NHS 24 GREEN

NHS 24 09 AUGUST 2018 BOARD MEETING FOR ASSURANCE

EXECUTIVE REPORT TO THE BOARD

This paper provides a high-level overview of key developments across NHS 24 since the last Board meeting.

Executive Sponsor: Executive Team

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Transformation Programme

1. INTRODUCTION

1.1 The format of this report positions topics under the six key priorities identified within NHS 24's Corporate Strategy. A review of the format of the report is being considered by EMT in order to improve the flow of content from one reporting period to another.

2. IMPROVING SERVICES TO ENSURE CONTINUOUS QUALITY, SAFE AND EFFECTIVE PATIENT CARE

2.1 Pandemic Flu Planning

Analysis of the National Pandemic Flu Service (NPFS) web application has been completed and will be presented to the EMT, together with an options paper for NHS 24’s response to a flu pandemic for consideration and agreement on the preferred option. This includes options for how the NPFS may or may not be used in conjunction with NHS 24 flu response plans and digital self-help resources.

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NHS 24 GREEN

2.2 Urgent Care Patient Journey Working Group

Working with HIS, ISD and the University of Stirling, OOHs mental health related patient journeys in the unscheduled care data mart 2011-16 have been analysed, revealing 14% of calls to 111 were mental health related. Mental health related journeys had more steps and were more complex, and showed wide regional variation. 40% of 111 calls passed to primary care OOHs were managed by telephone. The report was circulated to SG and will be factored into our programme of redesign for Mental Health.

2.3 Pharmacy

The Head of Pharmacy was an invited plenary speaker at two conferences in June. The Association of Pharmacy Technicians UK in Glasgow on the topic of ‘Empowering Technicians into the Future’, and the International Symposium on Pharmaceutical Sciences in Ankara, Turkey, on the topic of ‘Pharmacy and Integrated Care’. He also was also a named author on a poster displayed at the NHS Conference in Glasgow entitled, Shetland Isles Telepharmacy: Utilising Pharmacy Skills’. The Head of Pharmacy was also reaffirmed as Chair of the Scottish Pharmacy Board of the Royal Pharmaceutical Society, which is the professional body organisation for pharmacy, at the beginning of July and will serve one more year in the post.

2.4 Evaluation Framework for NHS 24

On behalf of the Service Development Directorate, the Head of Pharmacy who has a lead R&D role organisationally, is leading a short-life working group to develop an Evaluation Framework for NHS 24. The working group has met twice and work is now at an advanced level with the drafting of a document and the creation of an interactive digital pathway being presented on clinical knowledge publisher. The final meeting of the group is planned for 27 August with the Evaluation Framework being finalised for the beginning of September.

2.5 Advanced Practice Academies

Following the establishment of the West of Scotland Advanced Practice Academy and the Scottish Executive Nurse Directors commitment to replicate the academy model across Scotland, the East and North Academies have now held inaugural meetings and representatives from NHS 24 are core members of these groups.

2.6 Trainee Advanced Nurse Practitioners (TANPs) Cohort 1

The three TANPs in Cohort 1 have successfully passed the Objective Structured Clinical Examination (OSCE) aspect of their end of Year 1 assessment and now progress to the Prescribing Module in September 2018. They will be supported, supervised and mentored through this challenging module by GP colleagues in the Lanarkshire Medical Group. In addition they will continue to undertake clinical placements in National/Territorial Health 2

NHS 24 GREEN Boards to provide a wide and varied clinical experience which will underpin clinical knowledge, experience and understanding to support advanced clinical decision making and critical thinking skills.

From September 2018 Cohort 1 TANPs will also be deployed for an average of two days per week within NHS 24 to carry out the identified tests of change and contribute to other areas of the service, such as the Clinical Decision and Content development function.

2.7 Workload Tool

The Nursing and Midwifery Workforce Workload Planning Programme (NMWWPP) team and the subject matter expert Keith Hurst continue to analyse the data collected during the observation of practice. Once the analysis is complete the team will provide NHS 24 with the results and outcome. It is anticipated that the national team will be in a position to provide a prototype tool for testing during autumn 2018.

2.8 Quality Improvement Activity Update

Public protection evaluation at day 60 is complete with plans in place for face- to-face day 90 evaluation. Thereafter, it is expected that improvements will be put into place to ensure the implementation of the most efficient and effective use of Public Protection resources.

Discussions have been ongoing with Healthcare Improvement Scotland/The Care Inspectorate and NHS 24, in relation to establishing an SBAR handover with Nursing and Care homes. Tests of change work continues with Erskine and Renfrewshire Nursing Homes which so far has yielded encouraging results. This would indicate Nursing Homes find using the SBAR advantageous. This provides reflection time which can negate the requirement for a call to NHS 24, or when they do, they have all the relevant information required and are more aware of the outcomes they need for their patient.

2.9 Duty of Candour

A paper will be submitted to the to National Clinical Governance Group in September 2018 which will reflect that Duty of Candour is now live and all systems and process have been updated.

2.10 Quality Strategy

The quality strategy is due to be finalised by December 2018. A draft document has now been completed and engagement will take place with key stakeholders in a work group in August 2018 to ensure all key areas and services are included and that the intended action plans are realistic and deliverable.

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NHS 24 GREEN 3. RESETTING OUR CULTURE, CREATING CAPACITY, CAPABILITY AND CONFIDENCE IN OUR PEOPLE AND TEAMS

3.1 The Senior Nurse for Mental Health continues to provide enhanced mental health & well-being training to staff across the organisation. All NHS 24 staff have also been made aware of the importance of becoming more trauma informed/ trauma aware.

3.2 Leadership Development: Further sessions have been offered since the last reporting period, specifically: • Crucial accountability • Empowered for building a stronger organisation: The Vision and Model for Middle Management • Quality Appraisal and Career Development • Espresso sessions; What is Digital? and Productive Working

3.3 Foundation Apprenticeships: We are currently working with Glasgow Kelvin College to take on 3 Foundation Apprenticeships in IT, commencing in September 2018 until April 2019. It is anticipated that the 3 apprentices will work across HR, Health Information Services and Technology.

3.4 Delivery of e:ESS: The implementation of e:ESS is essential to providing a platform for future HR Shared Services which is an objective of both NHSScotland and the Scottish Government. The proposed roll out of e:ESS self service will be in four phases across August 2018 to March 2019. The plan for the roll out is progressing with HR working with managers in the service to delivery the implementation on time.

4. SIGNIFICANTLY IMPROVE OUR STAKEHOLDER ENGAGEMENT. ENSURE OUR SERVICES MATCH OUR STAKEHOLDER NEEDS

4.1 The Senior Nurse for Mental Health continues to represent NHS 24 on the Distress Brief Intervention national programme board. https://www.dbi.scot/

As part of the International Initiative for Mental Health Leadership, NHS 24 hosted an event for colleagues from across the UK, Australia and New Zealand in late May 2018. The Senior Nurse for Mental Health then attended a two day event in Stockholm to share innovations, network and find a solution relating to the particular challenges faced in Scotland regarding accessing appropriate mental health support.

4.2 Leadership Landscape (Primary Care)

Scottish Government have initiated a conversation with colleagues across National Boards, Local Authorities with an interest in both change leadership and professional education. A sub-group has been established which meets for the first time late August to determine the scale of the request and their individual contribution for the larger intended programme of support which is required to enable a significant transformation in the way primary care services are delivered. The sub-group is being led by the Director of Service

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NHS 24 GREEN Development, NHS 24.

4.3 New GP Contract

Work is underway, led by the Director of Service Development and Medical Director, to develop an Initial Agreement which will see the development of a resource and impact model to assess the likely costs and benefits associated with the support which NHS 24 could provide in relation to the new GP contract. Healthcare Improvement Scotland and National Education Scotland have a possible role in standard setting and review as well as specialist training and education and a collaborative approach to developing the Initial Agreement is being progressed. An output of this work is scheduled for late August.

4.4 Strategic Partnerships

A review is being undertaken by the Service Development Directorate, of all partnership agreements across the organisation, assessing relevance and identifying any gaps in alignment with our Organisational Strategy. An opportunity, following NHS 24’s Annual Review in 2017, to review the MoU(s) linked to the Alliance has taken place, and a single MoU has been prepared which aligns with both organisations' strategic ambitions.

4.5 Visit to NHS Shetland

Representation from the Medical, Service Delivery and Service Development directorates visited NHS Shetland in July. This was a positive opportunity to engage and understand the challenges of delivering services remotely. Follow up is being pursued in relation to Attend Anywhere, National Services Directory, Patient Reminder services, Mental Health, MSK and GP Triage models of care.

5. DELIVER THE SERVICE TRANSFORMATION PROGRAMME

5.1 Transforming Urgent Care

The In-hours GP Triage six month evaluation is being finalised, and will include a refreshed health economics assessment. This will act as a vehicle for further communications and engagement of the key outputs; successes and learning of the approach.

A commitment to Phase 1 2018-19 funding is awaited (at the time of writing).

Our Advanced Clinical Support programme has been defined for 2018-19 and groups established to progress our plans in relation to Virtual Working and E-prescribing.

5.2 Mental Health

Several workshops have taken place to define the scope of deliverables of our 5

NHS 24 GREEN tests of change for 2018-19. These will involve an expansion of MH Nurse Practitioners and Living Life support, a test of change to trial the use of webchat within Breathing Space and the continued integration of Moodjuice into NHS inform, as well as the expansion of self-help content for our Self Help Guide.

The NHS 24/SAS and Police Scotland proposal has been accepted by the Health & Justice Collaborative. SAS are confirmed as the lead agency. A workshop to map the existing service models, to explore the collaborative aspects and ultimately the joint operating model will take place late September.

NHS 24 has, following a SG request, submitted a proposal to enable growth aligned to our current MH redesign programme and existing services, as part of the Programme for Government.

The Technology Enabled Care (TEC) project stabilised and extended the provision of cCBT in Scotland for depression and anxiety into the remaining territorial Health Boards. All 14 Boards are now online offering cCBT as part of their routine service provision. Over 10,000 patients were initiated in 2017 and we expect, based on activity to date, around 15,000 patients will be initiated in 2018.

The license for the current therapy package (Beating the Blues) will come to an end in February 2019.

A small working group are working with finance and key national stakeholders to develop an outline business case including a procurement option appraisal to maintain and extend the cCBT service.

5.3 Modernising Out-Patients

Engagement continues with Scottish Government in relation to NHS 24’s role in supporting the Modernising Out-Patients Programme.

6. FULLY ALIGN THE NHS 24 STRATEGY WITH THE NATIONAL HEALTH & SOCIAL CARE DELIVERY PLAN

6.1 Strategic Engagement

As agreed during the SPRA process the organisation has strengthened its capability and capacity to plan and engage internally and externally through the appointment of two planning managers. The two successful candidates have an existing wealth of relevant experience in health care, social care and Integrated Joint Board settings. During the selection process they also displayed a level of enthusiasm to join NHS 24 and contribute to our exciting programme of organisational development and improvement and we therefore look forward to them joining us in September.

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NHS 24 GREEN 6.2 Collaboration with other Boards

As part of the work that the National Health Boards are taking forward, working collaboratively to identify ways to collectively standardise and share services, NHS 24 has had discussions with other Boards on a range of services.

The Procurement function is now supplied in a collaborative arrangement with GJNH and is working well. The transfer of Breathing Space donations to GJNH to hold as a separate fund within their endowment portfolio on behalf of NHS 24 has been agreed by NHS 24 and will now be considered for approval by the GJNH endowments committee. The transfer of the NHS 24 Payroll function from NHS National Services Scotland to NHS Greater Glasgow and Clyde will take place in November 2018.

National Boards’ Finance Departments are working on a Target Operating Model for future financial services delivery. It has been agreed that National Boards should have common financial processes in place across the 8 Boards. The intention is for each Board to adopt these processes from 1 April 2019.

7. CONFIRM THE ROLE OF NHS 24 IN DELIVERING WITHIN THE DIGITAL HEALTH AND CARE LANDSCAPE

7.1 Digital Health & Care Strategic Portfolio Board

NHS 24’s CEO will be one of two CEOs representing the wider group of NHS CEOs' on the above group. This new Board will be chaired by SG Health Finance Director. The first meeting of the group takes place on 30th August, with a proposed three meetings per year.

7.2 Art of the Possible Workshop

A workshop being led by CIO and Director of Service Development will be held in August with stakeholder representation internal as well as external including Scottish Government and Suppliers. The workshop will consider the digital vision aligned to our organisational Strategy 2017-22, and the opportunities this and the new Digital Health & Social Care Strategy could create for NHS 24 and its impact across the wider health and social care system.

8. CONCLUSION

8.1 Members of the Executive Management Team will be happy to provide further detail or answer questions in relation to any of the content of this paper.

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