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Forth Valley
Community Health Partnerships
Scheme of Establishment
‘Working Together For Healthier Communities’
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Contents
1. INTRODUCTION...... 5
1.1 OUR VISION ...... 6 1.2 BACKGROUND...... 6 1.3 OUR APPROACH IN FORTH VALLEY ...... 8 1.4 PRINCIPLES ...... 9 1.5 OBJECTIVES ...... 10 2. IMPROVING SERVICES...... 12
2.1 OUTCOMES...... 12 2.1.1 Shift locus of care to local communities...... 12 2.1.2 Closing the Inequality Gap – Mainstreaming Equality...... 13 2.1.3 Improved Access to Services ...... 14 2.1.4 Reduction in unnecessary admissions and providing alternatives to hospital admission ...... 14 2.1.5 Increased integration of services between primary, secondary, community and social care services ...... 15 2.2 RANGE OF SERVICES...... 16 2.2.1 Falkirk CHP ...... 17 2.2.2 Clackmannanshire CHP...... 17 2.2.3 Stirling CHP...... 18 2.3 STRATEGIC PLANNING & SERVICE REDESIGN ...... 18 2.3.1 Supporting Service Redesign and opportunities to develop new models of care...... 21 2.3.1.1 Implementing our Healthcare Strategy...... 21 2.3.1.2 Transitional Arrangements...... 21 2.3.1.3 Organisational Development...... 21 2.4 JOINT FUTURE ARRANGEMENTS...... 22 2.5 CHILDREN AND YOUNG PEOPLE SERVICES...... 24 2.5.1 Child Protection ...... 25 2.5.2 Clackmannanshire...... 25 2.5.3 Stirling...... 26 2.5.4 Falkirk...... 28 3. IMPROVING HEALTH...... 30
3.1 COMMUNITY PLANNING...... 31 3.1.1 Clackmannanshire...... 31 3.1.2 Falkirk...... 32 3.1.3 Stirling...... 33 3.2 JOINT HEALTH IMPROVEMENT PLANS / LOCAL HEALTH PLANS...... 35 3.3 THE ROLE OF PUBLIC HEALTH IN SUPPORTING CHPS...... 38 3.4 THE ROLE OF CHPS IN HEALTH IMPROVEMENT AND REDUCING HEALTH INEQUALITIES ...... 39 3.4.1 Joint Planning ...... 40 3.4.2 Staffing ...... 40 3.4.3 Training...... 40 4. ORGANISATIONAL ARRANGEMENTS...... 42
4.1 GEOGRAPHICAL BOUNDARIES...... 42 4.2 CHPS & THE FORTH VALLEY NHS BOARD...... 42 4.3 GOVERNANCE AND ACCOUNTABILITY ARRANGEMENTS...... 43 4.3.1 Falkirk...... 44 4.3.2 Clackmannanshire...... 45 4.3.3 Stirling...... 46 4.4 CHP COMMITTEES ...... 47 4.4.1 Membership...... 48 4.4.2 Role & Remit of the CHP Committee ...... 48 4.4.3 Frequency of Meetings...... 49 4.4.4 Role of Management Team...... 49 4.5 LEADERSHIP ARRANGEMENTS ...... 49
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4.5.1 Clinical Lead...... 50 4.5.2 Leadership Structure ...... 50 4.5.3 Locality Arrangements ...... 51 4.5.4 LHCC Professional Committee ...... 51 4.6 SUPPORT SERVICES ...... 52 4.7 PERFORMANCE MANAGEMENT ...... 53 5. WORKING IN PARTNERSHIP ...... 54
5.1 INVOLVING STAKEHOLDERS...... 54 5.2 ENGAGING LOCAL COMMUNITIES...... 54 5.3 PUBLIC PARTNERSHIP FORUM...... 55 5.3.1 Stirling CHP...... 55 5.3.2 Falkirk...... 56 5.3.3 Clackmannanshire...... 57 5.3.3.1 Clackmannanshire-Wide Community Engagement ...... 57 5.3.3.2 Community Fora ...... 58 5.3.3.3 Other Strategic Community Engagement Structures...... 59 5.3.3.4 Other Approaches to Engagement...... 60 5.4 LINKING CLINICAL AND CARE TEAMS ...... 60 5.4.1 Clinical Governance...... 60 5.4.2 Developing New Models of Care...... 61 5.4.2.1 The Role of Nursing...... 62 5.4.2.2 Allied Health Professionals...... 63 5.4.2.3 CHPs & the nGMS Contract...... 63 5.4.2.4 CHPs & Other Contracts...... 64 5.4.3 Information Sharing ...... 64 5.4.3.1 Sharing Information ...... 65 5.4.3.2 Shared Care...... 65 5.5 INVOLVING STAFF...... 66 5.6 WORKING WITH LOCAL AUTHORITIES ...... 68 5.7 WORKING WITH THE VOLUNTARY SECTOR ...... 69 6. BUILDING WORKFORCE CAPACITY...... 70
6.1 DEVELOPMENT PLANS...... 70 6.2 WORKFORCE DEVELOPMENT...... 70 6.2.1 Sharing Good Practice / Links to Research Activities...... 72 7. FINANCE...... 73
7.1 RESOURCING CHPS...... 73 7.1.1 Indicative Budgets ...... 73 7.1.2 Funding the CHP Public Partnership Forums...... 73 7.1.3 Development Plan budgets...... 73 7.1.4 CHP Support Services budgets...... 73 7.1.5 Proportion of resources devolved to CHPs...... 74 7.2 RESOURCE TRANSFER ...... 74 7.3 CHP ROLE IN RESOURCE ALLOCATION AND DECISION-MAKING...... 74 7.3.1 Joint Resourcing, Governance and Accountability ...... 74 8. RECOMMENDATIONS ...... 76
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Appendices APPENDIX A - PRIMARY CARE MODEL OF SERVICE CONFIGURATION ...... 77
APPENDIX B - HOSTING PROTOCOL ...... 78
APPENDIX C - DRAFT F V JOINT FUTURE PERFORMANCE MEASURES FRAMEWORK ...... 82
APPENDIX D - OUTLINE OF DEVELOPMENT OF PPF - STIRLING...... 87
APPENDIX E - ALLOCATION OF RESOURCES AND RESPONSIBILITY TO CHPS...... 88
APPENDIX F - GLOSSARY OF TERMS ...... 91
Tables TABLE 1 – RANGE OF SERVICES...... 18
TABLE 2 – HEALTH AND WELLBEING FUNCTIONAL GROUPS - STIRLING ...... 37
TABLE 3 – CHP COMMITTEE ARRANGEMENTS ...... 48
Figures FIGURE 1 - HEALTH PLANNING PROCESS...... 20
FIGURE 2 – CHILDREN’S PLANNING STRUCTURE - CLACKMANNANSHIRE...... 26
FIGURE 3 - OVERVIEW OF STIRLING INTEGRATED CHILD HEALTH PLANNING GROUPS....27
FIGURE 4 – FALKIRK CHILDREN’S COMMISSION ...... 29
FIGURE 5 – COMMUNITY PLANNING STRUCTURE – CLACKMANNANSHIRE...... 32
FIGURE 6 – COMMUNITY PLANNING STRUCTURE - FALKIRK...... 33
FIGURE 7 – EXISTING COMMUNITY PLANNING PARTNERSHIP STRUCTURE IN 2004 - STIRLING ...... 34
FIGURE 8 – CONCEPTUAL MODEL OF HOW THE CHP AND COMMUNITY PLANNING PARTNERSHIP WILL LINK - STIRLING...... 35
FIGURE 9 – MAP OF FORTH VALLEY AREA ...... 42
FIGURE 10 – ACCOUNTABILITY MODEL - FALKIRK...... 45
FIGURE 11 - ACCOUNTABILITY MODEL CLACKMANNANSHIRE...... 46
FIGURE 12 – ACCOUNTABILITY MODEL, STIRLING ...... 47
FIGURE 13 – PROPOSED COMMUNITY FORUMS – CLACKMANNANSHIRE...... 59
FIGURE 14 – CLINICAL GOVERNANCE REPORTING MECHANISMS – FV PRIMARY CARE OPERATING DIVISION ...... 61
FIGURE 15 – MULTI-AGENCY ‘STORE’ MODEL...... 65
FIGURE 16 - STAFF PARTNERSHIP FORUM ...... 67
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1. Introduction This document sets out our proposals to establish three Community Health Partnerships (CHPs) in Forth Valley and has been developed within the context of related national and local strategies, most notably ‘Partnership for Care’ February 2003, underpinning legislation The National Health Service Reform (Scotland) Act 2003 and supporting Statutory Guidance. Local Authority partners and other stakeholders have been engaged and consulted with as part of the development process and in the drafting of this document henceforth referred to as ‘The Scheme’. Representation has included:- • The public / Local Health Council; • Voluntary sector; • Clinical and non clinical staff; • Staff Partnership Forum; • NHS Forth Valley Board Headquarters, Acute and Primary Care Operating Divisions; • Local Healthcare Cooperatives (LHCCs)/Specialist Services Cooperative (SSC); • Independent Contractors; • Clackmannanshire, Falkirk & Stirling Councils; and • Community planning partners.
The Scheme describes how, through the introduction of CHPs, NHS Forth Valley and its partners will seek to have a more consistent and enhanced role in the delivery of integrated services and work towards making a measurable improvement to the health of the population in Forth Valley.
The Scheme is set out in sections and describes for each CHP:- • The geographical area & population; • Services managed or co-ordinated; • Functions exercised; • Membership; • Financial arrangements; • Organisational and accountability arrangements; • Development plans; • Relationships with; • The public; • Local Authorities; • The Board and its Officers/Divisions; and • Voluntary Organisations.
Whilst this Scheme describes the proposed arrangements and the direction of travel for CHPs from 1 April 2005, supporting development plans (see accompanying document - Forth Valley CHP Development Plans) describe the priorities that each CHP will action over time as CHPs mature and realise their potential. The Scheme recognises the need for flexibility if CHPs are to be a genuine
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reflection of the needs and aspirations of the communities they serve and as a result The Scheme should be viewed as the starting point to this evolutionary process.
1.1 Our Vision Community Health Partnerships open up a new set of opportunities, which empower communities and professionals to make a real difference to improving population health and improving the patient’s journey of care. The CHP (Scotland) Regulations 2004 and the Statutory Guidance provide the mechanism to develop relationships between professionals and communities who will work in partnership to design and deliver care services based on local need supported by the sharing of common boundaries between health and local authorities. Through this enabling mechanism, CHPs in Forth Valley will be uniquely placed to support and influence the delivery of our Local Healthcare Strategy. Developing relationships are dependent on the commitment of each individual to focus on the true spirit of the reforms and build on the work that is already taking place to bridge the gaps between primary and secondary care and between health and social care working in a truly integrated way.
In Forth Valley we recognise the opportunities that CHPs will give us to improve the health and well being of the local population. We will empower those who provide care across the health and social care spectrum, including the voluntary sector, to deliver service improvements through changes in the way skills and resources are deployed.
NHS Forth Valley and its partners will work towards developing a shared culture and will build effective communication and information systems that will support the achievement of improved outcomes described throughout this Scheme.
1.2 Background In Forth Valley the need to change the way services have been historically provided has been anticipated for some time. Forth Valley’s Healthcare Strategy addresses many of the challenges that face the NHS both nationally and locally, including : -
• predicted changes in population; • shortage of skilled professionals and the subsequent risk to continued stability of services; • new regulations; • changing working arrangements for staff; • the need to maintain and improve the quality of services and meet new clinical standards and guidelines.
Following extensive consultation in 2002 the Minister for Health and Community Care approved the proposed strategic direction in Forth Valley and as a result, in 2009 a new acute hospital will be built replacing the existing two District General Hospitals. Since then, further consultation has taken place
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which proposed short-term and longer term changes that are needed to reshape our hospital and community services. These changes will ensure that services can continue to be delivered in a safe, effective and sustainable way between now, 2009 and beyond. This is a substantial change programme and embraces almost every aspect of healthcare delivery in Forth Valley, namely: -
• a new model of health services for primary care and community services; • a new primary care out of hours service; • reshaped community hospitals; • changes to adult mental health services; and • temporary changes to acute hospital services.
Additionally, other national strategies such as ‘Joint Future’, ‘For Scotland’s Children’, ‘Mental Health Framework’, ‘Same as You’ and ‘Community Planning’ have added to the complexity of the NHS system within which this change agenda operates.
Two LHCCs were established in Forth Valley in April 1999 following the 1997 White Paper ‘Designed to Care’. In addition, and at the same time, a SSC was formed which provides area wide specialist hospital and community based services including adult mental health, older people, community alcohol and addictions, learning disability and child and adolescent mental health services.
As the Co-operatives have developed, additional responsibilities and challenges have arisen that were not identified in their original constitutions. The emphasis on partnership working, Joint Future, service redesign, managing prescribing and clinical effectiveness has increased significantly and placed additional demands on clinical managerial capacity.
The two LHCC operational units are broadly similar in size and cover, in the south LHCC a population of 145,000 and in the north LHCC a population of 134,000. The SSC provides services on an area wide basis across the total FV population of 279,000. The South LHCC is coterminous with Falkirk Council boundaries whilst the North LHCC is co-terminous with the Stirling and Clackmannanshire boundaries combined.
Both LHCCs and the SSC form part of the Primary Care Operating Division, whilst Acute services are delivered from within the Acute Operating Division. Both Divisions, since April 2004, form part of the NHS Board within the context of a single operating system.
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1.3 Our Approach in Forth Valley Although the lead agency responsible for the development of CHPs is the NHS Board, CHPs are not just about health services and this is an important new concept that needs to be emphasised and understood.
A multi-agency, multi professional CHP Steering Group was established in October 2003 which includes membership from, acute & primary care, (managers and clinicians) Local Authorities, Area Partnership Forum, NHS Forth Valley, LHCCs, SSC and the Local Health Council. The Steering Group agreed a set of principles that would underpin the CHP development process: -
• the involvement of as wide a range of individuals, groups as possible; • the recognition that CHPs are intended to evolve from LHCCs and build on very best practice; • partnership means equality; • maintain a focus on Service, Community, Patient & Carer Benefits; • the need to strike a balance between the optimal size and shape for CHPs and avoiding unnecessary disruption to service delivery.
‘Partnership for Care’ proposed that Boards should review their existing LHCCs with a view to building on the successes of these organisations and to recognise areas for improvement as the first step towards the development of CHPs. In Forth Valley it was agreed that the SSC should be reviewed at the same time. This review was completed in February 2004 and a report produced. The review recognised that co-operatives had been successful in achieving: - clinical engagement, effective strategies for clinical effectiveness and prescribing and establishing multi disciplinary communication networks, however, there were areas where improvements could be made including more effective joint working with the local authorities, voluntary sector and service users.
Following the outcome of this report, a number of approaches have been used to ensure the continued involvement and engagement of key partners :- • awareness raising sessions about CHPs held in each of the three local authority areas and one in rural West Stirlingshire, recognising the specific needs of a rural community; • Multi agency visioning workshops to inform the planning and implementation of CHPs; • Discussions with care groups and other specific interest groups to ascertain areas of concern and continue the engagement process; • Multi-agency development planning workshops within each local authority area; • Development of an internal website, regular communications via Staff Newsletter and CHP Briefing Sheets.
In July 2004, Forth Valley NHS Board approved the CHP Steering Group’s recommendation, presented in the form of an option appraisal, for three CHPs in Forth Valley, each coterminous with one of the three Local Authorities in Forth Valley. Subsequently three multi agency / professional
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CHP development groups were established and two multi-agency sub groups, Organisational Development / Workforce Planning and Corporate Governance, Finance and Accountability to take the development process forward.
1.4 Principles NHS Forth Valley has adopted a number of guiding principles within which CHPs will operate and these are, to some extent, mirrored in Extended Local Partnership Agreements. The overarching principle is that of partnership involving the NHS, local authorities, the private & voluntary sectors, and the public. To develop the partnership it is recognised that there must be shared goals, trust, respect of each others roles, team building and working towards a shared culture and language ensuring that all stakeholders are considered as valued partners. The guiding principles for the development of Community Health Partnerships are:-
Promotion of joint working between the NHS, local authorities, the private & voluntary sectors and the public to avoid duplication of service provision and achieve the streamlining of services;
Access to services which deliver added value to patients and carers should be improved;
Reduction of bureaucracy and duplication together with service redesign should be the main vehicles for building future workforce capacity;
Targets, which are both challenging and achievable, should be set to improve clinical outcomes, achieve better services for patients and demonstrate clinical governance;
Needs led, evidence based, innovative and equitable service provision should be delivered. This should take into account local community planning priorities and, where possible, recognise diversity and be responsive to local needs;
Evolution of CHPs should build on the successes of LHCCs & SSC, maintaining a clinical focus and retention of staff support whilst recognising priorities for improvement;
Responsibility with authority must be devolved to CHPs within an agreed accountability and corporate governance framework. CHPs should have proper management structures to ensure effective leadership, decision making and service delivery;
Strategic Planning, priority setting and resource allocation processes should actively involve CHPs to enable them to shape future service provision in their area;
Health Improvement and public health should be at the heart of service planning and delivery with CHPs making a significant contribution to improving health and reducing health inequalities;
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Integration of service delivery across the spectrum of care (Primary Care, Specialist Services, Secondary Care, Local Authority, Private and Voluntary Sectors) should be a priority to achieve more efficient, effective and clearer patient pathways;
Participation should be encouraged within CHP structures to enable public, patient and staff understanding of the challenges facing CHPs and to optimise service delivery. This participation will identify priorities for development and improvement. CHPs should ensure good communication networks are in place and that these are inclusive and accessible.
The following sections, informed by Statutory Guidance, describe how CHPs in Forth Valley will operate to enable them to meet the objectives set out in ‘Partnership for Care’ and underpinning legislation.
1.5 Objectives Specific and overarching objectives can be found in Forth Valley’s Local Health Plan, Local Community Plans, Joint Health Improvement Plans, Extended Local Partnership Agreements, Joint Improvement Targets and Joint Local Implementation Plans to which CHPs will become a major contributor. It is not the intention of The Scheme to replicate what is already in existence elsewhere except where this will lead to further clarity in relation to the specific requirements of The Scheme as stipulated in the Statutory Guidance.
Our process for evaluating and monitoring progress will be our local Performance Management and Review and Corporate Objective setting process (see section 4.7)
Our CHP Objectives are consistent with Statutory Guidance and include :- • Reduce waiting times for assessment, diagnosis, treatment and care in a systematic way across a range of services; • Manage waiting times for inpatient and outpatient services more effectively by understanding demand/supply and through redesign of services; • Minimise the number of inappropriate hospital visits by improving the quality of referrals to consultants and increasing the skills of community practitioners; • Minimise the number of inappropriate admissions and reduce the number of people admitted to hospital in an emergency by improving the level and quality of chronic disease management and increasing community based support (eg. mental health teams); • Minimise number of delayed discharges through increased provision of rehabilitation services, rapid response etc; • Minimise the time taken to agree care packages for individuals by extending single shared assessments; • Increase quality of care through the systematic implementation of evidence based care and multi- disciplinary guidelines and protocols;
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• Rationalise the number of single points of access for all community based services; • Reduce inequalities of access to information by providing targeted and coherent health messages particularly aimed at excluded or disadvantaged groups; • Reduce the number of premature deaths by preventable diseases through local actions by key partners to improve health; • Improve access to services by increasing the level of joint service provision and co-location of services; • Implement jointly agreed care packages for young children.
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2. Improving Services 2.1 Outcomes CHPs have been created specifically to improve outcomes1. In Forth Valley CHPs will be the vehicle to enable and support improvement in the quality of local services and will lead the process through which the following outcomes will be achieved: -
2.1.1 Shift locus of care to local communities NHS Forth Valley is reviewing almost every aspect of service provision within its healthcare strategy. In taking forward decisions about the future delivery of acute services in Forth Valley, a decision was also made to examine the future shape and pattern of primary care and community services. The vision being simply that –
‘What can be done safely and effectively in primary care should be done in primary care.’
The model in Appendix A describes how services will be configured in primary care to meet needs at different levels i.e. GP practice level, locality level and Forth Valley level and gives examples of the type of services that might be provided at each level.
To support these developments, proposals to provide ‘extended’ services closer to home were approved following a public consultation exercise. In order to do this improved clinical facilities grouped in a number of localities will be developed. Examples include :- • public health nursing model being developed in Forth Valley to enhance community involvement both in locality community groupings and in school communities; • Strathendrick Care Home in Balfron has been extended to include a 2-bedded unit for rehabilitation and respite following a health needs assessment of the elderly population of rural West Stirlingshire; • A programme of investment in community healthcare premises / health centres.
As Forth Valley’s new model of care for community hospitals develops, local access to a range of services will emerge including :– • Rehabilitation and Intermediate care services; • NHS continuing care for older people with complex care needs; • Palliative care; • Day hospital services; • A base for multi-disciplinary and multi-agency rehabilitation teams; • The possible future development of inpatient resources in primary care.
1 Statutory Guidance, October 2004, p8
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Forth Valley has a multi disciplinary, multi-agency group to address issues in relation to delayed discharges, this group agrees, monitors and reviews the annual joint delayed discharge plan.
2.1.2 Closing the Inequality Gap – Mainstreaming Equality Building on ‘Our National Health: A plan for action, a plan for change’, ‘Patient Focus Public Involvement’ and ‘Partnership for Care’, NHS Forth Valley has been developing processes to identify action required to make services better and more responsive to the needs of patients under the banner of Patient Focus and Public Involvement (PFPI). There are three different levels of involvement: individual patient level, patient or care group level and the community/wider public level. It is recognised that PFPI is of particular importance for services responding to patients with additional or special needs and people at risk of experiencing exclusion and inequality.
The PFPI agenda has broadened to incorporate ‘Fair for All - the wider challenge’, mainstreaming diversity and tackling inequality. A Race Equality Scheme and Fair for All Action Plan has been published, setting out NHS Forth Valley's commitments to meet the requirements of the Race Relations (Amendment) Act 2000. This work will ensure that we consider the various and diverse needs of our patients, the public and our staff in relation to age, disability, gender, race/ethnicity, sexual orientation and religion/faith and that differences between people are recognised and valued. This action plan will be further developed to mainstream equalities and take account of the equality target groups and cross cutting issues (eg poverty, mental health, homelessness, involvement in the criminal justice system, marital status and language or social origins.) as defined by SEHD/NHS Scotland.
Progress on the PFPI agenda is monitored through the Health Plan, where it is one of the national priorities, forming a key part in the Performance Assessment Framework (se section 4.7). Progress is monitored against the four 'pillars' of involvement, namely:-
• Building capacity and communication; • Encourage involvement; • Provision of Information; • Responsiveness of local services to address the aspirations and concerns of patients and local communities.
We will continue to work with Partners to reduce inequalities. The Forth Valley Joint Disability Strategy Group is working to address these issues, which includes assessing ways to identify the specific needs of people with disabilities. The Disability Advisory Service in Forth Valley has been recognised by the Scottish Executive as an example of good practice, which is being replicated throughout NHS Scotland. The service offers information, support and advice to staff and people with a disability and those individuals from diverse communities. However, people with a disability and in particular communication difficulties, still experience challenges in accessing current service
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provision. The needs of disadvantaged groups should and will increasingly be seen as an integral part of services and not as an ‘add on’.
2.1.3 Improved Access to Services Both Forth Valley LHCCs are involved in wave 1 of the Primary Care Collaborative Programme. For the 10 practices involved in the collaborative there has been evidence of improved access to a primary care professional since the inception from the programme. On average, to date, there has been an improvement from 4.8 days down to 2.3 days (=52%) in access to a GP in Forth Valley. Access to practice nurses has, on average, seen an improvement from 4.1 Days down to 2.1 days (=49%) and patient satisfaction has risen from a baseline of 79% to 89%. The Collaborative Programme is now actively engaged in recruiting other GP practices onto the scheme.
In Clackmannanshire, a new Community Hospital is being built and is due for completion in 2007. This will become the base for a range of health and local authority professionals who will be co- located at the premises. Both Stirling and Falkirk will also see the development of Community Hospitals in the next 5-7 years to deliver new models of care for Forth Valley.
Nurses, as the largest single professional group of NHS staff have an increasing contribution to play in improving access and care. For example, NHS 24 was launched in Forth Valley in August 2004 and provides a health advice and telephone triage service delivered by experienced and appropriately trained nurses. As the new arrangements for delivering a local Out of Hours service develop, so will the opportunity to develop an integrated model of care to include GPs, nurse practitioners, pharmacists, psychiatric nursing, paramedics and other professionals in the delivery of service. This will mean that patients will have the opportunity to be seen by the healthcare professional who is best equipped to meet their needs.
2.1.4 Reduction in unnecessary admissions and providing alternatives to hospital admission Delivering preventative, assessment, diagnostic and treatment services in a community setting as alternatives to admission and to assist in the reduction of waiting times will be important outcomes for CHPs and the wider health and social care system. CHPs will also have a more active role in managing waiting times for inpatient and outpatient services by using their understanding and influence over local demand and by increasing their involvement in the redesign of services to adjust supply. Some examples where work is being done already, including reference to the new General Medical Service (nGMS) Contract (see also section 5.4.2.3) include:- • Near Patient Testing which includes the monitoring of rheumatology medication side effects resulting in the need for fewer return out patient visits (GMS enhanced service); • Anti-coagulation monitoring linked to the redesign of anticoagulant services in hospital is shifting the monitoring role from hospital to primary care services (GMS enhanced service);
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• Minor surgery carried out in primary care will help reduce the number of referrals to secondary care (GMS enhanced service); • Minor injury service – patients have local access avoiding the need to attend A&E departments (GMS enhanced service); • Management of patients requiring complex care packages in the community, providing earlier discharge and minimising lengthy hospital stays; • Referral guidelines implemented in cardiology, physiotherapy, and gastroenterology that increase the quality of referrals to consultants and increase the skills of community practitioners; • Community based dermatology clinics in Alloa. Practitioners with a special Interest deliver this clinic and through the successful Community Outpatient Programme bid, the intention is that further clinics will be established. This work is complementary to a radical redesign of hospital based dermatology outpatients clinics; • Supported Diabetic Clinics – Clinics in general practices negate the need for hospital visits; • Adult Mental Health Redesign – Forth Valley are in the process of redesigning adult mental health services, to ensure a balance of provision between hospital care for those that are most ill and in need of intensive care and treatment, and community based services that provide care and treatment as close to the patient’s home as possible. As a result of a capacity planning exercise alternatives to admission have been developed including enhanced community support via extensive care at home packages; • Community based epilepsy project to improve access to specialist services for people with epilepsy and improve primary care management. This project has recently won an award for innovation and good practice; • A back pain service aimed at reducing orthopaedic referrals using the extended role of AHPs (Physiotherapists); • Community Musculoskeletal services developed by podiatry and physiotherapy; • The Gold Standards Framework for palliative care encourages and facilitates primary health care teams to deliver end of life care within a patient’s own home. This includes anticipating problems that might otherwise end in a hospital admission. There are now 21 Forth Valley practices providing this care.
2.1.5 Increased integration of services between primary, secondary, community and social care services Generally, people who require care and treatment are not so concerned about who is providing that support, rather that the service they receive is of a high quality, delivered by people with the right competencies, appropriate to their needs and accessible at a time and place suitable to their situation. There are examples already in Forth Valley where integration of services has benefited patients:- • Development of multi agency, multi professional learning disability teams; • Integrated mental health day service in Clackmannanshire;
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• Exercise and Lifestyle Programme for Coronary Heart Disease/Transient Ischaemic Attacks (TIA)/obese patients; • Local Managed Clinical (Care) Networks for Diabetes, Stroke, Coronary Heart Disease, Palliative Care, Community Alcohol and Drug Service, Multiple Sclerosis; • Regional Managed Clinical Networks e.g., Epilepsy, Learning Disability; • NHS Forth Valley Oral Health Strategy; • Work is progressing on models of intermediate care and rehabilitation to deliver more services closer to home either as an inpatient in community hospitals or care homes and care at home.
CHPs will continue to look at ways in which services can be further integrated and quality improved through the systematic implementation of more evidenced based care and multi–disciplinary guidelines and protocols. In the area of chronic disease management in particular, there are opportunities for multi- disciplinary teams to shape future service delivery and to become involved in service planning to provide real benefits for patients. The traditional roles of nurses and allied health professionals can and are being reviewed and developed and multi-professional models in chronic disease management are progressing. This not only leads to improved services for patients but also provides practitioners with opportunities for role development and career advancement. This approach will require robust information systems to support communication between professional groups and the patients themselves in Forth Valley. The implementation of the Single Shared Assessment (SSA) across Forth Valley and proposals for single shared assessment in child protection (see section 2.5) will lead to better communication and cooperation between health and social care, reducing the time taken to agree care packages, streamline service and provide easier access.
2.2 Range of services The range of services / functions that will be managed within CHPs in Forth Valley from April 2005 are detailed in table 1. The decision to host the majority of services in the first instance is based on a number of factors. • The division of a service would disadvantage it clinically; • The efficiency, effectiveness and cohesion of a service would be adversely affected by its division; • The sustainability of a service would be adversely affected on the grounds of clinical risk/patient safety, affordability and economies of scale/critical mass; • There is insufficient specialist clinical and managerial capacity within a service to participate in, and operate across, more than one CHP arrangement; • Services engaged in major service redesign would be better supported in a hosting arrangement in the short term; or alternatively the longer-term outcome of redesign would point to a hosting arrangement.
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To support local hosting arrangements a hosting protocol has been developed following wide ranging discussion and debate. Details of the hosting protocol are in Appendix B. NHS Forth Valley has undertaken to review the initial configuration of services within the first 12 months and development plans supporting this Scheme of Establishment (see accompanying document - Forth Valley CHP Development Plans) will outline anticipated future service arrangements, particularly in relation to services that will only be hosted in the short term. Opportunities to review the positioning of services between acute and primary care sectors will arise as we take the health care strategy forward and develop plans for community hospitals and the new acute hospital. Decisions around beds/service provision in the new acute hospital will mean that there will need to be an early debate about services that will be better integrated into CHPs.
Currently community based unscheduled care (the new GP Out of Hours service) is managed within the Primary Care Operating Division and will be included in the review of the Primary Care Organisation (see section 4.2). Each CHP will have a role in influencing the delivery of this service via representation on a clinical reference group being established to focus on unplanned care across the local Forth Valley system. Delivering safe, sustainable health and social care services will remain the basic principle in determining how services will be most effectively managed and delivered in the future. Similarly, Primary Care Administration will initially be managed by the Primary Care Division and will be included within the review of the Primary Care Organisation. (see section 4.2).
2.2.1 Falkirk CHP The Falkirk CHP will initially host older peoples services including old age psychiatry and community hospitals, learning disability inpatient services including the additional support team and complex care. Current plans within the Falkirk area anticipate that there will be integrated learning disability and integrated mental health services with single managers from 1st April 2005. Plans for these services are being finalised with a view to ensuring their full integration into the CHP framework from 1st April 2005. The CHP will subsume the current joint planning arrangements for community care with managerial decisions, including aligned budgets being taken within the CHP framework. A detailed timescale for a move of Local Authority services and / or responsibilities into the CHP has not been developed at this time. Falkirk Council is committed to developing a CHP that "adds value" to current arrangements and further decisions on operational and managerial changes will be taken as the CHP evolves.
2.2.2 Clackmannanshire CHP The Clackmannanshire CHP will initially host mental health services as described in table 1. In Clackmannanshire there is already an integrated mental health day care team with a joint manager, employed by the Local Authority and reporting to both health and the local authority managers. By 1 April 2005 there will be a pooled budget for this service which will managed within the Clackmannanshire CHP. Further opportunities to integrate local authority services into the CHP after 1 April 2005 will be considered, i.e. community care and assessment teams.
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2.2.3 Stirling CHP The Stirling CHP will initially host allied health professionals, specialist primary care nursing services (excluding complex care), health promotion, community dental services, child health administration, family planning and primary care pharmacy services (pharmacy management, including clinical pharmacy and prescribing support).
The Community Care resources in Stirling Council are aligned as part of the Joint Future arrangements, and this position will continue. Partners have progressed some integrated services, e.g. the learning disability team, rapid response and rehabilitation units. Partners will work towards further opportunities for integration and joint working in areas where this improves service outcomes.
It has been agreed that the Children's Community Planning Partnership be the forum for taking forward integrated children's services in the Stirling area (see section 2.5.2). The accompanying CHP development plan document outlines how this will be taken forward over the next year. table 1 – range of services Core Services/functions within each CHP Hosted Services / functions
Independent contractor services – dentists, Allied Health Professionals optometrists, general practitioners, pharmacists (excl administration) Community Nursing Specialist primary care nursing services Public Health Nursing Team Community Dental Learning Disability Community Teams Child Health Administration
Public Health Practitioners Health promotion
Community Learning Disability Residential Family planning Resources Learning disability inpatients and additional support team Mental Health services (incl Adult Psychiatry, Adult Psychology, Behavioural Psychotherapy, Child and Adolescent Mental Health and Community Alcohol & Drug Services) Older People Services (incl Old Age Psychiatry and Community Hospitals) Primary Care Pharmacy Services (Pharmacy Management, including clinical pharmacy & prescribing support)
2.3 Strategic Planning & Service Redesign The intention is that there will be a matrix management structure whereby service planning and professional planning networks will co-exist across the Forth Valley system. Forth Valley has agreed to undertake a review of existing area wide, multi-agency strategic planning groups and reporting mechanisms on a phased basis. Phase one has already started and includes a review of current
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client specific planning groups (adult mental health, older people, adult learning disability, children, adult palliative care and adult physical disability). It is anticipated that revised arrangements, in the form of client group specific Partnership Groups, cross cutting each of the CHPs, will be in place by 31 March 2005. Phase two will encompass disease specific health planning groups (eg. MCNs) and it is anticipated that any revised arrangements, subject to review, could be in place by September 2005 at the latest. Reviews will seek to ensure that clinical involvement and influence in the planning, commissioning, leadership and delivery of services for these client groups is retained. (see section 4.5).
A FV system wide approach to strategic planning will ensure that clinical and non clinical standards are improved within effective governance arrangements, there is improved equity of access and that professional identity and integrity can be maintained. CHPs will develop mechanisms whereby local joint planning initiatives can be identified leading to a seamless and coordinated approach to local service delivery within agreed outcome and service improvement targets.
Specifically, in relation to Community Alcohol and Drug Services, Forth Valley already has an area wide, multi agency Substance Action Team (SAT) and the Community Alcohol and Drug Service will initially be hosted by the Clackmannanshire CHP. Arrangements for reaching decisions on the planning and delivery of jointly managed and resourced CADs services will be in line with the hosting protocol (see Appendix B) and any new arrangements that arise following the review of strategic planning groups referred to earlier.
The existing Health Planning process is outlined in figure 1 below. The Service Design Board is our Service Redesign Committee in Forth Valley and brings together senior clinical and managerial leaders of change across Forth Valley to help steer the shape of services. The Service Design Board is chaired by the Chief Executive of NHS Forth Valley supported by an Associate Chair, the chair of the Area Clinical Forum. Current membership includes the Chief Executives of the Divisions, NHS Forth Valley Directors of Medical, Nursing, Public Health, Finance and Strategic Planning, as well as Associate Medical Directors from the Acute Division and LHCC chairs. The membership of the Service Design Board will be reviewed and extended to include clinical representation from each CHP replacing the existing LHCC representation.
The purpose of the Strategic Planning Group within this process is to pull the various local, regional and national plans together to ensure consistency with Board policy and strategic intention and to oversee the delivery of priorities identified in the Forth Valley Local Health Plan. The Strategic Planning Group is chaired by the Director of Strategic Planning and membership includes, Board Directors of Public Health, Finance, local planning leads, Area Clinical Forum, Area Partnership Forum and members from the two operating divisions. The Group reports to the Forth Valley NHS Board through the Service Design Board.
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It is important to acknowledge that multi-disciplinary and multi-agency planning takes part as an integral part of this planning model. There are a wide range of care group / disease / topic specific planning groups which work effectively together across staff groups and organisational boundaries to develop specific strategies and plans. This work feeds up in the form of specific plans / strategies and workplans, to the Strategic Planning Group. This will continue.
To ensure that CHPs are fully involved in decisions made in relation to Strategic Planning and to ensure influence in the regional planning process, it is intended to expand the membership of the Strategic Planning Group to include nominated members from of each CHP including local authority representation. This will ensure that there is a more holistic planning model that will link through its membership to community planning structures (see section 3.1).
Strategic Services Development Plans (SSDPs) will be developed from the existing strategic documentation relative to the current Capital Planning Groups. Current Capital Plans and Groups will initially inform the SSDPs, however, in the longer term the SSDPs will direct the need for, and approach of, the capital planning process.
Details of the range and extent of responsibilities and authority devolved to CHP Committee and its management team, will be reflected in the Scheme of Delegation. figure 1 Health Planning Process
NHS FORTH VALLEY HEALTH PLANNING PROCESS
NATIONAL PRIORITIES
COMMUNITY PLANS REGIONAL FV SERVICE ______PLANS & FINANCIAL PLANS HEALTH IMPROVEMENT PLANS
FORTH VALLEY HEALTH PLAN
FV STRATEGIC PLANNING GROUP
SERVICE DESIGN BOARD
NHS BOARD
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2.3.1 Supporting Service Redesign and opportunities to develop new models of care The Service Design Board oversees an integrated programme of work aligned with the strategic vision for NHS Forth Valley. The programme of work is described in our Change and Innovation Plan and covers a range of activities categorised into 3 main priorities :–
• Implementing our Healthcare Strategy; • Transitional Arrangements; • Organisational Development.
2.3.1.1 Implementing our Healthcare Strategy. NHS Forth Valley is undergoing a significant period of change leading to the transfer of acute hospital services to a new acute hospital at Larbert in 2009 with a complete redesign of our community services (see section 1.2). The five main activities listed below have a number of specific interventions to which time and effort is being directed to engage with staff across our organisation, as well as staff from other agencies and the voluntary sector, and to engage with the public to ensure commitment to change. • Supporting the creation of Community Health Partnerships; • Supporting the development of the new Acute hospital; • Supporting the development of Clackmannan Community Hospital; • Developing primary care services including enhanced services; • Developing community hospitals for Stirling and Falkirk together with reshaping of our care home provision.
2.3.1.2 Transitional Arrangements There are a number of crucial activities being progressed to ensure the continued delivery of safe and effective services in Forth Valley. All of these are driven by external initiatives necessitating changes in our current service delivery. Each of the activities, listed below, challenges established ways of working. Teams of staff and users are involved in remodelling these services. • Implementing primary care out of hours services and thereafter integrating with Accident and Emergency services; • Temporary changes to acute hospital services; • Redesign of both community and acute mental health services; • Meeting national targets eg. waiting times, delayed discharges; • New models of GP enhanced services.
2.3.1.3 Organisational Development The change programme described above requires commitment from clinical and managerial leaders and our Service Design Board provides the forum for bringing together these leaders and ensuring our strategic vision is led from the top of our organisation. There is commitment from the Service Design Board to developing our organisation and to embed our strategic vision in our change
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activities. Much of the work associated with our organisational development is integral to the activities described above but there are also key strategies being used to support and manage changes, these include:- • Developing effective leadership and management of change through education and training; • Redesigning services to involve people in change across the NHS system and with key partners to remove barriers, reduce overlap and duplication and share responsibility; • Workforce Planning and Development – specific and practical approaches to developing our workforce with partnership agreement; • Communication strategies to involve people in decisions about changes which affect them.
Our programme of change here in Forth Valley is challenging and reaches across the whole system (see accompanying CHP Development Plan document). Our Service Design Board is used to focus efforts towards identifying and supporting incremental change to achieve our longer term vision for the future. In practice our change activities are progressed with staff and user involvement to ensure ownership and commitment to new models of care and there are many ways in which this is achieved. For example, in Forth Valley Community Resource for Education Audit and Teamwork (CREATE) has been operational for some time. This initiative has successfully provided protected time for ongoing learning and support for clinical and administrative staff within GP practices. This initiative will continue within the CHP structure and a mechanism for expanding this opportunity for other professionals will be examined.
2.4 Joint Future Arrangements Community Health Partnerships will be responsible for ensuring the ongoing and extended implementation of A Joint Future.
The jointly planned developments which flow from the Extended Partnership Agreements will be taken forward by each CHP and include :-
• Establishment of Integrated Adult Community Mental Health Service in Falkirk by April 2005 (see section 2.2.1); • Consolidation of the Integrated Learning Disability Team in Stirling and a proposal for an integrated Community Mental Health Service (see section 2.2.3); • Further extension to the integrated Community Mental Health Day Hospital Service in Clackmannanshire (see section 2.2.2); • Pooled budget for Mental Health Day Services in Clackmannanshire by April 2005 (see section 2.2.2); • Extension of Joint Community Rehabilitation Services building on developments in Stirling and Clackmannanshire; • Further opportunities for integration around services for older people building on the Framework for Joint Services 'Better Outcomes for Older People';
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• Further extension to the integrated Learning Disability Team in Falkirk by April 2005 (see section 2.2.1).
Arrangements exist currently to jointly manage Joint Future Services through hosting structures. These include high level overview groups, joint management teams and joint managers operating at a senior level and able to effect change in the development of integrated services.
CHPs will become the vehicle for taking forward Joint Future initiatives and each Partnership will consider how the current Joint Future structure can be integrated effectively into the CHP Joint Governance arrangements. These reviews will take place at an early date and within 6 months of the CHPs being established.
Overall, Partners are committed to working through CHPs to promote a closer interface with Primary Care, Secondary Care and Social Care Services and to foster closer working and integration at the frontline. Partners will build on joint organisational development plans including joint training to assist in creating a culture of joint working within the CHPs. (see accompanying document - Forth Valley CHP Development Plans).
The Scottish Executive is encouraging local partnerships to develop local improvement targets within four National Outcome areas:
• Supporting more people at home as an alternative to residential and nursing care; • Assisting people to live independent lives through reducing inappropriate admission to hospital, reducing time spent inappropriately in hospital and enabling supported and faster discharge from hospital; • Ensuring people receive improved quality of care through faster access to services and better quality services; • Better involvement and support of carers.
All the Joint Future Partnerships have produced their initial response to the national outcome targets and have developed indicative local improvement targets. Additionally, a Forth Valley wide Performance Measures Group has been working on behalf of the Joint Future Partners to produce an agreed Performance Measures Framework (see Appendix C). This is work in progress and will be taken forward by CHPs. (see accompanying document – Forth Valley CHP Development Plans). The four National Outcome areas have been used to develop the Framework. A series of performance measures have been identified for each outcome area with each measure broken down to provide robust background information, eg. data source, constraints, definitional points.
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2.5 Children and Young People Services All CHPs will build on the recommendations of ‘For Scotland’s Children: better integrated children’s services’ (2001) and the report of the child protection review ‘It’s Everyone’s Job to Make Sure I’m Alright’.
‘For Scotland's Children’ identified the integration of Children's Services as a key policy initiative that includes a broad range of stakeholders. The report outlined a number of specific action points for all local agencies:-
• Consider Children's Services as a single service system; • Establish a joint Children's Service Plan; • Ensure inclusive access to universal services; • Co-ordinate needs assessment; • Co-ordinate interventions; • Target services for those with additional needs.
Recent guidance from the Scottish Executive regarding the production of Integrated Children's Service Plans for the period 2005-2008, reinforces the need to improve Integrated Children's Services across all sectors. The development of these plans will be progressed locally through the following structures: -
• Clackmannanshire Children's Services Plan Management Group; • Falkirk Children's Commission; • Stirling Children's Community Planning Partnership; • Forth Valley Integrated Planning Group for Child Health; • Forth Valley Child Health Forum.
The Integrated Planning Group for Child Health is a multi-agency group with direct links to each of the Local Authority Children's Services planning structures. It has a remit to identify, implement and evaluate priorities for the development of Integrated Children's Services with Local Authority and Voluntary Sector partners.
Membership of the group consists of representatives from Clackmannanshire, Falkirk and Stirling Councils, Primary Care Operating Division, North and South LHCC, Barnardos, Aberlour Child Care Trust, Acute Operating Division and NHS Forth Valley Board.
The Child Health Forum is the main forum for all NHS services working with children to identify, develop and evaluate child health priorities. Membership of this group is made up of the Heads of Services of all the Child Health Services.
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Both of these groups will have a key role in the development of the Single Integrated Children's Service Plan for the period 2005-2008. However, as part of the review of existing area-wide, multi- agency strategic planning groups (see section 2.3), it is anticipated that revised arrangements, potentially in the form of a Children's Partnership Group, cross cutting each of the CHPs will be in place by 31st March 2005. This group will have a key role in monitoring the implementation of the plans and supporting the integration of Child Health Services with partner organisations. CHPs will be the vehicle to take forward the implementation of the Integrated Children's Service Plans at a local level, streamlining the child’s pathway of care.
2.5.1 Child Protection Following the review of a number of high profile child protection cases the Scottish Executive launched a ‘Child Protection Reform Programme’; this included the establishment of a National Delivery Action Team. The programme has focused on a number of issues and has undertaken developments in the following areas –
• Development of a children’s charter for children and young people; • Development of a Frame for Standards; • A review of the Child Protection Committees;
A crucial aspect of the reform programme is ensuring that all services and organisations work together to provide support and assistance for children and young people who maybe at risk. A Forth Valley Child Protection Action Group was established to ensure a consistent approach in determining child protection priorities within health and to undertake an implementation / monitoring role. The membership of this group will be reviewed in the light of CHPs.
The local structures for Child Protection Committees are currently under review with the anticipation that changes will be implemented by August 2005. CHP’s will have a crucial role in influencing this review to ensure that they are supported effectively at a local level.
2.5.2 Clackmannanshire The planning framework for children & young people’s services in Clackmannanshire has been developing to take account of the agenda laid out in ‘For Scotland’s Children: better integrated children’s services’ (2001), to provide excellent universal services for all children and to target additional services to meet need and reduce inequalities. In response to Scottish Executive guidance expected to be issued towards the end of 2004, the next three year plan for Clackmannanshire will be a plan for all children and will draw together existing separate plans for children’s social work, school education, child health and youth justice.
In order to develop integrated services in this context, four multi-agency theme groups have been established to take forward the 2005 – 2008 plan. These are: Children & Young People in the Community; Early Years & Childcare; Children & Young People who need Additional Support, and;
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Caring for Children and Young People (see figure 2). CHP representatives will sit on these theme groups as appropriate. The theme groups will have a key role in engaging with children, young people, their families and carers to involve them in planning children’s services. This will be done in a number of ways through existing service processes and through building on forums such as Dialogue Out and pupil councils in schools. Further development of ways to listen to the views of children and young people will also be addressed in the wider community engagement model currently under development (see section 5.3.3). figure 2 – children’s planning structure - Clackmannanshire
Community Health Partnership Representation
Children's Services Plan Management Group
Children & Young Children & Young Early Years & Caring for Children People in the People Who Need Childcare & Young People Community Additional Support
Community Health Partnership Representation
2.5.3 Stirling The Stirling Children’s Community Planning Partnership has responsibility for the development of integrated children’s services reflecting the priorities identified ‘For Scotland’s Children’ and ‘Its Everyone’s Job to Make Sure I’m Alright’. It is anticipated that the Children's Community Planning Partnership's Child Protection sub-group will be the local Child Protection Committee in Stirling subsequent to the review of the structure and remit of the Forth Valley Child Protection Consortium and its Child Protection Committees. This arrangement will provide clear links to the children's service planning process and to Community Planning generally.
The Children’s Community Planning Partnership currently has five sub-groups as shown in figure 3 covering:-
• youth justice; • integrated community schools; • children’s health in Stirling;
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• child protection; • Stirling children’s partnership.
It has links with the Integrated Planning Group for Child Health which is a Forth Valley wide group, the Child Health Forum and the Stirling Community Planning Health & Well Being Functional group (see figure 3 and sections 3.1.3 and 3.2.3). figure 3 Overview of Stirling Integrated Child Health Planning Groups
OVERVIEW OF INTEGRATED PLANNING GROUPS FOR CHILD HEALTH
National Child Health Agenda
Forth Valley Integrated Forth Valley Child Health Forum Forth Valley Planning Group for Child Wide Partnerships Health
Stirling Children’s Stirling Council Health and Community Planning Stirling Community Health Stirling Council Area Wellbeing Functional Group Partnership Partnership Partnerships
Children’s Partnership Children’s Community Child Health (Child Care) Partnerships Co-ordination Child Protection Youth Justice Group
Links with Universal, Communication e.g. Health Promoting Children’s Community links, e.g Substance Schools, Hungry for Looked After Children Affected By Mental Health Early Action Team Success, Eco Schools Children Disability and Wellbeing Assessment
The priority for the next three years is to develop and implement a single overarching plan for all services to children and young people in the Stirling Council area, reflecting the recent guidance provided by the Scottish Executive on preparing integrated Children’s Services plans for the period April 2005 to April 2008. The Children’s Community Planning Partnership will have responsibility for co-ordinating the process for :- • assessing local needs; • identification of priorities and objectives; • agreeing implementation strategies and resources for delivery on identified priorities/objectives; • engaging staff, service users and the public in these decisions; • ensuring arrangements for monitoring. In carrying out these activities the Children’s Community Planning Partnership will ensure it links with all relevant agencies delivering services to children and young people and that it works with the emergent Public Partnership Forum (see section 5.3.1) to ensure effective engagement of staff, service users and the public in the development of its plans.
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The Children’s Community Planning Partnership current membership comprises representatives from NHS Forth Valley, Central Scotland Police, Stirling Children’s Panel, the Reporter’s Office, Barnardo’s Scotland, as well as elected members and officers from Stirling Council Children’s Services, Community Services and Housing Services.
The CHP will consider whether the membership of the Children’s Community Planning Partnership should be widened to enable it to carry out its role as the forum for taking forward Integrated Children’s Services in the Stirling Area.
2.5.4 Falkirk Falkirk Children's Commission is the main vehicle for Children's Service Planning in the Falkirk area and is responsible for the development of the priorities laid out in ‘For Scotland's Children’ and ‘It's Everyone's Job to Make Sure I'm Alright’. It is a sub group of the Health Theme Group.
The Falkirk Children's Commission currently has six sub-groups as shown in figure 4. These cover:-
• Youth Justice; • Child Protection; • Integrated Learning Communities; • Early Years; • Domestic Abuse Forum; • Youth Strategy.
It also has links with the Integrated Planning Group for Child Health, which is a Forth Valley wide group (see section 2.5), Falkirk Joint Health Improvement Group and Falkirk Local Substance Forum. (see sections 3.1.2 and 3.2.2).
Following recent guidance provided by the Scottish Executive on the preparation of Integrated Children's Service plans for the period 2005-2008, the Commission's key priority for the next three years will be the development, implementation and monitoring of the single plan. This will be a plan for all children bringing together Social Work, Education, Health and Voluntary Sector partners.
The sub-group on Youth Strategy is response for undertaking consultation with young people through Dialogue Youth and Pupil Councils. A wider consultation exercise will be undertaken over the next six months in relation to the planning process.
Current membership of Falkirk Children's Commission comprises representatives from:-
• NHS Forth Valley; • Central Scotland Police;
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• Falkirk Children's Panel; • SCRA (Reporter’s Office); • CVS; • Council Services:- • Housing & Social Work; • Education; • Community; • Corporate & Commercial.
figure 4 – Falkirk Children’s Commission
FALKIRK COUNCIL/NHS FORTH VALLEY Community Health Partnership CHP
Community Planning Board
Corporate Community Management Health Theme Group Safety Theme Agency Management Team Group Pan Forth Valley Planning, including Integrated Planning Group for Child Health
Falkirk Joint Health Children's Commission Improvement Group Falkirk Local Executive Substance Forum
Integrated Domestic Falkirk Youth Child Protection Child Health Early Years Learning Youth Strategy Abuse Forum Justice Group Committee Forum Communities
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3. Improving Health A key aim of NHS Forth Valley and its partners is to improve the key life circumstances on which health is based, improve lifestyle and reduce health inequalities. The recent Director of Public Health (DPH) Annual Report to the NHS Board demonstrated that health inequality in Forth Valley has narrowed over the past 14 years but also that major inequalities still exist between the most affluent and the most deprived in our population. NHS Forth Valley has monitored the lifestyle of both adult and child population in regular surveys since 1989. This information is used by the NHS, Councils and others to inform and work with communities and help set health targets.
Health Improvement is everybody’s business illustrated by the following: - • The work of health, local authorities, community & voluntary groups and others in the community; • The NHS Forth Valley health promotion programme; • The Health Improvement Fund (HIF) programme of work; • Health Promotion delivered within the GMS contract.
Within each CHP the role of Local Authorities is hugely important in health improvement and continues to develop year on year. Local Authorities have a statutory role to play in health improvement and are working to achieve fundamental changes in health through Social Inclusion Partnerships, New Community Schools, Healthy Living Centres, housing and economic development and many other programmes. The joint appointment of health improvement officers in the three Local Authorities is further recognition of their statutory duty to improve health. These professionals have a key role in health improvement and have developed close links with their NHS partners. A wide range of primary care health professionals now have national recognition of their public health role. The development of CHPs brings increasing opportunities for primary care professionals to contribute to public health leadership across the new organisation. In addition the councils have recently been designated the ‘power of well - being.’
The NHS Forth Valley Health Promotion department’s health improvement programme is set out in the annual operational plan. In common with most NHS programmes in Scotland this programme has traditionally followed the ‘setting’ and ‘topic’ approach. The settings have been Community, Workplace, Education and NHS and the topics have included sexual health, substance use, physical activity and mental health. There is an opportunity to change the working practice with creation of CHPs. The operational plan is updated annually following consultation with partners. Each element of the programme has aims, objectives and evaluation. There is recognition that with the creation of CHPs the operational requirements of the department will need to be reviewed with a view to maximising the integration and effectiveness of the service.
The Forth Valley Public Health network is a multidisciplinary group, which draws on community development approaches to work within communities and can be very effective in delivering within the CHP.
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National drivers such as ‘Health Challenge’ and ‘Towards a Healthier Scotland’ in general guide the health improvement.
3.1 Community Planning Community Planning is about public organisations working in partnership with each other and with communities to create living environments that respond to the social, environmental, economical and health needs of local people. The Local Government Scotland Act 2003 placed on public authorities a statutory duty of Community Planning. The duty places a responsibility upon Councils to initiate, maintain and facilitate the provision and planning of public services within the Local Authority areas through the Community Planning process. Community Planning is seen as the overarching partnership framework helping to co-ordinate initiatives and partnerships and where necessary acting to rationalise and simplify planning and service structures.
The primary aims of Community Planning are :-
• to ensure that people and communities are genuinely engaged in decisions about public services which affect them; • to focus on closing the opportunity gap; • a commitment from organisations to work together in providing better public services.
3.1.1 Clackmannanshire The community planning framework in Clackmannanshire is long-established. Health improvement is a key theme in the local Community Plan and is taken forward by the Clackmannanshire Health Alliance.
The Health Alliance, (which sits within the overall community planning framework) is the mechanism through which the respective partners:-
• develop capacity of services across agencies to work together on health improvement; • ensure and enable joint working arrangements are set up to achieve shared objectives and targets; • monitor and evaluate joint working on health improvement; • develop consultation across services and communities to promote health improvement.
The Health Alliance feeds directly into the Clackmannanshire Alliance, which is the overarching strategic forum for community planning locally. It is anticipated that the CHP, once established, will form an integral part of this structure and be a natural evolution of the framework to enable a broader range of service providers and service users to be involved and to feed into planning processes (see figure 5).
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It is expected that some of the component parts of the Health Alliance, such as the Joint Future Group, will remain as integral elements of the overall structure. Specifically Joint Future processes could be incorporated within the CHP Committee, while there will be an opportunity to streamline other components (see section 4.3.2). figure 5 – community planning structure – Clackmannanshire
Clackmannanshire Current Structure Clackmannanshire Anticipated Structure
CLACKMANNANSHIRE Executive ALLIANCE Group CLACKMANNANSHIRE (membership includes NHS FV, ALLIANCE Executive Council and other partners) (membership includes NHS Group FV, Council and other partners)
HEALTH ECONOMIC COMMUNITY ENVIRONMENT ALLIANCE DEVELOPMENT SAFETY THEME TEAM (membership is THEME TEAM THEME TEAM NHS FV and Council) HEALTH ECONOMIC COMMUNITY ENVIRONMENT ALLIANCE DEVELOPMENT SAFETY THEME TEAM (JOINT FORUM) THEME TEAM THEME TEAM
Operational Group (Managers)
Joint Future Committee
Executive CHP Other Sub Group Committee Groups as Joint Future appropriate Managers’ (to be Group determined)
3.1.2 Falkirk The Falkirk Community Planning Partnership involves representatives from all partner agencies across the voluntary, community, public and private sectors. The Community Planning structure (see figure 6) has five theme groups. The Health Theme Group, chaired by a representative from NHS Forth Valley, has responsibility for the following areas: -
• Community Care; • Joint Future; • Children’s Services; • Substance Misuse; • Health Improvement; • Health Inequalities; • Older People; • Children & Young People; • Accessibility and Provision of Health Care Services; • Physical Health; • Primary & Acute Services.
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figure 6 – Community Planning Structure - Falkirk
(A) THE FALKIRK PARTNERSHIP Scrutiny and Strategic Direction
(B) PARTNERSHIP BOARD Organisational Leadership
(D) (C) JOINT ORGANISATIONAL PARTNERSHIP EXECUTIVE DEVELOPMENT GROUP Champion the process and ensure that it delivers
(E) (E) (E) (E) (E) ECONOMIC HEALTH COMMUNITY ENVIRONMENT & COMMUNITY DEVELOPMENT & Including Children, Joint REGENERATION TRANSPORT SAFETY TOURISM Futures etc
Health Improvement Subgroup
This Falkirk-wide model is underpinned by local community planning based on the six local area forums. A Falkirk Local Community Planning Team has recently been appointed, and will roll out Local Community Planning throughout Falkirk. It is anticipated that these local activities will link to the Public Participation Forum (see Section 5.3.2).
Joint work between the Community Planning Partnership’s Regeneration Theme Group and the Health Improvement sub group for the Regeneration Outcome Agreement has provided a foundation for focusing on reducing health inequalities in Falkirk.
CHPs will develop and mature within the context of Community Planning, and managing that relationship will be key to the integration of service planning and delivery. It is anticipated that joint structures will be reviewed in line with the proposed accountability arrangements outlined in section 4.3.1.
3.1.3 Stirling The Stirling Community Planning Partnership (CPP) is an unincorporated body which co-ordinates the Community Planning process in the Stirling area and has over 50 member organisations, covering community, voluntary, public and private sectors. This demonstrates the depth of commitment to Community Planning across the Stirling area. All structures operate by working in tandem with Local Community Planning Organisations and to ensure priority is given to geographical communities of particular need via the Stirling Regeneration Strategy and the forthcoming Regeneration Outcome Agreement. (see figure 7)
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figure 7 – Existing Community Planning Partnership Structure in 2004 - Stirling
Community Community Councils Plan Regeneration
Urban Stirling Community Planning Regeneration Local Partnership & SCPP Team Company Community Planning Organisations Community Steering Group Engagement Task Group
Lifelong Development & Children's Community Health & Learning Community Safety Planning Partnership Well-being
Sub & Working Joint Health Groups Improvement Plan
In Stirling the Children's Community Planning Partnership has lead community planning responsibility for the children’s health improvement agenda (see section 2.5.2). The Health and Well-being Functional Group is the lead community planning forum for adult and older peoples health improvement. The groups have established links to ensure that work is complementary. The Stirling CHP will be represented on both strategic groups and each relevant sub and working group.
Figure 8 overleaf provides a conceptual model of how the CHP & CPP will link. The Stirling CHP development plan outlines key actions required over the next year to put appropriate governance management and reporting structures in place.
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figure 8 – conceptual model of how the CHP and Community Planning Partnership will Link - Stirling
Community Planning
NHS Forth Valley Stirling Council Board Planning Community
Children’s Health & Community Well-Being Planning Group Community Partnership Community Community Planning Health Planning Partnership Public Partnership Joint Futures Partnership Forum
Community Planning
The following sections outline in more detail how the Community Planning Partnership will take the common agendas forward in partnership with the CHP.
• Section 2.5.2 - Children and young people services; • Section 3.2.3 – Joint Health Improvement Plans / Local Health Plans; • Section 5.3.1 - Community engagement/PPF.
3.2 Joint Health Improvement Plans / Local Health Plans Joint Health Improvement Plans set out objectives, strategies and actions for each organisation within the community planning partnership to improve health and reduce inequalities within the local population. The Health Improvement process is different within each local authority area and reflects local circumstances. This is detailed in the following sections.
In broad terms the role of each CHP will be to act as a bridge between the wider community planning discussions and increased involvement of local communities. CHPs will be responsible for translating strategic plans into action at the frontline. As partnerships develop, the intention is that JHIPS will become more focussed, taking account of the wider determinants of health.
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3.2.1 Clackmannanshire One of the main roles of the current Health Alliance (see section 3.1.1) is to develop the JHIP and to monitor its implementation. In addition, the Health Alliance feeds into the development of the Local Health Plan at Forth Valley level. It is expected that the CHP will take on this role within the revised community planning framework.
3.2.2 Falkirk The Joint Health Improvement Plan, currently a project of the Falkirk’s Community Planning Partnership’s Health Theme Group (see section 3.1.2), will become a primary CHP commitment in partnership with the Falkirk Community Planning partners. Specific, evidence-based assessment of community needs, local priorities for addressing health inequalities, the Falkirk Strategic Community Plan, and national and Falkirk health improvement priorities will continue to form the foundation for the Falkirk JHIP, ‘Feel Good Falkirk’.
Falkirk’s local community planning partnership provides the overarching framework for planning and provision of public services; included in this work is the development of consultation and engagement mechanisms with other partners, with communities of interest, and with individual community members (see section 5.3.2). The Health Theme Group and Health Improvement sub group will continue to coordinate development of the JHIP. The working structures and the role of the Health Improvement sub group will be reviewed prior to April 2005 within the context of the Falkirk CHP and Community Planning. Falkirk’s health improvement officers and NHS Forth Valley’s public health practitioners have established a team approach that will form the basis for integrating broader voluntary sector and community participation into health improvement planning.
In addition, through the new CHP, the Health Improvement sub group will have enhanced access to and input from wider community partners working with the CHP as well as the Public Partnership Forum (see section 5.3.2). Planning and implementing redesign and redistribution of services to address inequalities and target health improvement generally will be supported by the richer input across community and service sectors. This broader participation will also enable meaningful evaluation of effectiveness to increase access to services for excluded or disadvantaged groups and to improve service delivery. Health and social services will continue to be joined up through joint planning and implementation to maximise the CHPs impact on health inequalities. Coordination of cross-cutting health issues across community planning and CHP structures will be especially important and will be monitored through the joint performance management process (see section 4.7).
3.2.3 Stirling The Stirling Community Planning Partnership Health and Well-being Functional Group is responsible for the development of the Joint Health Improvement Plan for the Stirling area. The Stirling JHIP - Working Together of a Healthier Stirling, sets out agreed health improvement interventions that focus on life stage, setting, priority populations and topics.
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The Stirling CHP will have a key role in shaping JHIPs and it has been agreed that the Health and Well-being Functional Group continue to be the vehicle to take forward this agenda in the Stirling area. The Children’s Community Planning Partnership will continue to be the vehicle for taking the planning of integrated services for children (see section 2.5.2). The groups have established links to ensure that work is complementary. The Health & Well-Being group will provide the planning foundation for the following priorities.
• Health Improvement • In terms of adults and older people the Health and Well-being Functional Group and its associated sub-groups will provide the planning foundation for the following. (see table 2) table 2 – Health and Wellbeing Functional Groups - Stirling Life Stage Setting Population Special Focus Programmes
• Healthy Ageing • Workplace (SHAW) • Gender • Physical Activity • Environmental Health • Carers • Food • Urban • Substances and Alcohol • Rural • Tobacco • Primary Health Care • Mental Health • Prisons • Access to Services • Sexual Health
• Reducing Health Inequalities The Stirling Regeneration Strategy and the forthcoming Regeneration Outcome Agreement will outline the required focus on inequalities in health and the interventions required to reduce the health gap between communities. The JHIP will inform this process.
• The JHIP • The Health & Well-Being group will develop and monitor the implementation of action plans to ensure the delivery of the current JHIP’s objectives; • The JHIP will be reviewed periodically to ensure it continues to be relevant to the changing needs of the population.
The Health and Well-being Functional Group will reorganise to ensure that it is structured to effectively deliver on the above priorities and meet its obligations in relation to Primary Health Care and Health Improvement responsibility within the CHP framework. Key to the successful development will be the on-going link between each of the community planning functional groups, (see section 3.1.3), children and young peoples services (see section 2.5.2) and the implementation of joint futures (see section 2.4).
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The Stirling Development plan outlines the key development priorities in this area (see accompanying document - Forth Valley CHP Development Plans).
3.3 The role of Public Health in supporting CHPs Improvements in the health of the population can only be achieved through the combined actions of everyone working to improve health in its broadest sense. This section refers to the specific actions of those services and individuals specifically identified as "Public Health" (including Health Promotion) whose primary function is the delivery of activity which can be included within the following 10 key areas:-
1. Surveillance and assessment of the population's health and well-being - including managing, analysing and interpreting of information, knowledge and statistics; 2. Promoting and protecting the population's health and well-being; 3. Developing quality and risk management within an evaluative culture; 4. Collaborative working for health; 5. Developing health programmes and services and addressing inequalities; 6. Policy and strategy development and implementation; 7. Working with and for communities; 8. Strategic leadership for health; 9. Research and development; 10. Ethically managing self, people and resources - including education and continuing professional development.
Broadly therefore the role of public health consists of, health protection, health improvement and the development and improvement of services - and the facilitation and support of organisations, agencies and individuals in these activities.
Public health tends to take a preventative focus, and aims to consider a wide range of influences on health, not just NHS services. A further aim is to reduce health inequalities, as described in Annual Reports of the Director of Public Health for Forth Valley.
Public health approaches include, needs assessment (considering the gap between the current situation and the ideal), health impact assessment (estimating the effects of plans before they are implemented) and evaluation (measuring the effects of plans after they have been implemented).
The public health directorate of Forth Valley NHS Board will provide expert advice on public health activity and provide some direct health protection functions, such as communicable disease control and emergency planning. It also provides strategic leadership in public health.
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For each CHP, a Consultant in Public Health Medicine will be identified as the key link to the public health directorate. There is recognition that with the creation of CHPs the Directorate of Public Health will need to review operational requirements in order to maximise integration and effectiveness.
The Forth Valley Public Health Network consists of public sector staff in Forth Valley, and others, who carry out any activity, which can be considered as public health. The network will provide support through communication between members, and with the public health directorate.
Further aspects of the role of public health include the identification of current and potential future activity in public health in Forth Valley, and measuring and increasing public health capacity. This includes the development of the relevant human resources, in terms of training and raising awareness.
3.4 The role of CHPs in health improvement and reducing health inequalities NHS Forth Valley recognises that health improvement is everybody’s business. CHPs will need to adopt a broad definition of health recognising that life circumstances such as housing, employment and income can play a key role in influencing health and well-being. In order to meet the requirements of ‘Improving Health in Scotland – The Challenge’ and ‘Towards a Healthier Scotland’ a total population health approach will be needed with tackling inequalities a priority recognising the need to focus both on national and local priorities.
CHPs offer an opportunity for partnership approaches to health improvement within communities, education, planning, housing and economic development. Within health the introduction of public health nursing teams, who bring together the function of nurses working in schools and health visitors, now link closely with public health practitioners, the health promotion department, local authorities, community and voluntary groups to focus on local health improvement work. Consequently there is a sharing of the health improvement agenda. Primary care practitioners already provide a wide range of public health activities and this will continue and develop further following the establishment of CHPs who will have a key role in monitoring and performance management against national and local targets in these areas.
There are many people both within and outside the NHS family for whom health promotion is part of their daily work. CHPs will need to support this work and facilitate capacity building and partnership working to effect real change.
Examples include:- • support work within the workplace setting to provide specialist training and advice on workplace health issues and policy development; • Support for schools in achieving health promoting schools status by 2007;
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• Support for physical activity and nutrition programmes such as Paths to Health and Forth Valley Food Links.
3.4.1 Joint Planning CHPs will ensure robust links with community planning processes in their area through joint health improvement plans. (see section 3.1).
Forth Valley wide joint planning groups are in place for all Community Care Groups including adult mental health, older people, adult leaning disability, children, adult palliative care and adult physical disability (see section 2.3). Local implementation groups are also in place in each CHP area. These will continue to support the developing work of CHPs. These local planning groups are also integrated within Joint Future Management Teams, which are in place in each CHP area.
Significant progress has been made in ensuring the involvement of users and carers in local planning groups specifically in the areas of mental health and people with a learning disability. CHPs will ensure these links are maintained and strengthened.
Joint Commissioning of services is a developing area in Forth Valley but there are a number of initiatives, which will be progressed and supported through the CHP structure, for example:-
• A joint draft commissioning model has been produced; • The future redesign of Bonnybridge Hospital is being progressed on a joint commissioning model; • The scope for joint commissioning of services to support the management of delayed discharges in Forth Valley; • A joint Complex Care Panel is in place which joint funds and commissions services for people with very complex health and social care needs.
3.4.2 Staffing CHPs will recognise and support the roles of practitioners involved in building the capacity of the public health workforce, eg. Public Health Practitioners, Local Authority Health Improvement Officers and Health Promotion Officers. The role of these staff will include joint health improvement planning and complementary development of operational plans for the health promotion department.
3.4.3 Training CHPs will provide adequate training for all staff related to public health and health improvement through mechanisms such as CREATE (see section 2.3.1.3) and development of a core training programme within the health promotion department.
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3.4.4 Integrating public health and health improvement • CHPs will ensure robust links with their identified link Consultant in Public Health Medicine. Consultants in Public Health will be closely involved in CHPs and key areas of work will be jointly agreed between the Director of Public Health and CHP General Managers in line with Joint Health Improvement Plans; • The health promotion department will be hosted in a CHP. A senior officer from the department will act as a link for each CHP and ensure development of the department’s operational plans to support local joint health improvement planning. The operational delivery of the service will need to be reviewed to maximise integration and effectiveness; • The Director of Public Health will be the Strategic Lead for Health Improvement across NHS Forth Valley and will agree the strategic direction of CHP Health Improvement activity in discussion with the CHP. The Director of Public Health will continue to professionally supervise the CPHMs and also be the professional lead for the Health Promotion Manager.
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4. Organisational Arrangements 4.1 Geographical Boundaries Three CHPs will be established in Forth Valley from 1 April 2005 coterminous with the three Local Authorities. The Falkirk CHP will retain the same geographical boundaries as the Falkirk LHCC and serve a population of 145,000, The Stirling CHP will provide services to a population of 86,000, whilst the Clackmannanshire CHP will provide services to a population of 48,000. Figure 9 outlines the geographical boundaries for each CHP.
Figure 9 – Map of Forth Valley Area
4.2 CHPs & the Forth Valley NHS Board NHS Forth Valley currently has two Operating Division Committees. The Primary Care Operating Division Committee will continue to exist from April 2005 for an interim period of six months to ensure the smooth transition between LHCCs/SSC to CHPs and to oversee the review of the Primary Care Organisation and its sub committees and options for future configuration. Throughout this period CHPs will technically be sub Committees of the Forth Valley NHS Board and will report to the Primary Care Operating Division Committee. During this interim period, the NHS Board will clarify its proposals for the future accountability arrangements for CHPs on the assumption that the Primary
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Care Operating Division Committee will cease to exist and that CHP Committees will become Committees of the NHS Board alongside the Acute Operating Division Committee.
4.3 Governance and Accountability Arrangements Initially accountability for CHPs will be to the NHS Forth Valley Board. However, sections 4.3.1, 4.3.2 & 4.3.3 describe the aspirations for each CHP in terms of joint governance arrangements. The models described in these sections will be reviewed to ensure they are consistent with the Corporate Governance structures of both NHS Forth Valley and Local Authorities. It is anticipated that the Governance Arrangements for each CHP will be slightly different dependent on the size and complexity of the CHP and the Local Authority that it will partner.
CHPs will assume responsibility for the overall NHS resources committed to Joint Future including Resource Transfer and Delayed Discharge monies. (see section 7 and Appendix E). In the short term CHPs will support the Joint Future structures that currently exist in each area, including the Joint Future Management Teams, and will report to the Joint Committee progress on Joint Future initiatives. It is anticipated that within an early timeframe there will be a review of the Joint Future structure and a realignment with the Joint Governance arrangements proposed for each CHP to progress towards further alignment of services, seeking opportunities to integrate, achieve financial advantages and operational synergy (see sections 4.3.1, 4.3.2, & 4.3.3).
NHS Forth Valley considers that Local Authorities will become equal partners, integral to the governance of the CHPs. Each CHP will be accountable through the CHP Committee for delivering Value for Money in the use of Joint Future funds and the achievement of specified goals as set out in the extended partnership Agreement.
The Scheme of Delegation will reflect an outline scope of devolved functions and responsibilities, whilst at this stage, not defining delegated financial limits. NHS Forth Valley revised its Scheme of Delegation and financial limits from 1 April 2004, this, together with the Standing Financial Instructions (SFIs) and Standing Orders (SO) will to be reviewed by 31 March 2005 to reflect the role of CHPs. This will be progressed with the review of the wider Primary Care organisation and the Primary Care Operating Division (PCOD). The vision regarding governance and management is to balance maximum delegation and flexibility with governance and probity.
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4.3.1 Falkirk The preferred accountability model to evolve from 1 April 2005 for the Falkirk CHP is shown in figure 10 and will be subject to ongoing review. The model includes a multi-agency Joint Committee. The Joint Committee would be a facilitative forum through which joint health (acute and primary care) /local authority business is discussed and guidance and recommendations given on policy / strategic issues. Agreed statements from this group would then be passed back to the Local Authority and Health Board who, on approval, would delegate actions via the CHP Committee to the CHP Management Group. There would be no direct line of accountability between the Joint Committee and the CHP Committee.
The Joint Committee currently exists and its membership and operation will be reviewed, however, It is anticipated that membership would include executives, senior local authority officers, NHS executives and non-executives (including AOD representatives), Chair, Clinical Lead and General Manager from the CHP Committee. Frequency of meetings has still to be agreed but it is anticipated that this will be two/three times a year.
The longer term aspiration for the Falkirk CHP would be to provide some delegated decision making powers for health related issues to the Joint Committee from both the Local Authority and NHS Board. As such there is a desire to move to a properly constituted joint committee in the medium term. The CHP Committee would then be accountable to the Joint Committee as the representative body of the Health Board and Local Authority in respect of those delegated functions and retain accountability to both the NHS Board and Local Authority for other non delegated decisions. However, further investigation needs to be carried out in order to ensure that any joint committee is, and can be, properly constituted in terms of local authority and health legislation.
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figure 10 – Accountability Model - Falkirk
Facilitative, non decision making role
Health Board Joint Committee Local Authority
accountability CHP Committee reporting
Strategic Arena Role & Function to include CHP Management Performance Team Management
Operational Delivery with support team
4.3.2 Clackmannanshire The preferred accountability model to evolve from 1 April 2005 for the Clackmannanshire CHP is shown in figure 11 and will be subject to ongoing review. The model includes a multi-agency Joint Forum which will be an evolution of the existing Health Alliance which sits within the community planning process. This provides an opportunity to integrate the two agendas and provide a more coordinated approach. (see section 3.1.1). The Health Alliance/Joint Forum would be a facilitative forum through which joint health (acute and primary care) /local authority business is discussed and guidance and recommendations given on policy / strategic issues. Agreed statements from this group would then be passed back to the Local Authority and Health Board who, on approval, would delegate actions via the CHP Committee to the CHP Management Group. There would be no direct line of accountability between the Health Alliance/Joint Forum and the CHP Committee.
Membership and operation of the Health Alliance/Joint Forum will be reviewed, however, It is anticipated that membership would include executives, including elected members, senior local authority officers, NHS executives and non-executives (including AOD representatives), Chair, Clinical Lead and General Manager from the CHP Committee. Frequency of meetings has still to be agreed but it is anticipated that this will be two/three times a year. Over time, it is feasible that the Health Alliance/Joint Forum could merge with the CHP Committee and incorporate Joint Future processes (see figure 5).
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The longer term aspiration for the Clackmannanshire CHP would be to provide some delegated decision making powers for health related issues to the Health Alliance/Joint Forum from both the Local Authority and NHS Board. The CHP Committee would then be accountable to the Health Alliance/Joint Forum as the representative body of the Health Board and Local Authority in respect of those delegated functions and retain accountability to both the NHS Board and Local Authority for other non delegated decisions. Legal advice suggests that to provide decision making powers to the Health Alliance/Joint Forum would currently require a change to primary legislation hence this option remains aspirational at this stage. figure 11- accountability model Clackmannanshire
Facilitative, non decision making role
Health Alliance / Health Board Local Authority Joint Forum
accountability CHP Committee reporting
Strategic Arena Role & Function to include CHP Management Performance Team Management
Operational Delivery with support team
4.3.3 Stirling The preferred accountability model to evolve from 1 April 2005 for the Stirling CHP is shown in figure 12 and will be subject to ongoing review. The model includes a multi-agency Joint Forum. The Joint Forum would be a facilitative forum through which joint health (acute and primary care) /local authority business is discussed and guidance and recommendations given on policy / strategic issues. Agreed statements from this group would then be passed back to the Local Authority and Health Board who, on approval, would delegate actions via the CHP Committee to the CHP Management Group. There would be no direct line of accountability between the Joint Forum and the CHP Committee.
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Membership and operation of the Joint Forum will be reviewed, however, It is anticipated that membership would include executives, including elected members, senior local authority officers, NHS executives and non-executives (including AOD representatives), Chair, Clinical Lead and General Manager from the CHP Committee. Frequency of meetings has still to be agreed but it is anticipated that this will be two/three times a year.
The longer term aspiration for the Stirling CHP would be to provide some delegated decision making powers for health related issues to the Joint Forum from both the Local Authority and NHS Board. As such there is a desire to move to a properly constituted joint committee in the medium term. The CHP Committee would then be accountable to the Joint Forum as the representative body of the Health Board and Local Authority in respect of those delegated functions and retain accountability to both the NHS Board and Local Authority for other non delegated decisions. However, further investigation needs to be carried out in order to ensure that any joint committee is properly constituted in terms of the legislation. figure 12 – accountability model, Stirling
Facilitative, non decision making role
Health Board Joint Forum Local Authority
accountability CHP Committee reporting
Strategic Arena Role & Function to include CHP Management Performance Team Management
Operational Delivery with support team
4.4 CHP Committees NHS Forth Valley will adhere to ‘The Community Health Partnerships (Scotland) Regulations 2004’ which came into force on 1 October 2004 and as such it is not intended to reiterate the detail within the Regulations in The Scheme.
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4.4.1 Membership It is anticipated that the minimum membership of each CHP Committee from 1 April 2005 will be as outlined in the Statutory Guidance and the CHP (Scotland) Regulations 2004. The Chair of each CHP will be a non-executive director of the NHS Forth Valley Board. Support will be provided to individuals to enable them to fulfil their role and fully participate in the work of the CHP (see accompanying document - Forth Valley CHP Development Plans). During the initial six month period the specific requirements of each CHP Committee in relation to role, remit and function will be reviewed and this may lead to changes in CHP Committee membership to better reflect the duties of the Committees. Table 3 describes the Committee arrangements as they may evolve over the first three years. (This period will be shortened if possible and may vary from CHP to CHP) table 3 – CHP Committee Arrangements 1 April 2005 Year 3 Who sets CHP Objectives? ¾ NHS Forth Valley (80%) ¾ Shift in balance between ¾ Joint Commissioning for the two as breadth and integrated services / range of services within Integrated planning groups CHPs expands (20%) Who will CHPs be accountable ¾ Formally the NHS FV Board ¾ Joint Accountability to? and the PCOD (initial 6 /Governance Board months) ¾ Whole system scrutiny ¾ Local Authority CHP Committee Members - Formally to the relevant Local Authority Committees and informally to community planning boards and integrated services groups. Who Manages within CHPs? ¾ General Manager reporting ¾ General Manager to be a through PCOD CEO to NHS joint post between health Forth Valley Board CEO and Local Authority ¾ Links to Joint Future ¾ Joint devolved/pooled Groups for integrated budgets services ¾ Increased joint management posts within all levels of CHP Delivery Status Quo ¾ Whole service vertical integration of care groups with horizontal professional leadership ¾ Local CHP interpretation of national priorities where practicable.
4.4.2 Role & Remit of the CHP Committee The role of the CHP Committee will be to promote organisational change and drive forward the service improvement agenda, ensuring effective delivery of devolved functions. The Committee will operate across health and local authority sectors and will have a key role in making local policy decisions and influencing national priorities and opportunities for further integration of healthcare & partnership services through membership of the Chair/General Manager on the NHS Forth Valley and
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Service Redesign Boards. The Committee will inform and influence a range of plans (local health plan, Community plan, JHIP etc) and will empower frontline staff to improve outcomes and the delivery of quality services within a clear accountability framework. The Committee will, jointly with its management team, prioritise resources for the population it services based on need and develop joint service plans with partners. The Committee will also ensure compliance of the CHP against corporate, clinical and staff governance standards and will monitor the performance of the CHP, reporting to the NHS Board. The decision making authority along with financial management of delegated budgets will be as defined in the Scheme of Delegation and in accordance with Standing Financial Instructions.
CHP Committees will also look at the scope for developing care governance arrangements for those services that are jointly managed.
4.4.3 Frequency of Meetings It is anticipated that CHP Committees will initially meet bi-monthly, moving to quarterly meetings. (this will be subject to review). It is further anticipated that these meetings may be conducted in open session to encourage public participation and interest in matters concerning the wider health agenda in their area.
4.4.4 Role of Management Team To support the CHP Committee a Management Team will be appointed and led by a General Manager. A process will be agreed for the appointment to senior positions within the CHP Management Team that will be consistent with organisational change policy. The Management Team will be responsible for driving the CHP agenda forward including the day to day management and decision making of the CHP as empowered by the CHP Committee and NHS Forth Valley Board. The Management Team will be responsible for the development of local service delivery plans ensuring community engagement in the process. They will have responsibility for some delegated functions currently within the community planning agenda and will work towards achieving greater integration of services and making tangible progress in line with action plans to improve health and tackle inequalities in health. The Management Team will be expected to deliver the Forth Valley corporate objectives for CHPs and the Organisational Development Plan (see accompanying document - Forth Valley CHP Development Plans) and be responsible for the financial management of the CHP. It is anticipated that formal meetings of the Management Teams will take place fortnightly in the first instance and this will be subject to review.
4.5 Leadership arrangements Each CHP will have a Chairperson and a General Manager appointed by Forth Valley NHS Board. Recognising the need for clinical engagement and to promote clinical involvement and ownership of the CHP agenda, CHPs will each have an appointed Clinical Lead. The Clinical Lead will take
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forward policy & strategic issues working with lead clinicians/heads of service/care groups who will continue to be responsible for operational management and professional leadership of their service within the context of the matrix management approach that is being reviewed (see section 2.3). The five area wide care groups are :- • mental health; • older people; • child and adolescent mental health; • community alcohol and drug service; • learning disability.
The individual Heads of Service who will be managed by a CHP under a hosting arrangement will continue to provide professional leadership to their staff on an area wide basis. Whilst being responsive to local need, Heads of Service will need to balance this against the need to maintain equity of service across the Forth Valley population.
Professional Leadership for Pharmacy will be provided by a Corporate Lead within a clearly defined protocol. It is envisaged that this will be taken forward through an area wide review of pharmacy services.
Professional arrangements for staff working within joint services will be in line with the joint Staffing Framework and consistent with the Learning Disability Integrated Services template.
4.5.1 Clinical Lead The Clinical Lead within each CHP (who may be from any health care profession) will be jointly accountable to the CHP chairperson and General Manager. The clinical lead will have a professional line of accountability to the Primary Care Operating Division / Board Medical Director. The role will include :- • Identifying local health needs and priorities and developing integrated strategies to address them; • Further supporting and developing clinical and care networks; • Ensuring continued adherence to clinical governance standards to improve quality and ensure patient safety; • Facilitation & dissemination of information through established communications networks and forums; • Promote multi-disciplinary education and training; • Embrace opportunities to develop new models of care created as a result of implementation of new contracts.
4.5.2 Leadership Structure To maximise clinical engagement and allow delivery of clinical effectiveness and joint working strategies at a local level there will be a requirement to redesign existing clinical roles and develop
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capacity within the new organisation. In recognising that one of the benefits of the LHCCs/SSC has been a less hierarchical structure and therefore greater influence in decision making and service development; new arrangements will attempt to protect this principle to maintain and enhance clinical engagement. The existing roles and remit of LHCC Clinical Lead/Chair, SSC Clinical Reference Group Chair, Locality Co-ordinators, Primary Care Nursing Locality Co-ordinators, Associate Medical Directors, Clinical Effectiveness Co-ordinators, and Heads of Service are acknowledged and their roles and responsibilities will be reflected in the new arrangements put in place for CHPs. It is important to agree priorities to allow optimal use of clinical capacity to maintain and build on communication networks and enhance joint working and holistic care. Links between clinical and care teams need to be maintained, strengthened and expanded upon. MCNs, (see section 2.1.5) provide examples of how these links can be forged. It is anticipated that CHPs, as with LHCCs, will provide appropriate clinical representation to inform the MCN planning process (see section 2.3).
4.5.3 Locality Arrangements The Forth Valley LHCC/SSC Review completed in February 2004 found that existing locality structures within Forth Valley had worked well in bringing multi agency groups together to discuss issues pertinent to local communities through effective networking.
It is intended that these locality arrangements and the role of locality co-ordinator (see section 4.5.2) will be reviewed to take account of the broader partnership working remit of CHPs to include additional input and liaison with users, local authority and voluntary sector. As a result it is anticipated that locality structures will become better integrated into planning and delivery processes. The role of Locality Co-ordinator will be reviewed and could be different within the three CHPs. It is expected that localities will underpin and encourage multi-disciplinary / agency partnership approach the planning and delivery of services within their locality.
The role and remit of Primary Care Nursing Locality Co-ordinators will also be reviewed taking into account the need to drive forward the challenging change agenda for nurses (see section 5.4.2.1). Nurse leaders will ensure that standards are maintained and that patient care is safe and effective.
The Organisational Plan (see accompanying document - Forth Valley CHP Development Plans) references the need to develop a structured approach to professional nurse leadership in Forth Valley to take account of the educational requirements and role developments needed to meet future healthcare needs i.e. Hall 4, Nursing for Health, A Framework for Nursing in Schools.
4.5.4 LHCC Professional Committee ‘Partnership for Care’ required all Boards to review their LHCC Professional Committee in light of the development of CHPs. In Forth Valley, the LHCC Professional Committee was formed as a statutory body following direction proposed in ‘Designed to Care’. The remit includes reporting of priority issues to the Area Clinical Forum, which in turn informs the NHS Forth Valley Board. As the agenda of LHCCs broadened, capacity issues and the need to minimise duplication of work was recognised
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as paramount. This was matched by the recognised need for effective partnership working. Membership was subsequently increased to include representation from the SSC, Local Authorities and the Local Health Council to enable the Committee to meet the challenges of ‘Partnership for Care’ - facilitate the CHP agenda and to afford broader effective influencing and implementation of clinical priorities. In recognition of the expanding CHP agenda and to achieve more effective whole system decision making within the context of the Health Care Strategy, it is anticipated that representatives from Acute Care will be required to join the new forum that will replace the LHCC Professional Committee.
It has also been recognised that as part of the review of strategic and planning groups in Forth Valley (see section 2.3) there is an opportunity to review the role and remit of the Area Clinical Forum. This statutory body requires to ensure appropriate area wide membership with a current favoured option to increase membership to include representation from directorates within secondary care.
Initially, the group that will evolve from the LHCC Professional Committee (nominally referred to for the purposes of The Scheme as the CHP Professional Committee) and the Area Clinical Forum will have distinct roles. There remains the possibility that the revised membership remit and constitution of the Area Clinical Forum could subsume the responsibilities of the CHP Professional Committee, in taking forward clinical priorities and development of pathways and models of care. These discussions will take place over the next few months with clarity around future phased development and configuration of these forums available by April 2005.
4.6 Support Services To properly support the level of devolved decision making and accountability given to CHPs and beyond, a range of professionals will support each CHP including Finance, Information & Technology, Quality, Planning & Human Resources (HR). Work is ongoing to determine the detailed range of support services that can feasibly, and appropriately, be devolved to CHPs and interim arrangements will be determined by April 2005. It is anticipated that staff who currently fulfil these roles within the existing co-operative structures will be re-deployed on a ring fenced basis according to their substantive post and the requirements of each CHP. There will be an early review of these initial arrangements pending the outcome of the review of the primary care operating division functions (see section 4.2). Single system reviews of HR, IM&T and Finance will also be completed within the same timescale. Support arrangements will be reviewed as a result of future changes in relation to interim hosting arrangements (see sections 2.2).
It is intended that operational management for support functions will be through the CHP General Managers, whilst professional support will be provided by Corporate Leads within a clearly defined protocol. This arrangement may change in light of the area wide service reviews. A range of models supporting the underlying matrix management structure are being reviewed.
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4.7 Performance Management Our process for evaluating and monitoring progress will be through our local performance management and review process linked to the Performance Assessment Framework (PAF) and Accountability Review. The NHS FV Area Performance Management Framework describes the performance management system as key to the effective working of a single NHS system, and the requirement to ensure a robust integrated system that works on the principles of single-system working, which include: -
• Devolving real decision making power as close to the front line as possible; • Ensuring that healthcare professionals work much more closely together so that patients experience a co-ordinated health service; • Support work across the boundaries of NHS Boards, whether through Managed Clinical Networks, other clinical or care networks and regional planning processes; and • Support work with other key stakeholders, including local authorities, the wider public sector and voluntary groups.
Significant work has been undertaken via Joint Futures to develop a Joint Performance Assessment Framework in response to the four stated national outcomes. This work will be integrated with the NHS FV area performance management arrangements to ensure that the same information can be reported across partnerships.
Some targets and objectives are set nationally and through the Accountability Review process, others will be set locally within an overall planning and performance management framework. Through the performance management framework, objectives are cascaded to teams and to individuals for delivery. This will facilitate the devolution of decision making to each CHP. The intention is that CHPs will be expected to monitor and review performance associated with specific elements of the Local Health Plan, local improvement targets, and extended partnership agreements and to report on:-
• The development of patient focussed services; • Managing capacity effectively through e.g. the minimisation of delayed discharges; • Access to services including access to a primary care professional and current waiting times; • Provision of effective care including quality indicators, clinical activity; • Progress against health improvement targets agreed through the JHIP process; • Delivery of the various strands of the healthcare strategy, shifting the locus of care; • Patient centred safe care including reviewing complaints and incidents; • Effective joint working arrangements; • Staff governance issues including sickness and other absence, recruitment and retention; • Financial and operational performance including implementation of operational plans and delivery of services within budget, with effective internal controls.
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5. Working in Partnership 5.1 Involving Stakeholders The success of CHPs will be measured to some extent, but not exclusively by the ability of each CHP to work in partnership with local authorities, the voluntary sector, independent contractors, and the public and other partners. NHS Forth Valley recognise that Partnership will not be measured by the success of the CHP Committee alone but through evidence at the frontline and at all levels in between. CHPs in Forth Valley will adopt the principle of developing leaders at all levels and will produce a robust framework to support all staff to develop their roles within the partnership enabling and encouraging local support and innovation. Forth Valley will build on existing & robust working arrangements in relation to staff partnership.
The key to continued involvement, particularly of independent contractors and specialist services will be to demonstrate areas where CHPs have begun to make a difference to patient care and population health. The guiding principles of community engagement are :- • Build on existing good practice; • Ensure widest possible participation; • Special attention to diversity and equality.
CHPs provide an opportunity, through the development of inclusive engagement, to enable local communities to identify and have ownership of their local health and healthcare service.
5.2 Engaging Local Communities NHS Boards now have a statutory duty to involve the public, users and carers in decisions about the way services are provided in their area. Throughout the development of its healthcare strategy NHS Forth Valley has widely consulted local communities via a number of mechanisms including consultation fairs, newsletters, advertorials, freephone lines, website, staff bulletins etc with the support and involvement of the Local Health Council. CHPs will continue to access existing mechanisms to involve and engage communities and will, jointly with local authorities and the Local Advisory Council develop improved communication mechanisms especially for hard to reach groups.
A Patients Panel has been established by NHS Forth Valley to provide a public sounding board as the Interim arrangements of the healthcare strategy are developed. This panel will also be involved in plans for the new hospital at Larbert. The panel consists of members of the public from across all three local authority areas and is supported by a multi agency steering group. There is also an established Disability Action Group, which includes membership from service users and their representatives, that acts as an advisory group in relation to health related initiatives within Forth Valley.
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A Public Involvement Network is also being established which will include members of the public with a general interest in health or in a specific area of health / healthcare. Members can classify their level of participation.
In addition, Joint Future Implementation Groups are multi-agency, involving service users and carers. Other service user and carer networks, such as those within Mental Health and Learning Disability Services are well established.
There is already a strong local commitment to active citizenship and community engagement within each local authority and these are described in section 5.3 in relation to the development of Patient Partnership Forums for each CHP.
5.3 Public Partnership Forum The development of Public Partnership Forums for each CHP will provide a useful network of individuals and groups and it will be important to avoid duplication and role confusion with other national and local bodies. By using existing mechanisms in a co-ordinated way, there already exists the capacity to provide information and to engage geographical communities and communities of interest. The PPF and community engagement processes are inextricably linked. Each CHP has adopted a different approach to the development of its PPF. These are described below.
5.3.1 Stirling CHP The Public Partnership Forum (PPF) will have responsibility for engaging with the widest range of communities in relation to the services provided by the CHP. It is anticipated that it will do so not only through an information network but also through participative meetings and focus groups. To achieve this the PPF will require the direction of an executive committee.
The role of the executive committee (see Appendix D) will be to identify the best means of engagement for specific issues, to set the agenda for open PPF meetings, and to draw on the extensive means of community engagement that already exists throughout the Stirling Area, whether this is geographically or issue based.
Geographic engagement currently occurs through a variety of means including community councils, local community planning, community newspapers, the NHS Forth Valley Public Information Network and the Stirling Assembly. A wide range of issue based engagement also occurs through the Community Care Forum, Council of Voluntary Services, Pupil/Student Councils, Dialogue Youth, the Health & Wellbeing Alliance, support to regeneration areas, ethnic minority associations (Chinese Association; Pakistan Association; Indian Association; Arabic Association), community care groups, patient pressure groups and contacts with the local business community. Appendix D provides an illustration of how the PPF can harness this wide range of existing engagement.
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Drawing on this engagement base, an open PPF meeting should be held early in the life of the CHP to appoint the executive committee. The PPFs two representatives on the CHP will be drawn from this committee. It will be important that both a transparent selection process for these representatives and national guidance stating that at least one of these representatives should be from the voluntary sector is applied.
The PPF cannot simply be an information network. It must, in the spirit of Community Planning, seek to have influence over the improvement of health and care services and health in general. To ensure the link is made with Stirling’s Community Planning Partnership (SCPP) it is considered that the PPF should sit alongside the existing functional groups within the Partnership structure (see section 3.1.3). This will bring a consistency of approach as two of these groups (Health & Wellbeing and the Children’s Community Planning Partnership) are also seen as having a key function within the CHP. An additional benefit will be the links this will provide with the development of any new area community planning structures. Early discussions will be required with the SCPP Steering Group to house the PPF within the Partnership. As outlined in the statutory guidance administrative support for the PPF will be provided by the CHP.
5.3.2 Falkirk The Falkirk PPF will rest on the foundations of already extensive consultation and participation structures across health and service sectors. A mapping of health-related public participation activities is in progress, which will reflect structures in the NHS, across Council Services, the voluntary sector and in the Community Planning Partnership (including developing local community planning activity). The goal for the Falkirk CHP is to develop a PPF that utilises a number of flexible and broadly inclusive mechanisms that move beyond typical consultation into true public involvement with planning, implementation and evaluation of CHP-delivered services. The design of these mechanisms, based on the principles of equality and diversity referenced in the Involving People Advice Notes, will be adaptable to varied levels of engagement by diverse participants. The overarching vision is public participation that improves health and reduces health inequalities by enhancing the planning, design, re-design and delivery of services in Falkirk.
The Falkirk PPF will need to support public engagement that encompasses issue-based and population-based involvement, one-off and ongoing interaction, organisational and individual input. Involvement of Falkirk organisations and individuals in the planning for the PPF therefore is crucial to success, and the precise form of the PPF will emerge from the consultation and participation activities over the year prior to March 2006. These activities will include a public forum to bring together individuals and community-based organisations to choose an initial steering group for taking the PPF forward and for identifying initial representation on the CHP Committee. Preparation for the public forum will include awareness-raising actions and formal and informal discussions with key interest groups as well as activities such as workshops co-sponsored with CVS Falkirk and Dialogue Youth and user involvement in development of participation recruitment materials.
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Initial tasks of the PPF will include negotiation of a working agreement regarding roles and responsibilities with members of the PPF and the wider CHP. This process will be supported by the PPF support team and the local office of the Scottish Health Council. The agreements will be reviewed yearly by the PPF and the CHP Committee. The details of PPF structures, particularly decision making and management functions, will need to be worked out with input from the public and voluntary sector organisations.
Perhaps more than any other CHP development, the PPF will need to grow out of the strengths and experiences of people and organisations in Falkirk. As a consequence, the plan for creating a PPF that is dynamic and flexible and that contributes meaningfully to improved health and well-being requires from the start the input and investment of the public and community-based organisations. Attracting and supporting that involvement is the primary focus for the PPF for 2005-2006.
5.3.3 Clackmannanshire Discussions around the establishment of the PPF taking account of recent guidance (‘Involving People, Draft Advice Notes’ SEHD August 2004) are ongoing in Clackmannanshire and will continue post the establishment of CHPs. As a basic principle there is acknowledgement that the PPF should build on what already exists rather than become an additional group or set of groupings. On that basis, and within Clackmannanshire there are already several networks in existence, which facilitate community engagement. Many of these have been in place since before the development of statutory community planning and they have served the partners well. However, with the advent of statutory community planning and the development of CHPs, the partners in Clackmannanshire have recognised the importance of having a formal and cohesive strategic framework for community engagement, which augments and enhances the current arrangements. (see section 3.1.1)
Proposals for new mechanisms at Clackmannanshire wide and local neighbourhood level are being considered. These are being developed to complement existing community engagement structures across Clackmannanshire.
5.3.3.1 Clackmannanshire-Wide Community Engagement There are currently 9 community councils in Clackmannanshire representing most of the towns and villages. They meet on a regular basis and come together quarterly for a Joint Community Council Forum. They are represented on the Clackmannanshire Alliance.
Clackmannanshire Council and Scottish Enterprise Forth Valley formed a steering group to create a Clackmannanshire CVS. It is managed by representatives of voluntary and community groups. The CVS Board employs a Manager, who is a member of the Alliance and can, therefore, represent the voice of the voluntary sector at Alliance level.
Clackmannanshire Tenant and Residents Federation is an umbrella organisation for tenants of the 3 main landlords in the area:- Clackmannanshire Council, Ochilview Housing Association and Paragon
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Housing Association. Its remit is to promote the rights of tenants and residents throughout Clackmannanshire, working for the improvement of their housing conditions, amenities and environment. It is well established having being formed 10 years ago. It has a representative on the Alliance.
5.3.3.2 Community Fora To further extend partnership working in Clackmannanshire, the Alliance is having discussions about the establishment of a Forum (see figure 13) to represent the views of communities and communities of interest on issues that affect Clackmannanshire as a whole. This will link closely with the planned Local Community Planning Areas (probably four geographic areas within Clackmannanshire). In addition, there will be a community input from the Regeneration Outcome Areas (ROA) through a Regeneration Forum.
In relation to the issues, which come within the locus of the Forum, it is likely that its roles will be to: • discuss and debate; • formulate views and make recommendations to appropriate agencies; • inform and influence the appropriate agencies; • review and influence decision making; • support the involvement of the wider community; • provide community input to the work of the Alliance.
The forum is likely to develop a structure, which involves community representatives from each of the local community planning partnerships and the Regeneration Forum.
It is expected that representatives of these same forums will play an active role in the Public Partnership Forum, which will be developed over the next 12 months.
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figure 13 – proposed community forums – Clackmannanshire
Community Forum Community Partnership Team For ROA areas
Local Local Local Local Community Community Community Community Planning Planning Planning Planning Partnership Partnership Partnership Partnership
5.3.3.3 Other Strategic Community Engagement Structures Underpinning all these community engagement mechanisms is a community learning strategy, which the main Alliance partners are signed up to. The Clackmannanshire Community Learning Strategy is an integral component part of the community planning framework and has been signed up to by many Alliance partners including: Clackmannanshire Council, Clackmannan College, Scottish Enterprise Forth Valley, Clackmannanshire Volunteer Development Agency, Central Scotland Police, NHS Forth Valley and representatives of the voluntary sector.
One of the main goals within the Community Learning Strategy is: "To maximise the strength of community and voluntary organisations and promote active citizenship". Crucially, one of the Strategy's main themes is developing community capacity. The role of the community planning partnership, through the Community Learning Strategy, therefore, is primarily to enable so that the expertise and resources local people bring can be used in ways that build the capacity of communities to determine local priorities, to tackle local issues and own the solutions for themselves.
As such, the partnership's ambitions are to help create:-
• communities where people feel they are listened to and their ideas acted upon; • a vibrant, successful and inclusive community and voluntary sector; • well-organised and managed community and voluntary groups; • communities that influence and shape public policy and practice; • communities that control local assets and services; • communities where people can get involved as active citizens at a level that suits them, and on issues that matter to them.
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5.3.3.4 Other Approaches to Engagement As part of its consideration of community engagement overall, the partners in Clackmannanshire are aware that a range of methods will be required to be used in tandem with the more traditional methods, particularly to engage with some of the ‘difficult to reach groups.’
There is a wealth of experience and good practice across the various partners on which to draw and other approaches to engagement which have been developed include: - • use of Civic Commissions (Citizen's Juries) for detailed consideration of strategic issues (such as health, transport and priorities for education); • use of People's Panel in Alloa South & East (which may be augmented by a Clackmannanshire wide Peoples Panel – ‘Clackmannanshire 500’); • e-citizen projects; • "planning for real" (recently used very effectively by the CPT in Alloa South & East); • use of drama, particularly to engage young people.
The partners intend to tailor their approaches to engagement to ensure that there exists a range of mechanisms at different levels for communities to being involved. A key stand of its community engagement strategy will involve making best use of existing mechanisms and developing good practice from the Social Inclusion Partnership (SIP) and elsewhere.
5.4 Linking Clinical and Care Teams 5.4.1 Clinical Governance Clinical Governance is defined as ‘corporate accountability for clinical performance’2. Following dissolution of Trusts and the creation of Operating Divisions guidance was issued that each Division should have a Clinical Governance Committee. In Forth Valley each Operating Division has a Clinical Governance Committee reporting to the Forth Valley Clinical Governance Committee which is a formal Committee of the NHS Forth Valley Board. This arrangement allows for a strategic overview together with capacity to manage a large and growing agenda with clear accountabilities. NHS Forth Valley will retain a Joint CHP/Primary Care Clinical Governance Committee (replacing the PCOD Clinical Governance Committee) following the establishment of CHPs.
Since 1998, the Primary Care Operating Division has striven to develop a framework that embeds and supports clinical governance throughout the organisation. This has evolved into an infrastructure that engages and empowers frontline staff in determining and supporting national and local priorities. It would therefore be extremely important to sustain and build on this progress into the future. Theoretical and practical support for these activities is currently provided by the Clinical Effectiveness Support Service (CESS) which consists of a core team of individuals who have complementary and
2 Sam Galbraith June 1998
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wide-ranging skills. It is envisaged that for an immediate period the CESS will retain its core function and be accessed to further develop and support clinical governance within the CHPs.
Currently a number of sub groups report to the Primary Care Operating Division Clinical Governance Committee as shown in figure 14. These groups have been put in place over the last 5 years and in the first instance it is proposed that they continue to be supported. These structures will be reviewed and consideration given to how clinical effectiveness and other issues eg. clinical risk management, education and training and policies and procedures across both primary care and specialist services can be best addressed following the establishment of CHPs. It is also recognised that the role of teams and individuals that support the overall quality agenda should be reviewed within the context of the review of the Primary Care Organisation (see section 4.2). figure 14 – Clinical Governance Reporting Mechanisms – FV Primary Care Operating Division
NHS Forth Valley Primary Care Operating Division
Child Protection Action Committee Minute Clinical Governance Reporting Mechanisms
Infection Control
NHS FORTH VALLEY Clinical Records Committee Clinical Governance Committee (Board Level) Complaints Monitoring
Medical Equipment Committee Primary Care Operating Division Research and Acute Care Operating Division Development Committee Clinical Governance Committee Clinical Governance Data Protection Committee Committee. (Chaired by Austin Dunn, Fair for All Development Non Executive board member) Group
Ethics Committee
LHCC Clinical Boards North- Stuart Cumming South- Gordon McInnes Area Drugs and SSC Clinical Reference Group Therapeutics (Chaired by Susan Bishop, Chief Pharmacist. Committee. This committee has direct input Includes GM, CESS) to executive members Clinical Risk LHCC Clinical Effectiveness s Sub group Group Primary Care Drugs Primary Care Education LHCC IM & T and Therapeutics Prescribing Coordination (Chaired jointly by North and South Committee Group group Associate Medical Directors includes CESS)
Adult Mental Community Learning Services for Child and South LHCC North LHCC Health Alcohol and Disabilities Older People Adolescent representatives representatives Drug Services Mental Health
Draft Version 4, 7 September 2004
5.4.2 Developing New Models of Care The role of the CHP in developing new models of care cannot be seen in isolation from other initiatives referred to elsewhere in The Scheme such as Redesign, MCNs, Primary Care Collaboratives, the New GMS Contract (nGMS), Integrated Learning Communities etc (see sections 2.1, 2.3.1 & 5.2). CHPs will, however, through creating a structure that will support an environment where clinical activities can be co-ordinated and better integrated, provide the mechanism to foster innovation and build on the good work that has already been achieved within LHCCs and the SSC. Forth Valley has many good examples of where new models of care have already been and continue
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to be developed to bring closer working between clinicians, some of which have been referenced in section 2.1. It is not the intention in The Scheme to provide a list of all such achievements, however, readers can obtain examples on request if required.
Other sections in The Scheme, (see sections 2.3, 4.5, 5.2), describe how CHPs will ensure that there are appropriate links in place to enable full involvement in the influencing, planning and delivery of services and for developing new models of care that meet the needs of local communities.
5.4.2.1 The Role of Nursing Despite the range and complexity of backgrounds nurses retain a professional identity and are governed by one professional code of conduct and standards. They remain the largest group providing ‘hands on’ care and therapeutic interventions within the NHS.
As nursing roles develop so does nursing practice. CHPs along with the Director of Nursing Services will ensure that nursing practice is safe and effective and that it is developing in a systematic way, in line with policy and evidence base and that there is an equitable service throughout Forth Valley NHS area. (see section 4.5)
The current nursing agenda includes; - • Public health nursing; • Framework for Nursing in Schools; • Framework for Mental Health Services and Mental well being; • Hall 4 – changing emphasis from surveillance towards a health promotion/public health model based around the individual child, families and communities; • Issues arising from changes in general medical contract; • Out of hours nursing/ unscheduled care – developing skills/roles; • Nurse practitioners – developing roles/ skills; • Nurse consultants; • Mental Health Act – changes in practice; • Nurse prescribing; • Clinical supervision; • Child protection; • Clinical Education roles; • Workforce Planning and succession planning; • Continued professional development; • Development of practice protocols and patient group directives; • Development of healthcare support workers – training and roles; • Working in partnership, for example, single shared assessment; • Rural Midwifery and the Framework for Nurses working in General Practice.
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The single shared assessment (see section 2.1.5) is perhaps the biggest move towards an integrated approach between health and local authority staff. There is potential for further collaboration which will enhance patient care and services for example, the care delivered in care home environments.
5.4.2.2 Allied Health Professionals Through the use of preventative, assessment and rehabilitative strategies and interventions, the Allied Health Professions are critical to the physical and mental well being of many people. They support people of all ages in managing and recovering from a range of conditions, helping them to optimise their quality of life. They enable children and adults to make the most of their skills and abilities and to develop and maintain healthy lifestyles. In addition, many AHPs provide specialist diagnostic assessment and treatment services, services that are frequently to be found in primary and community settings. These are often examples of AHPs working in extended roles taking on the tasks and roles traditionally undertaken by doctors.
Whilst advances in medical science are aimed at saving and prolonging life, the particular skills and expertise of AHPs are often critical to ongoing assessment, treatment and rehabilitation of individuals. Practical interventions from AHPs can often be the significant factor in enabling people to recover movement or mobility, overcome visual problems, improve nutritional status, develop communication abilities and restore confidence in everyday living skills, consequently helping them to sustain and enjoy quality of life even when faced with life-limiting conditions. Examples of AHPs expanding roles in providing alternatives to hospital admission can be found in section 2.1.4.
Section 4.5 describes the leadership arrangements for AHPs that will ensure that professional leadership is maintained. Section 2.2 and the Hosting protocol in Appendix B describe the hosting arrangements that will be applicable to small and / or specialist services, like AHPs that fall within agreed hosting criteria.
5.4.2.3 CHPs & the nGMS Contract The nGMS contract introduces the potential for fundamental and far reaching changes in practice across primary care and local systems. It creates opportunities for flexibility and innovation at practice level and beyond. As a general principle, it is anticipated that CHPs will support the development of nGMS in the following ways, each of which has been referenced throughout The Scheme:- • co-ordinate enhanced services, re-enforcing redesign initiatives from a local perspective (see section 2.3.1); • minimise the demands on secondary care by supporting redesign initiatives such as the outpatients programme supported by the CCI (see section 2.3.1); • creating better links to MCNs (see section 2.1.5); • improving approached to chronic disease management (see section 2.1.5); • creating closer links to social services (see section 2.2);
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• enhancing practices role in health improvement (see section 3); • modernising services, enhancing greater integration of services, and role expansion and development of practitioners (see section 2.1.5).
5.4.2.4 CHPs & Other Contracts The new Consultant Contract provides for protected time to be given to develop skills, training and proficiency. CHPs will support contractor services and as well as seeking to develop each discipline, they will take the opportunity of integrating services within health and across boundaries. A new contract for community pharmacy is reaching final form, with a phased implementation from April 2005. The contract will bring opportunities for redesigning pharmacy services, modernising premises and making best use of the skills of community pharmacists and their support staff to meet local needs.
CHPs will support the development of four core services: - • Chronic medication service; • Minor Ailments Service; • Acute Medication Service, and • The Public Health Service.
In addition, they will services which are determined as being necessary to meet local need e.g. services for substance mis-users, palliative care, out of hours, and advice to care homes.
There has been recent national consultation on modernisation of new dental services with the expectation that a new contract will be forthcoming in the near future. New optometric services are presently the subject of a national review, which will lead to modernisation as for the other contractors.
5.4.3 Information Sharing Protocols are already well developed within Forth Valley as a result of joint future working. An Information Sharing Protocol has been agreed, including an agreed process for consent. A protocol for the investigation of multi-agency complaints has been developed by the Stirling Partnership with applicability of use across the Forth Valley area. All work has taken full account of national guidance on data protection and Caldicott principles. The CHP will draw on these solid foundations to support and develop further sharing of information.
CHPs will work with both local & national partner organisations to support the development of local IT systems including GPASS, PIMS, Acute & Local Authority Systems. This will ensure we have datasets & reporting systems fit for purpose, which will primarily support direct patient care & enhanced decision making but will also support service management, NHS planning & appraisal.
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With care delivery & planning increasingly crossing organisational boundaries, ways of safely transmitting and accessing patient information need to be developed. Locally this will be achieved through the development & increased rollout of key systems such as SCI Store and SCI Gateway.
5.4.3.1 Sharing Information The public expects the appropriate sharing of information between care organisations.
Exchange of information is encouraged between partner organisations. The eCare project has established appropriate data sharing protocols for direct care – this good practice is being extended to all other areas of direct care (e.g. Single Shared Assessment). Additionally protocols will be established to clarify the appropriate exchange of identifiable and non-identifiable information for non- direct care (e.g. planning purposes). The Data Protection Act 1998, the Caldicott Report and the CSAGS Report will be used as reference points.
5.4.3.2 Shared Care Without electronic means sharing care information can be cumbersome and bureaucratic. NHS Forth Valley will support processes, such as single shared assessment, through appropriate use of IM&T, enabling shared information subject to legislative constraints. In particular sharing will only be enabled following informed consent by the individual concerned.
NHS Forth Valley is, and will continue to be, an active participant in national programmes for modernising government in partnership with local councils, police and local enterprise companies to improve access to local services. figure 15 – multi-agency ‘store’ model
Patient Summary Information Assessment Information Assessment Information Primary Care Stirling Social Work Multi-agency Community SCI Store Falkirk Store Care Social Work
Clacks Secondary Social Work Informed Consent Care
SW Staff NHS Staff Figure 15 illustrates the model for development based on as multi-agency “store” to support single shared assessment
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5.5 Involving Staff The Staff Governance Agenda as outlined in “Our National Health” highlighted our responsibilities to take forward the Staff Governance Standard which indicates that staff are entitled to be : – • Well informed; • Appropriately trained; • Involved in decisions that affect them; • Treated fairly and consistently; • Provided with a safe working environment.
NHS Forth Valley has a firm track record of successful partnership with staff. The Area Partnership Forum and Primary Care Operating Division (PCOD) Partnership Forums commenced in 1999, as outlined in the Staff Partnership Agreement. These provide staff with an opportunity to influence how we take forward national and local strategies. These forums have a key role in ensuring NHS Forth Valley meets the Standard, along with the Staff Governance Committee. Critically there has been a partnership approach with staff to the CHP development process.
A staff survey developed nationally on behalf of the Area Partnership Forum was issued in NHS Forth Valley in 2001 and 2003. This tells us what we are doing well and what we could be doing better in terms of Staff Governance Standard. The results of the surveys are taken forward as action plans by each area and function. The Area Partnership Forum and the local/divisional Forums review progress on these action plans.
Staff are represented on the Forth Valley Area and PCOD Partnership Forums by Accredited Staff Side Officers and an Employee Director. The Employee Director is an NHS Forth Valley Board member, elected by Staff Side Representatives, who has area-wide, overarching responsibility for liaising with Staff Representatives, communicating and representing staff on Staff Governance issues at a Strategic level.
It is envisaged that when the three CHPs are established in Forth Valley, the current LHCC and SSC Staff Forums will be integrated into a Joint CHP Staff Partnership Forum (formally PCOD Partnership Forum) as represented in Figure 16.
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figure 16 Staff Partnership Forum
Staff Partnership Arrangements
NHS Forth Valley Board
Staff Governance Committee
Area Partnership Forum
Joint Future Staff Forum
Joint CHP Partnership Forum Acute Hosp Ancillary NHS FV Board (Clackmannan CHP) Partnership Forum Partnership Forum Partnership Forum (Falkirk CHP) (Stirling CHP)
Staff Staff Staff Staff Staff Staff
An accredited Staff Side Representative, elected to the role by their respective Branch Committee, will represent each CHP within this forum and be a member of the CHP Committee. Branch Committees will review the Staff Side Representation annually with no maximum term of office. The Staff Side Representative in each CHP will also be a full member of the Area Wide Partnership Forum. In this way frontline staff will be represented at every level within Forth Valley Partnership Arrangements.
Roles and responsibilities of the Staff Side Representative will include: - • Providing a staff perspective on CHP development, Staff Governance and service delivery issues considered by the CHP Committee and the NHS Board; • Act as a focal point for staff from across the CHP who wish to contribute to the business of the CHP Committee and Partnership Forums; • Explain the work of the CHP committee and the Partnership Forums and promote opportunities for staff to be involved in decision making locally; • Reflect the views of the Partnership Forums on the performance of the employers within the local CHP and wider NHS system in discharging their staff governance responsibilities; • Champion partnership working and provide a vital link between the CHP Committee, the Joint CHP Staff Partnership Forum and the Area Partnership Forum; • Engage with frontline staff through communication with Branch Committees, local Branch Stewards, the provision of Staff Organisation newsletters, NHS Forth Valley Staff News, by personal approach and via the Partnership Forums Intranet Website; • Communicate and consult with, and support the Employee Director role.
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CHP General Managers, will also be members of the Joint CHP Staff Partnership Forum with responsibilities to comply with and implement the staff governance standard, ensuring a consistent approach across the 3 CHPs. It is envisaged that General Managers, the Employee Director and the Staff Side Representative, in consultation with staff groups will further review and build upon formal communication mechanisms and processes for selection of staff to working groups and reporting mechanisms.
The Joint CHP Staff Partnership Forum will build on current good practice and continue to work with the Acute Division Staff Partnership Forum and the Area wide Staff Partnership Forum to develop policies and procedures. These will be commended to non NHS staff working in the CHP and independent contractors.
Every effort will be made to secure continued membership from Family Practitioner Services and establish firm membership links with CHP Clinical Forums to ensure frontline staff have a direct avenue to influence and initiate change.
The Joint Future Staff Forum, which is well established in Forth Valley will continue in its current role, ensuring the Joint Future Staffing Framework is applied appropriately within the development of CHPs and is inclusive of our Local Authority Partners.
It is intended that an explorative and developmental review of our Partnership Forums, including the Joint Future Staff Forum be undertaken during the next 12 - 18 months. Part of this development work would be to review the terms of reference, expectations and relationships of the Forums, ensuring clarity of purpose leading to simplified arrangements to ensure inclusive and productive representation of our CHP Partner Organisations. This will be an evolutionary process, guaranteeing Forums remain fit for purpose. The SEHD Partnership Unit would support this work,
5.6 Working with Local Authorities NHS Forth Valley anticipate that Local Authorities and the Voluntary Sector will be integral and full partners within the CHP as they mature and evolve and this is reflected in Joint Governance arrangements, Schemes of Delegation and reporting arrangements (see sections 4.3, and 7). As CHPs develop, an increasing amount of joint service provision and joint outcomes will be agreed. This will only happen if partners have a better understanding of each others’ roles and a level of trust is built up between individuals and agencies. In Forth Valley a considerable amount of joint work is being undertaken already at the front line via Joint Future arrangements, community planning arrangements and multi-agency strategic planning groups, the Joint Staffing Framework and Joint Performance Assessment Frameworks. (see sections 2.3, 2.4, 3.1, 5.5 and accompanying document - Forth Valley CHP Development Plans). As CHPs develop, opportunities will be explored to align processes such as Staff Governance and Clinical/Professional Governance arrangements.
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5.7 Working with the Voluntary Sector In Forth Valley there is a wide range of voluntary organisations and community groups providing services or conducting activities relevant to the CHP. These range from large national service providers operating locally through paid staff (e.g Penumbra, Carr Gom), through to groups of volunteers who come together motivated by self-help, with little or no paid staff involvement (eg. Braveheart, Forth Valley Disability Sports, Grangemouth Stroke Group). In between there are local organisations providing services through a combination of paid staff and volunteers (eg Hope Project, Council Associations for Mental Health). Within the context of The Scheme, the voluntary sector refers to the community and voluntary sector and not specifically to carers although the vast amount of support provided to disabled people by unpaid carers should be acknowledged here.
The strengths of the sector are:- • Long standing experience in partnership working; • Capacity for innovation; • Grassroots strength; • Putting people first; • Building social capital and capacity; • Mobilising people around issues of poverty and disadvantage; and • Diversity.
The diversity of the voluntary and community sector is one of its strengths, but it also creates a significant challenge for the process of involvement alongside the need to ensure adequate and sustainable resources.
Through their involvement in the PPF voluntary sector providers will become inextricably linked to the development of their local CHP and through membership on the CHP Committee will be increasingly involved in service planning and delivery and decision making.
Locally the three Councils for Voluntary Service (CVS) organisations in Forth Valley are very supportive of the concept of CHPs and have a key role in developing capacity within the voluntary sector and to facilitate appropriate involvement with, for example, the community planning process. It is probable that the practicalities of working with the voluntary sector will be developed differently in each CHP area to reflect the local arrangements that already exist within the voluntary and community sector. These will be developed taking account of the draft framework ‘Building Local Compacts for Health’ developed by Voluntary Health Scotland.
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6. Building Workforce Capacity 6.1 Development plans NHS Forth Valley Organisational Development plan and local CHP Development Plans are detailed in the accompanying CHP Development Plan document.
6.2 Workforce development NHS Forth Valley has a firmly established culture of supporting Organisational change and development that places patients, staff and the public as equal partners in the design and delivery of health care and health improvement. It is intended that this approach is extended within CHP development to achieve not just structural change but change in functions and outcomes which impact on behaviours and systems which will be experienced by our patients, partners, staff and public. In developing and building CHPs in Forth Valley achieving cultural change will present some challenges. Our guiding principles are firmly based on our vision of PARTNERSHIP. All partners will model ways of working that are not only inclusive of staff, patients and communities but values their diversity and contribution. Within CHPs we are determined to build upon and sustain a transformational culture which invests in developing and empowering all partners, to provide services which are underpinned by creativity, innovation, individual and team responsibility.
In order to achieve these outcomes CHPs will support our workforce to develop and deliver service and health goals.
Management and leadership support will be provided by a CHP Management Team, which will be further supported by senior functional teams. Each Management function will have a dedicated lead committed to the CHP and Professional Support will be provided by lead and designated Clinicians from professional and operational services.
Organisational Development Support will be provided across the CHPs from the area-wide Organisational Development (OD), HR, Training & Development Team delivering an agreed CHP Organisational Development Plan. Forth Valley Primary Care Division has a well developed Organisational Development Plan which will encompass the establishment and development needs of CHPs in the following ways: - • Development of a local CHP Induction Programme for all partners and communities which takes account of both geographical/local and area-wide staff orientation; • Scoping of a Leadership and Management Development Plan to include the development needs of CHPs inclusive of Partner Organisations and to build upon current training and development activities already planned for staff at every level within the organisation; • Developmental Activities to agree and build upon a set of Common Behavioural Competencies for Leadership and Management set out by the NHS Leadership Framework;
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• Extension of the Partnership Short Course Programme and scoping of the needs of all CHP partners by the Joint Human Resources Development Group; • Review of current Joint Future Training and Development Plan activities to further support CHP Development and Partnership working; • Annual review of the NHS Forth Valley Local Learning Plan with Local CHP needs identified. • Development of a Succession Planning Strategy, which addresses areas of personal, career and organisational development at every level within CHPs and the wider organisation; • Identifying and developing the capacity required for CHPs to fulfil their responsibilities for Health Improvement by taking forward the Skills for Health Programme; • Supporting the Public Health and Health Promotion Teams integration with CHPs and in taking forward a Health Improvement Training Plan for CHP Staff and partners at all levels; • Supporting the delivery of the Pay Modernisation agenda. The CHP will have a key role in ensuring that the benefits of the Pay Modernisation Programme are fully realised and deliver value for money. Modernising the NHS Pay system is vital not only to ensure that the workforce are rewarded fairly for what they do, but also to help deliver fast, modern services for patients. The benefits of pay modernisation will be the delivery of a new pay system offering fairness and equity. This will enable NHS Forth Valley to deliver on improved, fast and modern services for patients, providing, the opportunity to redesign jobs and services which are vital to the success of the CHP Services. • Developing the work of the Workforce Design and Implementation Team in delivering an effective Workforce and Development plan and supporting current and future creative practices in the following areas: - • Defining and rolling out models of good practice; • Developing extended roles for clinicians, professionals and other staff groups; • Supporting Professional leads in developing clinicians and clinical leaders; • Exploring best value in delivery by agreeing and defining baseline competencies for partner care workers; • Developing joint care/clinical training opportunities; • Developing AHP and Nurse led services; • Involving GP’s, clinicians and other professionals in service redesign and change processes; • Exploring Integrated Team working at every opportunity; • Ensuring equity and movement of service delivery across CHPs and service boundaries to achieve best value for patients.
Workforce planning will continue to be a centrally organised function within NHS Forth Valley and will be responsible for the maintenance and accuracy of employee personnel records, which provides the core data required for workforce analysis.
Each CHP will have an associated HR advisor to provide support. This HR adviser will be the communication link between the CHP and the central workforce planning team ensuring that the
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workforce planning needs of a specific CHP are understood and addressed in a timely manner. Where there are implications for other CHP/central services, the workforce planning team will ensure effective communication and involvement as appropriate.
To ensure that local service developments are included in the regional workforce plans, the central workforce planning team will drive an annual workforce planning process for each professional area. This is a standard process defined by the central group and applied to all staffing areas. The process involves gathering service developments from each CHP, extrapolating the required change in workforce establishment or skill mix and consolidating the information into a regional plan. It is anticipated that with changes in regional workforce planning this will rapidly become a highly sophisticated exercise requiring significant clinical input and lateral thinking.
6.2.1 Sharing Good Practice / Links to Research Activities The Clinical Effectiveness and Research and Development strategy of the overall organisation strives to continually build on the established infrastructure that actively supports staff members in engaging in clinical effectiveness activities. This approach focuses on providing practical and theoretical tools and resources in a variety of formats to support the development and implementation of care that is founded on best practice. There are mechanisms in place that allow for local research findings to be considered and disseminated throughout the organisation as appropriate. For example, there is an established mechanism by which all national reports, guidelines and guidance are considered and decisions made as to any further action required by each of the respective Clinical Governance Committees. Reports of both research and clinical effectiveness/governance activity are disseminated using a number of mechanisms. All reports are placed on the clinical effectiveness website which lies in the public domain and staff members alerted to relevant entries. Biannual newsletters are circulated throughout the organisation containing relevant information. Formal links with the Local Research of Ethics Committee and individual researchers are in place to ensure wide spread awareness of all local research. Reports of resultant activity are also presented to each of the respective Clinical Governance Committees of the organisation for consideration. It is intended that all these arrangements will continue.
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7. Finance 7.1 Resourcing CHPs To deliver the expected benefits of developing the CHP structure, CHPs require to be appropriately resourced, recognising the financial constraints that currently exist. Consequently, resource limits will be set for the CHPs, which will reflect the services for which they are responsible (including hosting) and CHPs will operate within those financial limits. At 1st April 2005 only NHS financial resources (subject to the pooled budget for integrated day care service at Clackmannanshire) will be devolved to CHPs. These will be subject to formalisation as part of the financial planning process for 2005-06 and will mirror the Health plan. For completeness Appendix E details the Joint Future aligned budgets currently held by local authorities and a summary of the health commitment to Joint Future.
7.1.1 Indicative Budgets Appendix E reflects indicative budgets for devolved functions and services to the three CHPs. Budgets in respect of Prescribing and Family Health Service (FHS) have been included in the CHP financial position, however, they are currently linked to the review of the Primary Care Organisation (see section 4.2). Options for managing these are summarised as follows:-
• budgets are fully devolved to CHPs for local management and accountability, however there are strict protocols regarding virement and the management of over/underspends. This is the favoured model from the perspective of ownership and accountability, however further work is being done to risk assess these options; • budgets are fully devolved to CHPs for local management and accountability; • central management of prescribing and FHS budgets; • central management of prescribing and FHS budgets but influenced by local management involvement.
7.1.2 Funding the CHP Public Partnership Forums There is an underlying recognition to establish, and resource, individual CHP PPF’s. The extent of required resources will be determined as individual CHP PPFs are established.
7.1.3 Development Plan budgets To support the development of CHPs, an initial development fund of £20k will be required through the reallocation of existing resources. An additional amount of £16,500 (£5,500 per CHP) will also be available through participation in the National Skills for Health Programme.
7.1.4 CHP Support Services budgets As at 1st April 2005, the initial position will reflect the migration of LHCC/SSC support service budgets into the new CHPs. The allocation between CHPs will be based on the specific CHP management arrangements as determined in section 4. These arrangements will be reviewed pending the
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outcome of the review of Primary Care Operating Division functions, single system working and the impact of future changes to interim hosting arrangements (see 4.6).
7.1.5 Proportion of resources devolved to CHPs At 1st April 2005, based on the devolved budgets reflected in Appendix E, the percentage of the total NHS Board revenue allocation to be devolved to CHPs will be 48%.
7.2 Resource Transfer Resources are transferred each year from NHS Forth Valley to each Council, this money is labelled “Resource Transfer” and is utilised by each Local Authority to provide community care services. Overall accountability for resource transfer lies with each NHS system. Our aim is to ensure that within each CHP there is a joint approach to determining Resource Transfer spend against each client group and this fund has therefore been shown as devolved in Appendix E.
7.3 CHP role in resource allocation and decision-making CHPs will be represented at NHS FV Board and will be fully involved in decisions on the use of all NHS financial resources. The resources devolved to CHPs will include the overall NHS resources committed to Joint Future including delayed discharges and resource transfer (see section 4.3). The draft Scheme of Delegation and Roles and Responsibilities Framework will outline the level of devolved decision-making.
7.3.1 Joint Resourcing, Governance and Accountability Section 4.3 details the Organisational Arrangements, and reflects an evolutionary approach. Section 4 identifies the existence of joint accountability and reporting issues that need to be addressed and the resolution of these will influence the future design of governance, accountability and reporting frameworks.
Process, finance and accountability frameworks are being developed to facilitate future joint resourcing arrangements with local authority partners. The development of specific frameworks will be dependent on progress, and outcomes, from the individual CHP Development Plans (see accompanying document – Forth Valley CHP Development Plans), in particular, the following specific aspects included in those Plans:-
• Identify the membership of the management teams, their roles, remit and responsibilities; • review individual CHP Schemes of Delegation, taking particular account of the different arrangements which exist between the NHS and Local Authority approaches; • review the reporting structure, management and accountability arrangements within CHP Schemes of Delegation to support devolution of decision-making to frontline staff; • agree the definition of delegated authority levels; • agree the lines of accountability;
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• review and develop local managers’ roles and responsibilities; • review and develop management structures to promote the integration of services.
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8. Recommendations The Scottish Executive is asked to approve the Scheme of Establishment and supporting Development Plans in the accompanying document as outlined.
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Appendix A Primary Care Model of Service Configuration Future Primary Care -
North/South Fo rth V alley G P p r a c t ic e le v e l L o c a lit y le v e l F o r t h V a lle y le v e l le v e l
GP practice level Locality level North/South Forth Valley level Forth Valley level services at this level include: services at this level include: services at this level include: services at this level include: • GP assessment • Physiotherapy • Specialist family planning services • Acute inpatient services • GP treatment • Podiatry • Primary care out of hours services • Other specialist acute services • Nurse treatment • Dental services • Community learning disability teams • Acute outpatient services • Nurse practitioner services • Community pharmacy • Substance misuse services • Day surgery • GMS family planning services • Occupational therapy • Specialist GP services • NHS24 • Health promotion/education • Speech & language therapy • Day hospital services • Acute emergency services • Antenatal/postnatal • Community mental health nurse • Day treatments • other specialist emergency services • Chronic disease management clinics • Specialist GP services e.g. • Acute outreach specialist • Ambulance and other patient e.g. asthma, diabetes etc dermatology clinics/consultations transport services • Well person clinics • Nutrition & dietetics • Minor injuries • Cervical cytology screening • Community learning disability nurse • Community Hospital services • Childhood immunisation • Pre/post natal and parent craft • paediatric OT • Community midwifery • Community care worker • clinical psychology • minor injuries/surgery • Optometry • child & adolescent mental health services • Counselling • Specialist GP services • Minor surgery • Community mental health teams • School nursing (adults and elderly) • Palliative care nursing • Non-acute beds e.g. rehabilitation, • Specialist nursing services palliative care & intermediate care
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Appendix B
Community Health Partnerships Hosting Protocol
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1. Purpose 1.1 This protocol clarifies the arrangements for the hosting of a service within a CHP. A hosted service being defined as a service that is organisationally located within one CHP but which provides services across more than one CHP and/or Acute Operating Division within Forth Valley.
1.2 This protocol covers CHPs and the services that are hosted within them. This protocol does not extend to cover services that are currently provided by the acute sector or local authorities. This will be reviewed as CHPs develop.
2. Guiding Principles of Hosting 2.1 The general principle underpinning the development of CHPs is the local management of integrated community services. However the division of small services or services currently provided on an area wide basis could have a detrimental effect on the ability of the service to function effectively and efficiently.
A service will therefore be hosted in one CHP if it can be demonstrated that:
• The division of the service would disadvantage it clinically; • The efficiency, effectiveness and cohesion of a service would be adversely affected by its division; • The sustainability of a service would be adversely affected on the grounds of clinical risk/patient safety, affordability and economies of scale/critical mass; • There is insufficient specialist clinical and managerial capacity within a service to participate in, and operate across, more than one CHP arrangement; • Services engaged in major service redesign would be better supported in a hosting arrangement in the short term; or alternatively the longer-term outcome of redesign would point to a hosting arrangement.
2.2 The hosting of a service would be expected to demonstrate that some or all of these eligibility criteria had been met and that alternative ways of addressing these issues had been considered.
3. Roles & Responsibilities of the Hosted Service and Hosting CHP 3.1 Heads of hosted services in conjunction with Professional Leads and CHP General Managers will ensure that equity and high standards in the provision and development of services is maintained across all CHPs. Hosted services in conjunction with CHPs will ensure that clinical governance arrangements and professional standards are co-ordinated, maintained and developed.
3.2 It will be the responsibility of the hosted services and clinical and management staff of CHPs to establish appropriate operational links.
4. Influencing Service Delivery and Improvement 4.1 Heads of hosted services will be eligible to attend CHP Committee meetings when issues affecting their services arise, either from the perspective of the CHP or from the service itself.
4.2 There will be clear lines of formal communication established to ensure CHP Committees are informed about hosted services delivered locally that are being hosted by another CHP.
5. Planning and Delivery of Hosted Service Provision across CHPs 5.1 Area wide joint planning of hosted services will continue and this will influence local CHP priorities and service delivery. All CHPs will agree the service description and delivery profile of the service to be hosted and service provision will be in accordance with simple jointly agreed service agreements.
5.2 No one service will be able to make unilateral changes to service provision locally without engaging in an agreed decision-making process that is open, transparent and inclusive. Heads of hosted services in conjunction with Professional Leads and CHP General Managers will be required to approve any significant changes to the provision of a hosted service. In the case of major service change the NHS Board should be advised and consultation with the Public may be required.
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5.3 Information flows that exist across and within services will be examined to identify and reduce gaps to enable improved planning and decision making.
6. Resource Arrangements for Hosted Services 6.1 General Managers will maintain overall management and financial accountability for services hosted in their CHP, with devolved responsibility and accountability for the operational management of service budgets given to Heads of hosted services. Jointly they will agree levels of virement in accordance with established Standard Financial Instructions. The use of resources will be open, transparent and regularly reported.
6.2 The allocation of staff will be subject to capacity and the clinical needs of the local population. Staff shortages will be managed flexibly by Heads of hosted services and any pressures within hosted services will be risk assessed and managed by CHP General Managers and Heads of hosted services.
7. Review Arrangements 7.1 CHP General Managers and Heads of hosted services will be responsible for ensuring mechanisms are in place to monitor and agree amendments to the hosting protocol.
Approved By
------Name/Signature of General Manager Date Clackmannanshire CHP
------Name/Signature of General Manager Date Falkirk CHP
------Name/Signature of General Manager Date Stirling CHP
------Name/Signature of Head of Hosted Service/Department Date
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Appendix C
Draft Forth Valley Joint Future Performance Measures Framework as at 01 December 2004
INDEX National Outcome 1 Supporting more people at home as an alternative to residential and nursing care National Outcome 2 Assisting People to live independent lives through reducing inappropriate admission to hospital, reducing time spent inapproprately in hospital and enabling supported and faster discharge from hospital National Outcome 3 Ensuring people receive improved quality of care through faster access to services and better quality services National Outcome 4 Better involvement and support of carers
Tasks 1 Tasks 2 Tasks 3 Tasks 4
Some key questions to consider
Are there service user outcomes that should be included in our Joint Future Performance Framework? Is the quality aspect adequately covered? How could we measure participation of service users and carers? Are there Health Service performance measures that should be included? The Scottish Executive expects local partnerships to set their own targets. Which targets are appropriate?
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Draft Forth Valley Joint Future Performance Measures Framework as at 01 December 2004
Supporting more people at home as an alternative to residential and nursing care
Refe renc e Column 1Column 2 Column 3 Column 4 Column 5 Column 6 Column 7Column 8 Column 9 Target Data Available Economy Performance National Efficiency Measure Performance to be or Local Effictiveness Currently Data System measured C F S Performance Indicator Description Policy Quality Definitional Points reported Y/N C F S H Source Appropriate "balance" is dependent on factors such as needs and risk To measure that the Ratio of People 65+ receiving community care budget/resources. locally agreed balance compared to the number of People 65+ in care Define Community 1a of care is appropriate homes (and NHS Long Stay) Local Effectiveness Carepp Services. p NYYYN Ratio of Expenditure on people 65+ in "balance" is To measure that the receipt of services to keep them in the dependent on factors locally agreed balance community compared to expenditure on such as needs and 1b of care is appropriate people 65+ in care homes setting National Effectiveness risk budget/resources Y (LA only) Y Y Y N Appropriate Ratio of Expenditure on people 18-64 in "balance" is To measure that the receipt of services to keep them in the dependent on factors locally agreed balance community compared to expenditure on such as needs and 1c of care is appropriate people 18-64 in care homes setting National Effectiveness risk budget/resources Y (LA only) Y Y Y N No. of People 65+ in receipt of an intensive To measure that package of Home Care service (10+ hours) intensive care packages expressed as a rate per 1000 population 1d are in place aged 65+ National Effectiveness Y (LA only) Y Y Y
To measure the No of care package to keep people in the packages of care within community within defined expenditure defined bands of bands, for example, under £5k, between £5k 1e expenditure and £10k, over £10k and under £20k Local Economy N N N N N
The Scottish Executive expects local partnerships to set their own targets. Which targets are appropriate?
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Draft Forth Valley Joint Future Performance Measures Framework as at 01 December 2004
Assisting People to live independent lives through reducing inappropriate admission to hospital, reducing time spent inappropriately in ho and enabling supported and faster discharge from hospital
ReferColumn 1Column 2 Column 3 Column 4 Column 5 Column 6 Column 7Column 8 Column 9 Target Data Available Economy Performance Efficiency Indicators Performance to be National or Effectiveness Definitional Currently Data System Measured C F S Performance Indicator Description Local Policy Quality Points Reported C F S H Source
Anna Grogan To compare duration of Duration of delay in time bands split by - Health 2a delays reason (only for discharged patients) National ISD defined Y YYYY Database
% of people whose hospital discharge Anna Grogan To compare delayed has been delayed split by reason for - Health 2b discharge reasons delay National Quality,Efficiency ISD defined Y YYYY Database To monitor the availability of transitional/rehab beds in relation to other types of Can you suggest an indicator to capture 2c care the performance at column 1 Local Effectiveness N Can you suggest an indicator to capture the 2d Radid Response performance at column 1? National Y Can you suggest an indicator to capture the 2e Preventing admissions performance at column 1? National N Can you suggest an indicator to capture the 2f Supporting Discharge performance at column 1? National N
The Scottish Executive expects local partnerships to set their own targets. Which targets are appropriate?
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Draft Forth Valley Joint Future Performance Measures Framework as at 01 December 2004
Ensuring people receive improved quality of care through faster access to services and better quality services
Refe Column 1Column 2 Column 3 Column 4 Column 5 Column 6 Column 7Column 8 Column 9 Target Data Available Economy Performance National or Efficiency Measure Data Performance to be Local Effectiveness Definitional Currently System Measured C F S Performance Indicator Description Policy Quality Points Reported Y/N C F S H Source Single shared assessments completed expressed as a percentage of total To measure the assessments completed. To be reported by JPIAF 6, table 1 effectiveness of the care group 18-64 and people 65+ with and National definitions will be 3a implementation of SSA without dementia and by agency. JPIAF Effectiveness used N To measure the Percentage of assessments that are shared 3b effectiveness of e-care electronically National N Time taken to complete a community care assessment reported by time bands (% in JPIAF 6, table 2 To measure the speed of band) i.e. up to 3 days, 4 to 6 days, 7 to 27 Efficiency and definitions will be 3c access to services days, 28 to 55 days, over 56 days. National Effectiveness used N To measure initial enquiry to first provision of Time interval from initial enquiry to provision Efficiency and 3d service of first service Local Effectiveness N
To measure initial enquiry Time interval from initial enquiry to full Efficiency and 3e to full provision of service provision of service Local Effectiveness N To measure the quality of 3f service provision Which care standard (s) are relevant?
The Scottish Executive expects local partnerships to set their own targets. Which targets are appropriate?
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Draft Forth Valley Joint Future Performance Measures Framework as at 01 December 2004
Better involvement and support of carers
Refe Column 1Column 2 Column 3 Column 4 Column 5 Column 6 Column 7column 8 Column 9 Target Y/N Data Available Economy Efficiency Performance Performance to National or Definitional Effectiveness Measure Currently Data System be Measured C F S Performance Indicator Description Local Policy Points Quality ReportedY/N C F S H Source Support of Carers' asessments completed as a National and JPIAF 4a Carers percentage of carers' assessments offered Local definition Effectiveness N
Carers who receive partial service provision Support of or full service provision. Which option is 4b Carers best or is there a better indicator? N
Annual expenditure on carers' respite (split by client group) as a percentage of ? what denominator e.g. total revenue spending on Support of community care by the three councils and 4c Carers the health service Quality N
The Scottish Executive expects local partnerships to set their own targets. Which targets are appropriate?
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Appendix D
O utline of developm ent of P ublic P artnership Forum (P P F)
PPF Voluntary Sector Representative on Representative on CHP Committee CHP Committee
PPF Executive Group Facilitation & Training
Public Partnership Forum (PPF) Inform Local Discussion re Health Public involvement in planning & C om m unities Improvement decision making
S tirling Community C om m unities Patient Ethnic Assembly Councils of interest Pressure Groups Minorities
Pupil & Student H ealth & CVS Health Voluntary sector Councils W ellbeing A lliance Related Groups other than CVS
Any interested individual patient, carer, local network, group, & organisation in Stirling Council Area who have an interest in the work of and receive services from the Community Health Partnership
Existing networks Supported by S tirling Stirling Council Networks Supported by ? C.V.S. Council & NHS FV
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Appendix E Forth Valley NHS Board
Allocation of Resources and Responsibilities to Community Health Partnerships
ClackmannanStirling Falkirk Forth Valley WTE £'000 WTE £'000 WTE £'000 WTE £'000 HCH Devolved Services ** Community Nursing (HV, 42.70 1,551 89.00 3,167 114.29 3,998 245.99 8,716 Practice Phlebotomist 3.47 57 3.47 57 School Nursing 2.63 72 6.97 215 7.10 218 16.70 505 Community Learning ** Disability Nursing 1.87 62 4.73 175 7.00 237 13.60 474 Public Health Practitioner 1.00 30 2.00 61 2.52 89 5.52 180 ** Carer Support Service 162 0.00 162 Walk The Talk 1.00 2 1.00 2 Port Health Medical 0.20 8 0.20 8 Pregnancy Tests & Multistix 3 7 10 0.00 20 Locality Resources 2 1.00 40 0.42 117 1.42 159 Locality Support Fund 5100.0015 IHD Clinics 98 0.00 98 Diabetic Clinics 97 0.00 97 Locality Admin Staff 3.56 59 7.12 118 14.40 233 25.08 410 Primary Care Collaborative 0.20 9 0.80 36 1.00 45 2.00 90 CREATE 0.33 31 0.67 60 1.00 93 2.00 184 CRR/NRR 16.90 459 33.08 1,020 49.98 1,479
Total HCH Devolved 52.29 1,824 130.19 4,350 184.48 6,482 366.96 12,656 No of No of No of No of Family Practitioner Services Devolved Practices Practices Practices Practices General Medical Services (Excl GMS IT) 7 4,832 21 9,663 27 14,495 55 28,990 General Dental Services 6 1,868 16 3,735 18 5,603 40 11,205 General Pharmacuetical Services 13 970 24 1,940 27 2,911 64 5,821 General Optometric Services 4 372 13 744 15 1,116 32 2,232
Total Family Practitioner Services Devolved 8,041 16,083 24,124 48,248
TOTAL DEVOLVED 52.29 9,865 130.19 20,432 184.48 30,606 366.96 60,904
Prescribing 9,287 14,491 25,999 49,777
Note: ** represents "Health" services which are fully, or partly, aligned to the Joint Future agenda
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Appendix E (cont)
Clackmannan Stirling Falkirk Forth Valley WTE £'000 WTE £'000 WTE £'000 WTE £'000
HCH Hosted Services ** Continence Advisory Service (incl N/H Supplies) 4.65 371 4.65 371 Marie Curie Nursing 31 31 Cancer Palliative Care 0.80 30 0.80 30 ** Night Nursing Service 16.80 560 16.80 560 Complex Care Nursing 21.80 1,794 21.80 1,794 ** Disability Services 2.59 95 2.59 95 ** Tissue Viability Service 2.58 113 2.58 113 ** ** Podiatry 31.47 1,039 31.47 1,039 ** Occupational Therapy 61.63 1,422 61.63 1,422 ** Art therapy 3.88 140 3.88 140 ** Music Therapy 0.94 26 0.94 26 ** Garden Therapy 2.10 50 2.10 50 ** Dietetics 15.51 663 15.51 663 ** Physiotherapy 12.70 513 12.70 513 ** Speech and Language Therapy 54.01 1,957 54.01 1,957 ** ** Community Dental Service (CDS) 28.82 1,142 28.82 1,142 Child Health Admin 18.20 333 18.20 333 GMS IT 3.00 540 3.00 540 Community Medical Services to LA's 26 26 Family Planning 3.83 281 3.83 281
Health Promotion 33.60 1,256 33.60 1,256 Prescribing Support Team 9.70 388 9.70 388
** Adult Mental Health 365.00 12,833 365.00 12,833 ** Behavioural Psychotherapy 8.60 315 8.60 315 ** Adult Clinical Psychology 15.64 741 15.64 741 ** CADS 29.73 1,252 29.73 1,252 ** Child & Adolescent Psychiatry 8.10 438 8.10 438 ** Child & Adolescent Psychology 6.20 334 6.20 334
** Learning Disabilities I/pat 63.82 2,046 63.82 2,046 ** Elderly 410.55 11,643 410.55 11,643 GP Nursing Homes 92 92
Total Hosted Services 433.27 15,913 306.81 10,976 496.17 15,575 1,236.25 42,464
Management Services Clinical Boards & Sub Groups 0.00 149 LHCC Management / Professional Support 20.00 1,021 Delayed Discharges 1,830 Resource transfer (Committed) 14,982
SSC Management Support 9.80 496 Total Management Services 0.00 0 0.00 0 0.00 0 29.80 18,478
Grand Total 485.56 35,065 437.00 45,899 680.6572,180 1,633.01 171,623
Note: ** represents "Health" services which are fully, or partly, aligned to the Joint Future agenda
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Appendix E (cont)
Clackmannan Stirling Falkirk Forth Valley WTE £'000 WTE £'000 WTE £'000 WTE £'000
Grand Total (carried forward) 485.56 35,065 437.00 45,899 680.65 72,180 1,633.01 171,623
Residual Primary Care 14,205
Acute Sector 130,363
Board Services and Contingencies 17,835
Other commissioned services from outwith Board Area 24,323
NHS FV (per Board Finance Report to 30th September 2004) 358,348
CHPs as a %ge of total NHS funds 48%
Acute 36%
Other 16%
Local Authority - Joint Future involvement
Summary Financial Report for Period to 31 October 2004 Clackmannan Stirling Falkirk Total
Annual Annual Annual Annual Budget Budget Budget Budget Aligned Resources £'000 £'000 £'000 £'000 (to 31-3-2004) Council Hosted - Service
Care Management Services - Staffing 1,869 4,431 6,300 Care Homes, Supported Accomm & Respite Services 8,734 12,370 27,656 48,760 Home Support Services 226 6,051 6,277 Day Care Services 423 2,036 3,149 5,608 Other Services 834 1,373 6,140 8,347 Mental Health Act Implementation 209 209 Resource Transfer (4,132) (4,627) (8,759) Mental Illness Specific Grant Projects 89 89
Aligned Resources - Council Hosted 10,217 19,865 36,749 66,831
Total Commitment to Joint Future
Local Authorities 66,831
Health 33,378
100,209
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Appendix F Glossary of Terms
Accreditation A process, based on a system of external peer review using written standards, designed to assess the quality of an activity, service or organisation. Acute sector Hospital-based health services which are provided on an in-patient or out-patient basis Allied health Healthcare professionals directly involved in Professions (AHP) the provision of primary and secondary healthcare. Includes several groups such as physiotherapists, occupational therapists, dieticians, speech and language therapists, art/music therapists, podiatrists, radiographers, orthoptists, orthotists and prosthetists. Formerly known as professions allied to medicine (PAM). AOD Acute Operating Division Assessment The process of measuring patients’ needs and/or the quality of an activity, service or organisation. Audit Systematic review of the procedures used for diagnosis, care, treatment and rehabilitation, examining how associated resources are used and investigating the effect care has on the outcome and quality of life for the patient. Carer A person who looks after family, partners or friends in need of help because they are ill, frail or have a disability. The care they provide is unpaid. CEO Chief Executive Officer CESS Clinical Effectiveness Support Service CHP Community Health Partnership Clinical effectiveness The extent to which specific clinical interventions, when deployed, do what they are intended to do, ie maintain and improve health, securing the greatest possible health gain from the available resources. This is assessed through clinical effectiveness programmes. Clinical governance A framework through which NHS organisations are accountable for both continuously improving the quality of their services, and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish. Management of clinical risk at an organisational level is an important aspect of clinical governance. Clinical risk management recognises that risk can arise at many points in a patient’s journey, and that aspects of how organisations are managed can systematically influence the degree of risk. Clinical service Service provided by healthcare professionals. Communication strategy A written statement of objectives for effective Communication and a plan for meeting these objectives.
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Continuing professional development (CPD) An ongoing commitment to learning in various forms, which maintains and enhances professional standards of work. CREATE Community Resource for Education Audit and Teamwork CVS Council for Voluntary Service Diagnosis Identification of an illness or health problem by means of its signs and symptoms. This involves ruling out other illnesses and causal factors for the symptoms. Discharge A discharge marks the end of an episode of care. Types of discharge include in-patient discharge, daycase discharge, day-patient discharge, out-patient discharge and allied health professions (see AHP) discharge. Evidence -based medicine Evidence-based clinical practice is an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best. Family health services See primary care FV Forth Valley GP General Practitioner Guidelines Statements which help in deciding how to treat particular conditions. Health Council Each NHS Board area has a Health Council, an organisation whose aim is to promote public consultation and participation in health-related matters. Sometimes referred to as a Local Health Council. Healthcare professional A person qualified in a health discipline. HR Human Resources Implementation Putting into practical effect; carrying out a task or project. Induction programme Learning activities designed to enable newly appointed staff to function effectively in their new job. Intervention Healthcare action intended to benefit the patient. JHIP Joint Health Improvement Plan Legislation Laws passed by a parliament. LHP Local Health Plan Local Health Care Co-operative (LHCC) In Scotland, Local Health Care Co-operatives are voluntary groupings of GPs and other local health care professionals intended to strengthen and support the primary health care team in delivering local care. Managed Clinical Network (MCN) A formally organised network of clinicians. The main function is to audit performance on the basis of standards and guidelines, with the aim of improving healthcare across a wide geographic area, or for specific conditions. monitoring The systematic process of collecting information on clinical and non-clinical performance. Monitoring may be intermittent or continuous. It may also be undertaken in relation to specific incidents of concern or to check key performance areas.
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multidisciplinary A multidisciplinary team is a group of people from different disciplines (both healthcare and non healthcare) who work together to provide care for patients with a particular condition. The composition of multidisciplinary teams will vary according to many factors. These include: the specific condition, the scale of the service being provided, and geographical/socio-economic factors in the local area. national strategy Describes the government’s approach to achieving a particular goal. nGMS New General Medical Contract NHS Board The overall purpose of NHS Boards is to ensure the efficient, effective and accountable governance of the local NHS system, and to provide strategic leadership and direction for the system as a whole, focusing on agreed outcomes. OD Organisational Development outcome The end result of care and treatment and/or rehabilitation. In other words, the change in health, functional ability, symptoms or situation of a person, which can be used to measure the effectiveness of care and treatment, and/or rehabilitation. palliative care Palliative care is the active total care of patients and their families by a multi- professional team when the patient’s disease is no longer responsive to curative treatment. patient A person who is receiving care or medical treatment. A person who is registered with a doctor, dentist, or other healthcare professional, and is treated by him/her when necessary. Sometimes referred to as a user. patient journey The pathway through the health services taken by the patient (the person who is receiving treatment), and as viewed by the patient. PCOD Primary Care Operating Division policy An operational statement of intent in a given situation. primary care The conventional first point of contact between a patient and the NHS. This is the component of care delivered to patients outside hospitals and is typically, though by no means exclusively, delivered through general practices. Primary care services are the most frequently used of all services provided by the NHS. Primary care encompasses a range of family health services provided by family doctors, dentists, pharmacists, optometrists and ophthalmic medical practitioners. Procedure The steps taken to fulfil a policy Protocol A policy or strategy which defines appropriate action in specific circumstances. Protocols may be national, or agreed locally to take into account local requirements.
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PFPI Patient Focussed and Public Involvement PPF Public Partnership Forum Referral The process whereby a patient is transferred from one professional to another, usually for specialist advice and/or treatment. Rehabilitative Intended to aid return of physical or mental function after illness or injury, often with the assistance of specialised medical professionals. risk management A systematic approach to the management of risk, staff and patient/client/user safety, to reducing loss of life, financial loss, loss of staff availability, loss of availability of buildings or equipment, or loss of reputation. Scottish Executive Health The Scottish Executive Health Department is Department(SEHD) responsible for health policy and the administration of NHSScotland. Website address: www.show.scot.nhs.uk/sehd/ SCPP Stirling Community Planning Partnership secondary care Care provided in an acute sector setting. See acute sector. shared care protocol Recommendation for care provided by more than one clinician in different settings. SSA Single shared assessment SSC Specialist services co-operative Statutory Enacted by statute; depending on statute for its authority as a statutory provision. Required by law. strategy A long-term plan. systematic Methodical, according to plan and not casually or at random. treatment plan Protocol of care which specifies what should be done, when and with what aim.
Source :- Extracts from the glossary of terms have been obtained form ‘Safe and Effective Patient Care’ –National Overview May 2003, NHS Quality Improvement Scotland
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