a trajectory of 1506.
9 NHS Forth Valley has action plans against the Scottish Government Health Department programme of Key Milestones established in support of target delivery.
Delayed Discharge There were 2 delays over six weeks recorded at the December 2011 census, all within the Falkirk area. There remain a number of delays under 6 weeks, 26 at the December census, that are causing capacity challenges within the system. Overall however there has been a steady improvement in the position. Activity continues in both health and Local Authorities to achieve census date targets and to consolidate and sustain the position. Health and Local Authority continue to work with families to support an appropriate move into care with interim placements where necessary. Weekly meetings and ‘man-marking’ of patients is used to support this activity. Due to a number of reasons there are limited vacancies across the care home sector adding to pressure within the system.
7. CORPORATE RISKS
Corporate Risks continue to be reviewed on a monthly basis by the Executive Performance Management Group (PMG). The Corporate Risk Register (CRR) has been transferred to the Safeguard system which offers a number of benefits in particular ‘real time’ information management. This allows risks to be reassessed as soon as the owner updates any actions. A substantial review of the CRR was carried out in November. In line with the Risk Register Guidance this will be carried out on a quarterly basis, with the next review expected in February 2012. Key risks are highlighted to the NHS Board through this Board Executive Performance Report. Significant risks are detailed below.
Finance Risk and Efficiency Savings Finance risk for 2011/12 is high as noted in the Executive Summary. All efforts are focussed on ensuring financial balance with specific actions detailed including voluntary severance scheme, management review and service by service reviews, however, given the current economic position this is proving extremely challenging.
Pandemic Flu Strategic planning ongoing to ensure it is in line with new national framework. Review of local plans for winter 11/12.
Failure to deliver service change to meet new care models across the Strategy The integrated approach to delivery continues to be the focus with links to workforce plans per work stream. Progress is reviewed routinely at the Healthcare Strategy Programme Board and also the Performance
10 Management Group (PMG). This coupled with ensuring an affordable model indicates this risk remains very high pre and post mitigation.
Workforce planning Work is on-going to deliver an affordable workforce plan in line with Financial Savings Plan and the Local Delivery Plan. The development and implementation of the workforce plans is an iterative process accordingly the time line for associated workforce changes requires to take into account key steps identified in the organisational change policy. This work is supported by a dedicated General Manager with various strands of work being brought together through the Workforce in Transition Group.
Inability to meet waiting time targets The financial position is impacting on ability to fund strategies to sustain waiting time performance, including access to capacity at the Golden Jubilee National Hospital. Contingency plans are in place for each specialty and progress is regularly reviewed at the Performance Management Group (PMG).
Delayed discharges To meet and sustain the delayed discharge zero position in partnership against the current financial pressure continues to pose challenges. A range of actions are in place to reduce delays for patient discharges including Joint Improvement Team working with local authority partners and health however the number of bed days lost is impacting on overall capacity.
Service Impact of Industrial Action The impact of industrial action on service delivery has been identified as a new corporate risk in the November 2011 review. Plans have been developed in partnership with staff side representatives in respect of service delivery on November 30th and for any further planned action.
11 8. RECOMMENDATION
The Board is asked to note: The key items of information detailed within the Chief Executive’s Summary of this report The main areas highlighted in the Performance Summary, noting the December 2011 position The Corporate Risks reported The Communications Update in Appendix 1 The Healthcare Associated Infection Reporting Template (HAIRT) in Appendix 2 The Performance Summary and trend information detailed in Appendix 3
Author of Paper Name Designation Beverley Finch Head of Corporate Services
Approved By Name Designation Fiona Mackenzie Chief Executive
January 2012
12 Appendix 1
Communications Update - October - December 2011
Executive Summary The last few months of 2011 was a busy period for the Communications Department as the team dealt with a number of high profile issues. Additionally a new communication plan was developed to support our winter plans and reinforce the importance of making use of local services. This included our first local launch of the national NHS ‘Be Ready for Winter’ campaign which provided advice on how to stay healthy during the winter months with information on how to access local services and the development of a new Winter Zone on the NHS Forth Valley website. Work was also undertaken to promote the services provided by local pharmacists during the festive period, reminding local people to make sure they have enough medication, raising awareness of the Forth Valley pharmacy opening times and ensuring that people know how to access emergency supplies
The team managed media coverage in relation to two cases of botulism that were linked to a family from the Forth Valley area (the first cases in Scotland in over 10 years) and the follow-up screening of staff and students at Forth Valley College for TB after two students tested positive for the condition. The team also dealt with the national public sector strike on 30 November and the impact of the severe weather at the beginning of December 2011.
A wide range of promotional events were organised in the run up to the festive period. This included a special visit from Santa to the Children’s Ward to distribute presents donated by local businesses. Forth Valley Royal Hospital also welcomed its first Christmas and New Year babies and the Communication Team worked closely with ward staff to publicise the first deliveries. These included two very special new arrivals from the same street in Tullibody which attracted widespread national and local interest.
Throughout the period, the Communication Team continued to proactively promote a wide range of service developments and initiatives. This included the launch of two new books charting the history of Falkirk District and Stirling Royal Infirmaries. We also launched new ‘virtual’ tours of the labour suite at Forth Valley Royal Hospital, which give pregnant women the chance to see inside one of the new en-suite delivery rooms.
Work continued to raise awareness of the Minor Injury Unit in Stirling. This included the installation of new high-profile signage and a series of promotional features and patient case studies in local media across Stirling and Clackmannanshire.
In December 2011, a new more modern, up-to-date content management system for the NHS Forth Valley website was successfully implemented. The system provides far more functionality as well as enabling us to post instant updates. Work is now underway to train nominated website authors across the organisation.
13 During the period, the Communications Department responded to more than 70 media and out-of-hours enquiries, a significant increase on the previous three month period. We also issued 27 proactive press releases and 64 media statements. A total of 93% of the coverage was either positive or neutral with only 7% negative, again an improvement on the last three month period. Throughout this same period, 15 staff briefs were issued. Further information and a detailed analysis of coverage is highlighted below.
FOI Requests The table below details the number of FOI requests received to date and highlights how many met or exceeded the 20 working day deadline.
Over 20 % Over 20 Month Requests Reviews Met % Met days days October 2011 39 0 35 89 4 11 November 2011 36 0 30 86 6 14 December 2011 21 0 9 2 Total
Forward Look One of the main priorities for the first quarter of 2012 is to raise awareness of the changes and service moves taking place at Falkirk and Stirling Community Hospitals during this period. These include the relocation of the Minor Injuries Unit (MIU) to the ground floor of the former maternity unit and the transfer of services from Bannockburn Hospital and Orchard House health centre to Stirling Community Hospital. This will enable The Queen Elizabeth Wing to be demolished, as planned. Ophthalmology services currently provided at Stirling Community Hospital and GP services from Park Street Medical Practice will also transfer across to Falkirk Community Hospital.
There is also an ongoing communications plan to promote a wide range of service developments and initiatives including the development of a new Maggie’s Centre for Forth Valley on the Forth Valley Royal Hospital site, the introduction of several new tele-health initiatives which are improving the lives of children with autism and young people with epilepsy, the introduction of eye screening for pre-school children across Forth Valley and the roll out of an interactive online health promotion resource for secondary school pupils.
14 Media Monitoring and Analysis
Positive 61% Proactive 79% Negative 7% Reactive 21% Neutral 32%
Stirling Observer 30% Falkirk Herald 22%
Coverage by Newspaper The Herald 5% Alloa Advertiser 11%
Central FM 2% The Sun 2%
Bo'ness Journal 1% Daily Record 4% STV News 2% BBC News 4% Daily Telegraph 1% Allan Water News/Herald 1% Building Bett er Healthcare 1% Mirror 2% Sky News 1% Scotsman 3% Daily Mail 1% Eventing Times 1% Belfast Telegraph 1% Telegraph 1% The Huffington Post 1% The Guardian 1% Glasgow south and eastwood extra 1% Stirling Council Newsletter 1%
Newsline 1% Sunday Post 2% Enquiries by Newspaper Consolidated PR 3% Daily Mail 8% Daily Record 3% Press Association 2% Daily Express 2% Big Partnership 2% The Sun 3% Mail on Sunday 3% Richard Simpson 2% General Release 7% Scotsman 2% Freelance 2% Stirling Observer 2% Falkirk Herald 24% Alloa Advertiser 2% BBC Radio Scotland 3% Central Scotland Press Agency 3% Central FM 7% STV News 2% Press Association 4% BBC Scotland 3% ITN 2% Sky News 2% The Herald 3% Enquiries by Subject Car parking and transport 6% Women and Children 3% Health Awards 3% Acute Care 4% Staff 9% Patient Records 2% Patient Meals 3% Hospital Woodland 3% Industrial Action 13% Waiting imtes 2% Botulism 25% Public Health 7% Disabled Badges 2% Knife Crime 2% FVRH 4% Mental Health 2% Annual Review 2% Pharmacy 2% Community Hospitals 2% Finance 2% Organ Donation 2%
15 Appendix 2
Healthcare Associated Infection Reporting Template (HAIRT) Section 1 – Board Wide Issues
This section of the HAIRT covers Board wide infection prevention and control activity and actions. For reports on individual hospitals, please refer to the ‘Healthcare Associated Infection Report Cards’ in Section 2.
A report card summarising Board-wide statistics can be found at the end of section 1
Key Healthcare Associated Infection Headlines for January 2012 Additions to the HAIRT
The SGHD has requested changes to the tables and charts in the HAIRT. The changes include: o Hand hygiene compliance charts replaced with a table o Cleaning compliance charts replaced with a table o NEW estates monitoring compliance table o NEW chart for the total number of SAB cases (MRSA and MSSA)
HEAT Targets
Clostridium difficile infections (CDI) remain stable across NHS Forth Valley and remains one of the lowest rates in Scotland.
Staphylococcus aureus bacteraemias (SABs) remain statistically stable across NHS Forth Valley. .
Norovirus
In December we had our first norovirus outbreak in one ward in Forth Valley Royal Hospital. Due to the number of single rooms available, all cases were isolated and as a result no beds were blocked maintaining normal service delivery.
Staphylococcus aureus (including MRSA)
Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at:
Staphylococcus aureus : http://www.nhsinform.co.uk/Health-Library/Articles/S/staphylococcal- infections/introduction
MRSA: http://www.nhsinform.co.uk/Health-Library/Articles/M/mrsa/introduction NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248
16 A new HEAT target has been set for 2012/13 that all Health Boards across Scotland achieve a SAB rate of 0.26 per 1000 AOBDs. Our rate between April 2010 and March 2011 was 0.44 per 1000 AOBDs.
Following epidemiological analysis of our data, we are now working with various stakeholders to look at areas such as wound management and the appropriate use of invasive devices to help further reduce our numbers.
Over the last 12 months, our average number of SAB cases is 7 per month. In December 2011, the number of patients with a SAB infection was 8. Only one case was hospital attributed.
Clostridium difficile
Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at: http://www.nhsinform.co.uk/Health-Library/Articles/C/clostridium-difficile/introduction NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/clostridiumdifficile.aspx?subjectid=79
A new HEAT target has been set for 2012/13 that all Health Boards across Scotland achieve a CDI rate of 0.39 per 1000 OCBDs. Our rate between April 2010 and March 2011 was 0.19 per 1000 OCBDs.
Over the last 12 months, we have managed to reduce the number of CDIs to an average of 3 per month. In December 2011 there was 1 case of CDI reported.
Hand Hygiene
Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: http://www.washyourhandsofthem.com/ NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at: http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx
This month, the HPS national audit report for September / October 2011 gave NHS Forth Valley top marks with 97% compliance with hand hygiene opportunities. Results for January / February hand hygiene audit will be available in the next publication of the HAI reporting template.
17 Cleaning and the Healthcare Environment
Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national cleanliness compliance monitoring can be found at: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: http://www.nhshealthquality.org/nhsqis/6710.140.1366.html
Outbreaks
During the months of November and December 2011 there was one outbreak of norovirus. No other outbreaks from any other pathogenic organism were reported. A weekly update from Health Protection Scotland can be found at: http:/www.hps.scot.nhs.uk.
Other HAI Related Activity Local Infection Control Team NHS FV has an Infection Control Team which: • Advises and trains staff in how to prevent infection and to ensure no transfer of infection occurs. • Develop infection control programmes, e.g. hand hygiene.
Scottish Patient Safety Programme A number of areas in the programme focus specifically on reducing healthcare associated infection in theatres, general wards and in critical care units and work is currently underway in pilot areas within Forth Valley Royal Hospital. The work of the SPSP is integrated with all of the other actions described in this report that are being taken forward in NHS Forth Valley to reduce HAI.
Three examples of the work to reduce healthcare associated infection are: - preventing ventilator associated pneumonia and catheter related blood stream infections in critical care and increasing hand hygiene in wards.
Public and Patient Involvement Forth Valley is fortunate to have a committed patient and public involvement through the Patient Public Forums in the 3 Community Health Partnerships and the Patient Public Panel who are actively engaged in improving healthcare services including preventing HAI and monitoring domestic services.
Patient Panel members are working collaboratively with the Infection Control team performing HAI monthly compliance audits across Forth Valley Royal Hospital and the community hospitals.
MRSA Screening Since January 2010 NHS Forth Valley has been successfully screening all elective admissions and specific emergency admissions for MRSA. This is a government initiative to help reduce the incidence of MRSA cross infection throughout NHS Scotland. Earlier this month Scottish Government published the Pathfinder Report detailing the findings of the three boards who piloted the MRSA screening programme prior to the rest of NHS Scotland. From this report, amendments to the screening rationale have been changed and patients will now be screened following a Clinical Risk Assessment (CRA).
18
Risk Management The risks around managing HAI are considered at every clinical level and included in Risk Registers held in departments. HAI also features in two different sections of the Corporate Risk Register (CRR). The CRR is reviewed every month to make sure all actions to manage any risks are being taken.
Primary care Primary care covers a wide area, and includes community hospitals, dental practices and GP practices across NHS Forth Valley. All too often, media attention is directed to the activity and progress within the acute hospitals eg Stirling Royal Infirmary and Forth Valley Royal Hospital. The Infection Control Team provides a full time 5 day service (out of hours covered by the Duty Microbiologist) to Primary care; the service includes advice, support and education and training by the Infection Control Nurses and Nurse Consultants. This service is crucial; reducing the incidence and number of patients with a HAI in Primary care, can help reduce the HAI incidence in the acute hospitals. For instance strict antimicrobial management in the community can reduce patients developing conditions such as C.difficile Infections (CDI) or even the potential development of multi resistant bacteria which could be subsequently introduced to the hospital environment.
19
NHS Forth Valley Total Staphylococcus aureus Bacteraemia Cases (all ages)
14
This report card details our Board wide performance for SABs (MRSA and MSSA), 12 CDI's, Hand Hygiene and Cleaning C ompliance. 10 8
Reports published by Health Protection Scotland detailing the national progress of 6 the SAB and CDI targets indicate that NHS Forth Valley rem ain statistically stable 4
and in line with the rest of Scotland. 2
0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Hand Hygiene Monitoring Compliance (%) 1087 61055107124 8 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 96 95 98 97 98 100 97 99 99 99 96 98 MRSA Bacteraemia Cases (all ages)
12
Cleaning Compliance (%) 10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 8 92 94 95 95 93 95 95 96 96 96 96 96 6
4
2 Estates Monitoring Compliance (%) 0 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 95 96 96 98 97 97 99 99 100 99 99 99
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 420320031211
Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)
8 12100 7 1080 6 8 5 60 4 6 3 40 4 2 220 1 0 00 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11Jan-11 Feb-11 Feb-11 Mar-11 Mar-11 Apr-11 Apr-11 May-11 May-11 Jun-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Oct-11 Nov-11 Nov-11 Dec-11 Dec-11
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 13 7 2 44 5 11 3 3 1 6 6 73 8 5 57 61037
20
Quarterly rolling year Clostridium difficile Infection Cases per 1000 total occupied bed days for HEAT Target Measurement
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0 Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oc t 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 S ept 12 Dec 12 Mar 13
Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance 0.20 0.17 0.15 Target 0.39 0.39 0.39 0.39 0.39 0.39 0.39 0.39 0.39
Quarterly rolling year Staphylococcus aureus Bacteraemia Rates per 1000 Acute Occupied Bed Days for HEAT Target Measurement
0.5 0.45 0.4 0.35 0.3 0.25 0.2 0.15 0.1 0.05 0 Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oc t 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13
Apr 10 - Jul 10 - Oct 10 - Jan 11 - Apr 11 - Jul 11 - Oct 11 - Jan 12 - Apr 12 - Mar 11 Jun 11 Sept 11 Dec 11 Mar 12 Jun 12 Sept 12 Dec 12 Mar 13 Actual Performance 0.44 0.41 0.45 Target 0.26 0.26 0.26 0.26 0.26 0.26 0.26 0.26 0.26
21
Healthcare Associated Infection Reporting Template (HAIRT) Section 2 – Healthcare Associated Infection Report Cards The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals which do not have individual cards, and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics.
Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). Data are presented as both a graph and a table giving case numbers. More information on these organisms can be found on the NHS24 website:
Clostridium difficile : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139§ionID=1 Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346 MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252§ionID=1 For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card. Understanding the Report Cards – Hand Hygiene Compliance Good hand hygiene is crucial for infection prevention and control. More information can be found from the Health Protection Scotland’s national hand hygiene campaign website: http://www.washyourhandsofthem.com/ Hospitals carry out regular audits of how well their staff are complying with hand hygiene. The first page of each hospital report card presents the percentage of hand hygiene compliance for all staff in both graph and table form.
Understanding the Report Cards – Cleaning Compliance
Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ The first page of each hospital Report Card gives the hospitals cleaning compliance percentage in both graph and table form.
Understanding the Report Cards – ‘Out of Hospital Infections’ Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and sources not related to healthcare. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital.
22
Forth Valley Royal Hospital Total Staphylococcus aureus Bacteraemia Cases (all ages)
5
4
This report card details the SAB (MRSA & MSSA), C DI, Hand Hygiene and 3
Cleaning Com pliance for Forth Valley Royal Hospital. 2
1
0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Hand Hygiene Monitoring Compliance (%) 110000121102 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 97 95 99 97 98 100 97 98 97 98 96 98 M RSA Bacteraemia Cases (all ages)
5
Cleaning C ompliance (%) 4 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 3 94 93 96 97 95 95 94 96 95 96 96 96 2
1 Estates Monitoring Compliance (%) 0 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 99 100 100 99 100 99 100 99
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 100000000000
Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)
5 1005
4 480
3 360
2 240
1 120
0 0 0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11Jan-11 Feb-11 Feb-11 Mar-11 Mar-11 Apr-11 Apr-11 May-11 May-11 Jun-11 Jun-11 Jul-11 Aug-11 Aug-11 Sep-11 Oct-11 Oct-11 Nov-11 Nov-11 Dec-11 Dec-11
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov -11 Dec- 11 022000100111 010000121102
23
Community Hospitals Total Staphylococcus aureus Bacteraemia Cases (all ages)
1 0.9 0.8 This report card includes SABs and C DIs acquired in our com munity hospitals. 0.7 The hospitals include Stirling Com m unity Hospital, Falkirk C omm unity Hospital, 0.6 0.5 Bonnybridge Hospital, Bo'ness Hospital, Bellsdyke Hospital, Clackmannan 0.4 Hospital, Bannockburn Hospital and Lochview. 0.3 0.2 0.1 0 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11
Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 000000000000
M RSA Bacteraemia Cases (all ages)
1 0.9 Cleaning C ompliance (%) 0.8 0.7 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 0.6 92 94 95 95 92 95 95 96 96 95 95 95 0.5 0.4 0.3 0.2 Estates Monitoring Compliance (%) 0.1 0 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 92 97 97 99 97 98 98 98 99 98 98 99
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 000000000000
Clostridium difficile Cases (ages 15 and over) MSSA Bacteraemia Cases (all ages)
5 1001 0.9 4 0.880 0.7 3 0.660 0.5 2 0.440 0.3 1 0.220 0.1 0 00 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11Jan-11 Feb-11 Feb-11 Mar-11 Mar-11 Apr-11 Apr-11 May-11 Jun-11 Jul-11 Jul-11 Aug-11 Aug-11 Sep-11 Sep-11 Oct-11 Oct-11 Nov-11 Nov-11 Dec-11 Dec-11
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 001000000000 000000000000
24
O u t of Ho sp ital Infectio ns C lo s trid iu m d ifficile Infection Cases
10
9
8
7
6
5 This report card details all SAB and CDIs that were not acquired during their stay at hospital. 4
3
2
1
0 Jan-11 F eb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 O ct-11 Nov-11 Dec-11
Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 O ct-11 Nov-11 Dec-11 103144311220
M SSA Bacteraem ia Cases MRSA Bacteraem ia Cases
10 10
9 9
8 8
7 7
6 6
5 5
4 4
3 3
2 2
1 1
0 0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11 F eb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11
Jan-11 F eb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 O ct-1 1 N o v -1 1 D e c- 11 557174355935 100210031211
25 Appendix 3
Quality Improvement and Assurance A Strategic Balanced Scorecard for NHS Forth Valley has been developed with on-going work in respect of providing and building upon the qualitative and quantitative data which will enable and support improvement and assurance. The local focus is across the six dimensions of quality with a balanced approach to measurement. This is reflected in the on-going development of a strategic dashboard and the refocusing of the Board Executive Performance Report.
Format The following templates update the position against locally developed quality indicators and HEAT targets Progress symbols are noted as:
Improvement in period
Position maintained
Deterioration in period
Where trajectories have been agreed, this will be reported as red, amber or green
R Off trajectory >5% Minor deviation from A trajectory <5% G On track
The narrative will provide contextual information and support
1 NHS Forth Valley Strategic Balanced Scorecard Performance Dashboard December 2011
Equitable ImpRAG Efficient ImpRAG Timely ImpRAG
EQ1 a) E thn icit y record ing - pat ien ts A E1 Finance R T1 1 8 wee k Refe rral to Treatm en t G
b) E thn icit y record ing - staff A E2 Non Core Staff Costs A T2 a) Cancer 31 day target G
EQ2 Suicide rate G E3 Prescribing GG b) Cancer 62 day target
EQ3 Cardiovascular health checks G E4 Secondary Care Doctor's appraisalG T3 Access to drug treatment G
EQ4 Smoking cessation G E5 Average length of stay G T4 Access to child & adolescent mental health G
EQ5 A lcoho l b rief in terve ntion G E6 Bed occupancyG T5 % A&E waits <4 hours R
EQ6 Child Healthy W eight G E7 Inp atient ca ncellations A
EQ7 Fluoride varnish A E8 Same day surgery A Effective Imp RAG
EQ8 Breastfeeding rate R E9 Did Not Attends A V1 a) Antimicrobial use - Acute A
E10 Pre-operative stay GGb) Antimicrobial use - Primary care
Safe Imp RAG E11 a) Theatre efficiency - under run G V2 Em ergency bed days >75 years G
S1 Hospital standardised mortality rate GAb) Theatre efficiency - late start V3 Boarding G
S2 Adverse events A E12 Attendance management R V4 A&E attendance A
S3 Acute Assessment Unit Cardiac arrest calls G V5 a) Delayed discharge >6 weeks A
S4 Staphylococcus Aureus Bacteraemia A b) Delayed discharge <6 weeks A
S5 Clostridium Difficile G V6 Bed days lost due to delayed discharge A
S6 Hand hygiene G
Person Centred Imp RAG Improvement in period Off trajectory >5% R P1 Inpatient survey - care experience G Minor deviation from Position m aintained A trajectory <5% P2 Complaints R Deterioration in period On track G P3 Clinical quality indicators G
P4 Long Term Conditions G
P5 Patien ts adm itted to stroke unit G
2
Dimension of Quality:
EQUITABLE (EQ)
3 EQUITABLE: PERFORMANCE TRENDS
EQ1a: Ethnicity recording - % of patients where ethnicity EQ1b: Ethnicity recording - 95 % of staff to have their has been recorded ethnicity recorded Target: 100% Position: 53% @ Sept 2011 Target: 95% Position: 93.13% @ Sept 2011
Staff ethnicity - % known % Ethnicity Completeness in SMR & EDIS datasets 97.0% 70% 96.0% 60% 50% 95.0% 40% 94.0%
30% Acti vi ty
20% 93.0% 10 % 92.0% 0%
91.0% Dec-10 Mar-11 Jun-11 Sep-11 date
The above graph highlights that 53% of patients had The above graph shows that 93.13% of staff have ethnicity recorded at Sept 2011 ethnicity recorded which remains slightly below the The recording of ethnicity is not consistent across all 95% target the units with levels ranging between 35% and 95% This figure is updated on a quarterly basis with the December figure due for reporting at the end of January
EQ2: HEAT Target - reduce Suicide Rate between 2002 EQ3: HEAT Target - achieve agreed number of and 2013 by 20% Cardiovascular Health Checks during 2011/12 Target: 14 Position: 11.9 @ Dec 2010 Target: 1000 Position: 1033 @ September 2011
Suicide Rates per 100,000 Number Cardiovascular Health Population Checks 12 0 0 20 10 0 0
15 800 600 10 400 5 200
0 0
A ct ual Traject ory Actual Traject ory
The above graph shows that NHS Forth Valley is The year-end target for March 2011 was exceeded ahead of the target for December 2010 with 2538 checks carried out against a trajectory of The measure is as a rate per 100,000 population 998 The next update is due summer 2012 A target for 2011/12 has been agreed as 1,000 Cardiovascular Health checks to be carried out by March 2012 The above graph highlights that excellent progress continues in respect of this target with 1033 checks carried out against a trajectory of 500, exceeding the target end point.
4 EQUITABLE: PERFORMANCE TRENDS
EQ4: HEAT target - deliver smoking cessation services EQ5: HEAT Target - achieve agreed number of Alcohol to contribute to NHS Scotland target of 80,000 Brief Interventions during 2011/12 successful quits (at one month post quit) over the 3 year period ending March 2014 Target: 3002 Position: 531 @ Sept 2011 Target: 3676 Position: 4013 @ Sept 2011
Number of Successful Number of Alcohol Brief Smoking Quit Attempts Interventions 3500 4500 3000 4000 3500 2500 3000 2000 2500 150 0 2000 1000 150 0 10 0 0 500 500 0 0
A ct ual Traject o ry Actual Trajectory
A target for the 3 year period ending March 2014 A target of 3676 Alcohol Brief Interventions to be has been agreed as 3002 successful quits achieved by March 2012 has been agreed The above graph highlights a position of 531 in Sept The September position of 4013 interventions against a trajectory of 500 exceeds the trajectory of 1838 and the March 2012 Recent work includes the development of single target system referral between acute and community Work continues to progress well across a range of smoking cessation services settings which include areas that are not measured Enhanced recording and data gathering in place to as part of the target i.e. community pharmacies and maximise quit rates for Keep Well clients, through Keep Well pharmacies and GP practices EQ6: HEAT Target - achieve agreed completion rates EQ7: HEAT Target - 60% of 3 and 4 year olds in each for Child Healthy Weight interventions over the 3 year SIMD quintile to have twice year Fluoride Varnish period ending March 2014 Applications by March 2014 Target: 883 Position: 0 @ Sept 2011 Target: 60% Position: 0.76% @ June 2011 (in line with trajectory)
% 3 or 4 yr olds with at least 1 Number of Child Healthy Fluoride Varnish Application Weight Interventions 6.0% 900 800 5.0% 700 4.0% 600 500 3.0% 400 2.0% 300 200 1. 0 % 10 0 0.0% 0
FV Trajectory Activity Trajectory Scot land
NHS Forth Valley achieved 613 interventions Baseline data is 0.2% at December 2010 with an all against a target of 580 at March 2011 Scotland position of 0.2% A target for the 3 year period ending March 2014 Quarterly trajectory agreed for target period from has been agreed as 883 interventions June 2011 with NHS Forth Valley 4.24% behind the The above graph shows the trajectory for this period trajectory of 5% highlighting that the activity within Forth Valley is Scotland position for June is 1.28% against a plan of aligned to the school year and is expected in the 11.2% recording period to December 2011 as per agreed 2010/11 was a developmental year for this target trajectory with full year data expected end 2011
5 EQUITABLE: PERFORMANCE TRENDS
EQ8: Standard HEAT Target - increase Breast Feeding for 0-8wk old babies to 27.7% by March 2011 Target: 27.7% Position: 23.3% @ March 2011
% Breast Feeding at 6-8 30% weeks
25%
20%
15 %
10 %
FV Traject ory Scot land
The above graph shows that NHS Forth Valley is behind the target with 23.3% at March 2011 against a trajectory of 27.7% The Scotland position for March 2011 was 26.1% There are wide variations in rates across the area due to socio-economic factors. Each CHP group along with acute services is working with partners to ensure focus on areas of inequality e.g. healthy start
6 Dimension of Quality:
SAFE (S)
7 SAFE: PERFORMANCE TRENDS
S1: Scottish Patient Safety Programme - 15% reduction S2: Scottish Patient Safety Programme - 30% reduction in in Hospital Standardised Mortality Rate (HSMR) adverse events
Target: 15% Position: 0.99 @ quarter end June 2011 Target: 17.5 per thousand Position: 28.9 @ Oct 2011
Standardised Mortality Ratio (SMR) Regression line 2.0
1.5
1.0
0.5 Standardised Mortality Ratio Mortality Standardised
0.0 Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Oct- Apr- Dec Jun Dec Jun Dec Jun Dec Jun Dec Jun 2006 2007 2007 2008 2008 2009 2009 2010 2010p* 2011p HSMR with regression line Oct 2006 – June 2011 for NHS Forth Valley acute hospital sites. June data is Taking the NHS Forth Valley baseline of 25.4 a 30% provisional reduction in adverse events sets a target reduction to HSMR compares actual deaths with expected deaths 17.5 per thousand within 30 days of admission. It fluctuates over time Twenty case notes are reviewed monthly and assessed and is influenced by various factors such as age and against the Global Trigger Tool, which is a tool to diagnosis of patient. This will vary between hospitals identify triggers that may indicate patient harm. The HSMR is intended to monitor trends over time with a process of review identifies if this is indeed harm that view to seeing improvements against target resulted from healthcare or if the event was part of the Data is published quarterly with 0.88 the Scotland illness process itself position for quarter ending June 2011 Data is reported on a retrospective basis Data for quarter ending September 2011 is due for The October rate showed an increase to a rate of 28.9 publication at the end of February 2011 per 1000 patient days and the detailed analysis of the 5 events has been fed back to the clinical units S3: Acute Admissions Unit Cardiac Arrest Calls - S4: HEAT Target – further reduce Healthcare Associated Reduction in Cardiac Arrests to less than one cardiac Infections by 2012/13 so that Staphylococcus Aureus arrest per month by the end of the year Bacteraemia cases are 0.26 or less per 1000 occupied bed days Target: <1 Position: 0.64 @ Dec 2011 Target: 0.26 Position: 0.4 @ Dec 2011
Cardiac Arrests & Cardiac Arrest Calls in Acute Rate of M RSA/M SSA per Admissions Unit 10 1000 Occupied bed days 9 0.9 8 0.8 s 7 0.7 0.6
ission 6 5 0.5 4 0.4 3 0.3
peradm 1000 2 0.2 1 0.1 0 0
0 0 1 1 1 n-11 c-11 ct-10 e Aug-1 O Dec-1 Feb-11 Apr- Ju Aug-1 Oct-11 D Cardiac arrest calls Cardiac arrests Goal Line FV Trajectory Scot land Data is per 1000 admissions The March 2011 target was not achieved Target to reduce cardiac arrests to less than one per New trajectory agreed from June 2011 to March 2013 month by end December 2011 from a baseline position of 0.5 There is an increase in the average number of The number of patients with SABs in December was 8; admissions by about 50% following the move the 2 hospital acquired, 3 healthcare acquired, 3 community FVRH to about 1500 per month acquired The in month position is 0.4 against a trajectory of 0.36 Scotland position for quarter ending June 2011 is 0.34
8 SAFE: PERFORMANCE TRENDS
S5: HEAT Target - reduce Clostridium Difficile Infections S6: Scottish Patient Safety Programme - % of staff (CDIs) for patients 65 or over to 0.39 or less per 1000 undertaking Hand Hygiene practice as per infection total occupied bed days by March 2013 control requirements Target: 0.39 Position: 0.2 @ Dec 2011 Target: 95% Position: 98% @ Nov 2011
C.Difficile Infections per 1000 % SPSP Hand Washing occupied bed days (aged 65+) Compliance 1 0.9 10 0 % 0.8 95% 0.7 90% 0.6 0.5 85% 0.4 80% 0.3 75% 0.2 70% 0.1 0
FV Traject ory Activity National Audit Scot land
NHS Forth Valley is sustaining the target with an in The above graph highlights that the November 2011 month rate is 0.2 against a trajectory of 0.33 Scottish Patient Safety Programme Hand hygiene The number of patients 65 years or over with compliance is 98% Clostridium Difficile Infections (CDI) for December HPS national audit report for September / October was 1 which was hospital acquired 2011 gave NHS Forth Valley 97% compliance
9 Dimension of Quality:
EFFICIENT (E)
10 EFFICIENT: PERFORMANCE TRENDS
E1: Finance – forecast financial balance E2: Non Core Staff Costs
Target: Breakeven Position: £5.563 Target: Reduction Position: £8.035m spend for overspend at 31 Dec 2011 period to 31 Dec 2011
Non-Core Staff Costs Trend In-month Operational Financial Position 1,100,000 1200 2011/12 1,050,000 2010-11 2 0 11- 12
1,000,000 1000 950,000
800 900,000
£850,000 600 800,000 spend 400 750,0 00
200 70 0,0 00
cumulative over / (under) 650,000 0 600,000 Apr- May- Jun- Jul-11 Aug- Sep- Oc t - Nov- Dec- Jan- Feb- Mar- 11 11 11 11 11 11 11 11 12 12 12 A pr M ay Jun Jul A ug Sep Oct No v Dec Jan Feb M ar Period
£5.563m overspend to end of December 2011 Non core staff costs include bank, agency, locum, In month overspend trend continuing in line with overtime and on-call costs anticipated delivery of savings targets Costs remain higher than the same period to last Discussions with SGHD re financial support during year but have shown a slight downward trend in 2011/12 have concluded recent months With Scottish Government Health Department Whilst there are variances in other areas, the overall support and continued delivery of savings, financial difference between last year and this year relates to balance in-year is forecast Medical Locum and Agency costs
E3: Reduce prescribing costs per patient E4: % Secondary Care Doctors appraisals completed
Target: £183.65 Position: £200.17 @ Oct 2011 Target: 100% Position: 98.5% @ Dec 2011
Health Boards GIC per patient £210 2008 - 2011. 3-Year Total at December 2011
£200 No appraisal completed £190 for 3 year period 08-11
£180 Form 4 received and
£170 completed Annualised Totals Annualised
£160 Not applicable - new in post first appraisal 2011 £150
£140 Identifed individuals who Jul-06 Jul-07 Jul-08 Jul-09 Jul-10 Jul-11 Oct-06 Oct-07 Apr-07 Oct-08 Apr-08 Oct-09 Apr-09 Oct-10 Apr-10 Oct-11 Apr-11 Jan-07 Jan-08 Jun-07 Jan-09 Jun-08 Jan-10 Jun-09 Jan-11 Jun-10 Jun-11 Mar-07 Mar-08 Mar-09 Mar-10 Mar-11 Feb-07 Feb-08 Feb-09 Feb-10 Feb-11 Nov-06 Nov-07 Nov-08 Nov-09 Nov-10 Dec-06 Aug-06 Sep-06 Dec-07 Aug-07 Sep-07 Dec-08 Aug-08 Sep-08 Dec-09 Aug-09 Sep-09 Dec-10 Aug-10 Sep-10 Aug-11 Sep-11 May-07 May-08 May-09 May-10 May-11 no longer need NHS Ayrshire & Arran NHS Borders NHS Dumfries & Galloway NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow & Clyde NHS Highland appraised NHS Lanarkshire NHS Lothian NHS Tayside Scotland Form 4 received and completed - 294 The national graph above continues to demonstrate No appraisal completed for 3 year period 08-11 - 2 an ongoing reduction in the NHS Forth Valley Not applicable - new in post first appraisal 2011 – 21 average cost per patient. Identified individuals who no longer need appraised – 19 A second phase of the prescribing incentive scheme has been agreed and Practices are currently being All Consultants and Specialty Doctors have been asked to sign up to this. advised of their Enhanced Appraiser All processes moved to Enhanced Appraisal from November 2011 Appraisals now allocated on a monthly basis and reporting will begin to reflect this from January 2012
11 EFFICIENT: PERFORMANCE TRENDS
E5: Standard HEAT Target – Emergency inpatient E6: % occupancy rate average length of stay in days Target: 3.5 Position: 3.13 @ Dec 2011 Target: see text Position: see text
Emergency Inpatients Avg % Occupancy Avail Staff Length of Stay (days) Beds by Hospital 4 10 0 . 0 % 3.5 3 90.0% 2.5 80.0% 2 1. 5 70.0% 1 60.0% 0.5 0 50.0%
FV Traject ory FCH FVRH Scot land SCH
Average length of stay for emergency inpatients is Breakdown by hospital for December 2011 is: 3.13 days o Falkirk Community Hospital – 94.8% This is ahead of the target point of 3.5 days o Forth Valley Royal Hospital – 85.2% The most up to date published figure for all Occupancy rate of acute beds in Scotland at June Scotland is 3.4 days at December 2010 2011 was 82.7% (source of data: ISD website) 85% occupancy for acute beds is the accepted standard in acute beds and allows for optimum flow
E7: % of elective patients whose procedure is cancelled E8: Standard HEAT Target - increase Day Case & on the day of planned procedure or one day before Outpatient rates combined Target: 5% Position: 11% @ Nov 2011 Target: 84% Position: 80.3% @ Nov 2011
Operations Cancelled as % % BADS Daycase of Elective Admissions Procedures 90% 35% 30% 80% 25% 70% 20% 15% 60% 10 % 50% 5% 0%
FV Traject ory Scot land
The November 2011 position for operations The above graph shows that NHS Forth Valley day cancelled was 11% case and outpatient activity is maintaining a position This is a local 5% target. There is no aligned > 80% however remains below the trajectory of 84% trajectory at 80.3% Further shift in procedures carried out as day cases or as out patients following the Phase 3 move
There is up to a 3 month lag time therefore activity figures are provisional and will be updated on a rolling basis monthly
12 EFFICIENT: PERFORMANCE TRENDS
E9: Standard HEAT Target - reduce outpatient ‘Did Not E10: Standard HEAT Target - 15% reduction of pre- Attend’ rates (DNA) operative stay by March 2013 Target: 7.8% Position: 8.2% @ Dec 2011 Target: 0.19 Position: 0.08 @ Dec 2011
% New Outpatient DNAs Pre Operative LOS (Days) 0.70 14 . 0 % 0.60 12 . 0 % 0.50 10 . 0 % 0.40 8.0% 0.30 6.0% 0.20 4.0% 0.10 2.0% 0.00 0.0%
FV Traject ory Trajectory A ct ual Scot land
The position for December is 8.2% which is 0.4% The above graph shows that NHS Forth Valley behind the trajectory continues to stay ahead of target There is ongoing active implementation and Day surgery admission is the norm for patients monitoring of Patient Access Policy in respect of unless indicated otherwise ‘Did Not Attend’ patients Ensuring robust pre-operative pathway reduces need for admission before day of surgery Elective pathway agreed for all specialties and includes pre-operative assessment
E11a: Reduction in theatre under run hours as % of E11b: Theatre late start hours as % of available available (allocated planned) hours (allocated planned) hours Target: 5% or less Position: 9.1% @ Nov 2011 Target: 3% or less Position: 3.8% @ Nov 2011
Under Run Hours as % of Late Start Hours as % of Available Hours Available Hours 20.0% 7.0% 6.0% 15. 0 % 5.0% 10 . 0 % 4.0% 3.0% 5.0% 2.0%
0.0% 1. 0 % 0.0%
% Under Runs Target % Lat e St art Hours Target
The trajectory agreed with National Theatre Implementation Group is that 8% or less planned The target set by the National Theatre list hours will be lost through theatre sessions Implementation Group is that 3% of hours or less running under hours by December 2011 with a will be lost through theatre sessions starting late by further reduction to 5% by March 2012 December 2011. An under run is when a theatre session is finished A late start is recorded when theatre commences early by 45 minutes or more with the number of 15 minutes or more after the expected start time theatre list under run hours as a percentage of with the number of hours lost to late starts as a planned list hours providing the measure percentage of planned list hours providing the The Forth Valley position for November is 9.1% of measure available hours lost through under runs. This is an The position for November is 3.8% which is 0.7% improvement on the previous month but remains behind the trajectory of 3.1% however an slightly behind the trajectory point of 9.0% improvement on the previous month
13 EFFICIENT: PERFORMANCE TRENDS
E12: Standard HEAT Target - Attendance Management - to reduce sickness absence to 4% by March 2009 Target: 4% Position: 5.56% @ Nov 2011
Sickness Absence (% Hours Lost over total hours available) 8%
6%
4%
2%
0%
FV Trajectory Scot land
Focus on absence management continues as challenge remains in achieving this target with the March 2009 target of 4% not achieved The November 2011 position of 5.56% is an increase of 0.27% against the October position of 5.29% The year to date rolling average of 5.35%
14 Dimension of Quality:
TIMELY (T)
15 TIMELY: PERFORMANCE TRENDS
T1: HEAT Target - 18 week Referral to Treatment (RTT) T2a: HEAT Target - 95% of patients with Suspicion of cancer treatment is 62 days or less by December 2011 Target: 90% Position: 91.5% @ Nov 2011 Target: 95% Position: 95.7% @ Nov 2011
18 Week Referral to % Cancer treated within 62 Treatment days of Referral 100% 10 0 %
90% 90%
80% 80%
70% 70%
60% 60%
50% 50%
FV Traject ory FV Traject ory Scot land Scot land
In November 2011, 91.5% of patients were treated In November 2011, 95.7% of patients were seen within 18 weeks. This is ahead of the in month within 62 days, ahead of the December 2011 target trajectory and ahead of the December 2011 target Challenges remain within outpatient ophthalmology, gastroenterology and rheumatology, along with orthopaedic and general surgery inpatients
T2b: HEAT Target - 95% of patients with cancer treated T3: HEAT Target - by March 2012, 90% of clients will wait within 31 days by December 2011 no longer than 5 weeks & no client will wait longer than 10 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery Target: 95% Position: 95.1% @ Nov 2011 Target: 90% Position: 98.4% @ Dec 2011
% Cancer patients treated % P atients waiting < 5 within 31 days of Diagnosis weeks for drug or alcohol 10 0 % treatment from referral 100% 90% 90% 80% 80% 70% 70% 60% 60% 50% 50%
FV Traject ory Combined Drug Scot land Alcohol Traject ory
Combined trajectory submitted to Scottish Government with formal sign off received In November 2011, 95.1% of patients were treated Current activity exceeds the new target and in month within 31 days, slightly ahead of the December 2011 trajectory point of 81% with a combined performance of target 98.4% however local monitoring will distinguish Local action plans in place to reflect challenges that between alcohol and drugs continue within Breast Cancer and Urology Cancer The December 2010 target of ‘90% of clients will be services offered a treatment date within 4 weeks of referral’ was achieved and has been maintained
This data is provisional as performance is reported
quarterly
16 TIMELY: PERFORMANCE TRENDS
T4: HEAT Target - Faster access to Child & T5: HEAT Target - Zero patient will wait over 4 hours for Adolescent Mental Health Specialist Services discharge or transfer from A&E (CAMHS) - 0 patients waiting > 26 weeks March 2013 Target: Zero >26 weeks Position: 97% @ Dec 2011 Target: 98% Position: 93.7% @ Dec 2011
A&E % Waiting <4 hrs 100% of patients seen within 39 weeks – March 10 0 % 2012 target 95%
90% 97% of patients seen within 26 weeks – March 85% 2013 target 80%
75% 70%
FV Traject ory Scot land
By March 2011 no client will wait longer than 52 At the end of December 2011, 93.7% of patients weeks from referral to treatment for specialist waited 4 hours or less for discharge or transfer from CAMHS Services – target achieved A&E This will be reduced to 39 weeks by March 2012 This is an in-month deterioration of 3.8 % against a then 26 weeks by March 2013 November 2011 of 97.5% Trajectory for this target to March 2013 submitted Focused work continues to address issues in respect to Scottish Government in November 2011 of breaches
17 Dimension of Quality:
EFFECTIVE (V)
18 EFFECTIVE: PERFORMANCE TRENDS
V1a: National target – ≥95% of antimicrobial V1b: % seasonal variation of defined daily doses of prescriptions for empirical therapy are in line with local quinolones within primary care policy Target: ≥ 95% Position: 93% @ Oct 2011 Target: ≤ 5% Position: -3.9
From April 2011, revised targets have been set for NHS Scotland use of antibacterials in primary care by NHS antimicrobial prescribing nationally for Acute Care. Board, percentage seasonal quinolones 2010/11 (Winter v Any areas of non-compliance with policy are Summer) investigated by Acute Care Team Consultant with prescriber The quinolones are a family of synthetic broad-spectrum Findings are fed back to Clinician and Antimicrobial antibiotics. The term quinolone(s) refers to potent synthetic Management Group chemotherapeutic antibacterials
V2: HEAT Target - to reduce Emergency Bed days in V3: Reduction in the number of patients boarded out with age 75+ (rate per 1000 population) by March 12 their specialty Target: 4006 Position: 4003 @ Sept 2011 Target: Reduction Position: 191 @ Dec 2011
Acute Emergency Bed Days Cumulative Boarders Aged 75+ (Rate per 1000 500 0 population) 10 0 0 900 4000 800 700 3000 600 2000 500 400 10 0 0 300 200 0 10 0 0
FVRate SurgicalRat e MedicalRate Traject ory
New HEAT target for 2011/12 There were 191 patients boarded outwith their The September 2011 position of 4003 is ahead of speciality in December 2011 with an overall improving the agreed trajectory point of 4017 and the target for trend March 2012
*This position is currently provisional
19 EFFECTIVE: PERFORMANCE TRENDS
V4: HEAT Target - to reduce A&E attendances to 1500 V5a: Standard HEAT Target – no delayed discharges >6 (rate per 100,000 of population) by March 2014 weeks Target: 1500 Position: 1613 @ Dec 2011 Target: 0 Position: 2 @ Dec 2011
A&E Attendances per 100,000 Delayed Discharges Over 6 population 3000 weeks by CHP 2500 30 2000 25 20 150 0 15 10 0 0 10 500 5 0 0
Forth Valley Traject o ry FV Falkirk Scot land Stirling Clacks
The December 2011 position of 1613 is 115 above The total number of delayed discharges over 6 weeks the trajectory of 1498 at the December census was 2 The Scotland position for November was 2090 Both delays were within Falkirk
To Note: New HEAT target for 2012/13 No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013; followed by a 14 day maximum wait from April 2015
V5b: Reduction in the number of delayed discharge V6: Reduction in the number of bed days lost due to patients waiting < 6 weeks delays in discharge Target: Reduction Position: 26 @ Dec 2011 Target: Reduction Position: 712 @ Dec 2011
FV Bed Days Lost due to Delayed Discharges Under 6 Delayed Discharges weeks by CHP (excluding special codes) 60 3000 50 2500 40 2000 30 150 0 20 10 0 0 10 500 0 0
FV Falkirk Total bed days lost Stirling Clacks Over 6 weeks
The attached graph highlights that there were 26 A total of 712 bed day were lost in December with 139 delays under 6 weeks at the December census. over 6 weeks The improved position from an August 2011 high The overall trend is downward has been maintained with a further reduction in December of 26
20 Dimension of Quality:
PERSON CENTRED (P)
21 PERSON CENTRED: PERFORMANCE TRENDS
P1: Inpatient Care Experience survey P2: Complaints 20 day response rate
Target: Position: Target: 70% Position: 40.26% @ Nov 2011
120.00 Work is on-going in respect of developing and 100.00 testing the data base system with a range of 80.00 measures 60.00 Required changes have necessitated continued 40.00 testing of patient and staff experience workstreams 20.00
0.00 Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- 10 10 10 10 11 11 11 11 11 11 11 11 11 11 11 Acute CHP Total Taget
NHS Forth Valley Patient Experience co-ordinator continues to support individual wards and The above graph highlights that NHS Forth Valley’s departments in undertaking patient experience year to date cumulative position is 40.26%, which is surveys. This is ongoing work, with all acute inpatient behind target of 70% areas at Forth Valley Royal Hospital now online CHP position is 65.38%; Acute position is 27.45% Work has now been completed in respect of building Learning from complaints is taken forward within the a generic Patient Experience questionnaire aligned units and work is on going with the Patient Public with the Better Together national survey Panel to explore ways in which patient public questionnaire into the ‘Transforming and Improving partners can support the complaints process, e.g. Care’ database. Wards are beginning to receive capturing complainant’s experience of the process graphic representation of results for use as feedback at ward level. P3: Clinical Quality Indicators – falls, nutrition, pressure P4: Reduction in the number of bed days for long term area care conditions Target: 95% overall Position: 95.7% @ Dec Target: Reduction Position: 5741 @ Oct 2011 compliance 2011
% Compliance for Clinical Long Term Conditions, Bed Quality Indicators 10 0 % Days per 100,000 population 8500 96% 8000 92% 7500 88% 7000 84% 6500 80% 6000 5500 5000
Falls Fluid, Food, Nutrition Trajectory FV Pressure A rea Care Scot land
The above graph represents NHS Forth Valley’s compliance with the 3 National Clinical Quality NHS Forth Valley continues to perform well against Indicators of falls (97%), pressure area care this target which was previously a key HEAT compliance (95%) and food, fluid and nutrition measure compliance (95%) The position for December is 5741 bed days Leading Better Care facilitator and Lead Nurses are working closely within any areas that have been highlighted as having challenges in respect of overall compliance to support improvements within these areas
22 PERSON CENTRED: PERFORMANCE TRENDS
P5: HEAT Target - all patients admitted with a diagnosis of Stroke will be admitted to a stroke unit on day of admission or following day by March 2013 Target: 90% Position: 91.9% @ Nov 2011
% Admitted to Stroke unit same day of admission 100% 80% 60% 40% 20% 0%
FV Trajectory Scot land
This is a new target for 2011/12 The position for November is 921.9% against a trajectory of 68.7% The Scotland position for September was 84% for same day admissions to stroke units
*Patients discharged prior to spending 2 nights in hospital excluded
23
FORTH VALLEY NHS BOARD 24 January 2012
This report relates to Item 4.2 on the agenda
FINANCE REPORT FOR THE PERIOD ENDED 31st December 2011
1. Summary
This report provides a summary of the financial position for NHS Forth Valley as at 31st December 2011.
There is a statutory requirement for NHS Boards to ensure expenditure is within the Revenue Resource Limit (RRL) and Capital Resource Limit (CRL) set by the Scottish Government Health Department (S.G.H.D.).
The Table below provides a summary of the out-turn position:
Annual Actual Actual Budget Overspend / Overspend / Plan (Underspend) (Underspend) to 30/11/2011 to 31/12/2011 £m £m £m Resources Revenue Resource Allocation Core 420.272 0.000 0.000 Revenue Resource Allocation Non Core 50.236 0.000 0.000 Anticipated Resource Allocations 31.714 0.000 0.000 Income - other Scottish Boards 7.095 (0.022) (0.021) Income - Junior Doctors (NES) 6.218 0.000 0.000 Income - Miscellaneous 4.623 (0.005) (0.006) Total Resources 520.160 (0.027) (0.027)
Expenditure Plan Corporate and External Boards 108.805 0.060 (0.044) Acute Services 168.390 2.299 2.404 Waiting Times (0.205) 2.535 2.914 CHP, Prescribing and Other Areas 221.820 0.331 0.264 Committed Balances / Contingency 21.350 0.000 0.000 Total Expenditure 520.160 5.225 5.536
Total Net Revenue Out-turn 5.252 5.563
Net Capital Out-turn 0.000 0.000
The Operational Position to 31st December 2011 shows an overspend of £5.563m (overspend of £5.252m to end of November) on core services prior to offsets available, with the main areas of overspend being rehabilitation services, surgical unit nurse staffing, biologic drugs, delivery of Access Targets, Mental Health Services, AHP Services and cross boundary flow activity. To date Primary Care Prescribing is reporting an underspend as does Area Corporate Services.
1
The operational overspend in-month has reduced from an average of £0.926m in the first three months to £0.311m for December. This decrease confirms position is on track to achieve planned financial balance in-month for operational services by April 2012. The graph below illustrates the trend to date and includes the projected position from September onwards.
Operational Overspend in month 2011/12
1.2
1
0.8
0.6 £m
0.4
0.2
0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Actual Projected
Strict controls remain in place regarding vacancy management with Director of Human Resources / Director of Finance approval required for any post advertised outwith NHS Forth Valley, prescribing efficiency group meets regularly, catalogues reviewed and reduced for non-clinical spend, and compliance with national procurement contracts closely monitored.
The main remaining areas where spend reductions are being/ can be actioned relate to the in-year impact of the Voluntary Severance Scheme. To date there have been 53 approvals under the Voluntary Severance Scheme with a cost of £3.186m and producing recurring savings of £2.176m.
A significant proportion of Committed Balances / Contingency relates to the following areas: Prison Transfer – anticipated funding for first seven months to reflect merger accounting requirements Capital Grants Voluntary Severance Costs Brokerage Funding to offset operational projection CNORIS Funding for Legal Claims Annually Managed Expenditure Items
As previously reported, dialogue has been ongoing regarding NHS Forth Valley financial position including the particular issues faced during implementation of the Healthcare Strategy. Agreement has been reached as reported to the November Performance and Resources Committee. This funding combined with ongoing savings delivery allows confirmation that financial balance can be achieved. Repayment of this transitional funding is planned over a five year period using 2 proceeds from the sale of assets. This repayment is incorporated into the 2012/13 Five Year Financial Pan scheduled for Board approval in March 2012 and previously outlined to the Performance and Resources Committee.
Savings Plans to deliver underlying financial gap of £11.244m have been prepared with outline areas reported to the Performance and Resources Committee in October. Where feasible these are being linked to the Voluntary Severance Scheme programme to generate further management and admin savings.
Work is in progress developing 2012/13 – 2016/17 Financial Plan with initial plans scheduled for presentation at January Performance and Resources Committee and final plans for approval at the March Board meeting.
Regarding capital, a meeting with S.G.H.D. has been arranged for late January 2012 which will cover projected out-turn for 2011/12, top slice for reversionary interest and projected property sales.
3
2. Revenue Resource Limit
During the month of December 2011 the following allocations were received from the S.G.H.D.:
£m Core Revenue Resource Allocation as at 30th November 2011 419.997 Distinction Awards for NHS Consultants 0.501 Cross Border Prescribing – Baseline adjustment (0.378) Other 0.152 Core Revenue Resource Allocation as at 31st December 2011 420.272
Non-Core Revenue Resource Allocation at 30th November 2011 49.522 Capital Grants – transferred from Capital 0.596 Other 0.118 Non-Core Revenue Resource Allocation at 31st December 2011 50.236
Total Revenue Resource Allocation as at 31st December 2011 470.508
In addition to the notified Revenue Resource Limit of £470.508m, a further £31.714m is expected during the year, resulting in an anticipated Revenue Resource Limit of £502.222m. This anticipated funding includes:
Impairment £18.636m Project Cost Funding £1.000m non-recurring Transitional Costs non-recurring funding £4.000m Non recurring support up to £6.000m Non recurring funding £1.088m transfer from Capital receipts Prison Healthcare – funding for 1st April to 31st October 2011 £2.573m recurring. Although operational transfer was from 1st November accounting treatment under Merger Accounting requires that costs are reported for the full financial year and funding for the period prior to 1st November is anticipated to cover costs that will be transferred via the Payments on Behalf mechanism. Provisions (A.M.E.) return of £1.500m from Provision no longer required P.E.T. Scanning - deduction of £0.216m Various allocations totalling £0.133m
Also indicative funding of £31.291m to match the net expenditure during 2011/12 has been provided for remaining Family Health Services (Dental, Ophthalmic and Pharmacy contractors) - this funding remains ‘non-cash limited’.
4
3. Corporate and External Boards
The financial position for Corporate and External Boards to 31st December 2011 is an underspend of £0.044m (£0.060m overspend to the end of November).
Corporate and External Boards Revenue Resource Analysis for Annual Cumulative Year to Date The Period to 31st December 2011 Plan Plan Actual Variance £m £m £m £m
NHS Glasgow 18.095 13.571 13.612 0.041 NHS Lothian 11.049 8.286 8.512 0.226 Golden Jubilee NH 1.164 0.873 1.184 0.311 Other NHS Scotland 4.259 3.194 3.064 (0.130) Other Healthcare Providers 2.353 1.765 1.743 (0.022) UNPACS / NCAs / Exclusions 4.521 3.219 2.813 (0.406) Community and Voluntary Sector 1.809 1.200 1.200 0.000 Area Corporate 32.670 23.131 22.936 (0.195) Healthcare Strategy 2.168 1.668 1.799 0.131 Capital Charges 12.522 9.391 9.391 0.000 Annually Managed Expenditure - Impairment 18.195 2.994 2.994 0.000
Total 108.804 69.292 69.248 (0.044)
Externals net overspend of £0.020m (£0.076m at end of November) The key areas of financial pressure in 2011/12 are high cost treatments outwith the area for Mental Health Forensic Services and a reduction in income for services provided in Forth Valley for patients who are resident outwith NHS Forth Valley. The West of Scotland Cardiac Consortium 2011/12 Service Level Agreement reports an increase of £0.262m. The proposals across the West have been agreed and this is reflected in the report. Activity information for services outwith the Service Agreement has been received from Glasgow for the period to the end of October. This is lower than anticipated and this is reflected in the report. The main area of risk remains NHS Lothian activity and costs which is partly dependent on the outcome of regional discussions over the basis of the SLA agreement for 2011/12 and outstanding issues from 2010/11. It is hoped that these can be resolved by end of January.
Area Corporate: £0.195m underspend (£0.147m underspend to end of November) The impact of tight vacancy controls and the Voluntary Severance Programme have
resulted in the underspend.
Healthcare Strategy: £0.131m overspend (£0.131m overspend to end of November) The overspend is predominantly due to higher than budgeted expenditure on legal and advisor fees.
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4. Acute Services
Forth Valley Acute Services Revenue Resource Analysis for Annual Cumulative Year to Date The Period to 31st December 2011 Plan Plan Actual Variance £m £m £m £m
Surgical and Cancer Services 50.141 37.274 37.992 0.718 Medicine, Emergency Services and Rehabilitation 45.601 34.302 35.648 1.346 Women & Children's and Clinical Services 37.348 27.956 27.901 (0.055) Forth Valley Royal Hospital – Unitary Charge 33.848 26.290 26.243 (0.047) FVRH Transitional Costs 0.334 0.315 0.315 0.000 Corporate and HQ costs 1.118 0.751 1.193 0.442
Total 168.390 126.888 129.292 2.404
Waiting Times/ Access Targets 1.345 1.066 2.932 1.866 Top slice Golden Jubilee 90% (1.550) (1.048) 0.000 1.048 Net Waiting Times/ Access Targets (0.205) 0.018 2.932 2.914
The Acute Services financial position as at 31st December 2011 reflects a cumulative overspend of £2.404m (overspend of £2.299m to 30th November).
The December position represents an adverse movement from November, in-month movement of £0.105m compared to £0.249m the previous month. The in-month position in November was higher than expected, but when the two months are averaged the position is as anticipated. Budget phasing and biologic spend which is the main cause of fluctuation will be reviewed for 2012/13. A number of savings schemes have been implemented from August 2011 onwards following the move to Forth Valley Royal Hospital and an improving in-month trend is still anticipated over the remainder of the year.
Complex therapy drugs continue to present as a significant cost pressure in all directorates and are generating a combined year to date pressure of £1.258m Medical locum expenditure, both agency and on payroll, has significantly increased in 2011/12.
Main points to highlight are:
Surgical and Cancer Services: overspend of £0.718m (overspend of £0.657m last month) Reduction in in-month overspend has continued evidencing management actions delivering savings.
Medicine, Emergency Services & Rehabilitation: overspend of £1.346m (overspend of £1.268m last month) MECAR unit hosts the majority of complex therapy and of the overall Unit overspend £0.938m relates to this issue. Work on prescribing efficiencies in the West of
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Scotland has focussed on this area as a priority as it is an increasing pressure for all Boards.
Women & Children and Clinical Services: underspend of £0.055m (underspend of £0.047m to end of November) The position remains broadly breakeven, with some underlying financial pressures on laboratory services and sexual health services, which are being largely offset by underspends against pay budget areas.
Corporate and Headquarters: overspend of £0.442m (overspend of £0.467m to end of November) This reflects in part budgetary changes associated with nursing model of care with the balance of the overspend as in previous months relating to interpreter fees, taxis and postages.
Transitional Costs It is anticipated that minimal costs will be recorded through transitional costs in the remaining months.
Waiting Times/ Access Targets Current position to the end of December 2011 is an overspend of £2.914m (overspend of £2.535m to end of November). Efforts are focussed on reducing reliance on additional sessions which attract overtime and premia rate payments. Premia costs increased substantially during the month reversing the previous trend – further information required in this area. The longer term priority is ensuring sustainable plans within available resources.
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5. CHP, Prescribing and Other Area Services
CHP, Prescribing & Other Revenue Resource Analysis Annual Cumulative Year to Date For period to 31st Dec. 2011 Plan Plan Actual Variance £m £m £m £m
Clackmannanshire CHP 34.583 25.174 25.457 0.283 Falkirk CHP 22.889 15.455 15.466 0.011 Stirling CHP 10.151 6.713 6.705 (0.008) AHPs 11.558 8.712 9.057 0.345 Prescribing 62.968 47.338 46.971 (0.367) FV Facilities 16.593 11.861 11.860 (0.001) Complex Care 4.074 3.102 3.102 0.000 Resource Transfer 18.104 13.578 13.576 (0.002) Primary Medical Services 39.084 27.670 27.673 0.003 Prison Healthcare 1.816 0.707 0.707 0.000 Total 221.820 160.310 160.574 0.264
Family Health Services 31.291 23.377 23.377 0.000
Clackmannanshire, Falkirk and Stirling CHPs The financial position on CHPs at 31st December 2011 £0.283m overspend – Clackmannanshire CHP £0.011m overspend – Falkirk CHP £0.008m underspend – Stirling CHP £0.345m overspend – AHPs (Allied Health Professionals)
Each of the CHPs endeavour to achieve financial breakeven for the year as efficiency programmes progress, however due to low staff turnover levels overspends are reported. Focus within Clackmannanshire CHP is predominantly on delivery of Mental Health Service Savings.
Complex Care Complex Care continues to report a balanced position at the end of December and forecasts a breakeven position at March 2012.
Forth Valley Facilities Forth Valley Facilities’ financial position at the end of December is a balanced position and forecasts a breakeven position at March 2012.
Prescribing An underspend of £0.367m is reported for the nine month period ended 31st December. (This reflects seven month’s actual data combined with estimates for November and December).
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Interrogation of the most recent actual data reveals that the number of items prescribed in October was 1.1% higher than the same period last year, resulting in cumulative item growth of 1.7% for first seven months of 2011-12 compared to 2010- 11. Key growth areas include appliances and drugs used to treat musculoskeletal/joint diseases and ear, nose and oropharynx disorders.
Early indications suggest that the number of items prescribed in November is likely to be significantly higher than expected (linked to an increased number of dispensing days during the month compared to the same period last year, and also as Patients prepare for winter following last year’s adverse weather).
There was a slight increase in the average cost per item reported for October (up 4p per item) as expected following changes to the drug tariff in relation to items in short supply, and also due to increased stock holding of flu vaccines as Practices prepared for the start of the flu vaccine programme.
The overall position will be kept under review as actual prescribing data becomes available during the remainder of the financial year, particularly in relation to potential volume fluctuations.
Primary Medical Services (PMS) A small overspend of £0.003m is reported for the nine month period ended 31st December. As reported in previous months, a range of pressure areas continue to be experienced within Board Administered Funds (e.g. maternity leave cover, employer’s superannuation and Golden Hellos). At present, these pressures are being offset by fortuitous underspends on other elements of the PMS budget.
The overall position will be kept under review during the remainder of the financial year. In the meantime, breakeven is forecast at 31st March.
Prison Healthcare November marked the transfer of responsibility for prison healthcare from the Scottish Prison Service to NHS Scotland. Funding to meet the associated costs of the transfer was allocated to Boards in August. NHS Forth Valley received an allocation of £1.837m for the 3 prisons within our board area – this is expected to be fully utilised by 31st March.
Family Health Services Funding for the remaining Family Health Services (Dental, Ophthalmic and Pharmacy contractors) remains ‘non-cash limited’. Details of expenditure are identified below.
Year to Date Year End Family Health Services Actual Forecast For period to 31st December 2011 £m £m
General Ophthalmic Services 3.961 5.000 General Dental Services 12.222 16.391 General Pharmaceutical Services 7.194 9.900 Total Family Health Services 23.377 31.291
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Resource Transfer (breakdown for information)
Resource Transfer Annual Cumulative Year to Date For period to 31st December 2011 Plan Plan Actual Variance £m £m £m £m
Clackmannanshire 2.832 2.124 2.124 0.000 Falkirk 10.467 7.851 7.851 0.000 Stirling 4.761 3.570 3.569 (0.001) Perth & Kinross 0.013 0.010 0.009 (0.001) Total Expenditure 18.073 13.555 13.553 (0.002) Retraction - Nursing Homes 0.031 0.023 0.023 0.000 Total Expenditure 18.104 13.578 13.576 (0.002)
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6. Capital Resource Limit
Overall Position The forecast Capital expenditure for year-ended 31st March 2012 is currently £80.434m. This funding stream is made up of £73.101m confirmed from the Scottish Government Health Department (S.G.H.D.) and £4.383m in anticipated Core allocations giving a Capital Resource Limit (CRL). This is inclusive of capital grant funding of £1.455m and £1.495m in forecast Capital receipts that will be deducted from the total Capital expenditure to give the charge against a net Capital Resource Limit (CRL) of £77.484m. Details can be seen at Annex 1 to this report.
Funding Within the December 2011 financial allocation letter issued by S.G.H.D. two further allocations were confirmed. A deduction was made from the Core allocation in respect of Capital Grant funding to the value of £0.596m and a further Core allocation to the value of £0.069m was confirmed to support the Prison Healthcare Transfer to the National Health Service.
Expenditure Expenditure to 31st December 2011 was £75.651m inclusive of an in-month increase of £0.609m. Significant expenditure can be summarised as:
Ring fenced Allocations – expenditure on projects being funded from ring fenced allocations as at 31st December remains at £67.697m being the total value forecast for financial year 2011/12. This expenditure is in relation to the balance sheet addition for Phase 3 of the new Acute Hospital at Larbert.
Strategic Priorities – expenditure on Strategic Priorities projects as at 31st December 2011 totals £5.802m inclusive of an in-month increase of £0.149m. Significant expenditure during December included £0.084m on the decommissioning of the old Falkirk and Stirling Royal Infirmary sites and also a further £0.049m on projects within the new Acute Hospital at Larbert. In addition, further work was performed on the boundaries of the Bellsdyke Hospital site.
Primary & Community Care Modernisation – further expenditure was incurred during December Primary Care developments within the Falkirk Community Hospital site and also the projects underway at Dunblane and Dollar Health Centres bringing the total to date up to £0.357m from an available budget of £0.455m.
Community Hospitals – work is ongoing in developing the Community Hospital projects and to date the sum of £0.676m has been spent on the Falkirk Community Hospital site and £0.183m on the Stirling Community Hospital site. This is exclusive of projects being funded via Primary & Community Care Modernisation funding.
Area Wide Expenditure - Area Wide expenditure to the end of December 2011 amounted to £0.936m inclusive of an in-month increase to the value of £0.059m. £0.686m has now been spent on projects relating to the IM&T Strategy and a further £0.221m on the area-wide medical equipment replacement programme. There has also been a total of £0.029m expenditure incurred in relation to the Prison Healthcare Transfer to the National Health Service. 11
The summarised position is identified below and a more detailed analysis is attached as Annex 1.
Plan to Actual Variance Capital Resource Limit Date to Date to Date Plan Forecast Variance for the period to 31st December 2011 £m £m £m £m £m £m
Resources Approved Capital Resource Limit 5.404 7.167 1.763 5.404 5.404 0.000 Ring fenced allocations 67.697 67.697 0.000 67.697 67.697 0.000 Capital Grants 0.787 0.787 0.000 1.455 1.455 0.000 Anticipated Capital Allocations 1.763 0.000 (1.763) 5.878 5.878 0.000 Total Resources 75.651 75.651 0.000 80.434 80.434 0.000
Expenditure Ring fenced Expenditure 67.697 67.697 0.000 67.697 67.697 0.000 Regional Priorities 0.000 0.000 0.000 0.050 0.050 0.000 Strategic Priorities 5.802 5.802 0.000 7.036 7.036 0.000 Primary & Community Care Modernisation 0.357 0.357 0.000 0.455 0.455 0.000 Community Hospitals 0.859 0.859 0.000 1.076 1.076 0.000 Area Wide Expenditure 0.936 0.936 0.000 4.120 4.120 0.000 Total Expenditure 75.651 75.651 0.000 80.434 80.434 0.000
Saving/ (Excess) Against CRL 0.000 0.000 0.000 0.000 0.000 0.000
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7. Savings Programme
A summary of the Savings Report is attached at Annex 2. With an early Board Meeting this month the December Savings Schedules are not yet complete – a verbal update on any changes will be provided at the meeting.
Savings delivered to date total £13.536m with no significant changes. There are a number of areas where full year achievement is reported but no savings to date e.g. Operational Savings Balance £1.751m. Detailed work is close to conclusion for delivery of recurrent savings for these areas but non-recurrent savings / underspends are covering in-year.
Work is progressing on 2012/13 – 2016/17 Financial Plans with initial presentation to the January Performance and Resources Committee.
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8. Risk
A short summary of the most significant risks are outlined in the table below:
Key Assumptions/Risks Risk rating/Impact/£ Delivery of significant cash savings in Medium Risk : High Impact 2011/12 given low staff turnover rates Risk level has reduced in respect of delivering of (3.7% estimated in 2010/11) and in-year financial balance following confirmation timescale involved in consultation of transitional cost support from S.G.H.D. regarding service change
Delivery of further significant real cash High Risk : High Impact : £42.255m recurrent by savings in period 2012/13 – 2015/16 March 2016. Position will be updated as part of the Financial Plan 2012/13.
Delivery of 18 week Referral to Treat High Risk : High Impact : £4.000m commitment plus extension of At the same time as seeking significant cash programme to other care savings from services to meet demographic and groups/treatment lists inflationary pressures it is becoming increasingly difficult to maintain premia cost spend on waiting list activity resulting in high cost per case for no additional clinical benefit/outcome Equal Pay Medium Risk : High Impact : unquantified
Unitary Charge Inflation High Risk : Medium Impact : £1.376m recurrent per annum i.e. potential for £6.880m recurrent at end of 5 year period. Very recent announcements indicate R.P.I. (Retail price Index) reductions. An update will be included in Financial Plan for 2012/13.
Continued increase on Utilities / Travel High Risk : Medium Impact : not quantified. costs given trend in oil prices / Middle Current estimate 23% p.a. increase in future East crisis years.
Continued increase in CNORIS / Legal High Risk : Medium Impact : not quantified Claims cost particularly the Risk reduced in-year as nationally costs are lower implications of recent No Fault than anticipated but future year costs predicted to compensation rise. Implications of National Pay Policy – Medium Risk : High Impact : £2.000m p.a. assumed 1% but may be higher given £8.000m recurrent by end of period current R.P.I.
1% uplift per annum may not be High Risk : High Impact : £4.000m recurrent p.a. sustainable over 5 year life £16.000m recurrent by end of period. Plans currently being updated.
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Sustainability of receiving NRAC High Risk : High Impact : £1.150m p.a. uplift when overall resource reducing – £4.600m recurrent by end of period. local population continues to rise NHS Forth Valley is currently £11.1m below its target share of NHS resources. Risk likely to reduce for 2012/13 where NRAC funding increases have been included in Spending Review. Impact of low staff turnover rates on High Risk : estimated risk £ 0.904m ability to release cash savings from identified Savings areas Impact of voluntary severance scheme High Risk : estimated risk £ 3.000m not being affordable Confirmation of S.G.H.D. transitional support has resulted in release of local funding to support scheme up to £4m. Estimate further £3m required to meet management and admin savings. Operational Savings target not yet High Risk : estimated risk £ 1.751m signed off Outline schemes prepared and operational group completing detail. Non-Recurrent Review / Provision Low Risk : risk £ 1.648m review Now managed in-year. Volatility of current accounting High Risk: risk dependent on timing of planning treatment of Bellsdyke property sale permission for individual sites. and need to review accounting Estimate for 2011/12 is a loss of £0.816m which treatment of abnormal costs has been incorporated into year end projections. SERCO discussions Low Risk: recurrent position predominantly addressed. Conclusion reached and final outcome for backdated costs incorporated into projections.
PFI Anticipated Allocation As part of the final transfer review these are adjustments subject to further scrutiny. The Financial Model is scheduled to be re-run at the end of the Project and experience from other areas indicates this is a risk but there is no particular pattern which would allow quantification. Impairment Associated with the major service changes ongoing there is also a relatively high level of impairment identified some of which will only be confirmed later in the year dependent on indexation.
The main risks re Capital are: - timing and value of property proceeds - retention of savings achieved on FVRH equipment project - balance sheet treatment of Managed Bed Service Contract (estimated value under review) - confirmation of Capital Allocations.
A meeting is planned with the Scottish Government Health Department officers to review the Capital position and ongoing planning.
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9. Balance Sheet and Cash Requirement
The Balance Sheet indicates the value of fixed and current assets and liabilities for the period and the position at the year-end.
Opening Current Closing Balance Sheet as at 31st December 2011 Balance Position Balance £m £m £m Non-Current Assets Property, Plant & Equipment 437.260 500.508 501.538 Intangible Fixed Assets 1.689 1.689 1.690 Financial Assets 12.603 12.497 12.600 Total Non-current Assets 451.552 514.694 515.828
Current Assets Assets classified as held for sale 1.784 1.144 0.000 Inventories 0.921 0.943 0.920 Other current assets 0.000 0.000 0.000 Trade & other receivables 8.699 396 8.7009. Cash & cash equivalents 0.031 0.556 0.027 Total Current Assets 11.435 12.039 9.647
Total Assets 462.987 526.733 525.475
Current Liabilities Provisions -5.968 -5.965 -5.970 Trade & other payables -60.578 -60.580 -60.580 Other financial liabilities 0.000 0.000 0.000 Total Current Liabilities -66.546 -66.545 -66.550
Total Assets Less Current Liabilities 396.441 460.188 458.925
Non-current Liabilities Provisions -12.194 -8.544 -12.195 Trade & other payables -285.570 -343.300 -345.000 Other financial liabilities 0.000 0.000 0.000 Total Non-current Liabilities - 297.764 -351.844 -357.195
Total Net Assets 98.677 108.344 101.730
Taxpayers Equity General Fund 30.529 40.213 27.360 Revaluation Reserve 67.686 67.685 73.919 Donated Asset Reserve 0.462 0.446 0.451 Total Taxpayers Equity 98.677 108.344 101.730
The cash surplus over the last few months has now been addressed with a reduction in the amount of cash drawn down for November with aim that the spend during the month would reduce the surplus held in bank account. Cash and cash equivalents have reduced from £7.801m in the October Balance Sheet down to £0.370m last month. At the end of March 2012 the planned closing balance is £0.027m.
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10. Conclusion
The Board is asked to
note the revenue operational overspend of £5.563m to 31st December 2011
note that following conclusion of discussions with S.G.H.D. and based on current risks and ongoing delivery of savings in-year financial balance is achievable.
note work on-going preparing 2012/13 – 2016/17 Financial Plan with first draft for discussion at the January Performance and Resources Committee.
note the balanced capital position projected but discussions with S.G.H.D. required.
Fiona Ramsay Director of Finance and Planning 18th January 2012
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ANNEX 1
NHS FORTH VALLEY Position at 31st December 2011 Year end -Forecast CAPITAL RESOURCE LIMIT Plan Actual Variance Plan Forecast Variance As at 31st December 2011 £'000 £'000 £'000 £'000 £'000 £'000
NON-CORE FUNDING SGHD - IFRS Impact 67,697 67,697 0 67,697 67,697 0 Total Non-Core Income 67,697 67,697 0 67,697 67,697 0
PLANNED NON-CORE EXPENDITURE New Acute Hospital - Balance Sheet Addition 67,697 67,697 0 67,697 67,697 0 Total Non-Core Expenditure 67,697 67,697 0 67,697 67,697 0
Non-Core Balance Available / (Required) 000000
SOURCES OF CORE FUNDING Scottish Executive Funding - General Allocation 3,241 3,241 0 3,855 3,855 0 SGHD - Pfi Reversionary Interest -4,610 -4,610 0 -4,610 -4,610 0 SGHD - Pfi Reversionary Interest Assumed Allocation 4,610 4,610 0 4,610 4,610 0 SGHD - New Acute Hospital Equipment 4,156 4,156 0 8,029 8,029 0 SGHD - NSS Equipping 171 171 0 172 172 0 SGHD - HUB Initiative 0 0 0 50 50 0 SGHD - Primary & Community Care Modernisation Programme Underspend 357 357 0 455 455 0 SGHD - Healthcare Associated Infection 0 0 0 107 107 0 SGHD - Prison Healthcare Transfer 29 29 0 69 69 0 Total Core Incone 7,954 7,954 0 12,737 12,737 0
Planned Core Expenditure
Regional Priorities HUB Initiative 0 0 0 50 50 0 Wos - Quarriers Homes 000000 Total 0 0 0 50 50 0 Strategic Priorities Healthcare Strategy Project Costs 51 51 0 60 60 0 Bellsdyke Wall 86 86 0 104 104 0 New Acute Hospital - Equipment Phase 3 3,812 3,812 0 4,000 4,000 0 New Acute Hospital - Variations 343 343 0 830 830 0 New Acute Hospital - Signage 38 38 0 45 45 0 New Acute Hospital - Park including Maintenance 2 2 0 175 175 0 New Acute Hospital - Car Park 442 442 0 450 450 0 Clacks Lifecycle Costs 000000 SGHD - NSS Equipping 171 171 0 172 172 0 Demolitions / Decommissioning 857 857 0 1,200 1,200 0 Total 5,802 5,802 0 7,036 7,036 0 Primary & Community Care Modernisation Programme Primary Care Premises Review 0 0 0 51 51 0 Park Street FCH 275 275 0 300 300 0 Bo'ness Health Centre 12 12 0 25 25 0 Dunblane Health Centre 35 35 0 35 35 0 Doune Health Centre 1 1 0 10 10 0 Clackmannan Health Centre 21 21 0 21 21 0 Dollar Health Centre 13 13 0 13 13 0 Total 357 357 0 455 455 0 Community Hospitals Falkirk Community Hospital 676 676 0 676 676 0 Stirling Community Hospital 183 183 0 400 400 0 Total 859 859 0 1,076 1,076 0 Area Wide General Expenditure IM & T Strategy 598 598 0 1,144 1,144 0 IM & T Strategy (2) 88 88 0 500 500 0 Healthcare Associated Infection - Icnet 0 0 0 107 107 0 Prison Healthcare Transfer 29 29 0 69 69 0 Medical Equipment Replacement Programme 221 221 0 500 500 0 Contingency 000000 Total 936 936 0 2,320 2,320 0 Area Wide Other Expenditure Statutory Compliance 000000 FVRH Bed Management Contract 0 0 0 1,800 1,800 0 Total 0 0 0 1,800 1,800 0
Total Net Core Expenditure 7,954 7,954 0 12,737 12,737 0
General Balance Available / (Required) 000000
Savings/(Excess ) Against Capital Resource Limit 000000 ANNEX 2
NHS FORTH VALLEY April - Nov March 2012 SAVINGS PLAN 2011/12 Planned Actual Variance Planned Projected Variance as at 30th November 2011 £'000 £'000 £'000 £'000 £'000 £'000
Primary Care Prescribing 2,294 2,294 0 3,441 3,441 0
External : Cross Boundary Flow : Greater Glasgow and Clyde 733 733 0 1,100 1,100 0 External : Cross Boundary Flow : Scottish Ambulance Service 181 181 0 362 362 0 External : Total 914 914 0 1,462 1,462 0
Management Review : General Manager Posts x 2 42 42 0 84 84 0 Management Review : organisational structure 0 0 0 0 0 0 Management Review : Total 42 42 0 84 84 0
Income : NES : Clinical Simulator 143 143 0 214 214 0 Income : Falkirk : Rates Rebate 115 115 0 115 115 0 Income : Pharmacy Stock Write Off 0 0 0 261 261 0 Income : VAT recovery : Fleming case 85 85 0 145 145 0 Income : Total 343 343 0 735 735 0
Acute : Corporate : reduction in ABC ambulance journeys 15 15 0 30 30 0 Acute : Corporate : reduction in taxi journeys - labs 10 0 -10 20 20 0 Acute : Corporate : reduction in taxi journeys - patients 10 0 -10 20 20 0 Acute : Corporate : winter capacity funding 167 167 0 500 500 0 Acute : Corporate : Total 202 182 -20 570 570 0
Acute : MECAR : reconfigure junior doctors rota at Phase 3 - reduce by 5 wte 75 36 -39 175 175 0 Acute : MECAR : reduce bank spend in nursing by 15 wte 75 0 -75 175 175 0 Acute : MECAR : reconfigure out of hours service to 2 centres 69 49 -20 162 162 0 Acute : MECAR : Hospital at Night Integration 75 37 -38 150 150 0 Acute : MECAR : end admin bank and fill duties via wider discussion 73 0 -73 132 132 0 Acute : MECAR : phase 3 CAU extended day and limited overnight service 42 31 -11 99 99 0 Acute : MECAR : halt band 2 and Band 5 Fixed Term Contracts 38 52 14 63 63 0 Acute : MECAR : reconfigure smoking cessation and redeploy post holders 24 24 0 55 55 0 Acute : MECAR : redeploy 2 Band 6 Discharge co-ordinators to vacancies 20 15 -5 46 46 0 Acute : MECAR : relocate Band 7 non-clinical co-ordinator posts 17 13 -4 34 34 0 Acute : MECAR : end use of locums to fill junior gaps daytime/weekdays 20 20 0 30 30 0 Acute : MECAR : reduce consultant responsibility payments by 3 4 5 1 12 12 0 Acute : MECAR : cease payments to support hospital social work service 5 0 -5 11 11 0 Acute : MECAR : halt temporary contract for Delayed Discharges 4 4 0 9 9 0 Acute : MECAR : redesign phlebotomy - hold vacancy 7 11 4 10 10 0 Acute : MECAR : transfer locum bank to staff bank and redeploy to clinical admin 3 4 1 8 8 0 Acute : MECAR : epilepsy post - redesign 5 29 24 7 7 0 Acute : MECAR : reduce public holiday expenditure 4 0 -4 6 6 0 Acute : MECAR : Ambulatory Care - avoid investment 150 181 31 300 300 0 Acute : MECAR 710 511 -199 1,484 1,484 0
Acute : Surgical Services : Ambulatory Care - Medical EPA 0 0 0 110 110 0 Acute : Surgical Services : Designed Delivery Model : ITU/CCU Redesign 100 100 0 200 200 0 Acute : Surgical Services : Orthopaedic Knee Implants 60 78 18 90 90 0 Acute : Surgical Services : Ambulatory Care - Outpatient Redesign 40 7 -33 80 80 0 Acute : Surgical Services : Designed Delivery Model : Theatre Efficiency 22 23 1 45 45 0 Acute : Surgical Services : Ambulatory Care - one site working travel costs 14 15 1 30 30 0 Acute : Surgical Services : Orthopaedic Hip Implants 8 8 0 26 26 0 Acute : Surgical Services : Haemastatic Dressings 4 4 0 7 7 0 Acute : Surgical Services : Orthopaedic Trauma Implants 0 0 0 0 0 0 Acute ; Surgical Services : Orthopaedic Extremities 0 0 0 0 0 0 Acute ; Surgical Services : Surgical Face Masks 0 0 0 0 0 0 Acute ; Surgical Services : Head Wear 0 0 0 0 0 0 Acute : Surgical Services 247 235 -12 588 588 0
Acute : Women and Children : Demand Management 64 65 1 150 150 0 Acute : Women and Children : Designed Delivery Model : Labs and Radiology 65 66 1 130 130 0 Acute : Women and Children : Designed Delivery Model : Midwifery Nursing 63 63 1 100 100 0 Acute : Women and Children : EPA reductions 47 46 -1 70 70 0 Acute : Women and Children : Fiscal Contract 7 7 1 13 13 0 Acute : Women and Children : Sexual Health Non P 0 0 0 0 0 0 Acute : Women and Children : Discharge Notes 0 0 0 0 0 0 Acute : Women and Children : Family Planning Fees 0 0 0 0 0 0 Acute : Women and Childrens 245 247 2 463 463 0
Clacks CHP : Mental Health : Provision of IPCU beds to Lanarkshire 17 0 -17 25 25 0 Clacks CHP : Mental Health : Provision of IPCU beds - balance 0 0 0 0 0 0 Clacks CHP : Mental Health : Community Services Redesign 25 26 1 38 38 0 Clacks CHP : Mental Health : EPAs/Lochview/Out of Area/Low Secure Beds 0 0 0 0 0 0 Clacks CHP : Mental Health : Reduce Consultants On Call Rota 5 4 -1 7 7 0 Clacks CHP : Mental Health : Reduction in LD Nurse Bank 11 11 0 17 17 0 Clacks CHP : Mental Health : Clinical Nurse Management Restructure 33 33 0 100 100 0 Clacks CHP : CREATE 4406 6 0 Clacks CHP : Locality Resources 7 7 0 10 10 0 Clacks CHP 102 85 -17 203 203 0
Falkirk CHP : Complex Care 67 67 0 100 100 0 Falkirk CHP : CREATE 12 12 0 18 18 0 Falkirk CHP : Community Nursing 101 101 0 151 151 0 Falkirk CHP and Complex Care 179 179 0 269 269 0 ANNEX 2
NHS FORTH VALLEY April - Octt March 2012 SAVINGS PLAN 2011/12 Planned Actual Variance Planned Projected Variance as at 30th November 2011 £'000 £'000 £'000 £'000 £'000 £'000
Stirling CHP : AHP : Heads of Service 92 92 0 157 157 0 Stirling CHP : AHP : Clinical Service Model 0 0 0 0 0 0 Stirling CHP : Community Nursing : Bank Spend 45 45 0 67 67 0 Stirling CHP : CREATE 8 8 0 12 12 0 Stirling CHP : Fixed Term Contracts 3 3 0 4 4 0 Stirling CHP : Community Nursing (less offset) 71 71 0 106 106 0 Stirling CHP 218 218 0 346 346 0
Facilities : Admin and Clerical post 17 17 0 25 25 0 Facilities : Sleepknit (Community) 13 13 0 20 20 0 Facilities : Water 27 27 0 40 40 0 Facilities : Clacks Contract Specification 33 33 0 50 50 0 Facilities 90 90 0 135 135 0
Procurement 173 173 0 521 521 0
Strategy Implementation : asset management 970 970 0 1,676 1,676 0
Strategy Workforce Model - Acute 211 4 -207 634 634 0
Review Use of Funding Allocations 182 182 0 545 545 0
Total Savings Plan reported 30th May 2011 7,122 6,669 -453 13,156 13,156 0
Operational Savings Balance 876 0 -876 1,751 1,751 0
Area Corporate : HR (FYE of 10% - staffing associated) 65 65 0 97 97 0 Area Corporate : Finance (FYE of 10% - staffing associated) 93 93 0 140 140 0 Area Corporate : Medical Director (FYE of 10% - staffing associated) 81 81 0 121 121 0 Area Corporate : ICT (FYE of 10% - staffing associated) 88 88 0 132 132 0 Area Corporate : Total 327 327 0 490 490 0
Management Restructure (CY 3 months: recurrent impact above) 111 111 0 333 333 0
Redeployment List: 11 posts at 25k full year 92 92 0 275 275 0
Hospitality / Catering 25 25 0 50 50 0
Fixed Term Contracts: 50 posts at 25k : six months in CYE 208 147 -61 625 625 0
Contingency Reserve 667 667 0 1,000 1,000 0
SGHD Support 1,367 1,367 0 2,050 2,050 0
Final Savings Plan 10,794 9,404 -1,390 19,730 19,730 0
Pressures/Non-recurrent/Provision review 5,231 4,133 -961 7,847 7,847 0
Savings still to be identified 0 0 0 2,973 -2,973
Total Savings Plan reported 30th November 2011 16,025 13,536 -2,489 30,550 27,577 -2,973 ANNEX 2
Risk
LOW
MED LOW
LOW MED
LOW LOW MED LOW
LOW HIGH HIGH LOW
HIGH HIGH HIGH HIGH HIGH HIGH LOW LOW LOW LOW LOW LOW MED LOW LOW LOW LOW LOW LOW
LOW LOW LOW HIGH LOW MED LOW LOW LOW LOW LOW LOW
LOW LOW LOW LOW LOW LOW LOW LOW
HIGH MED LOW MED LOW LOW MED LOW LOW
LOW LOW LOW ANNEX 2
Risk
MED MED LOW LOW LOW LOW
LOW LOW LOW LOW LOW
LOW
LOW
HIGH
LOW
HIGH
LOW
LOW
MED
LOW
MED
LOW
LOW
MED
HIGH NHS Forth Valley Corporate Plan 2011/12
Mid-Year Review
Introduction
The NHS Forth Valley Corporate Plan 2011/12, approved by the NHS Board in August 2011, is the overarching document which details both national and local priorities for action for the year 2011/12. The Plan supports delivery against the NHS Forth Valley Integrated Healthcare Strategy, confirming key targets and priority actions for strategy delivery. The Corporate Plan incorporates the Local Delivery Plan, and is supported by the Financial and Capital Plans. The Corporate Plan is reviewed and updated on an annual basis.
The purpose of the Corporate Plan Mid-Year Review is to report the progress of projects and actions described in the Corporate Plan. The format follows a similar format to the Corporate Plan with progress reports on projects and actions across 9 sections as follows:
National Regional Partnership Forth Valley Wide Surgery Medicine, Acute Care and Rehabilitation Women and Children Community and Primary Care Mental Health
Highlights of the year to date include:
Successful handover of prison healthcare and transfer of Prison Health staff to NHS Forth Valley on 1 November 2011 The Carers Information Strategy was extended to 2011/2012, and subsequently as part of the strategic spending review, for a further three years Additional theatre time has been secured and recruitment of the 5th Consultant post can proceed, enabling implementation of the regional ovarian surgery model to be completed in 2012 Local Change Fund implementation groups have been established covering Clackmannanshire, Stirling and Falkirk Council areas and have agreed a number of projects including re-enablement, intermediate care, community capacity, training etc Extensive rationalisation of the retained estate is underway to support community hospitals and other primary care services. A Forth Valley wide property and asset management strategy has been created across all public agencies to assess co-location opportunities
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Urology is the “pilot” for the scheduling and rostering project and preparatory work is well underway with the urologists reviewing workload and rostering implications. The new Consultant urologist was appointed inDecember 2011 and it is anticipated that a new model of working will be introduced by the end of the financial year. The 2nd phase of the renal dialysis expansion plan at FVRH is in place, with all patients who wish their dialysis to be provided locally currently accommodated. All outpatients including transplant follow up patients have been repatriated from Glasgow to FVRH. The new SEAT Regional Eating Disorder Inpatient Unit building refurbishment programme was completed in December and the recruitment process continues, with opening planned for early 2012
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1. National Projects and Actions
Prison Health – this was handed over to the NHS on 1 November, with NHS Forth Valley taking responsibility for healthcare in the 3 local prisons. Contract arrangements of prison healthcare staff were reviewed and staff have been TUPE transferred to NHS Forth Valley. Further work progresses to demonstrate the outcomes outlined in the Corporate Plan i.e. that healthcare provision for inmates is safe, effective and efficient.
Getting it Right for Every Child (GIRFEC) A Multi-Agency Assessment and Screening Hub (MAASH) has been established at Larbert. The NHS Child Protection Team are now co-located with MAASH. Video Recorded Child and Family Interview facilities have been established supporting Early and Effective Intervention Pilot for at risk youngsters who offend. Multi Agency Regional GIRFEC Steering Group is continuing to meet with grant funds obtained from Scottish Government to support joint work on IT, communications and Multi Agency Integrated Assessment Framework. Local joint training of front line staff in principles and practice of GIRFEC is continuing. Working with Scottish Government on development of i-ACT (IT system for Information Sharing). MIDAS records system being rolled out to front line public health nursing staff following successful pilot
AAA Screening – NHS Scotland Board Chief Executives have approved implementation of the AAA screening programme on a phased roll out, with Forth Valley due to go live towards the end of 2013. Implementation planning is progressing locally
Hepatitis C Action Plan / Blood Borne Viruses – Hepatitis-C Action Plan completed in April 2011 and the Sexual Health & Blood Borne Virus Framework launched in August 2011. The MCN are working to bring together 4 strategic documents - Respect & Responsibility, Hep-C Action Plan, HIV Action Plan and Hep-B Action Plan. Performance indicators agreed: o Fewer newly acquired BBVs & STIs fewer unintended pregnancies o A reduction in health inequalities gap in sexual health & BBVs o People affected by BBVs lead longer healthier lives o Sexual relationships are free from coercion and harm o A Society where the attitudes of individuals, the public, professionals and the media in Scotland towards sexual health and BBVs are positive non stigmatising and supportive.
Working with Carers – The Carers Information Strategy was extended to 2011/2012, and subsequently as part of the strategic spending review, for a further three years. Action plans were submitted to the Scottish Government by the end of May. This included the development of a Forth Valley Integrated Carers Strategy incorporating the National Carers and Young Carers Strategy and the Carers Information Strategy. The first draft is currently out for comment with the aim to have it place ready for implementation during 2012/2013.
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2. Regional Projects and Actions
Renal Transport – a regional group has developed an assessment tool for renal patients seeking ambulance transport, and a review of the transport needs of the existing renal dialysis patients has commenced. The group is exploring both service provision for patients who do not meeting clinical transport criteria and signposting to alternative transport providers.
Oral Maxillofacial Surgery (OMFS) – Service model for complex elective and trauma OMFS work at the regional centre agreed by all participating Boards. Workforce plan being finalised to support the model. Implementation phasing being explored, though for FV patients, the complex elective patient pathway already includes surgery in the regional centre.
Ovarian Cancer – Additional theatre time secured and recruitment of the 5th Consultant post proceeding, enabling full implementation of the regional ovarian surgery model to be completed in 2012.
Cardiac intervention – West of Scotland Cardiac Plan agreed by Regional Planning group and a review of SEAT Cardiac Planning arrangements is proposed for early 2012.
Learning Disability MCN –Review due to be completed with regard to NHS only funded packages by April 2012. Jointly funded packages will be progressed in 2012 / 2013.
Efficiency & Productivity Work streams – Final reports of the working groups in WOS and SEAT due to report by the end of 2011, with implementation plans to follow.
Spinal Surgery – Local back pain pathway has been reviewed and meets the requirements of the national spinal pathway. Regional approach to spinal surgery has been agreed and further work progressing to determine future shape and form of spinal surgery services.
Telestroke Pilot – interim report gives 6 months of activity across SEAT Boards. Further understanding of outcomes, benefits and future delivery models is being prepared, to enable full evaluation of the pilot and support decision making on future service provision
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3. Partnership Projects and Actions
Reshaping Older People's Care/Change Fund – Local Change Fund implementation groups have been established covering Clackmannanshire, Stirling and the Falkirk Council areas. A number of projects have been agreed including re-ablement, intermediate care, community capacity, training etc. Area wide groups have also been established to take forward the development of a Joint Commissioning Framework for Older People. Resources were also identified in the Strategic Spending Review for a further three years with each area now developing more detailed implementation plans starting in 2012/2013.
Civil Contingencies – The Forth Valley Major Emergency Plan, Major Incident Plan and other plans were revised to take account of the full commissioning of FVRH and an exercise held in June to test them before Acute services were fully transferred. A Healthcare (Business) Continuity template has been developed, piloted and is currently being rolled out across the whole of NHS FV. This process will be completed during 2012/2013. Joint planning is progressing well with the other Category 1 responders with plans being developed to meet the Caring for People guidance and Winter Planning.
SAS redesign – National implementation of the Redesign Programme for Patient Transport Service has commenced and FV and the SAS are jointly exploring early work to support the programme implementation locally. FV is participating in the West of Scotland Renal transport redesign.
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4. Forth Valley Wide Projects and Actions
Service by Service Reviews – a draft scope for the end to end service review in Orthopaedics has been prepared and orthopaedics will be the pilot service for the wide review programme.
Acute Inpatient Transformation – Specialist ward configuration fully in place from July 2011 at FVRH.
Ambulatory Care – The operational workforce plan is being implemented in the planned ambulatory areas as opportunities to change the skill mix arise and are appropriate, e.g. staff leaving or returning from maternity leave on reduced hours. The workforce plan has been finalised and the “old” Day Medicine, Day Therapy and Discharge Lounge have been merged into one emergency ambulatory area. Work is still ongoing to improve the emergency ambulatory pathways already undertaken in Day Medicine and in addition to this a Huntington’s clinic and TIA clinic have been added to the remit of the rehabilitation centre. Work continues to improve the allocation of slots in day medicine and improve the overall coding in the unit to enable cases to be counted more effectively and on general improvements to existing pathways. Work is also underway to increase Day/23hour rates in Breast Services as part of the Cancer Modernisation Programme. Appropriate Orthopaedic trauma patients are being managed through Day Surgery avoiding unnecessary surgical admissions. Scheduling/Rostering work stream is ongoing. A review of Endoscopy is underway covering new patient referral pathways and protocols for returns A review of the admin processes was undertaken earlier in the year and improvements implemented.
Advance Care Planning – implementation progressing, linked to the DNA CPR policy.
Transforming admission, transfer and discharge process – implementation complete on opening of FVRH in July. Post implementation review progressing.
Health records – a single provider is in place for off-site storage and this arrangement is co-ordinated through procurement. The agreement with the provider includes document management i.e. arranging destruction of records at the appropriate time. Corporate Services have developed a protocol for off-site storage. Medical Records are being centralised on the FCH site, and this is almost complete. Implementation of document management systems (EDMS) is progressing. Procedures were implemented to ensure the appropriate disposal of records that could not be transferred to FVRH following Phase 1, 2 and 3 migration of acute services (off-site, relocation to appropriate FV storage facility or destruction).
Management Review – the review of management arrangements is ongoing
Demand Capacity and Access – a range of work progressing including demand management, reduction of waiting times premia payments and a DNA project. Speciality specific capacity and access work is underway. A Group is exploring 6
treatments of low clinical value and work has commenced to review thresholds for treatment. The Draft Access Strategy was presented to the Health Strategic Planning group in December with remaining work to be completed by the end of March. A significant rise in outpatient referrals has been experienced from August 2011 to date and reasons for this change are being explored Whole System Capacity and Pathway work streams are progressing, working with the Chief Operating Officer and other stakeholders to review plans
Procurement – East of Scotland Consortia Membership is progressing and input from NHSFV into the regional workplan. Local Procurement information system has been developed and rolled out to Clinical Units. National Key Performance Indicators (KPIs) have been developed with FV performance progressing well, with improvements in contract compliance and sourcing theatre supplies nationally. A local savings scoping exercise is underway with support from National Procurement to identify further areas of savings potential to support next year’s financial plan. The scoping exercise will support a wider intense review across NHSFV planned for January 2012. Membership of the National Procurement Efficiency Group has been established with NHS Forth Valley represented . Workplan and initial focus of the group is sharing good practice and developing information systems and tools.
Patient Safety Programme –the programme continues to be implemented across a wide range of clinical areas in NHS Forth Valley
Asset Utilisation – Extensive rationalisation of the retained estate is underway to support community hospitals and other primary care services. A Forth Valley wide property and asset management strategy has been created across all public agencies to assess co-location opportunities.
Contract Management – Performance management arrangements are working well.
Organisational Support Services – Project Manager appointed and Steering Group Established. Scope of review agreed and PID agreed. First meeting of Sponsoring Project Board December 2012.
Energy Management – Work has been underway to redesign the department following the retiral of the post holder in July. This has been concluded and a new individual is now in post. During that period, in collaboration with the community hospital development work, information on energy performance has continued to be monitored.
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5. Surgery Projects and Actions
Orthopaedic Review / Repatriation – end to end service review being scoped and premia payment reduction plan agreed.
General Surgery – Clinician appointed to lead short piece of work on the future delivery of general surgery and associated workforce plan.
Review of Pain Services – Service centralised in the pain unit at Falkirk Community Hospital. New consultant has taken up post. Pain Association Scotland pain management training courses secured for three years. Courses refreshed and updated. Pain Management Courses reviewed and changes to aims and structure under development
CEPAS implementation – Go live in Forth Valley scheduled for December 2011 as part of phased regional system roll out of chemotherapy electronic prescribing.
C-Port Implementation – regional implementation arrangements under review.
Chemotherapy review – local breast oncology arrangements improved in order to meet growth in demand for oncology clinics and chemotherapy. Regional work progressing, linked to national Cancer Modernisation programme.
Cancer Strategy/Action Plan – lead cancer team reviewing local strategy and action plan in the light of SGHD Better Cancer Care action plan issued in October and the associated the Detect Cancer Early Programme and Cancer Modernisation Programme.
Theatre transformation / Productive Theatre – Theatre schedules were prepared to support the move in July and to date these have proved effective. However the ongoing scheduling and rostering project will have a long term impact on efficiency and this work is ongoing.
Vascular Services – discussions with partner organisations progressing but have been delayed as the result of national work on a Vascular Framework for Scotland, due to be published shortly.
Curative OG resection surgery – patient pathways have been finalised which ensure that the majority of care in the diagnostic, pre-operative and post-operative phases for this group of 10 to 12 patients annually, are provided in FV and with surgery and immediate post-op inpatient care in Glasgow. Cost schedule provided and to be reviewed by Health Strategic Planning Group.
Bariatric Surgery – the national review has reported its findings and recommendations, and implementation will be taken forward by the Regional Planning Groups.
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Ophthalmology Review – Additional clean room has been developed and staffed to provide resource for intravitreal treatments and protect main theatre time for other procedures. The service continues to work with local AOC to refine optometry referrals e.g. new children’s referral pathway developed to be presented early 2012. Centralisation of the department at Falkirk Community Hospital has allowed staff changes to support different ways of working regarding out of hours and urgent patient care, which will also allow some efficiencies in patient pathways.
Urology Services – Work is ongoing and urology is the “pilot” for the scheduling and rostering project. Preparatory work is well underway and the urologists are now reviewing workload and rostering implications. New urologist appointed in December and it is anticipated a new model of working will be introduced by the end of the financial year.
Audiology review – Audiology waiting times have vastly improved as has the financial performance within the department. At the moment the situation is being monitored to ensure improvement is sustained.
Anaesthetics workforce – Options for future anaesthetic service delivery need to be aligned to ongoing service reviews in orthopaedics and general surgery, therefore the workforce plan cannot be completed until these reviews have been concluded. Further recruitment challenges have been experienced at Specialty Doctor level and conversion of two posts to Consultant level has been supported by the Health Strategic Planning Group.
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6. Medicine, Acute Care and Rehabilitation Projects and Actions
Respiratory Medicine – service redesign progressing along with sustainability planning.
Renal Medicine –Second phase of the dialysis unit expansion plan at FVRH is in place, and there is currently no waiting list for patients wishing to have their dialysis locally. All outpatients including transplant follow up patients now repatriated to FVRH from Glasgow Hospitals.
Neurology – Improvement work continuing with significant redesign of stroke pathway and services. Consultant appointment now in place. Review of specialist nurse role underway with intention to establish a generic nurse support.
GI Service Review - Limited progress to date due to vacant consultant post. Further discussion underway with team to update action plan.
Diabetes Development - Whole system redesign and transformation of diabetes services achieved. Further work now taking place to introduce electronic glycaemic control. Team now also participating in ‘Think Glucose’, a national pilot to improve Glycaemia control.
Cardiology - Improvement continues. Initial outcome well underway to being achieved with a significant reduction in waiting times. Heart failure nurses addressing needs of return patients with a view to freeing up new patient slots for consultants.
Acute and Urgent Care (Whole System) - Work now started with SAS on professional to professional calls and see and treat pathways
Acute and Urgent Care (Patient Flow) - Redirected use of contingencies. Patient boarding significantly reduced. Discharge numbers on a day to day basis significantly up on last year.
Acute and Urgent Care (Redesign Model of Care) - Improvement work continues, in particular around surgical services with pathways being developed with GP’s for six specific conditions. CAU now operating as a day model with improved outcomes.
Technology - Significant progress made with KPI’s now available for all ward areas. Significant efficiency in cost of providing patient flow with reduction in patient flow managers now at approx £0.200m saving
Optimising Access to Clinical Services (OPACS) - In place during the OOH period with significant increase in patients being redirected. Further service change was introduced in the daytime period at the Emergency Department from December 2011.
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Call Handling - Service in place now for all specialties. Working well from GP perspective. Further work required to ensure sustainable service in place.
GP Out of Hours Service - GP & ED/Minor Injuries Services now functionally integrated. Focus on efficiency. Changes made to drivers and receptionist duties and functions. Workforce plan nearing completion. Patient management system to be replaced in January 2012 which will provide robust information to support improvement to quality of service.
Emergency Care Network - Know who to turn to information now distributed to all households. Work continues on seven key milestones within HEAT action plan.
7. Women and Children Projects and Actions
Maternity Strategy – national frameworks for Maternity Services and for Maternal and Infant Nutrition now published. FV strategy will be updated to reflect the frameworks and other local, regional and national service changes and policy.
Maternity Care – the new model of maternity care has been fully implemented at FVRH following the transfer of women and children’s services in July.
Laboratories – review of laboratory services is progressing to plan.
Radiology – review of imaging services in Forth Valley is progressing to plan.
Hall 4 Implementation – Hall 4 compliant Vision Screening Programme agreed and screening commenced in September 2011.
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8. Community and Primary Care Services Projects and Actions
Primary and Community Care Services Development Plan – The Plan has been approved by the Healthcare Strategy Programme Board and has been shared with CHP Partnership Board ,CHP Sub Committees and the Joint Adult Strategic Planning Group. A Review is being undertaken currently to assess progress at CHP level against the Plan's key priorities.
Community Hospitals – The inpatient Model of Care in the Community Hospitals continues to develop. o Turnover continues to improve, evidenced by a 50% increase in admissions in the last two years. Waiting times are generally very short. o Managing the workforce plan through a frequently changing landscape has been, and continues to be, a challenge. o Key developments have seen the initiation of a new GP “portfolio” role and also ten stroke rehabilitation beds have been now embedded in ward 7 at Bannockburn. This model is working very well and now means that around 75 rehabilitation beds are available in community hospitals across the area. o During 2011/12 the Bonnybridge Hospital beds move to Falkirk Community Hospital and in the Bannockburn Hospital beds move to Stirling Community Hospital. This will lead to a more flexible environment with benefits for patients and for inpatient flow. Reshaping care for older people offers the opportunity to review bed based models of care and in particular the Stirling Care Village has already initiated a proposal to develop a more integrated approach to essential bed based care.
Equally Well – Work varies between CHP, but the following gives an overview of progress, and some specific examples: o Implementation of the national Early Years Framework is progressing o Work on positive parenting continues in each area o Each local alcohol and drug partnership has put together an action plan, with the beginnings of implementation o A Forth Valley wide substance use needs assessment is underway and the process of reviewing the Forth Valley substance use strategy has begun. o The Forth Valley Alcohol and Drug Partnership has agreed a consensus statement on alcohol. o NHS representation on licensing boards and forums has been reviewed and strengthened. o Activity regarding alcohol brief intervention continues to greatly exceed targets. o An asset-based approach focussing on Hawkhill in Alloa has brought a partnership approach to community development, and is supported by the Violence Reduction Unit. o Work on mental wellbeing has been reviewed, and each CHP area is progressing. Specific examples of work are: development of stress control group provision (all areas), social prescribing/referral (Falkirk), inclusion of WEMWBS (Warwick-Edinburgh Mental Wellbeing Score) in Clacks 1000. o The HEAT target for inequalities targeted cardiovascular risk assessment health checks has been exceeded 12
o Plans for extension of Keep Well beyond March 2012 are progressing well.
Long Term Conditions – NHS Forth Valley is one of four Scottish Health Boards to participate in an evaluation of the Key Information Summary (KIS) prior to a national rollout. The KIS will allow the sharing of anticipatory care plan information with out of hour providers. This will go a long way to achieving the outcomes detailed in the Corporate Plan. Eleven GP practices are signed up to participate and a KIS Project Board has been established. The evaluation will commence from February 2012. A recent meeting with senior staff at ISD explored two SPARRA developments that will improve SPARRA data and have this more accessible to practices and managers. The new SPARRA algorithm includes prescribing data and no longer requires people who have had a hospital admission to have a SPARRA risk score. Access to the new SPARRA online will provide GP practices and practitioners with customisable reporting function to interrogate the new SPARRA data and create bespoke reports based on the data they are interested in. ISD will provide training to interested GP practices in the new year. As part of whole systems working project, clinical pathways group now established. New local guidelines for neuropathic pain have been launched. NHS Forth Valley accepted as one of the five Scottish Boards to take part in the DALLAS research project.
Whole Systems – Three work streams are in progress with 56 out of 57 practices participating. The work streams are: o Reducing variability and in particular, ensuring the appropriate use of laboratory tests and imaging o Implementing the falls pathway and falls liaison in primary care, alongside implementation of DEXA scanning in Forth Valley o Patient safety and poly-pharmacy, focussing on frail patients, to ensure inappropriate drugs are not used and that unsafe medication combinations are eliminated Whole systems work in Forth Valley was one of ten areas of quality in primary care highlighted at the NHS Scotland Event in July 2011 All practices are participating in the QP QOF which is looking at the appropriate use of referral and admission pathways along with appropriate and efficient prescribing. This will be completed in March 2012.
DEXA /Falls – The DEXA scanner was delivered and installed in September, followed by a period of training for staff. Referral and patient management pathways have been completed and are being implemented in primary care.
Oral Health Strategy – Despite additional challenges i.e. transfer of Prisons and oral health workforce FV are broadly on track with targets. Regional MCN with partner Boards in the East of Scotland established. HEAT 9 is below trajectory but this in part due to the way in which the target is recorded.
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9. Mental Health Projects and Actions
Mental Health Delivery Plan – The consultation process on the National draft Mental Strategy on-going with a view to respond in January 2012 and thereafter define local priorities consistent with national outcomes.
Eating Disorder Inpatient Unit – The recruitment process progresses with the Regional Unit refurbishment completed and handed over to the clinical team in December 2011, recruitment of staff in progress and with the unit due to open to inpatients early in 2012.
Adult Mental Health and Older People Services Transformation – With reference to the Dementia Heat Target, the number of people in Forth Valley with a diagnosis of dementia as a percentage of the predicted prevalence stands at just over 61%. A Sustainability Plan has been agreed by the OAP Redesign Steering Group to ensure work continues between Primary and Secondary care services to maintain improvements to the above figure.
Redesign of community mental health services – Progress continues with the review of local Community Mental Health Services. Each of the three sectors have agreed to a Resource Centre Model. This would provide single referral pathway with a screening mechanism and be co-located with Social Work Services. Workforce Plans are being developed with a view to identify savings both in the short and long term.
Learning Disability programme – Work is being progressed through the Learning Disability Service Improvement Programme (LD SIP). The LD SIP building on joint working from the past year has now achieved a consensus on developing a local four tier service delivery model that will provide high quality care across Forth Valley. This will be driven and governed around personalised, needs based care.
Adult / old age psychiatry – Consistent with Dementia Strategy NHS Forth Valley and partner agencies are focusing the on two key areas: o providing support and information to people with dementia and their carers following diagnosis o improving the response to dementia through alternatives to admission and better planning for discharge.
with a view to identify what needs to be taken forward in order to meet these challenges and highlight the areas of good practice that are already in place to enable us to meet the standards.
CAMHS – Throughout 2011 NHS FV has consistently met the 52 week target and has a 98% RTT within 26 weeks, with the exception of Learning Disability. Vacancies have been backfilled and FV now has a wte of 8.23 per 100,000 .
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GLOSSARY
AAA Aortic Abdominal QP QOF Quality and Productivity Aneurysm Screening (Indicators) Quality Outcomes Framework AOC Area Ophthalmic Committee SAS Scottish Ambulance Service BBV Blood Borne Viruses SEAT South East and Tayside CAMHS Child and Adolescent SGHD Scottish Government Health Mental Health Services Department C-Port Chemotherapy planning SPARRA Scottish Patients At Risk of system Readmission and Admission CEPAS Chemotherapy Electronic TIA Transient Ischemic Attack Prescribing System DALLAS Delivering Assisted Living TUPE Transfer of Undertakings Lifestyles at Scale Protection of Employment DEXA Dual Energy X-Ray WOS West of Scotland Absorptiometry DNA Did Not Attend WTE Whole time equivalent DNA CPR Do Not Attempt Cardio- Pulmonary Resuscitation EDMS Electronic Document Management System FCH Falkirk Community Hospital FVRH Forth Valley Royal Hospital GIRFEC Getting it Right for Every Child HALL 4 Health for All Children HEAT Health Improvement Efficiency Access and Treatment ISD Information Services Division KIS Key Information Summary KPI Key Performance Indicator LD SIP Learning Disability Service Improvement Plan MAASH Multi-Agency Assessment and Screening Hub MCN Managed Clinical Network OMFS Oral Maxillo-facial Surgery OG Oesophago-gastric PID Project Initiation Document
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Forth Valley NHS Board
24 January 2012
This report relates to Item 5 on the agenda
NHS Forth Valley Integrated Healthcare Strategy 2011-2014
(Paper presented by Professor Fiona Mackenzie, Chief Executive)
For Approval
SUMMARY
1. NHS FORTH VALLEY INTEGRATED HEALTHCARE STRATEGY 2011 -2014
2. PURPOSE OF PAPER
The purpose of this paper is to present the updated NHS Forth Valley Integrated Healthcare Strategy 2011-2014 to the NHS Forth Valley Board for approval.
3. KEY ISSUES
Board Members were provided with an update on progress in relation to the development of the updated strategy at its September 2011 Board Meeting and were given the opportunity to comment on the draft document at the November 2011 Seminar.
The strategy represents a refresh of the existing strategy and is supported by a number of detailed plans.
Key aspects of the revised strategy include:-
Our vision remains unchanged; Major model and infrastructure changes now largely complete; Acknowledgement of new national strategies, for example the Quality Strategy, Efficiency and Productivity Framework, the Christie Commission and the recent Government announcement regarding the integration of adult health and social care; A strengthening of our efforts on preventative healthcare measures; Emphasis now on embedding new models of care and improving the patients experience and consistency of care across the primary and secondary care system; Increasing our focus on working in partnership and greater integration with other Health Boards and with partner agencies; Recognition of the challenging economic climate facing the public sector as a whole and the need to balance improving the quality of our services against continuing to live within our means.
4. FINANCIAL IMPLICATIONS
The revised strategy acknowledges the unprecedented level of financial challenge faced by NHS Forth Valley now and in the coming years. The emphasis is now firmly focussed on maximising efficiency and productivity as we drive forward the delivery of our Integrated Healthcare Strategy and is implicit within our Financial Plan.
5. WORKFORCE IMPLICATIONS
NHS Forth Valley’s Workforce Modernisation Strategy sets out the clear future focus in delivering health improvement and healthcare services through a modernised workforce. NHS Forth Valley aims to become the employer of choice working in partnership to deliver our service commitments.
There may be implications for the public sector workforce as a result of the increasing emphasis on joint and integrated working with partners. Any impact will be fully discussed as appropriate between partners.
6. RISK ASSESSMENT AND IMPLICATIONS Risks to implementation of our strategy are recorded within the Corporate Risk Register that is routinely monitored through the Performance Management Group and relevant Board Committees.
7. RELEVANCE TO STRATEGIC PRIORITIES
The NHS Forth Valley Integrated Healthcare Strategy defines the Strategic Priorities.
8. RELEVANCE TO DIVERSITY AND / OR EQUALITY ISSUES
NHS Forth Valley’s vision is to provide health improvement, healthcare services and employment opportunities which promote equality for all and which eliminate any risk of discrimination.
9. CONSULTATION PROCESS
Comments on the draft strategy have been sought from Forth Valley NHS Board Members, General Managers and a range of other key individuals. Comments have also been sought from Stirling and Clackmannanshire Local Authority partners via the Joint Partnership Board. Due to unforeseen circumstances it has not been possible to seek comments formally from the Falkirk Partnership Board. The strategy will be presented to the next Falkirk Partnership Board at its meeting scheduled to take place in March 2012.
10. RECOMMENDATION(S) FOR DECISION
The Forth Valley NHS Board is asked to: -
Approve the NHS Forth Valley Integrated Healthcare Strategy 2011-2014. Approve that delegated authority is given to the Chief Executive to incorporate any minor amendments that may be proposed following the Falkirk Partnership Board Meeting in March 2012. Note that in the unlikely event that proposed amendments made by the Falkirk Partnership Board are of a material nature that these will be presented to the NHS Forth Valley Board for approval prior to inclusion.
11. AUTHOR OF PAPER/REPORT:
Name: Designation: Beverley Finch Head of Corporate Services
Approved by: Name: Designation: Fiona Mackenzie Chief Executive
Version 8a - 16 January 2012
NHS Forth Valley Integrated Healthcare Strategy
Fit for the Future
2011– 2014
Approved Date: January 2012 Review Date: January 2014
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CONTENTS
FOREWORD...... 3 SUMMARY ...... 4 1. INTRODUCTION...... 5 2. THE FORTH VALLEY ...... 6 3. ENVIRONMENTAL DRIVERS ...... 7 3.1. Population Projections...... 7 3.2. Expenditure...... 9 4. NATIONAL FRAMEWORKS ...... 11 5. NATIONAL AND LOCAL DRIVERS ...... 16 6. STRATEGIC VISION ...... 17 7. OUR COMMITMENT ...... 19 8. OUR VALUES ...... 20 9. OUR APPROACH TO DELIVERY ...... 21 9.1 Culture...... 21 9.2 Integration ...... 21 9.3. The Importance of Improving Health...... 22 9.4 Infrastructure...... 23 9.5 Shifting the Balance of Care...... 24 9.5.1 Key Initiatives for Primary Care ...... 26 9.5.2 Long Term Conditions ...... 26 9.5.3 Anticipatory Care Planning- Thinking Ahead ...... 26 9.6. Providing the Best Experience of Care...... 28 9.7. Maximising Efficiency and Effectiveness ...... 29 10. PERFORMANCE MANAGEMENT & GOVERNANCE ARRANGEMENTS ...... 32 10.1 Performance Management...... 32 10.2 Governance Arrangements & Supporting Strategies...... 34 10.2.1. Delivering a Modern Workforce ...... 34 10.2.2. Communication ...... 35 10.2.3 Patient Focus, Public Involvement ...... 35 10.2.4. Equality and Diversity...... 36 10.2.5. eHealth ...... 36 10.2.6. Financial Plan...... 37 11. CONCLUSION ...... 38
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FOREWORD
This updated Integrated Healthcare Strategy acknowledges the progress that has been made since August 2009 when we last published our Strategy. In 2004 we set out a vision to invest in Primary and Community Care, Community Hospitals and to streamline Acute Services. This year we, to a large extent, completed our major model and infrastructure changes towards achieving this vision as we celebrated the opening of the third and final phase of the new Forth Valley Royal Hospital.
This achievement marked the end of several years of planning and development involving a range of professionals both within and outwith Forth Valley and an unprecedented level of public engagement.
We are now entering a new and exciting chapter of quality improvement as we continue to design and deliver healthcare services fit for the future. Our focus now is to fully embed the new and integrated models of care across the range of care settings from acute through to the network of four community hospitals and other primary and community care facilities.
Our Vision, To Improve Health and Healthcare for the people of Forth Valley, remains unchanged.
Within this context, however, we must acknowledge the findings of the Christie Commission which recommends a radical reshaping of Scotland’s public sector landscape. It is estimated that a staggering 40% of all spending on public services is on interventions that could be avoided by prioritising a preventative approach.
Forth Valley has always had improving quality at the heart of everything it aims to achieve. Whilst this will be our focus, we recognise that this needs to be achieved within the context of unprecedented economic and financial challenge. We therefore need to balance improving quality with the requirement to increase efficiency and productivity whilst at the same time reducing costs. To achieve this, our focus will be on consistent delivery of best model practice, reduction of waste and eradication of unnecessary duplication of work.
NHS Forth Valley is not alone in terms of the challenges currently being faced and as a consequence we continue to seek out opportunities to work in partnership with other NHS Boards, Local Authorities and the third sector in particular to achieve economies of scale, prioritise preventative measures, reduce health inequalities, improve patient care and maximise efficiencies. Our Strategy will endorse the need to maximise our efforts in this regard and look towards greater integration of service delivery consistent with the recent Scottish Government announcement in December 2011.
I recognise that delivery of our Strategy depends on the valuable contribution of our staff. Through continued development of a culture of redesign and improvement and by building on our reputation as an employer of choice, I firmly believe that NHS Forth Valley has the tools to contribute to the Scottish Government’s aim for Scotland to be recognised as a world leader in healthcare quality.
I commend this Strategy to the Forth Valley NHS Board.
FIONA MACKENZIE CHIEF EXECUTIVE JANUARY 2012
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SUMMARY
This strategy sets out the key aims, plans and priorities for NHS Forth Valley over the next few years and highlights the main challenges and issues we face during this period as we work to achieve our vision ‘To Improve Health and Healthcare for the people of Forth Valley’.
Like other NHS boards and public sector organisations across the country, NHS Forth Valley faces significant challenges due to the difficult economic environment. Changes in the population we serve will also have a major impact on demand for our services due to the increasing number of older people who are living longer. The health of local people continues to be a challenge as we work with partners to tackle problems caused by obesity, poor diet, smoking and alcohol use.
Our key priorities for 2011 – 2014 are to:
Prevent ill health Improve the experience of patients and involve them in their care Increase the quality, safety and consistency of care Work in partnership Increase the effectiveness and efficiency of the services we provide Deliver care as close to home as possible
Achieving these priorities will require close working between hospital and community based services as well as close working with our three local council partners. Closer integration between health and social care services is already planned following the Scottish Government’s announcement in December 2011 that Community Health Partnerships will be replaced by Health and Social Care Partnerships, which will be the joint responsibility of the NHS and local councils.
The way healthcare is delivered across Forth Valley has been transformed over the last few years and, in 2011; we completed our major service and infrastructure changes towards achieving our vision as we celebrated the opening of Forth Valley Royal Hospital. The focus now is to continue our efforts to deliver high quality, safe and efficient services and fully embed our new ways of working across the organisation.
This will require further changes to the way services are designed, organised and managed, building on the redesign and improvement work which has already been carried out in many areas. It will also require the commitment and contribution of staff across the organisation to ensure we develop and deliver affordable services which not only meet the needs of today’s patients, but are also fit for future generations.
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1. INTRODUCTION
Across the developed world healthcare systems are challenged by 4 main issues: improving health, securing quality, integrating services and maximising the use of resources. The NHS in Scotland is no different; indeed it is better placed than most to respond to these challenges given that it is not market driven and already operates within an integrated system. This Strategy acknowledges the changing economic environment in which we must now operate.
Significant change has already occurred in NHS Forth Valley in line with our Integrated Healthcare Strategy. Further challenges and opportunities now exist as we progress towards achieving our vision.
Additionally, NHS Forth Valley, in common with the NHS and the public sector in general, is facing a significant and unprecedented financial challenge over the coming years. This, along with the implications that will arise as a result of projected demographic changes and the continuous efforts to improve population health, address health inequalities and prioritise preventative spending requires strong leadership and courageous decision making. This makes it all the more urgent that we redouble our efforts to work more closely with partners and bring these issues to the fore within our strategy to mutually seek to improve performance and reduce costs.
In July 2011 we completed our major model and infrastructure changes as we celebrated the opening of the third and final phase of the new Forth Valley Royal Hospital. This achievement marks the end of several years of planning and development and is an acknowledgement of the tremendous and sustained effort from all those involved in the process including staff, the public, local authorities, professional advisors and other stakeholders.
We are now entering a new and exciting chapter of driving quality improvement throughout the organisation, streamlining patient pathways and achieving greater consistency of care as we continue to design and deliver healthcare services fit for the future. Our focus now is to fully embed the new and integrated models of care across the range of care settings from acute through to the network of four community hospitals, based in Bo’ness, Clackmannanshire, Falkirk and Stirling and other primary and community care facilities.
This links very closely the joint interests of the NHS and our partners in not only delivering new models of care and facilities but in improving population health and reducing inequalities. Our continued focus on partnership working and working towards greater integrated service provision with improved outcomes is one of the cornerstones of our updated strategy and this is why our strategy sets out our commitment to work together with other public, commercial and voluntary agencies and organisations to make a real difference for the people of NHS Forth Valley.
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2. THE FORTH VALLEY
The Forth Valley covers a geographic area from Killin and Tyndrum in the North and Strathblane to the west and Bo’ness in the South, see diagram 1.
Diagram 1 Forth Valley Location
The Forth Valley NHS Board controls an annual budget of around £500 million, employs around 8000 staff and is responsible for providing health services for and improving the health of the population of Forth Valley.
NHS Forth Valley is a single integrated system comprising acute hospital services, and a range of community based services which are delivered through the three Community Health Partnerships (CHPs) in Clackmannanshire, Falkirk and Stirling. Each of these is co-terminous with its corresponding local authority.
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3. ENVIRONMENTAL DRIVERS
There are three major influences that will impact on how the NHS in Scotland currently functions and how it is likely to operate in the future. These are the dramatic change in Scotland’s demography, Scotland’s public health record and the unprecedented climate of financial constraint.
The following section describes the changing demography of Scotland’s and Forth Valley’s population, particularly in the older age group, and projected increases in demand. These are contrasted with financial projections which suggest that Scotland’s public expenditure is planned to fall by 14.9% (or £4.5bn) in real terms between 2009/10 and 2015/2016.
Scotland’s public health remains relatively poor compared to its OECD counterparts despite some areas of good progress, for example, in heart and lung conditions subsequent to the introduction of the smoking ban in 2006.
This message is forcing public services to re-think current structures and governance arrangements, making it ever more pressing that partnerships with the private and third sector become more effective. This has, to date, proved to be very difficult to achieve as a result of different accountability arrangements between agencies and budgetary inflexibility, still strongly focussed on organisational allocations which can hamper joint working to achieve outcomes.
In the current financial climate, the key financial challenges for NHS Forth Valley are the delivery of cost reductions to maintain recurrent financial balance, ensuring the affordability of the healthcare strategy, and improving efficiency and value for money.
3.1. Population Projections
The United Kingdom population is projected to increase by more than 4 million over the next 10 year period to 65.6 million by 2018 and 71.6 million by 2033. Within this, the major population increases are predicted to occur in England with constituent countries not expected to significantly change. The predicted population increase for Scotland rising from 5.3 million in 2013, 5.4 million in 2018 to 5.5 million by 2033.1
However, the spread of Scotland’s population is predicted to change dramatically. Between 2013 and 2023, the 75+ population, who are the highest users of NHS services, is expected to rise by 31.6% and by 2033 will have risen by 67.1%. Similar patterns are predicted for the 65+ age group which is expected to rise between 2013 and 2023 by 13.3% and by 2033 will have risen by 32.7%.
This impacts not only on healthcare provision but staffing availability to provide services.
“In general the older a person is the more ill-health they will suffer.”2 Whilst we can expect an increase in the level of need and demand for health and social care services, as a result of the ageing population, we need to bear in mind that the balance of evidence at an international, British and Scottish level is that age for age; older people have been getting healthier.3 Nevertheless, the next twenty years will see a continuing shift in the pattern of disease towards long term conditions and growing numbers of older people with multiple conditions and complex needs. The changing shape of Scotland’s population is illustrated in diagram 2.
1 NHS Forth alley Director of Public Health Annual Report 2008-2010 2 The Kerr Report (2005), A National Framework for Service Change in the NHS in Scotland: Building a Health Service Fit for the Future, Scottish Executive 3 ibid 7
Diagram 2 – Population Predictions
Forth Valley had an estimated mid year 2010 population of around 293,386 with Stirling estimated at 89,850, Falkirk at 153,280 and Clackmannanshire at 50,6304 Table 15 shows the projected population to 2033 by council area and Forth Valley Health Board area (2008 based data). The table shows that by 2033 Forth Valley area will have an increase in population of 10% with the biggest percentage increase in the Clackmannanshire area.
Table 1 2013 2018 2023 2028 2033 Clackmannanshire 52,900 55,400 57,900 60,400 62,600 (+18.3%) Falkirk 155,900 160,200 164,400 168,100 171,200 (+9.8%) Stirling 89,500 90,800 92,300 93,600 94,300 (+5.4%) Total 298,300 306,400 314,600 322,100 328,100 (+10%)
FV Health Board Area 298,000 306,100 314,300 321,600 327,800 (+10%)
Table 26 shows how the population of the Forth Valley Health Board area is predicted to rise by age band between 2013 and 2033 (2008 based data). The table also highlights that the biggest increase is within the 75+ age group and mirrors the trend nationally. It also illustrates changes from previous predicted figures. The update shows a predicted reduction in the 50-64 age group whereas previous projections based on 2006 data suggested that figures would rise in this age group and would reduce in the 30-49 age group which had traditionally been a significant element of the national workforce.
4 Registrar General Office (Scotland) (www.gro-scotland.gov.uk) 5 ibid 6 Registrar General Office (Scotland) (www.gro-scotland.gov.uk) 8
Table 2 2013 2018 2023 2028 2033 0-15 53,900 54,700 55,500 55,500 55,900 (+3.7%) 16-29 53,600 53,800 52,500 52,900 53,900 (+0.6%) 30-49 79,100 75,700 76,000 79,500 81,300 (+2.8%) 50-64 58,400 62,900 65,500 61,400 56,600 (-3.1) 65-74 29,800 32,300 32,700 35,700 39,800 (+33.6%) 75+ 23,200 26,700 32,100 36,600 40,300 (+73.7%) Total 298,000 306,100 314,300 321,600 327,800 (+10%)
Changes to the state pension age and the number of people who will be of working age will have a bearing on how heath services can continue to be delivered in future years.
Notwithstanding the demographic implications affecting the future delivery of healthcare services, NHS Forth Valley remains committed to providing the best possible care for all residents on an equitable basis.
3.2. Expenditure
Scottish public expenditure is planned to fall by 14.9% (or £4.5bn) in real terms between 2009/10 and 2015/16. The revenue position for the NHS has been protected more than other programmes and in 2012/13 will receive an actual uplift of 1%. Whilst this does offer a degree of protection it will not match health inflation which over the past 5 years across NHSScotland is around 3-4% and expected to continue into the years ahead.
Challenges of NHS inflation include:-
Demographic change and profile of morbidity; People’s increasing expectations of rapid treatment Availability of new clinical developments, including new, and often costly, drugs; and Impact of pay & prices;
These issues need to be seen within the context of a long term history of spending growth (an average of 4% since the inception of the NHS).
In addition, public sector capital resources available to the NHS are under severe pressure with a 36.5% real term reduction in capital resources available to the Scottish Government over the Capital Spending Review period.
In their NHS Overview Report, Audit Scotland commented that, ‘Despite the slowing rate of funding increases, the NHS continues to face growing demand for its services. Budgets will come under pressure as costs associated with pay, energy, prescribing and demographic changes rise at a faster rate than funding increases. This leaves NHS bodies with a major challenge to find significant savings so they can continue to provide the same level and quality of services within their available budgets.’
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NHS Forth Valley, therefore, in common with the public sector in general, is facing a significant financial challenge over the next few years. Permanent reductions in spend of £30.5m are required by March 2012 and work is underway to produce sustainable recurrent savings plans to address the recurrent position. For future years, based on current assumptions, the Board financial plan highlights a further requirement of approx £10 million of cost reduction per annum to maintain financial balance.
The increasing overall population in Forth Valley relative to other NHS Boards, and more specifically the increase in the elderly age groups, places an additional cost pressure on service delivery, particularly in primary care and community settings. Under the current resource allocation which is based on a combination of factors including population, rurality and deprivation levels, NHS Forth Valley is £11.3m below its target (NRAC) share of funding.
The emphasis is now firmly focussed on maximising efficiency and productivity as we drive forward the delivery of our Integrated Healthcare Strategy and is implicit within our Financial Plan.
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4. NATIONAL FRAMEWORKS
In addition to the environmental drivers referred to in section 3, a number of national planning frameworks influence our strategy.
In December 2007 the Scottish Government published a document Better Health Better Care which forms the blueprint for the direction of travel for all NHS Boards in Scotland. It emphasises the need for modernisation of health services and specifies that treatment and support should be provided as close to the patient’s home as possible with the evolving model of care being “embedded in communities.”
The document also introduces the concept of a mutual NHS where patients see themselves as partners in care and not just receivers of services. This will “further strengthen the collaborative and integrated approach to service improvement that is the hallmark of Scotland’s NHS.7” Mutuality in healthcare requires to develop in ways that add value and include frontline staff in service role redesign. There requires to be a greater emphasis in the future on working in partnership with patients, families and carers that allows the development of anticipatory care planning and ways of working where patients feel enabled to be responsible for and are appropriately informed about aspects of their care management.
A package of measures to improve patients' experience of the NHS became enshrined in law as the Patient Rights (Scotland) Bill was passed in February 2011. A legal treatment time guarantee and a legal right to complain are among the package of measures passed by the Scottish Parliament. Measures in the bill include: • a 12-week treatment time guarantee • provision for a patient advice and support service • bringing in a legal right to complain • a duty on Scottish Ministers to publish a Charter of Patient Rights and Responsibilities
The Bill ensures that patients know what their rights are and have access to independent support and advice to assist them in their dealings with the NHS. The bill is one of a raft of measures the Scottish Government has implemented such as the Quality Strategy and the Patient Experience Programme to ensure that people are partners in their own care.
In December 2008 the Scottish Government published the Equally Well Implementation Plan in response to a Ministerial task force on health inequalities recognising that “Scotland's health is improving rapidly but it is not improving fast enough for the poorest sections of our society. Health inequalities remain our major challenge." The plan addresses the challenges faced by the most deprived and vulnerable in our communities and the co-ordination of future activity and cross cutting initiatives required of the NHS, local government, third sector and other community planning partners. The plan emphasises the role of Community Planning Partnerships as the local leads.
7 Better Health Better Care Action Plan December 2007 11
The plan acknowledges the complex inter-play of factors, for instance; using alcohol as an example. This is fundamentally a lifestyle factor but culture, age, heritage, social networks, employment, housing; mental health and other factors are all relevant. It is not simply a cause and effect relationship. These factors are highlighted in diagram 3.
Diagram 3 – Lifestyle Factors
The Scottish Government’s Strategic Narrative identifies 3 challenges for the NHS in Scotland;
Changing demography Scotland’s public health record Economic environment
The Scottish Government’s response to these challenges is;
Commitment to the NHS founding principles; Integration and collaboration not competition or markets; Less care in acute settings and more at home or in the community; Integration of health and social care; and Greater efficiency and productivity.
The conditions required to meet the challenges are;
Quality improvement must drive the agenda; With people not to them; and In partnership with our staff and those who work with us.
In order to drive the changes needed to meet the challenges described, the Scottish Government produced The Healthcare Quality Strategy for NHSScotland and an NHSScotland Efficiency and Productivity Framework 2011-2015.
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The Scottish Government launched The Quality Strategy in May 2010 with the intention that Scotland should build upon its existing foundations to ensure that everything the NHS does is integrated and aligned to deliver the highest quality healthcare services. This will provide recognised, world-leading quality healthcare services for the people of Scotland. Work is underway to streamline and align all activity to three Quality Ambitions based on the internationally recognised Institute of Medicine (IoM) six dimensions of healthcare quality, Effective, Efficient, Safe, Timely, Patient Centred, and Equitable.
The Quality Ambitions are:-
mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity and clear communications and shared decision-making
there will be no avoidable injury or harm to people from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times
the most appropriate treatments and interventions, support and services will be provided at the right time for everyone who will benefit, and wasteful or harmful variation will be eradicated.
The Scottish Government produced the Efficiency and Productivity: Framework 2011-2015 in February 2011. The Purpose of the Framework is to identify priority areas to improve quality and efficiency whilst ensuring good value for money. The Framework is a companion to the Quality Strategy and provides a baseline for the changes that will need to be undertaken by the Scottish Government Health Directorates, NHS Boards and other public sector organisations.
The Framework has three overarching themes:
Support – supporting the NHS workforce and is linked closely to the Quality Strategy highlighting the importance of staff being appropriately skilled to deliver the necessary changes; Enablers – identifying, sharing and sustaining good practice. Enablers refer to benchmarking and access to the right quality, performance and productivity data, the effective use of technology and the support of the National Quality and Efficiency Support Team (QEST); Cost Reductions – reducing variation, waste and harm. Within which seven workstreams have been identified nationally where there are envisaged to be further savings and quality improvements to be made.
Evidenced Based Care Preventative and Early Intervention Outpatients, Primary and Community Care; Acute Services Flow and Capacity Management Workforce Productivity Prescribing Procurement, Shared and Support Services Services Redesign, Transformation and Innovation.
Diagram 4 indicates that quality and efficiency are not exclusive and that it is possible to achieve improvements in quality and efficiency at the same time.
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A number of national initiatives and action plans underpin the Quality Strategy and support the NHS to deliver the quality ambitions. These include Scotland’s Patient Experience Programme – Better Together, the Scottish Patient Safety Programme, and the development of the NHS Inform which provides a co-ordinated approach to information provision and a single source of quality assured health information for the public in Scotland.
Diagram 4 –Quality & efficiency - Two sides of the coin
Quality & Efficiency – Two sides of the coin
“To improve the overall quality and efficiency of NHSScotland while ensuring good value for money and achieving financial targets.”
More recently the Christie Commission Report on the Future Delivery of Public Services was published in June 2011. The report called for radical reform of Scotland’s public services in terms of delivery of services and also signalled a need for cultural change. The report detailed four objectives of a reform programme centred around people and communities and building up their autonomy and resilience; greater emphasis on public sector organisations working together; prioritising prevention, reducing inequalities and promoting equality and continued emphasis on improving performance whilst at the same time reducing costs.
The Scottish Government published ‘Renewing Scotland’s Public Services – Priorities for reform in response to the Christie Commission’ in September 2011. The document responded positively to the findings of the Christie Report and described the Government’s approach to public service reform built on four pillars.
Decisive shift towards prevention; Greater integration at local level driven by better partnership; Enhanced workforce development; and More transparent focus on improving performance.
In December 2011 Health Secretary Nicola Sturgeon set out the Government’s plan to integrate adult health and social care. Legislation will be introduced, following consultation, which will herald a radical reform of Community Health Partnerships which will be replaced by Health and Social Care Partnerships responsible for delivery against nationally agreed outcomes. 14
The NHS Forth Valley Integrated Healthcare Strategy and supporting plans provide the local response to these documents and acknowledges the progress already made across NHS Forth Valley towards shifting the balance of care, away from reactive hospital based care, to community based preventive and rehabilitative models. Key to this is improving communication, promoting understanding of the single system approach and effective information sharing at the interface of different parts of the healthcare system.
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5. NATIONAL AND LOCAL DRIVERS
We must also consider other drivers. In our previous Strategy documents, we set out our reasons why we needed to change the way health services were delivered and these have remained broadly unchanged, however, of particular significance is the continuing and increasingly challenging financial and economic climate.
Our main drivers are:-
Demographic changes including the ageing population and expanding population leading to an increased burden on healthcare services particularly from the higher incidence of long term conditions;
Economic constraints;
Public health challenges particularly around inequalities;
Costly technological and medical advances in patient care and communication;
Public and patient expectation and experience of care;
Pressures and changes within the workforce resulting in potential issues in recruiting and retention of staff including the impact of the European Working Time Regulations and Modernising Clinical Careers
Impact of legislative change, for example the Equality Act and transfer of primary healthcare services from Scottish prisons to the NHS from November 2011;
The modernisation of services, focussing on quality and clinical effectiveness;
The need to achieve the most effective and efficient utilisation of resources to support service modernisation and development, including ensuring delivery of care is consistent, reducing variation and duplication and ensuring the most appropriate care options are provided;
National drivers in service redesign to shift the balance of care, for example, shortening waiting times, improving services for those with long term conditions and improvements in mental health care.
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6. STRATEGIC VISION
Our Strategic Vision is To Improve Health and Healthcare for the people of Forth Valley which we will achieve though a combination of objectives:-
strengthening our efforts on preventative healthcare measures; improving the patients experience building a culture of person centred care that recognises the patient as a partner; ensuring the quality, safety and consistency of care for people who have entered the healthcare system; increasing our focus on working in partnership with other Health Boards and greater integration with local authority partners; and delivering care as close to home as possible.
We recognise that we cannot achieve our vision alone and this is why the consistent message throughout our strategy is one of partnership and integration. In particular, we must work with our partners to maximise efficiency, continue our efforts to reduce health inequalities and to enable us to meet the needs of an increasingly elderly population and prevalence of long term conditions.
This approach is consistent with the thinking behind Triple Aim an international learning initiative developed by the Institute of Healthcare Improvement (IHI) in the USA. The objectives of this programme are to:-
Improve the health of the population; Enhance the patient experience of care (including quality, access and reliability) and; Reduce or at least control the per capita cost of care.
Our focus over the next 3-5 years will be to continue to drive forward health improvement, anticipatory care and self managed care so that the demand for traditional healthcare services can be reduced or at least managed within the capacity that is available. Our emphasis on preventative healthcare requires a joint approach between ourselves and key partners and will only be possible if we seek to improve the wider determinants of health such as individual lifestyle factors and other social and community networks and the broader environmental conditions facing the general public.
At the same time, once people enter the healthcare system, we need to make sure that the quality of care they receive is second to none and that it is delivered to a consistent and high standard ensuring patients receive the right care, in the right place, at the right time delivered by the most appropriate professional which is both efficient and effective. We will continue to streamline our processes and reduce duplication by making best use of available technology to automate systems wherever possible.
We will seek out opportunities to work with other NHS Boards on either a regional or a national basis where it makes sense to do so. This will be in areas where there are economies of scale, where there are opportunities to share backroom services and where services are of a specialist nature which require central or regional ‘centres of excellence.’
We recognise that the majority of people do not want to stay in hospital for any longer than they need to and we will continue to work with our partners and with patients and carers themselves to ensure that people being discharged from care within NHS acute services go on receiving the care that they require in the appropriate community setting delivered by the right people with the 17 right skills. This may also mean that services traditionally provided by NHS staff could be delivered jointly in future between ourselves and the Local Authority and / or the third sector. What is important is that the care should be person-centred and the delivery of that care should not be restricted by artificial and historical boundaries within and across the public sector.
Our strategic vision, however, must be set within the context, as described earlier, of significant financial constraint. Over the next few years we cannot underestimate the effect that this will have on our ability to continue to deliver everything that we have set out to do and still live within our means.
This means that we will need to make difficult decisions. We will prioritise which key areas must be delivered to meet our strategic objectives, protecting the delivery of core front line services. However, to continue to achieve this, we will need to look at how other services are currently configured, the value and benefits of these services to patients and how they could be delivered differently in the future.
Section 9 details our approach to delivering our strategy in more detail and highlights how important it will be for our entire workforce to embrace the changing environment and circumstances in which we will now need to operate to create a sustainable future.
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7. OUR COMMITMENT
It is essential, given the changing economic landscape previously outlined, that there is a shared vision and a collective ethos that enables people to reach a common purpose. To this end we remain committed to:-
Work in partnership; with public, patients and local authorities as a means of improving health and healthcare and reduce health inequalities, integrating services where it is safe and efficient to do so;
Support our staff, and have belief in their abilities and expertise making it possible for them to deliver excellence taking account of the continuing and increasing impact of change;
Improve patient safety; improving consistency of care and safe and effective services within a safe environment protecting patients and staff from harm;
Modernise services; promoting a climate of continual quality improvement through the development of new models of care improving the patients' experience;
Be as effective as possible, making the best and most efficient use of resources; and
Ensure fair and equal access to services in support of the Equality and Diversity agenda.
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8. OUR VALUES
The commitments outlined in section 7 are underpinned by a set of core values. We believe that adopting a fundamental belief system across our organisation which is exhibited by the behaviours of each individual employee will inform everything we plan and do.
Our Values are:-
Person Centred – we will treat people as individuals, embedding mutuality in care and involving “every patient, every time8” in decisions about the care they receive and planning for future services; enabling them to be a partner in their care with a responsibility to help manage their condition.
Ambition – we have high expectations in Forth Valley to deliver world class health and healthcare services fit for the 21st century.
Integrity – we will act with integrity at all times and be accountable, open and honest in everything we do.
Respect – we will treat each other, our partners and the people who access our services with dignity, respect and humanity.
These values are aligned to our organisational culture, behaviours, practices and processes.
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9. OUR APPROACH TO DELIVERY
To deliver our strategy against the backdrop of the unprecedented financial challenge and the implications that will arise as a result of projected demographic changes requires strong leadership and courageous decision making. We are fortunate within NHS Forth Valley to have a history of being able to make difficult decisions, through the leadership of our Board and supporting Executive Team. We must continue to have the confidence to do this in the future.
We have already acknowledged that twenty-first century healthcare involves important changes to the way we work.
9.1 Culture
We recognise that to continue to deliver high quality services over the next five years, requires the sustained commitment of our workforce and adoption of a positive culture of redesign and improvement. We will continue to develop our workforce, ensuring appropriate skills and full engagement in leading change throughout the organisation. We will embed the continual pursuit of patient safety and efficiency and maintain our focus on improving the patient experience. Effective workforce planning lies at the heart of encouraging a responsive workforce and this requires a focus on joint planning with our partners.
The involvement of the public, patients and carers continues to be an essential element in the development and implementation of our Strategy. We no longer want to be seen as doing things to people. We want to create a culture whereby the patient, wherever possible, is fully involved in decisions about the care they receive. This is already happening and in many areas patient and public involvement has become an integral part of the way services are developed and provided.
Patients and the public are involved at all levels of our organisation, contributing to the work of committees and helping to develop clinical services in both the acute setting and in the community. We aim to continue to develop this relationship, so that patients and the public are involved in all appropriate aspects of our service, at the right time using the highest quality involvement.
We must continue to strengthen the role of Community Health Partnerships so that we can better engage local communities in developing new approaches to improving the social challenges that exist within Scotland and encouraging individuals to become more involved in and responsible for their own health and preventative care.
9.2 Integration
The recent Government announcement regarding plans to integrate adult health and social care and reform Community Health Partnerships will provide the necessary leverage to allow NHS Forth Valley to progress with its integration agenda alongside our local authority partners.
We are already in discussion around the implications of locally restructuring public services with each of our three Local Authority partners in Stirling, Falkirk and Clackmannanshire. Stirling and Clackmannanshire Councils have already reviewed some of their services and are moving to a more integrated approach towards the delivery of social care services.
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Our work locally will build on national initiatives particularly the Change Fund to support the shift in the balance of care and models of integrated working. One example of the latter is the proposed Care Village aligned with the Stirling Community Hospital site. Within our joint planning for this development are proposals to develop new primary care premises within the City of Stirling for a number of our GP Practices.
We believe that true visionary leadership is required between ourselves and our partners and the development of a collaborative culture is paramount. We can no longer afford to have different approaches to very similar issues as has been customary in the past.
Similarly, as the NHS is facing a period of significant financial constraint, all NHS Boards are looking at opportunities to work on a regional and or a national basis if this means that services can be delivered more efficiently and effectively. This partnership approach is being championed by all Chief Executives.
9.3. The Importance of Improving Health
It is increasingly important in response to the changing environment that we, along with our partners, focus our efforts on the area of improving health. Population projections for Forth Valley suggest both a growing population and an ageing population. With an increasingly elderly population, the provision of healthcare must reflect the specific health needs of this substantial group i.e. the impact of long term conditions on health, cancer, the incidence of which increases with age, and the need to maintain patients in the community by a combination of supported self care and tailored local services. This sits alongside the requirement to provide quality care in collaboration with local authorities and the third sector, to meet both the social and healthcare needs of this group, whilst ensuring that this is cost effective, efficient, timely and safe. It is essential that future models of care demonstrate more close and effective integration between health and social care providers in the planning and delivery of care, to enable the increasingly elderly population to be cared for in the most appropriate settings.
However, it is also important from a public health perspective to prioritise early years, children and young people in order to maximise the long term health gain which should be achieved from early interventions.
We firmly believe that to make a fundamental shift in population health and healthcare outcomes our efforts must be focussed on understanding the determinants of health described in diagram 5 and not just health related services.
This requires a much wider response than health alone and for this reason a fundamental part of our strategy relates to strengthening the intensity of our relationships with other parties, in particular Local Authorities to agree a shared set of outcomes within a common endeavour.
One of the key priorities for Community Health Partnerships (CHPs) remains to be to make a significant contribution, in partnership, with the public, the voluntary sector, community planning partners, Primary Care Teams and Community Services, regeneration outcome groups and Local Authorities in their area to fulfil their responsibility for improving health and addressing health inequalities of their local communities.
The Equally Well Implementation Plan referred to on page 11, details a radical programme of change across the key priority areas of children’s very early years; drug and alcohol problems and links to violence; mental health and wellbeing; anticipatory care and employability.
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A Forth Valley Health Improvement and Health Inequalities Group was established to take an overview of action to address health improvement and health inequalities on many fronts. This group has produced a paper reviewing high impact areas in health improvement, which concluded that early years, employability and anticipatory care should be the priorities for Forth Valley. It is acknowledged that the timeline for sustained improvements across populations is longer term and the provision and development of core services requires to be complimentary until the shift in impact on population health is seen.
Diagram 5 Determinants of Health
The overall focus is very much on improving health outcomes; for example, work has been done on alcohol consumption using a logic based approach developed by NHS Health Scotland. Stakeholders have been working together, and starting with the desired outcome, have worked backwards to identify the outputs and inputs required to achieve improvement. This logic based approach, focussing on outcomes will be adopted for other areas.
Clackmannanshire Healthier Lives is an example of a focussed health improvement initiative delivering a patient centred ‘health check’, which is tailored to the specific needs of the patient identified in partnership with the patient. The aim is to ensure referral and / or signposting to support interventions which will help the individual address risk factors, e.g. unhealthy weight and smoking. The result should be an improvement in overall health and wellbeing preventing longer term complications of ill health. This initiative signals the benefits that can be realised through changing behaviours as individuals increasingly take responsibility and ownership for their own health and well being.
9.4 Infrastructure
In July 2011 we completed our major model and infrastructure changes as we celebrated the opening of the third and final phase of the new Forth Valley Royal Hospital. Our focus now is to fully embed the new and integrated models of care across the range of care settings from acute through to the network of four community hospitals, based in Bo’ness, Clackmannanshire, Falkirk and Stirling and other primary and community care facilities. Internal site reconfiguration is underway at both Falkirk and Stirling Community Hospital sites and key service moves will be completed by the summer of 2012.
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Stirling Community Hospital will bring together services currently operating from Kildean, Bannockburn Hospital and Orchard House which will all become surplus to requirements. Discussions continue with Stirling Council to explore proposals to create a Care Village on the Stirling Community Hospital site which could lead to the creation of new care facilities and sheltered housing thus supporting the integration of health and social care services. An initial business case is being developed and detailed proposals and timescales will be agreed following this exercise.
Services currently provided at Bonnybridge Hospital have been re-located to Falkirk Community Hospital and work is underway to explore options to transfer adult mental health services from Westbank and Dunrowan which will benefit patients in terms of co-location of services and would also allow the decommissioning and disposal of these premises.
Our Strategy is to maximise the use of our existing estate across the entire Board area for an interim period of 3-5 years, during which time work will continue to explore other potential options for premises developments, including different funding models and joint working with partner organizations and innovative approaches to the development of health and social care accommodation.
Over the last year much work has been done with Local Authority and other public partner organisations in the production of a joint Asset Management Strategy and planning for how this and the potential joint projects arising from it will be implemented. This includes improvements in premises infrastructure in relation to primary care services to ensure that these are fit for purpose now and as our strategy and healthcare requirements evolve.
Our Corporate Offices have also been rationalized and we have declared Gladstone Place surplus to requirements with staff being dispersed across our existing estate and also occupying space within premises owned by Stirling Council and at Larbert Police Station.
9.5 Shifting the Balance of Care
We understand that for most people their first and perhaps only ongoing contact with the NHS is within primary care. This covers a wide range of professional staff including general practitioners, dentists, optometrists and community pharmacists as well as community and specialist nursing and rehabilitation teams. Shifting the balance of care away from reactive episodic care in an acute setting to team based anticipatory care closer to people’s homes is a vital part of implementing our strategy and is consistent with current national thinking. This is why our models of care continue to be developed across a single system which integrates both primary and secondary healthcare services as well as increasingly looking for opportunities to integrate with partner agencies.
We recognise the need to continually review and improve the quality of healthcare within Forth Valley to enable a shift in the balance of care towards community based settings and develop alternatives to admission while ensuring that referrals for specialist services are appropriate to need and in line with best model practice and guidance.
This requires the development of an informed multidisciplinary workforce to support patients and communities. Appropriate and effective workforce development to ensure a model of care that is fit for future needs is dependant on strong partnership working. There needs to be a greater focus on promoting evidence based practice to ensure that resources are used appropriately, variability is rationalised and consistent highest quality practice is delivered.
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This work is facilitated locally through the Releasing Time to Care programme. This is a national quality improvement initiative that involves acute and community services assisting teams to address wasteful activities while enabling staff to re-invest the saved time improving patient experience making care more accessible, reliable and safe. Crucially it is a process that empowers teams to identify solutions to local issues and offers opportunities to gather relevant and timely data to inform the organisation and delivery of care. The programme emphasises the importance of planning and delivering integrated care in partnership with patients and other service providers.
Our future model of care needs to be increasingly provided in an integrated way that meets the needs of the whole person. In addition, individuals need to be increasingly empowered to play a fuller part in the management of their health.
This aspiration needs to be considered across the 6 dimensions of quality as well as being embedded within the Triple Aim principles of Best Health, Best Care and Best Value that support the development of our Healthcare Strategy model and Primary Care Development Plan.
We also need to ensure that care will be clinically effective and safe while delivered in the most appropriate way within clear, agreed pathways.
Our work locally needs to compliment the key national actions highlighted in “Delivering Quality in Primary Care”. These are to:
Work with independent contractors on proposals to ensure that all contracts are better able to support the delivery of quality care; Improve access for patients; Develop and implement the Scottish Patient Safety Programme in Primary Care; Ensure we have in place an up-to-date, agreed suite of care pathways; Develop as part of the Quality Measurement Framework, national quality indicators for delivery of primary medical services out of hours; Continue to give priority to anticipatory care; Help professions with their workforce planning; Take steps to ensure more effective partnership working between the different Primary Care professionals; Continue to prioritise and implement cost effective solutions to improve communications within Primary Care and between Primary and Secondary Care; Ensure Primary care practitioners contribute to a clearer understanding between patients and practitioners on what it will mean to be a fully mutual NHS in the next decade; and Ensure that NHS performance management and accountability reflect the importance of Primary Care with NHS Boards working closely with independent contractors and CHPs.
There is a need for shared responsibility from the wider organisation and professionals to increase the use of evidence based safe practice to promote consistent, high quality practice that ensures appropriate and efficient use of resources and corresponding reduction of wasteful variability.
To facilitate this, and to enable behavioural change, clinicians require information about their activity within key priority areas put into context using area wide comparative data.
These actions require the organisation to ensure that this approach is supported by effective communication, education and training and workforce development strategies.
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9.5.1 Key Initiatives for Primary Care
The overarching workstream to ensure the development of quality services within primary care is the Primary Care Development Plan which forms a major strand of the Forth Valley Integrated Healthcare Strategy.
This work which has been informed by the use of the Community Services Diagnostic project, logic modelling and tiered model promoting the development of integrated care pathways will inform the future direction of travel for primary care and community services delivery.
In addition, while a large number of important projects are underway it may be useful for the purposes of this document to focus on activity relating to 5 substantive areas of work central to improving quality. These are:-
Long Term Conditions; Whole System Working; Prescribing Efficiency; Scottish Patient Safety Programme; Releasing Time to Care.
9.5.2 Long Term Conditions
In Forth Valley the work outlined within the Long Term Conditions Collaborative has been led by the Long Term Conditions Action Group (LTCAG).
Significant progress has been made around 3 main workstreams relating to
Self Management Complex Care Condition Management
There is a need to support and sustain further work to facilitate a shift in the balance of care and support best model practice and self management.
The model of care developed for patients with Long Term Conditions is also appropriate to ensure the implementation of integrated care pathways for mental health including depression, schizophrenia and bipolar disorder being progressed through the mental health collaborative.
9.5.3 Anticipatory Care Planning- Thinking Ahead
Prioritising anticipatory care, particularly for our frail population and those who are housebound often with long term conditions or complex health and social care needs will therefore encourage a shift in care from the hospital setting to the community setting. More than this it will facilitate a shift to more proactive, preventative approaches away from services which are geared to react to the development of disease.
We have already undertaken significant service changes and will continue to do so as a step towards embedding the new models of care and toward shifting the balance of care away from acute to community based service provision as appropriate, recognising the importance of patients and their carers as partners in developing their overall care. Implementation of effective supported self management for patients, carers and professional partners is an important enabler to delivering service change and maintaining patients in the community.
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For example we want to provide more community based services and reduce avoidable admissions to hospital for patients with long term conditions, patients in care homes, patients over 75 and patients who are over 65 who have had two or more admissions. Shifting the Balance of Care requires changes in behaviour of professionals as well as individuals service users.
An example of how we are endeavouring to enable professionals to change their behaviour is the Whole System Working Project that allows GPs to reflect on their clinical behaviour related to priority areas where GPs are key stakeholders such as prescribing, emergency admissions and enable changes to clinical behaviour as appropriate informed by provision of relevant data and evidence. The work has helped to highlight the main issues, priorities and challenges faced by primary care while informing the development of whole system models of care. Practice profile folders containing practice specific data were developed with relevant information and standardised work for practices to take forward within defined areas. The profiles included practice and, where appropriate, individual GP data set alongside comparative locality, CHP and Board- wide data.
The whole system working project workstreams to date have focussed on:
Discharge Planning Emergency Admissions A&E attendances Referral Variability Prescribing Cancer pathways
The Forth Valley Whole System Working Project has informed the development of the national GMS Contract Quality and Productivity work introduced in April 2011.
Forth Valley is also taking a lead role in the development and testing of ways to make Primary Care safer and more reliable as part of a Health Foundation funded programme “Safety Improvement in Primary Care” (SIPC). The outputs of this programme will inform the development of national safety programme for primary care.
NHS Forth Valley introduced a tiered model approach, see diagram 6, to demonstrate how people move through the system either up, down or across the tiers according to their immediate needs. It demonstrates that the vast majority of care is delivered in people’s homes, through to specialised services delivered through complex partnership working which require to be provided in regional or national based facilities.
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Diagram 6 – NHS Forth Valley Tiered Model Illustrating Key Principles of Care and Partnership Working
Patient Choice Hospice Integrated 24/7 Tier 5 Community Hospital partnership working End of life care Community Tier 4 Co-ordinated admission, More serious discharge and alternatives exacerbations Acute Hospital or single episodes -Telehealth, IC packages Intensive Care Packages Care needs more complex Tier 3 Referral management Enduring or complex problem. Community Hospital Partnership Care mostly managed in community Intensive Care but requiring specialist input Packages and respite Self management Risk assessment Tier 2 Diagnostic, Co-ordinated care Established Long Term Condition or Health Problem Outreach Care managed in Community Rehab and Rehab Services Diagnosis Best model Practice Tier 1 Primary Care System awareness Development of Symptoms Community Pharmacy Home and Health promotion Tier 0 Community Signposting Well
To realise our potential to shift the balance of care we will require to ensure that we are making best use of capacity and capability across both community and acute care settings. The model describes the needs within each tier as well as the possible organisational responses. It also promotes care pathway development, identifies service interfaces, interrelationships and co- dependencies. The model should be viewed as allowing patients to access care at a level appropriate to their needs but with a key driver to rehabilitate and enable individuals to a tier with care accessible at a community level as is practical.
9.6. Providing the Best Experience of Care
We will celebrate the successes achieved in NHS Forth Valley and build on these to deliver further improvements in the quality of healthcare and the efficient delivery of healthcare services whilst accelerating the pace of change in order to get it right for every person every time.
We want to provide patients with the best experience of care, providing services when and where people want to receive them. We will continue to embed our new models of care, increasing consistency in the way services are delivered and improving user satisfaction. We will maximise opportunities for multi disciplinary team working, breaking down traditional boundaries and improving communications between professions.
We acknowledge that the success of implementing our new models of care is dependent on our ability to work jointly with each of the three Local Authorities and the third sector to support people in their homes, preventing admission and supporting discharge as discussed earlier.
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The emphasis is on improving quality, based on the six IoM dimensions of healthcare quality as described on page 13.
The ongoing safety of our patients is of utmost importance and remains a top priority for NHS Forth Valley. By improving the consistency and reliability of care and reducing variation in practice, we will avoid injuries from care. We will continue to implement the Scottish Patient Safety Programme aimed at establishing a safety culture throughout the organisation leading to, for example, a reduction in the number of Healthcare Associated Infections.
We will build on the success of the Patient Experience Programme work through implementing improvements based on feedback from patients and carers. We want to provide patient centred care that is responsive to individual patient preferences.
We want to avoid waste and reduce duplication and complexity in our system by streamlining processes and maximising the use of all our resources including our workforce, supplies and equipment. For example, by adapting our skill mix and maximising the use of technology we can increase the time clinical staff can spend in direct contact with patients.
We will continue to adopt standardised protocol based care to increase consistency of approach, for example, to referrals, emergency admission and discharge rates, length of stay and clinical practice and continue to reduce the length of time people have to wait for treatment.
We want to ensure that every patient receives the same standard of care regardless of gender, ethnicity, geographic location and socio-economic status.
We will continue to make sure that our services are evidence based and that the right services are provided to people only when they really need them through streamlining the patients’ pathway of care. We will also endeavour to implement improvements in healthcare which are supported by evidence based execution i.e. use implementation evidence, are person centred, link quality and cost and which set aims for quality at every level.
We will review the pathways of care across the whole healthcare system and the interfaces with social care and the third sector. We want to ensure that the most appropriate care and treatment is provided in the most appropriate setting and at the most appropriate time. We will strive to achieve optimum performance in relation to both quality and performance indicators to maximise the quality and efficiency of the care provided.
9.7. Maximising Efficiency and Effectiveness
The duty of best value has been in place since 2002. It places a duty on Accountable Officers to make arrangements to secure continuous improvement in performance whilst maintaining an appropriate balance between quality and cost; and in making those arrangements and securing that balance have regard to economy, efficiency, effectiveness, the equal opportunities requirements and to contribute to the achievement of sustainable development.
There are nine characteristics of Best Value which Public Bodies are expected to demonstrate:
Commitment & Leadership; Accountability; Sound management of resources; Responsiveness and consultation; Use of review & options appraisal; Sustainable development; 29
Equal opportunities; Joint working; and Sound governance at strategic and operational levels.
Each of the nine characteristics remain equally relevant now, however, their nature has evolved in light of the changing context within which Public Bodies have operated over recent years. There is now a focus on five generic and two cross-cutting themes which define the expectations placed on Accountable Officers by the duty of Best Value.
Best Value characteristics have been re-grouped in a way which both emphasises the connections between the characteristics and assists partnerships working between Public Bodies and their partners as they deliver their outcomes.
The five themes are :-
Vision and Leadership; Effective Partnerships; Governance and Accountability; Use of Resources; and Performance Management.
The two cross-cutting themes which should be fully embraced across all activities are Equality and Sustainability.
We are committed to the principles of Best Value and continuous improvement. Within the context of the current economic climate, balancing improving patient experience, improving health and maximising efficiency and effectiveness remain increasingly challenging.
We are also committed to the principles of the NHS Scotland Efficiency and Productivity Framework described in page 13, with an emphasis on identifying priority areas for improving quality and efficiency. We will deliver a Forth Valley programme of efficiency, productivity and quality which will have the 4 objectives i.e. improving health and modernising services, improving the quality of care, making effective use of resources and living within our means. As part of this work we undertook a Whole Systems Review to identify further opportunities to improve efficiency and quality across pathways of care and in all care settings.
We will continue to investigate ways to gain efficiencies through increased emphasis on partnership working across public services. For example, The Forth Valley Property Asset Management Strategy was launched in September 2011 which was the result of a collaborative approach between other publically supported bodies. We are already sharing premises with local public sector agencies and will continue to look for opportunities to do this as well as ways in which we can share support services where it would be appropriate to do so.
By concentrating our efforts on improving health and maximising efficiency in the way we deliver services, we should not only be able to improve quality but control costs in our organisation and make sure that our resources are used to best effect.
We will monitor this by systematically reviewing our service and financial plans and by using our greatest commodity - our workforce to the best of their ability.
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Our staff are vitally important in achieving our vision. By developing skills and competencies to best effect and breaking down traditional professional boundaries we will create a modern workforce and ensure continuing provision of services that are equitable, sustainable, safe and effective, accessible and of good quality.
The ability to continually improve the quality and effectiveness of services will be greatly enhanced through efficient use of information technology. NHS Forth Valley will continue to progress actions detailed in our eHealth Strategy and associated eHealth Programme Plan.
Health services must be planned and delivered at a population level that allows local differences in health need to be addressed appropriately, while ensuring that the whole range of service provision from primary to tertiary care is effectively developed in an integrated way.
We also recognise the opportunities that exist to work jointly with other Health Boards to deliver a shared service agenda. For example, in certain circumstances it is safer and more efficient to deliver services on a regional or even, for the most specialised of services, on a national basis. We will continue to be involved in collaborative region wide approaches to integrate care for patients, and are already doing this for some cardiac and cancer services and in the planning and delivery of new drugs, technology and treatment.
One of the key functions of regional planning groups is to consider the sustainability of services across the entire region and where specialist services cannot be delivered by individual Boards, to plan for specialist expertise to be provided at a regional level. This will help ensure that services are provided at the most appropriate level and will take account of the increasing specialisation in some acute services and other developments in healthcare.
Similarly, we will continue to support the development of Managed Clinical Networks (MCNs) which provide a mechanism to promote consistency, excellence, redesign and quality of service throughout the patient’s care pathway. They bring service user and service provider views to the planning process to help improve patient care. There are a number of local, regional and national MCNs including CHD, Stroke, Diabetes, Palliative Care, and Neurological conditions. These are all supported by a redesign methodology including collaborative approaches to improvement such as long term conditions and mental health as well as workforce modernisation initiatives, for example, through contractual redesign and Locally Enhanced Services within the GMS Contract. Key to the success of these initiatives is effective communication, information sharing and intelligent use of comparative data.
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10. PERFORMANCE MANAGEMENT & GOVERNANCE ARRANGEMENTS
To make sure that our Strategy will make a real difference to the people of Forth Valley, we have systems and processes in place which measure progress against both national and local targets. We are also conscious that as many of the outcomes we aspire to cannot be delivered by health alone developing joint performance management systems with our key partners are of increasing importance. The following section describes our performance management and governance arrangements which will be subject to continual review.
10.1 Performance Management
The Scottish Government has set an ambitious target to make Scotland a more successful country and have developed a National Performance Framework which outlines that vision. It describes a set of aspirational targets and national outcomes against which public services will be measured to demonstrate economic growth. Diagram 7 illustrates the National Performance Framework.
Diagram 7- National Performance Framework The Purpose –a more successful country with opportunities for all Scotland to flourish through increasing and sustainable economic growth)
7 Long Term Aspirational Targets for Scotland (growth, productivity, participation, population, solidarity, cohesion, sustainability)
Wealthier & Fairer Healthier Safer & Stronger Smarter Greener
15 National Outcomes
45 National Indicators for public / parliamentary reporting
Other Service Single Outcome ……… HEAT Regeneration ……… ……… Agreements Agreements
28 targets Local Indicators Mutual Activity
Integral to the National Performance Framework are NHS Local Delivery Plans (LDP’s) and Single Outcome Agreements (SOA’s). Local Delivery Plans detail the commitments and targets for NHS Boards set by the Scottish Government. These are around the National HEAT Targets of Health, Efficiency, Access and Treatment (HEAT) referred to in the National Performance Framework.
SOAs were introduced following the signing of a historic concordat in November 2007 between the Scottish Government and each Local Authority in Scotland. The concordat signalled a new relationship of mutual respect and partnership between the two bodies. The key points of the concordat included a move towards accountability based on outcomes, greater local freedom, improved partnership working, a reduction in ring fenced funding and in levels of scrutiny.
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SOAs set out how each local authority and specifically community planning partnerships will work in the future towards improving the health and wellbeing of their local population in a way that reflects local need, circumstances and priorities consistent with national outcomes. In Forth Valley there are three SOAs, consistent with the three Local Authorities in the area. Although Local Authorities are the statutory leaders in community planning, NHS Forth Valley has been an active partner through each Community Planning Partnership. For instance, initiatives being tackled on a partnership basis include health improvement, care and services, health and homelessness, smoking, alcohol, obesity, sexual health, mental health and community care. The work being progressed through the Change Fund will need to reflect both SOAs and the NHS Integrated Healthcare Strategy.
Following a review of priorities across the organisation NHS Forth Valley has developed a Strategic Level Scorecard reflecting the National HEAT targets of Health, Efficiency, Access and Treatment (HEAT) referred to in the National Performance Framework and broader issues such as Healthcare Associated Infection (HAI). The aim of the Strategic Level Scorecard is to develop clear linkages between our vision and our objectives at an operational level.
The scorecard is underpinned by qualitative and quantitative data which will enable and support improvement and assurance. We have focussed across the 6 dimensions of quality, (safe, efficient, timely, person centred, equitable, and effective) with a balanced approach to measurement which has supported the strategic level scorecard development.
The scorecard is being used to develop the individual objectives of Executives and senior managers and is detailed in diagram 8.
Diagram 8 Strategic Level Scorecard
Corporate Vision Priority Action Drivers Measurement Objectives • Ethnicity recording • Suicide Rate Reduce inequalities & • Cardiovascular Health checks Improving improve health Equitable • Smoking Cessation • Alcohol Brief Intervention Health & Provide equitable • Child Healthy Weight • Fluoride Varnishing Modernising access to care • Breastfeeding Rate Services Improve joint outcomes • Prescribing targets for antimicrobial use • Emergency Bed Days > 75 working with all partners • Boarding Effective • A&E attendance To Improve • Number delayed discharge • Bed Days lost through delayed discharge Health and Improving the Quality Improve patient Healthcare • Inpatient survey – care experience of Care safety • Complaints for the • Clinical Quality Indicators Improve patient Person centred • Anticipatory Care Plans People of outcomes & experience • Patients admitted to stroke Unit
Forth • Hospital Standardised Mortality Rate Reduction in HAI • Adverse events Valley Making • Acute Admissions Unit cardiac arrest calls • Staphylococcus Aureus Bacteraemia effective Delivery of access Safe • Clostridium Difficile use of targets & • Hand hygiene capacity management resources • Finance • Bank & agency usage/spend • Prescribing • Consultant appraisal Efficient • Average length of stay Reduce variability • Bed occupancy • Inpatient cancellations Living • Same day surgery within our • Did not attends Achieve best use of all • Pre operative stay means • Theatre efficiency resources • Attendance management
Achieve sustainable • 18 week referral to treatment financial balance Timely • Cancer targets • Access to drug treatment • Access to child & adolescent mental health • A&E waiting times 33
10.2 Governance Arrangements & Supporting Strategies
To underpin everything we do, we recognise that we need to demonstrate good governance and best value as a publicly accountable body. Our commitment to the principles of Best Value can be evidenced through our Strategic Level Scorecard and the transparent and explicit links of performance management and reporting within our corporate structures. The overall approach within NHS Forth Valley underlines the principle that performance management as described in section 10.1 is integral to sound governance, decision making and prioritisation.
Our governance and management structures provide us with the framework for decision making and for ensuring systems and processes are in place to provide assurance to the public that resources are utilised effectively and efficiently and targeted at the areas of greatest need.
Our Committees along with our Healthcare Strategy Programme Board, Quality Improvement Steering Group and Strategic Planning Group play a key role in ensuring that future planning assumptions and initiatives are both in line with our strategic direction and are affordable.
Recognising the increasing importance of integrated working, NHS Forth Valley reviewed its CHP structures and has established Partnership Boards. These Boards are focussed on strengthening the broader partnership arrangements between health and local authorities and maximising collaborative approaches to integration both within health, across primary and secondary care and across sectors.
A number of supporting plans are in place which detail how we will implement our Strategy. The overarching of which is our Corporate Plan which is updated annually and details both national and local priorities for action and timescales for delivery.
In 2011 for the first time an Efficiency, Productivity and Quality Programme has been developed which brings together a number of projects from within the Corporate Plan which require particular corporate leadership and oversight. The programme identifies 4 strands which are consistent with our Strategic Level Scorecard referred to in diagram 8.
Improving health & modernising services; Improving the quality of care; Making best use of resources; and Living within our means.
Each project has clear leadership in place supported, where necessary, by redesign and organisational development expertise.
The Healthcare Strategy is fully supported by enabling Strategies such as the Workforce Modernisation Strategy, the eHealth Strategy, the Communications Strategy, Financial Plan, Primary and Community Services Development Plan and our local response to implementation of the Quality Strategy.
10.2.1. Delivering a Modern Workforce
NHS Forth Valley’s Workforce Modernisation Strategy sets out the clear future focus in delivering health improvement and healthcare services through a modernised workforce. NHS Forth Valley aims to become the employer of choice working in partnership to deliver our service commitments.
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The clear vision of how health and healthcare will be improved in Forth Valley along with the changes that have already taken place to support the opening of Forth Valley Royal Hospital has already had a beneficial effect on the ability to recruit and retain staff.
Workforce implications continue to be considered throughout the change process and risks analysed. Making best use of skills, providing continual development opportunities and embedding the new clinical model of care all add to making NHS Forth Valley an attractive place to work.
We are also working with partners such as local authorities and the third sector where we wish to build on positive relationships, increasingly working together in areas of shared interest and mutual benefit.
NHS Forth Valley is committed to :-
Increasing the knowledge and skills of its workforce; Continuing to develop new and extended roles for practitioners; Looking at ways in which joint health/social care appointments can be made; Considering opportunities to work more flexibly both in and out of hours; and Working in a multi-disciplinary and integrated way.
10.2.2. Communication
Effective communication is vital for the success of any organisation and its role in raising awareness, educating and informing patients and the general public on local healthcare services cannot be underestimated. The increasing pace and scope of change facing NHS Scotland, from an emphasis on improving health and new service and technological developments to changes in the way services are organised and delivered, also means accurate, timely communication is more important than ever before.
NHS Forth Valley has developed detailed communication plans to raise awareness of the healthcare strategy and ensure patients, the general public, staff and key stakeholders are aware of changes and improvements to health services across Forth Valley. These plans are reviewed annually and form part of the Board’s wider Corporate Communications Strategy which is designed to support the delivery of our corporate objectives.
10.2.3 Patient Focus, Public Involvement
The extent of change achieved in NHS Forth Valley is unprecedented and although NHS Forth Valley has been praised for its work on public consultation there is a continuing need to inform and engage both the public and staff as the vision continues to take shape. NHS Forth Valley is committed to driving forward the Patient Focus, Public Involvement (PFPI) agenda and has developed a structure of active networks to ensure patients and the general public are involved and have a real say in the way services are designed and delivered. This includes the Patient Public Panel (PPP) which has been closely involved in the development of the new Forth Valley Royal Hospital and Public Partnership Forums (PPFs) which provide input into the work of our Community Health Partnerships.
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10.2.4. Equality and Diversity
NHS Forth Valley’s vision is to provide health improvement, healthcare services and employment opportunities which promote equality for all and which eliminate any risk of discrimination. The equality and diversity agenda sets out significant challenges which are being addressed through the continued and developing work of the NHS Forth Valley Fair for All and Patient Focus, Public Involvement (PFPI) Frameworks. Working with local and national partners, and importantly, with our own workforce and communities, we aspire to deliver services and employment opportunities which are equal and fair for all and reduce inequalities.
Significant work will be completed over the next few years to ensure actions taken not only meet our Public Sector Duties under the Equality Act 2010 but also the diverse needs of the population of NHS Forth Valley
10.2.5. eHealth
The central premise of the eHealth Strategy is the concept of a ‘Paperlight NHS Forth Valley’. This will require not only adequate, robust and reliable information systems but a change in working practices from all staff involved in the care of the patient.
The benefits of a ‘Paperlight’ health service include:
Access to patient information where and when required, both within and outwith NHS Forth Valley; A fuller patient record; Fast, effective and efficient workflow, through instant clinical communication; Automatic documentation of workflow; and Reduction in transportation, filing and storage costs for paper case notes.
All of the above will lead to an improved patient experience as decisions are better informed and not delayed awaiting paper results.
The eHealth Strategy is entirely consistent with the Quality Strategy and has at its heart patient safety and clinical governance. eHealth offers the possibility for improvements to be made to the patient journey, provides support and validation to clinical decision making, helps prevent clinical incidents and can provide an audit trail not possible with paper based systems.
The eHealth Strategy recognizes that eHealth should be embedded within clinical care processes and reflects that implementing technology based solutions to help support the care pathway requires not only ownership at all levels within NHS Forth Valley but also a cultural shift away from traditional ways of working.
NHS Forth Valley will continue to minimise information governance risks through policy development, increasing staff awareness and technological solutions, making it easier to do the right thing and harder to do the wrong thing.
For example, the introduction of electronic whiteboards, replacing manual whiteboards, both improves the efficiency of the inpatient ward, whilst providing real-time information to manage resources.
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10.2.6. Financial Plan
NHS Forth Valley must live within its resources. Historically we have met statutory financial targets and have achieved efficient government savings obligations. However, with inflationary cost pressures now exceeding available resources, in an environment of demographic change and with the tightening of public funds at government level, there is a significantly heightened risk in our ability to deliver sustainable financial balance in the years ahead.
We recognise that within the context of increasing financial challenge, as outlined in section 3.2, there is an urgent and sustained need to increase our focus on how we spend our current resources to ensure maximum benefit is achieved and savings realised.
Our Financial Plan 2011/12 – 2015/16 has been developed within this context and that of the Local Delivery Plan (LDP) and details funding assumptions, baseline and anticipated spending, value for money initiatives and priority areas.
Progress against our Financial Plan is reported monthly to the Forth Valley NHS Board.
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11. CONCLUSION
This Strategy document re-affirms the strategic direction of NHS Forth Valley and describes how this will be taken forward over the next five years within the challenging financial environment.
Now that our infrastructure changes are largely complete our strategic focus will be on seeking opportunities to maximise efficiency and productivity in order that we can continue to maintain and improve the quality of services we provide and live within our means.
To do this we have to take bold steps and radically, not only think, but put into action, ways in which we can work differently with our partners across the public sector and within the NHS in Scotland.
We have said that we will prioritise working with the people of Forth Valley and our partners to improve health & wellbeing by promoting preventative, proactive and self care measures which aim to reduce the increasing burden on the provision of healthcare services.
We have also said that we will make sure that when people do need healthcare services, they will receive the best quality of care and not only that, they will be fully involved in decisions about their care and where that care is delivered.
Our increasing emphasis on partnership working and integration between health and social care will enable us to achieve much broader health improvement outcomes for the people of Forth Valley and jointly tackle the challenges that we now face both economically and in terms of predicted demographic changes.
There is no doubt that now and in future years the demand for healthcare and the circumstances in which we shall be operating in will be radically different from anything we have seen in the past.
38 FORTH VALLEY NHS BOARD
DRAFT Minute of the Area Clinical Forum meeting held on Thursday 17th November 2011 at 6.15 pm in the Boardroom, NHS Forth Valley, Carseview House, Castle Business Park, Stirling.
Present Dr Allan Bridges (Chair) Ms Lindsay Cowan, Area Optical Committee Ms Kathleen Cowle, Area Pharmaceutical Committee Dr Leslie Cruickshank, Falkirk CHP Dr Stuart Cumming, Stirling CHP Dr Marie Grant, Area Psychology Committee Ms Morag Harris, Allied Health Professionals Committee Mr Graeme Inglis, Healthcare Scientists Forum Mr Robert Johnston, Area Dental Committee Dr James King, Clackmannanshire CHP Ms Grace Love, Area Optical Committee
In Attendance: Ms Stephanie Doody, Mr Tom Hammond, Senior Planning Manager
1/ WELCOME AND APOLOGIES FOR ABSENCE
Dr Bridges welcomed everyone to the meeting and apologies for absence were intimated on behalf of Dr Keith Bowden, Area Psychology Committee, Ms May Fallon, ANMAC and Mr Ian Watt, Area Pharmaceutical Committee.
2/ HEALTHCARE SCIENCE – AN ACTION PLAN
The Area Clinical Forum received a presentation, “Healthcare Science – An Action Plan”, presented by Ms Stephanie Doody, Healthcare Science Educational Development Lead, Forth Valley/ Lanarkshire.
Ms Doody’s post was funded by NHS Education Scotland (NES) to support the implementation of the Scottish Government’s National Strategy “Safe, Accurate, Effective: An Action Plan for Health Scientists in Scotland (1997)” and covered various themes including, engagement, visibility, involvement with service users, leadership capacity, education, training, Continuing Professional Development (CPD), NES Networks and cross cutting.
Ms Doody outlined the responsibilities of the post and the work she was undertaking. It was a two year secondment which would end in March 2012. Ms Doody identified the achievements and challenges and the issues that were being considered for the future.
Discussion clarified certain issues raised and highlighted the importance of communication in an area of work that included a very diverse group of Healthcare Scientists.
Dr Bridges thanked Ms Doody for informing the Forum of this important development in the field of Healthcare Science.
3/ DELIVERING QUALITY THROUGH THE DEVELOPMENT OF INTEGRATED CARE PATHWAYS – JOINT EVENT WITH NHS FIFE.
Dr Cumming had previously circulated a paper. The planned event with NHS Fife would not now go ahead. However, NHS Forth Valley were proposing to continue as the National Leadership Unit had expressed a wish to work with them on an event.
After discussion the Forum agreed to support this proposal and made the following suggestions:
Dr Cumming to draft a programme with Ms Morag McLaren, Head of Organisational Development The Theme to be “Integrated Pathways” to demonstrate how all parts of a Single System can work more effectively together if properly integrated An evening in March 2012 to be identified, Venue to be at Forth Valley Royal Hospital or Stirling Community Hospital
Mr Hammond would discuss with Ms McLaren to ensure a venue was found and booked.
Each Committee was asked to identify examples of pathways that work well and those that required improvement to help draw out generic / common themes at the event.
4/ MINUTE OF THE AREA CLINICAL FORUM MEETING HELD ON THURSDAY 15th SEPTEMBER 2011
The minute of the Area Clinical Forum meeting held on Thursday 15th September 2011 was approved as a correct record.
5/ MATTERS ARISING
There were no matters arising.
6/ FEEDBACK FROM SCOTTISH GOVERNMENT ANNUAL REVIEW OF NHS FORTH VALLEY – MONDAY 7TH NOVEMBER 2011
Discussion highlighted that the revised structure of a joint meeting between the Area Clinical Forum and the Area Partnership Forum did not achieve as much as in previous years when the Area Clinical Forum met with the Minister alone.
Dr Bridges reported that apart from this the review had proceeded positively.
7/ AREA DENTAL COMMITTEE – DIFFICULTIES IN OBTAINING ACCOMMODATION
The letter from the Area Dental Committee secretary was noted.
After discussion it was agreed that Carseview could now be used as a venue for Area Dental Committee meetings. Dr Bridges and Mr Hammond would meet with the Corporate Services Manager and Consultant in Public Health for Dentistry to seek a clarification on the issues in relation to the training.
8/ CLINICAL CHAMPIONS AND PROGRESSING THE KNOWLEDGE INTO ACTION REVIEW
It was confirmed that this issue had been resolved by the Medical Director.
9/ AGENDA ITEMS FOR NEXT MEETING
Quality Improvement and Productivity in GP Practices (Dr Cumming) Stress Control (Dr Grant)
2 12/ ANY OTHER COMPETENT BUSINESS
There being no other competent business the Chairman declared the meeting closed.
13/ DATE OF NEXT MEETING
Thursday 19th January 2012 at 6.15 pm in the Boardroom, NHS Forth Valley, Carseview House, Castle Business Park, Stirling.
3
ACUTE SERVICES COMMITTEE
DRAFT Minute of the Acute Services Committee meeting held on Thursday 22 December 2011 at 9.30 am in the Board Room, Carseview House, Castle Business Park, Stirling.
Present: Dr Vicki Nash, Non-Executive Member (Chairman) Dr Allan Bridges, Chair, Area Clinical Forum Mr Simon Dryburgh, Assistant Director of Finance, Acute Services Ms Fiona Gavine, Non-Executive Member Ms Linda Gow, Non-Executive Member Mr James King, Non-Executive Member Dr Peter Murdoch, Associate Medical Director Mr Jonathan Procter, Director of Strategic Access and Capacity Planning Professor Angela Wallace, Director of Nursing Dr Iain Wallace, Medical Director
In attendance: Mr Ian Aitken, General Manager, Medicine, Emergency Care and Rehabilitation Mr David McPherson, General Manager, Forth Valley Surgery, Cancer Services and Facilities Ms Gillian Morton, General Manager, Women and Children’s and Clinical Services Ms Helen Paterson, Associate Director of Nursing Ms Alison Richmond-Ferns, Deputy Director, Human Resources
Mrs Ann Duffy, Committee Administrator
1. APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of Ms Margaret Duffy, Ms Janett Sneddon and Ms Maureen Coyle. Dr Vicki Nash welcomed Ms Helen Paterson to the meeting.
2. MINUTE OF THE ACUTE SERVICES COMMITTEE MEETING HELD ON27 OCTOBER 2011
The minute of the meeting held on 25 August 2011 was agreed as a correct record following amendment to Present: to read Dr Allan Bridges, Chair, Area, Clinical Forum and page 4 para 5: to read Dr Vicki Nash.
3. MATTERS ARISING
There were no matters arising of note.
1 4. FINANCIAL & PERFORMANCE REPORTS
4.1 Finance Report to End November 2011
The Committee considered a paper “Finance Report 1 April 2011 to 30 November 2011” presented by Mr Simon Dryburgh, Assistant Director of Finance.
Mr Dryburgh highlighted that the Acute Services financial position as at 30 November 2011 reflected a cumulative overspend of £2.299m, with the November in month overspend at £0.249m. This movement represented a move away from the previous trend of reducing in month overspend, however Mr Dryburgh gave members an assurance that this adverse movement in Acute Services did not impact on the overall NHS Forth Valley November position, due to better than anticipated performance in other areas offsetting the movement.
For November 2011 the main contributing factor to the change in financial performance was an overspend in the month on Complex Therapies of £0.187m. This affected all directorates, however the major impact was in the Medicine Emergency Care and Rehabilitation Directorate, who are accounting for an overspend in the month of £0.147m on Complex Therapies. Mr Dryburgh than gave a brief summary of each of the Directorate's financial performance and noted that expenditure reduction plans had delivered a saving of £1.176m against a target of £1.411m, representing an under recovery of £0.235m. In addition, nursing workforce savings were reporting a shortfall to November of £0.208m against a target of £0.212m, principally due to skill mix challenges and low turnover levels impacting on the ability to fully implement the model.
General Managers gave a commentary on the financial performance and saving achievement in their Directorates, Mr Ian Aitken in particular discussed the challenges on management of Complex Therapies in use across a broad range of specialities and continued practice of managing patient use of these drugs. Following discussion it was felt that a presentation on Complex Therapies would be useful to allow a deeper understanding of this issue, and this will be arranged for the next Acute Services Committee in February.
Dr Nash noted the finance report and the ongoing hard work by Directorates in their quest to identify further savings.
4.2 Director’s Report
The Committee considered a paper “Director’s Report” presented by Professor Angela Wallace, Director of Nursing.
Professor Wallace confirmed that following discussion at the last Acute Services Committee, it was agreed that a Director’s report would be produced for future Committees. The report would highlight information relevant to Acute Services whilst acknowledging the role of other committees in ensuring systems and processes are in place to support delivery of objectives, and the current review of Committee
2 structures underway including the establishment of the Performance & Resources Committee.
The report highlighted actions in place and performance in relation to attendance management, full details of which was provided routinely to the Staff Governance Committee, which was formally responsible for providing overall assurance to the Board that mechanisms were in place and are effective throughout the NHS system to provide the highest standard of staff management and performance.
Allison Richmond-Ferns gave a brief summary on absences recorded for October 2011. She advised that Unit management with General Managers continues on a daily basis and a programme of attendance clinics running throughout 2012 had been put in place.
In answer to a question from Ms Fiona Gavine regarding findings reported on staff anxiety, stress and depression, Alison Richmond-Ferns advised that stress management training would be provided to staff and management and plans were underway to focus on resilience programmes.
Similarly, the report highlighted complaints performance, on which it was noted a full report is routinely presented to the Clinical Governance Committee, which was responsible for promoting positive complaints handling, advocacy and feedback, including learning from adverse events and near misses.
Professor Wallace discussed the complaints update within the report and she advised that whilst there was a rise in complaints, they were mainly small complaints which were dealt with promptly. She advised that the November report would incorporate figures received from the Scottish Prison Service. An updated summary of the Complaints report would be included in the Director’s Report to the February Acute Services Committee Meeting.
Dr Nash said that the report had been very informative and would form a standing item on future agendas.
The Committee noted the Director’s Report.
4.3 Waiting Times Highlight Report to end September 2011
The Committee considered a paper “Waiting Times Highlight Report” presented by Mr Jonathan Procter, Director of Strategic Access and Capacity Planning.
Mr Procter advised that the Out Patient position at the end of November was reporting 329 patients waiting over 12 weeks. Taking into account the impact of the “industrial action”, this was in line with the forecast the as outlined in the previous month's report and within the risk scope as highlighted to the Scottish Government. Mr Procter advised that this represent a continued adverse trend that would impact on the quarter end position.
3 Within Inpatients, there were 98 patients waiting over 9 weeks at the end of the month, again taking account of the impact of the “industrial action”. This was better than forecast in the previous month's report and highlighted the continuing service pressures in Orthopaedics and General Surgery services.
Within the 18 Weeks RTT, October 2011 reported a performance level of 91.6% of patients being treated within 18 weeks this represented the third consecutive month of National Target achievement in advance of the December 2011 due date.
Mr Procter further reported that within Cancer Services, the 62 Day Target (including screening patients) was 96.0% which was ahead of the LDP target, with the 31 Day Target (including screening patients) showing 93.1% for Patients treated in Forth Valley which represented a small number of patients waiting longer than 31 days but this was in line with LDP requirements.
As highlighted in previous months there had been a rise in the overall demand for some key services and this was manifesting in an increased level of patients on the outpatient waiting list. Whilst the list size had stabilised over the past 3 months at 13,000 patients, this represents an increase of 8% from the beginning of the year and 16% from the position recorded 2 years ago. Mr Procter took the committee through the exceptions and risk reports and highlighted the forecast range for inpatients over 9 weeks and outpatients over 12 weeks in the run up to the December quarter end. The committee noted the risk assessment.
The detailed pressures had been highlighted and it was noted that General Managers and key clinical colleagues continued to review the trends and action plans going forward.
In answer to a question from Ms Fiona Gavine, regarding a cultural shift in A&E, Mr Aitken advised the committee of an increase in patients between 20 and 35 years old using the Emergency Department as their first point of contact rather than attending their own GP surgery and he agreed that there was a need to ensure adequate advice was given to all patients attending A&E.
Mr Procter highlighted the continued hard work by all and asked the Committee to note:-
The Overall performance at 30 November 2011 The Exceptions Report The Risk Assessment and supporting actions for December 2011 . The Committee noted the Waiting Times Highlight Report.
4.4 Update on Readmissions
The Committee received a verbal update on readmissions at Forth Valley Royal Hospital, by Mr Ian Aitken, General Manager, Medicine, Emergency and Rehabilitation.
4 Mr Ian Aitken gave a brief discussion highlighting work ongoing around readmission of patients and he advised that a formal audit would be carried out around 7 and 28 day readmissions.
Mr Aitken advised the Committee that an updated report would be presented to a future Acute Services Committee meeting.
Dr Nash thanked Mr Aitken for his update and it was agreed that a further report for a future meeting would be beneficial to the Committee.
4.5 4 Hour Access Target
The Committee considered a paper “Achieving Improved Emergency Department Quality Outcomes” presented by Mr Ian Aitken, General Manager, Medicine, Emergency and Rehabilitation.
Mr Aitken advised that NHS Forth Valley relocated its Emergency Department(ED) to Forth Valley Royal Hospital on the 12th July 2011. This purpose built Emergency Department offers the facilities to deliver the highest standard of emergency care for the local population. Despite this new clinical environment, and the additional capacity it had created to treat patients, compliance with the four hour access standard had continued to be poor. He highlighted that this project had been commissioned to understand the variability in performance of the four hour access standard and improve compliance through improving patient safety, staff productivity and cost efficiency.
Mr Aitken advised that the high level aims of the project were:
To strive to deliver a service that Forth Valley patients and the public can place value, trust and confidence in; To understand and communicate the role of the Emergency Department within NHS FV; To ensure an ED was developed which meets all NHS Scotland standards for quality and effectiveness, achieving a national reputation for excellence; To create the opportunity to develop a proud, skilled workforce of progressive, innovative thinkers that can consistently provide excellent care; and To define a sustainable service with agreed models of care.
Mr Aitken further advised the committee of the importance of providing a comprehensive view of the quality of ED care and developing robust relationships across all interfaces and partners to achieve high quality of care. He stressed the importance of ensuring every opportunity was taken to learn from local and national improvements.
The Committee noted the Achieved Improved ED Quality Outcomes report.
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4.6 Workforce Model for Acute Hospital Nursing
The Committee received a presentation “Core Acute Hospital Workforce Plan” from Ms Helen Paterson, Associate Director of Nursing and Mr Simon Dryburgh, Assistant Director of Finance, which highlighted:-
Strategy Model Consistent Principles Specialist Ward Model Ward Based Teams Cardiology Ward Urgent & Critical Care Emergency Care : A&E CAU – Daytime Only Model Ambulatory Care – Core Services Acute Pay Budget 2011/12 Affordability Ambulatory Care Transition Management Next Phase of Work
In a discussion following the presentation, Professor Angela Wallace confirmed that workforce tools and benchmarking were in place to ensure safe practice staffing levels were in place at all times.
In answer to a question from Councillor Gow regarding restrictions on career opportunities, Professor Wallace confirmed that band 2 and 3 staff skills would be developed to provide more assistance to trained nurse duties.
In answer to a question from Mr King on assessing the impact of safety in patient care, Professor Wallace advised that it was paramount to ensure nursing staff levels were safe and nursing staff were supported at all times with many procedures also in place to support patient safety, and to ensure that the correct staff were in place to provide the correct skill mix for ongoing successful patient care.
Dr Nash thanked Mr Dryburgh and Ms Paterson for the very informative presentation.
5. Any Other Competent Business
There was no other business of note.
6. Date of Next Meeting
The next meeting will be held on Thursday 23 February 2012 at 9:30am in the Board Room, Carseview House, Castle Business Park, Stirling.
6
Draft Minute of the Inaugural Clackmannanshire and Stirling Partnership Board Meeting held on Tuesday, 13th December, at 2 p.m. in the Council Chamber, Greenfield, Alloa.
Present: Clackmannanshire Council Councillor Reverend Sam Ovens (Chair) Councillor Janet Cadenhead Elaine McPherson, Chief Executive Deirdre Cilliers, Head of Joint Social Services/Chief Social Work Officer
Stirling Council Councillor Scott Farmer Bob Jack, Chief Executive Janice Hewitt, Assistant Chief Executive Deirdre Cilliers, Head of Joint Social Services/Chief Social Work Officer
NHS Forth Valley Professor Fiona Mackenzie, Chief Executive, NHS Forth Valley Mrs Kathy O’Neill, General Manager, NHS Forth Valley
Minute Taker: Olene Dykes, Business Support Officer, Clackmannanshire Council
The Chair welcomed everyone to the Inaugural meeting of the Clackmannanshire and Stirling Partnership Board.
1. APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of Councillor Graham Houston, Stirling Council and Mr Ian Mullen, Chair, NHS Forth Valley.
2. MINUTES OF MEETINGS HELD ON 13TH SEPTEMBER (STIRLING) AND 11TH OCTOBER, 2011 (CLACKMANNANSHIRE)
The minutes of the Stirling and Clackmannanshire Partnership Board meetings held on 13th September and 11th October respectively were approved as a correct record.
3. MATTERS ARISING
There were no matters arising.
1 4. CLACKMANNANSHIRE AND STIRLING COMMUNITY HEALTH PARTNERSHIP BOARD TERMS OF REFERENCE
The Clackmannanshire and Stirling Partnership Board considered a paper - Clackmannanshire and Stirling Community Health Partnership Board Terms of Reference.
Professor Fiona Mackenzie indicated that this was generally the same remit as existed for the formerly separate Boards.
It was suggested that, as is the case with Shared Services, an opposition Councillor be invited to be part of this Group. It was agreed that both Councils would nominate an opposition Councillor to the Board.
It was also suggested, and agreed, that members of the Partnership Board meet members of CHP Sub-Committee at a future date.
After further discussion, the terms of reference were agreed.
5. PERFORMANCE REPORT
A performance report by the General Manager had been circulated.
The following issues arising were discussed:-
a) CHP Sub-Committee Future Development
It was agreed it would be useful to have a joint meeting of the Stirling and Clackmannanshire Sub-Committees in the New Year to discuss the way forward. In addition, Councillors Cadenhead and Farmer would attend both the forthcoming meetings.
b) Performance Reporting
It was agreed future reports would focus on high level key indicators on strategic priorities.
c) Progress on the following four priorities was noted and the recommendations agreed:-
- Reshaping Care for Older People - Extending partnership services and integration - Learning Disability
6. LOCAL RESPONSE TO CHRISTIE REPORT
The Clackmannanshire and Stirling Partnership Board noted a paper prepared by Ms Margaret Duffy, Chief Operating Officer, NHS Forth Valley and Ms Janice Hewitt, Assistant Chief Executive, Stirling Council - Implications of Christie for Health and Social Care in Forth Valley.
It was noted that this report set out what the Councils and NHS Forth Valley would be doing as partners. Originally this was in place for Stirling but could similarly apply to Stirling/Clackmannanshire. Comments, if any, should be passed to Ms Hewitt.
2
7. NHS FORTH VALLEY INTEGRATED HEALTHCARE STRATEGY 2011-14
The Clackmannanshire and Stirling Partnership Board considered a paper - NHS Forth Valley Integrated Healthcare Strategy 2011-14.
It was noted that this was an existing strategy and was presented to the Board for comment. Any comments should be forwarded to the General Manager and would be incorporated in the final version to be considered at the NHS Board meeting in January.
8. CARE VILLAGE
Ms Hewitt provided an update on developments in the Stirling Council area in respect of proposals for a Care Village.
9. TILLICOULTRY 300 PROJECT
The Board heard a presentation from Mrs O'Neill outlining a recent study of patients in Tillicoultry Medical Practice. The purpose of the cohort was to assess the impact of health and social care and to help understand what burden of care was required. The cohort comprised of people who were registered with the practice and registered with Adult Care.
10. ANY OTHER COMPETENT BUSINESS
There being no further competent business to discuss, the Chairman closed the meeting at 4.00 p.m.
3
STAFF GOVERNANCE COMMITTEE
DRAFT Minute of the Staff Governance Committee meeting held on Tuesday 13 December at 9.30 a.m. in the Boardroom, NHS Forth Valley, Carseview House, Stirling.
Present: Dr K Facey (Chair) Mr B Clark Mr T Hart Mrs M Cornforth
In Attendance: Mrs Helen Kelly, Human Resources (HR) Director Ms M Duffy, Chief Operating Officer Ms L Donaldson, Associate Director of Human Resources Mrs M McLaren, Associate Director of Human Resources Prof Fiona Mackenzie, Chief Executive Mr Peter Mackie, Head of Risk Management (Item 5.3 only) Ms Shona Moore, Personal Assistant, (Minute Taker)
1/ APOLOGIES FOR ABSENCE
Apologies for absence were received from Mr Ian Mullen, Mrs Alison Richmond-Ferns and Mrs Janett Sneddon.
2/ MINUTES OF MEETINGS
2.1 Draft Minute of Staff Governance Committee meeting held on 16 September 2011
The draft minute of the Staff Governance Committee meeting held on 16 September 2011 was approved as a correct record.
3/ MATTERS ARISING
Dr Facey updated that further to discussion on Slips, Trips and Falls at the last meeting, Lesley Yarrow, AHP Consultant for Older Peoples Services would deliver a presentation to the February 2012 meeting.
At the September 2011 meeting the Committee had discussed the continuing problem of enforcing the no smoking policy on NHS premises and potential actions that could be taken. Mrs Kelly updated the Committee on further instruction that was awaited from the Scottish Government Health Department (SGHD) which would reaffirm no smoking on NHS grounds and premises. As a result the actions discussed at the September 2011 meeting would no longer be an option. This instruction from SGHD would also be challenging for patients in Mental Health Care services. The Committee agreed the need for further engagement with all stakeholders.
1
4/ RESHAPING THE WORKFORCE
4.1 Workforce in Transition - Including the Workforce Plan
The Committee received a report – Workforce in Transition – Update – presented by Ms Donaldson, Associate Director of Human Resources.
Ms Donaldson advised of plans for the Workforce in Transition Group to hold a stocktake meeting early in 2012. The purpose of this meeting is to reflect on achievements to date and consider and agree priorities for 2012/13. A report from this meeting would be presented to a future meeting of the Staff Governance Committee. The Committee also discussed the anticipated Government paper relating to Health & Social Care integration and the implications for workforce development and workforce planning. The Committee agreed that as future integrated models of care continue to evolve workforce planning would remain a clear organisational priority.
The Committee were also provided with copies of the workforce plan 2011/12 at Appendix 1. Following discussion the Committee noted the content of the Workforce Plan 2011/12 and it was agreed it would be circulated to all Non Executive Directors following ratification at the Area Partnership Forum on 16 December 2011.
(item 5.3 was brought forward on the agenda)
5.3 Health & Safety Update
The Committee received a report on Health & Safety from Mr Peter Mackie, Head of Risk Management.
Mr Mackie advised that this report was for the quarter July – September 2011. Mr Mackie updated on the following key points:-
All staff at Forth Valley Royal Hospital had attended fire safety sessions. Fire Officers had attended competency courses, this would become mandatory soon. Fire Officers, Manual Handling Coordinator and Serco’s Health & Safety Advisor had been trained as trainers for the use of the Emergency Evacuation Chairs. The new National Fire Risk Assessment System was now in place. This period had seen a slight increase in Fire & Rescue attendances at NHS Forth Valley premises.
There had been a slight increase in the number of security incidents being reported. CCTV cameras within Falkirk & Stirling Community Hospitals were being relocated due to the reconfiguration of buildings and services on these sites. There continued to be an increased risk of theft from the fabric of the buildings.
The Scottish Manual Handling Passport was currently being rolled out in NHS Forth Valley. The Safeguard system was now working effectively and continued to be improved.
Staff incidents were down by 1% from last quarter and the total number of patients involved in incidents reduced by 8%. Slips, Trips and Falls , Violence & Aggression and Harassment incidents made up 49% of NHS Forth Valley’s reported incidents which is 11% reduction
2
since last quarter. Needlestick injuries continued to rise and Mr Mackie advised the Committee of activity to address this trend.
The Committee also discussed the proposal by the Health & Safety Executive to levy charges on Public Sector bodies and feedback given by NHS Boards.
Following discussion the Committee noted the content of the Health & Safety update.
4.2 Organisational Development Update
The Committee received a report – Organisational Development Update – presented by Mrs McLaren, Associate Director of Human Resources.
The Committee had at the September 2011 meeting approved the Organisational Development (OD) Framework and Priorities 2011-2013.
Mrs McLaren advised that as the OD team would lose a member of staff through early retirement at the end of December, this would reduce capacity within the team and priorities would need to be realigned.
Mrs McLaren updated on the following priority actions:
NHS Scotland Staff Experience Framework – a Project Manager & Project analyst had now been appointed and the project would commence formally in January 2012. A full presentation would be given at the February 2012 Staff Governance Committee meeting. The Executive Team would receive a presentation at its December 2011 meeting on the outcome of the evaluation of internal coaching. An overarching OD plan has been agreed for the Falkirk Change Fund Partnership and work was currently underway to support the creation of an OD plan for the Stirling and Clackmannanshire Change fund Partnership. Leadership & Management Development Programme – the formal programme would be launched in January 2012. OD web pages were now fully developed and would be launched with a staff brief in December 2011. Secondary Care Medical Revalidation & Enhanced Appraisal – processes had now started with all doctors allocated an Appraiser. The OD team would support the pilot of a Multi Source Feedback Tool and Patient Feedback Tool starting in January 2012.
Following discussion the Staff Governance Committee noted the Organisational Development update.
4.3 Transfer of Prison Healthcare Services – Workforce Issues
The Committee received a report – Transfer of Prison Healthcare Services – Workforce Issues – presented by Mrs Helen Kelly, HR Director.
Mrs Kelly advised that all Prison Healthcare staff had transferred from the Scottish Prison Service to the NHS on 1 November 2011. NHS Forth Valley and other Boards contributed to the development of a national framework which had provided information and guidance on pensions, policy and terms and conditions of service, job evaluation and related pay issues. 3
Final guidance on Agenda for Change reviews was awaited. The Job Evaluation process for those SPS staff who transferred to NHS Forth Valley had commenced. The majority of staff transferring had requested a formal review of the banding for their post.
The Committee noted the report.
5/ STAFF GOVERNANCE
5.1 Attendance Management
The Committee received a report – Attendance Management – presented by Mrs Helen Kelly, HR Director
Mrs Kelly advised that the NHS Forth Valley absence figure for October 2011 was 5.29%, and although an improvement on October 2009 and October 2010, remains higher than the national average, in the same period, of 4.64%. NHS Forth Valley therefore required to remain focussed on this priority and to refresh our approach. Mrs Kelly stated however that the high level of change in NHS Forth Valley was and continues to impact on absence figures, Mrs Kelly also stated that NHS Forth Valley was one of the few Boards that is 100% SSTS compliant. Notwithstanding these issues the organisation would maintain a proactive approach to attendance management.
Mrs Kelly advised that a paper would be brought to the February 2012 meeting of the Staff Governance Committee to provide assurance that the refreshed approach had commenced and to update on the associated impact.
The Committee noted the report.
5.2 Staff Governance Standard Review
Dr Facey advised the Committee that she was involved in a SGHD group looking at updating the Staff Governance Standard. The five elements of the Staff Governance Standard were being looked at, with discussion around some being added or changed. It was hoped that the revised Staff Governance Standard would be available by March 2012 and the next meeting of the national group was scheduled for January 2012.
6/ RISK MANAGEMENT
6.1 NHS Forth Valley Corporate Risk Register
The Committee received a report – Corporate Risk Register – presented by Mrs Helen Kelly, HR Director.
Mrs Kelly reported that the refreshed Risk Management Strategy had been submitted to the November 2011 NHS Board meeting.
Mrs Kelly highlighted the points which were of particular note to the Staff Governance Committee. These were as follows:-
4
CR EUR 03 - Workforce Planning Risk – workforce risks remain in relation to workforce plans. CR EUR 04 – Workforce Planning Risk – Delivery of Integrated models with local authorities to ensure effective use of staff groups. Discussion was currently taking place on working with partners. CR EUR 10 – Equal Pay – this was an ongoing issue. CR EUR 11 – Absence Target – Focus continues on absence management as consistent with discussion at item 5.1. CR IQ 04 – Inability to complete training programmes – Range of actions underway to minimise the risk of staff being unable to complete statutory/mandatory programmes. Industrial Action – this was a recently added risk following the Industrial Action taken on 30 November 2011. This was uniquely not about employee/employers relations but about pensions. NHS Forth Valley had worked with Full Time Officers and Staff Side representatives and agreed a package of emergency services which were provided on 30 November. As a result a high standard of healthcare was maintained. This risk would remain on the Corporate Risk Register meantime as there was a potential for further industrial action.
The Committee noted the report.
7/ REPORTS TO NOTE
7.1 Knowledge and Skills Framework (KSF) and Agenda for Change
The Committee received an update on KSF & Agenda for Change from Ms Linda Donaldson, Associate Director of HR.
Ms Donaldson updated the Committee on ongoing work to review all Community Mental Health Nursing roles in NHS Forth Valley. It was hoped this work would be concluded by February 2012.
Ms Donaldson also updated on national negotiations underway with the aim of agreeing new on call payment arrangements for NHS Scotland.
The Staff Governance Committee noted the report.
7.2 HR Policy – Update
Mrs Kelly updated the Committee on the review of existing policies which would be reviewed by the Area Policy Steering Group. Mrs Kelly also updated on current Partnership Information Network (PIN) policy reviews.
The Committee noted the report.
7.3 Update on Learning, Education and Training Activities
Mrs McLaren, Associated Director of HR/OD & Learning updated the Committee on the following:-
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Learning, Education & Training Strategy Action Plan implementation. Improvement Skills Development Framework Healthcare Support Workers Mandatory Induction Standards & Code of Conduct Leadership, Management & Staff Development Plan 2010 – 2012 Communications Skills Development Framework Train the Trainer Programme for Learning, Education & Training providers in NHS Forth Valley.
The Committee noted the report.
8/ REPORTS FROM COMMITTEES
8.1 Minute of the Acute Services Partnership Forum held on 19 July & 20 September 2011
The Committee noted the minutes of the Acute Services Partnership Forum.
8.2 Minute of the New Acute Hospital Workforce Planning and Development Partnership Sub Group held on 30 August 2011
The Committee noted the final minute of the New Acute Hospital Workforce Planning and Development Partnership Sub Group.
8.3 Minute of the Health and Safety Committee held on 16 June 2011
The Committee noted the minute of the Health and Safety Committee.
8.4 Minute of the CHP Partnership Forum held on 9 March & 13 July 2011
The Committee noted the minutes of the CHP Partnership Forum.
8.5 Minute of the Area Partnership Forum held on 29 July & 28 October 2011
The Committee noted the minutes of the Area Partnership Forum.
9/ ANY OTHER COMPETENT BUSINESS
10/ DATE AND TIME OF FUTURE MEETINGS
The next meeting of the Staff Governance Committee would take place on Friday 3 February 2012 at 1pm Board Room A, Carseview House, Castle Business Park, Stirling.
There being no further business, the Chair closed the meeting at 11.25 a.m.
6
SUMMARY
1. TITLE OF PAPER
NHS FORTH VALLEY ENVIRONMENT STRATEGY 2009 -2014
2. PURPOSE OF PAPER
To highlight changes to the environment strategy created by the revised HEAT target and to review action dates.
3. KEY ISSUES
The HEAT target has changed to reflect national strategy and now takes the form of a two part target rather than a straight forward 2% per annum reduction in energy consumption. The new target requires a 3% reduction in CO2 emissions from fossil fuel use year on year and an annual 1% improvement in energy efficiency.
The target roll out of Corporate Greencode at the pilot site (Lochview) has been revised to March 2012 to reflect delays to agreed dates sanctioned by the HFS sponsored Corporate Greencode User Group and the need to formulate an action plan for the pilot site. The action plan is the final stage of the roll out process.
NHS Forth Valley has now submitted its footprint and annual reports as required to comply with the Carbon Reduction Commitment Energy Efficiency Scheme (CRCEES).
4. FINANCIAL IMPLICATIONS
NHS Forth Valley are now participants in the CRCEES and this year must buy allowances to cover our carbon emissions (22710 and CO2 at a guide price of £12/tonne £272,520). This base line was set in 2010/11 and includes the emissions from both PFI sites, although Forth Valley Royal Hospital was not fully operational for most of that period.
5. WORKFORCE IMPLICATIONS
It is at present expected that this strategy will be implemented using existing resources.
6. RISK ASSESSMENT AND IMPLICATIONS
NHS Forth Valley will be expected to comply with both SGHD targets and European legislation. Failure to comply with legislation would have severe financial penalties and potential legal action.
7. RELEVANCE TO STRATEGIC PRIORITIES
The strategy to reduce the footprint of the estate should help lessen the potential financial implications associated with CRCEES.
8. RELEVANCE TO DIVERSITY AND / OR EQUALITY ISSUES
This strategy will not adversely impact on diversity and or equality issues.
9. CONSULTATION PROCESS
The Strategy was developed in consultation with David McPherson, General Manager, Forth Valley Facilities and Surgical Services, Colin Russell, Energy and Environment Manager, and Conrad Binnie, Estates Services Manager.
10. RECOMMENDATION(S) FOR DECISION
The Forth Valley NHS Board is asked to: Approve changes to the Environment Strategy in support of the revised HEAT target Provide continued support to the Board level Environment Champion Recognise the need to continue to invest to support the implementation of the Environment Strategy
11. AUTHOR OF PAPER/REPORT:
Name: Designation: Colin Russell Energy & Environment Manager
Approved by: Name: Designation: David McPherson General Manager – Forth Valley Facilities & Surgical Services
NHS FORTH VALLEY
Environment Strategy 2009 - 2014
Date of First Issue 01 / 12 / 2009 Approved 24 / 11 / 2009 Current Issue Date 16 / 12 / 2009 Review Date 01 / 12 / 2012 Version Version 2.01 EQIA Yes 31 / 08 / 2009 Author / Contact Colin Russell, Energy and Environment Manager, 01786 433865 Group / Committee NHS Forth Valley Board – Final Approval
This document can, on request, be made available in alternative formats
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Management of Policies Procedure control sheet (Non clinical documents only)
Name of document to be loaded From front cover
Area to be added to * see areas available on the policy web-page
Policy Guidance Protocol Other (specify) Type of X document Immediate 2 days 7 days 30 days Priority X Questions Understanding Yes No X Required Archive file Yes No X Options External and Internal Where to be X published Internal only Specific Area / Target NHSFV wide X audience service
Consultation and Change Record – for ALL documents
Contributing Authors: C Russell
Consultation Process: D McPherson, C Binnie
Distribution: NHS Forth Valley Intranet
Change Record
Date Author Change Version
24/11/2009 GS Approved for publication V 2.00
29/11/2011 CR Amended titles of responsible officer V 2.01
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Contents 1. EXECUTIVE SUMMARY ...... 4
2. INTRODUCTION...... 5 2.1 PURPOSE OF STRATEGY ...... 5 2.2 VISION ...... 5 2.3 STRATEGIC AIMS...... 6 2.4 TIMEFRAME ...... 6 3. OBJECTIVES ...... 7 3.1 ENVIRONMENT MANAGEMENT ...... 7 3.2 ENERGY ...... 7 3.3 CLIMATE CHANGE ...... 7 3.4 WATER & WASTE WATER ...... 7 3.5 WASTE...... 8 3.6 TRANSPORT...... 8 3.7 PROCUREMENT...... 8 3.8 BIO-DIVERSITY ...... 8 3.9 SUSTAINABLE DEVELOPMENT...... 8 3.10 STAFF AWARENESS ...... 8 4. COMMUNICATION...... 9 4.1 COMMUNICATION AIMS AND OVERALL APPROACH...... 9 4.2 KEY MESSAGES...... 9 4.3 AUDIENCES ...... 9 4.4 COMMUNICATION CHANNELS ...... 10 4.5 COMMUNICATIONS OPPORTUNITIES...... 10 5. CONCLUSION...... 11
ANNEX A - ACTION GRID ...... 12
ANNEX B - ROLES AND RESPONSIBILITIES...... 14
ANNEX C - REFERENCES...... 15
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1. EXECUTIVE SUMMARY
This Environment Strategy sets out NHS Forth Valley’s commitment to the environment and shows how this commitment will be put into practice. This strategy reflects the NHSScotland Environmental Management Policy published under cover of Scottish Executive Health Department letter HDL(2006)21 dated 5 April 2006.
NHS Forth Valley has an important role in protecting the environment for residents of the area, staff, patients and visitors. It is also a major employer and purchaser of goods and services. What we do, and how we do it, can have a significant influence over the local environment and the health and well being of its residents.
NHS Forth Valley also has a responsibility to help reduce global concerns such as climate change. The Scottish Government and NHS Scotland have made it clear that they expect Health Boards to take a leading role within their communities in reducing emissions of greenhouse gases.
This strategy builds upon the existing work NHS Forth Valley has done to protect and enhance the environment. It outlines our environmental objectives for the services we deliver, and sets out how we will take account of environment issues in the way we work.
Progress towards meeting the stated objectives will be monitored and reported to the Performance Management Group.
This Strategy will inform the development of departmental business plans across NHS Forth Valley.
Fiona Mackenzie Chief Executive
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2. INTRODUCTION
2.1 Purpose of Strategy
Mankind’s use of natural resources has steadily increased since the time of the industrial revolution and it is becoming clear that this is not sustainable in the long term. Oil production is expected to peak in the near future, and the predicted shortages of water and space for the disposal of waste are further examples of why we cannot continue with a “business as usual” model. Governments around the world are legislating to reduce our impact on the environment and reduce our reliance on those natural resources that have a finite limit.
The planet’s climate is changing and global temperatures are rising. These changes are linked to rising concentrations of carbon dioxide in the atmosphere as a result of burning fossil fuels. Although increased temperatures are now inevitable the next 5 -10 years will be crucial if we are to avoid the worst of the climate change projections. In the slightly longer term the Scottish Government has set a target of an 80% reduction in greenhouse gas emissions by 2050 and more immediately introduced a HEAT target for 2010/2015 to reduce fossil fuel emissions by 3% year on year and improve efficiency by 1% per annum. NHS Forth Valley attaches the greatest importance to Environment Management that is practicable, safe and sustainable for its employees and members of the wider community who may be affected by the day to day activities of the organisation. The Scottish Government has made it clear that they expect Health Boards to take a leading role within their communities in protecting and enhancing the environment and in particular reducing emissions of greenhouse gases. With this in mind, this Environment Strategy has been prepared to provide a basis for doing all that is reasonably practical to achieve a service provision which minimises the impact of the organisation on the environment both now and in the future. Complimentary to the Environment Strategy are underpinning policies and strategies including Energy, Waste, Transport and Procurement.
2.2 Vision
The NHS Forth Valley vision is to take a leading role in protecting and enhancing the local environment for the benefit of residents, staff patients and visitors and to contribute to building a greener Scotland.
NHS Forth Valley will put the environment at the heart of our planning and decision- making and will support not just staff but the community as a whole to make greener choices.
This vision will be achieved through the development of environment management systems to ensure that best practice methods are adopted throughout the organisation and that environmental considerations are embedded within the organisations planning and decision making processes.
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2.3 Strategic Aims
The aims of this Environment Strategy are to:-
Outline how we can improve the environment, either alone or with others; Work towards the implementation of an Environment Management System in order to monitor performance against agreed indicators; Contribute to minimising the impact of climate change; Promote the principles of sustainable development; and Inform the development of Departmental Plans throughout the organisation.
2.4 Timeframe
This Strategy will cover the period 2009 – 2014 and will be reviewed annually.
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3. OBJECTIVES
Environment Management comprises a number of different components. Broad objectives are set out below with a supporting action plan at Annex A. The Scottish Executive Health Department’s Environmental Management Policy for NHSScotland sets out 15 Mandatory Requirements that must be addressed by all NHSScotland bodies, these are cross referenced throughout this section and the Action Plan.
3.1 Environmental Management
NHS Forth Valley will nominate an Environment Champion at Board level. At the same time an Energy and Environment Manager will be designated to lead on environment issues, develop policy and take the lead on achieving the objectives of this Strategy. An Environmental Management Group will be formed to lead on and take ownership of Environmental issues.
3.2 Energy
NHS Forth Valley has an Energy and Environment Manager in post and significant savings both in financial terms and in terms of CO2 emissions have been made over the past 5 years. NHS Forth Valley will continue to meet NHSScotland wide energy performance targets as a minimum standard. Mandatory Requirement 3.
3.3 Climate Change
It is likely that new emissions trading schemes will be introduced over the course of the next 5 years limiting the amount of CO2 that can be emitted by NHS Forth Valley.
NHS Forth Valley will continue to reduce its CO2 emissions and seek to meet or exceed targets, set as part of the HEAT objectives or other Scottish Government initiatives, through both improved energy efficiency and the increased use of renewable energy sources were appropriate.
Some impact from climate change is now inevitable however. NHS Forth Valley will develop a strategy to ensure that the impact of climate change is mitigated through the careful planning and design of new buildings and refurbishment.
3.4 Water & Waste Water
Water is an expensive and finite resource, furthermore the production of safe, clean drinking water and the treatment of wastewater is energy intensive. Scottish water is the largest emitter of CO2 in Scotland after the power generators. NHS Forth Valley will monitor water quality and the use of water across the estate, investigate as a priority any suspected leakage and seek ways of reducing consumption wherever possible.
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3.5 Waste
NHS Forth Valley has appointed a Waste Manager with responsibility for all aspects of Waste Management throughout the organisation. Mandatory Requirement 8. We will reduce the amount of waste produced, to minimise the risk to those involved in waste processing and the effect of the disposal of waste on the environment in both the short and the longer term. NHS Forth Valley will comply with agreed NHSScotland methods for assessing the quantity of waste generated and targets for reducing waste as they are introduced. Mandatory Requirement 7.
3.6 Transport
Transport and travel planning will be integrated with the plans and policies of other NHS Scotland bodies and the local authorities. NHS Forth Valley will seek to reduce the CO2 emitted from NHS Forth Valley’s vehicles in line with NHSScotland targets (which have yet to be agreed). Emissions caused by staff and patients travelling to and from NHS Forth Valley facilities will be addressed through an integrated travel plan. Mandatory Requirement 6.
3.7 Procurement
NHS Forth Valley’s Procurement Strategy will give due regard to issues of whole life cost and sustainability.
3.8 Bio-Diversity
Bio-diversity means, "the total variety of all living things." NHS Forth Valley acknowledges it is responsible for the impacts that its policies and operations may have on the natural environment and will not only mitigate any negative impacts but also proactively conserve and enhance bio-diversity.
3.9 Sustainable Development
Sustainable Development was defined by the 1987 Brundtland Report as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs.” For development to be sustainable it must meet not just the needs of the economy, but also of society and of the environment. Each of the elements outlined above will contribute to the aim of promoting sustainable development within NHS Forth Valley.
3.10 Staff Awareness
A good awareness, across all departments, of all of the issues outlined in this strategy is fundamental to its success. Raising staff awareness is a key function of the Energy and Environment Manager, Transport and Waste Manager and the Travel Manager. As such they are to deliver a regular programme of awareness raising events.
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4. COMMUNICATION
4.1 Communication aims and overall approach
A key part of the strategy is communicating the new approach, both within and external to NHS Forth Valley. Explaining the strategy and building support for its objectives will be vital in getting effective take-up from staff and the wider community. In all of this, communications should support the ongoing work of the Energy and Environment Manager.
Over the five-year period of the strategy, it will be necessary to work up a series of communication plans based on the specifics of each individual initiative being publicised. Nevertheless, it is still possible at the outset to provide a framework, to outline some of the communications channels that will be used, and to identify likely opportunities to promote our vision.
4.2 Key messages
To ensure clarity of communication, it will be necessary to draw upon our vision to create a series of key messages. While it is not expected to use these verbatim agreement at the outset on some overarching messages will be of assistance when the specific detail of the communications plan are developed. The following messages are proposed:
NHS Forth Valley is taking a leading role in protecting and enhancing the environment and in building a greener Scotland. We are putting the environment at the heart of our planning and decision- making. We want to support not just staff but the community as a whole to make greener choices.
4.3 Audiences
As stated in section 3.10, staff awareness is vital to the successful implementation of the strategy. Accordingly, the primary audience for this strategy should be members of staff. In addition there is a wider audience, the general public. NHS Forth Valley will address both audiences in order to promote our reputation as a green organisation and also to play its part in encouraging behavioural change at community level. Finally, consideration will be given to the messages we send to our public sector counterparts, private sector partners and local political and community representatives.
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4.4 Communication channels
The communication channels used will reflect the focus of delivering information to an internal audience. Suggested channels include:
Staff newsletters Marketing materials in staff areas Wage slip reminders Use of both the intranet and external website to highlight best practice and post news of new initiatives. A ‘green’ area that changes regularly with best practice points and “How To”…references for staff will be developed Face to face interaction, via a regular programme of awareness raising events
Externally, possibilities include:
community newsletters news releases placed articles in newspapers the external website, as outlined above public events making use of partner organisations' communications channels, for example using local authority household publications to highlight examples of joint working briefings for local representatives
4.5 Communications opportunities
Possible communications opportunities include: announcement of new initiatives highlighting best practice Environment audit results regular statistics, e.g. water consumption, vehicle emissions participation in local or national Environment events celebrating good practice
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5. CONCLUSION
NHS Forth Valley is committed to protecting and improving the environment for our staff and the community we serve. This strategy sets out our vision for the next five years and describes in more detail objectives in key areas that will contribute to achieving its strategic aims. With a presence across a wide geographical area and as a large employer with significant purchasing power NHS Forth Valley is well placed to take a leadership role on environment issues. Furthermore the adoption of the sustainable use of resources and environmental best practice will produce societal and welfare benefits that have a synergy with healthcare in the wider context.
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Annex A - ACTION GRID
Objective Action Responsible Target Date Officer 3.1 Oversee the implementation of Corporate Energy and Mar 12 Greencode across NHS Forth Valley. Environment Mandatory Requirement 1. Manager Form and chair regular meetings of an Energy and Nov 09 Environment Management Committee with Environment membership from both clinical and support Manager areas. Maintain a close working relationship with Energy and Ongoing the Energy and Environment Manager, Environment Transport and Waste Manager and the Manager Travel Manager. Ensure that both internal and external Energy and Ongoing Environmental Reports are accurate and Environment produced on time. Mandatory Manager Requirement 15. 3.2 Use the Scottish Governments Central Energy and Ongoing Energy Efficiency Fund to introduce energy Environment efficient equipment as appropriate Manager
3.3 Reduce CO2 emissions in line with HEAT Energy and Ongoing and other nationally agreed standards. Environment Manager Mandatory Requirement 3. Carry out an assessment of the likely Energy and Sep 10 impacts of Climate Change on existing Environment buildings. Develop an action plan to reduce Manager these impacts and implement were practical. Mandatory Requirement 5. 3.4 Carry out regular water consumption audits. Energy and Ongoing Environment Manager 3.5 Adopt Best Practice waste management Transport & Ongoing methodologies. Mandatory Requirement 7. Waste Manager. Provide specific guidance and appropriate Transport & Ongoing training for those required to deal with Waste Manager. Clinical waste, Waste Electrical and Electronic Equipment and Special Waste. Mandatory Requirement 10.
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Carry out regular waste audits. Transport & Ongoing Waste Mandatory Requirement 14. Manager. 3.6 Minimise the environmental impact of the Transport & Ongoing Board’s Fleet of vehicles, leased cars and Waste Manager staff commuting habits. Mandatory and Travel Requirement 6 Manager Put in place procedures to gather accurate Transport & Mar 10 data, when available, or use best practice Waste Manager estimates to establish vehicle CO2 and Travel emissions. Baseline figures will be Manager. established by March 10.
3.7 Guidance on environment and Energy and Mar 10 sustainability will be provided for those Environment responsible for producing the specification Manager / Head against which buildings and equipment is of Procurement purchased. The environmental impact of the building or Head of Sep 10 equipment during operation and at end of Procurement life disposal should be important considerations during the procurement process. 3.8 NHS Forth Valley will undertake an audit of Energy and Feb 10 its current bio-diversity assets; landscaped Environment areas, gardens, woodlands, habitats and Manager wildlife. Procedures will be put in place to ensure Energy and Sep 10 that the impact of future projects on bio- Environment diversity is mitigated as far as possible. Manager 3.10 Regular awareness raising events will be Energy and Ongoing held. Environment Manager, Transport & Waste Manager and Travel Manager
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Annex B - ROLES AND RESPONSIBILITIES
It is the responsibility of all line managers to ensure that the Environment Strategy is efficiently implemented by staff at all levels. The responsibility for specific aspects is as follows:
The Chief Executive and Directors are responsible for:
Ensuring that Policies and Procedures are in place which ensure effective Environmental Management.
The Energy and Environment Manager is responsible for:
The overall co-ordination of all Environment Management issues.
Developing and implementing an Environment Policy that demonstrates NHS Forth Valley’s commitment to sustainability and the proper management of the environment.
The roll out of Corporate Greencode Software throughout NHS Forth Valley and the subsequent maintenance of an effective Environment Management System.
The management of all utilities including gas, electricity, fuel oils, water, waste water, sewerage etc.
Setting annual consumption and savings targets and monitor performance against these in respect of energy consumption, carbon dioxide emissions and water consumption, ensuring, as far as possible, that they are achieved.
Implementing and managing relevant emissions trading schemes, working with SEPA, DEFRA and other government agencies to ensure compliance.
The Transport and Waste Manager is responsible for:
Ensuring that all waste is handled and disposed of in accordance with the Environmental Protection Act and other relevant guidance.
That the production of all types of waste is minimised as far as is practicable.
That the use of the NHS Forth Valley transport fleet is managed in such away as to minimise its impact on the environment.
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Heads of Departments and Managers are responsible for:
Ensuring that staff are made aware of the contents of this strategy.
Discouraging practices which result in the excessive use of resources (including energy and water).
Ensuring that the procedures relating to waste handling are understood and adhered to throughout their department.
Referring identified problems to the Energy and Environment Manager or the Transport & Waste Manager for specialist advice.
Ensuring that the views of their department are represented at the Environmental Management Committee.
All Members of Staff are responsible for:
The responsible use of energy and water in their day to day activities.
The minimisation of waste.
Ensuring that waste and in particular Clinical and Special waste is handled correctly.
Reporting any incidents relating to poor waste management procedures, pollution or the inefficient use of energy or water to their line manager.
Annex C - REFERENCES
Scottish Executive Health Department letter HDL(2006)21 dated 5 April 2006
Health Facilities Scotland NHSScotland’s Environment Management Action Plan dated July 2008
Health Facilities Scotland’s Draft Sustainable Development Strategy for NHSScotland dated March 2007
Health Facilities Scotland’s The Biodiversity Duty and NHSScotland January 2007
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Publications in Alternative Formats
NHS Forth Valley is happy to consider requests for publications in other language or formats such as large print.
To request another language for a patient, please contact 01786 434784.
For other formats contact 01324 590886, text 07990 690605, fax 01324 590867 or e-mail - [email protected]
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