MARCH 2017 MARCH A plan for person-centred, innovative healthcare to help Lanarkshire to healthcare flourish innovative person-centred, A plan for Achieving Excellence Achieving NHS Lanarkshire Achieving Excellence March 2017 Contents Foreword 2 1 THE CASE FOR CHANGE AND LANARKSHIRE QUALITY APPROACH 3 2 THE CHANGING HEALTH AND SOCIAL CARE NEEDS OF THE PEOPLE OF LANARKSHIRE 9 3 THE ROLE OF HEALTH AND SOCIAL CARE PARTNERSHIPS 17 4 WORKSTREAM SUMMARIES 23 Introduction 24 Primary Care 24 Long Term Conditions 32 Older People’s Services 35 Mental Health and Learning Disability 38 Alcohol and Drugs 42 Maternity, Early Years, Children and Young People 45 Planned and Unscheduled Acute Care 49 Orthopaedic Services 55 Cancer Services 64 Stroke Services 68 Palliative Care 72 5 CROSS CUTTING SERVICES 75 Pharmacy 76 Property 80 eHealth and Digital Technologies 84 Transport 88 6 THE WORKFORCE OF THE FUTURE 92 7 PLANS FOR SERVICE CHANGE 99 8 FINANCIAL RESOURCES 104 9 LISTENING TO YOUR VIEWS 107 Glossary of Abbreviations 111 Contents 1 Foreword It is five years since NHS Lanarkshire published “A Healthier Future – A Framework for Strategic Health Planning” which set out a route map to improve the quality of the services we provide, while also setting out our plans for meeting the future health needs of the Lanarkshire population. In that time, we have seen important changes in the way in which health and social care is planned and delivered. The needs of the population, and the way in which clinical services are provided, have also moved on. So, in 2016 NHS Lanarkshire revised and refreshed the Healthcare Strategy, looking to the future healthcare needs of the population. Our vision is to ensure these services are safe, effective, person-centred and sustainable. Our aim in Lanarkshire is to develop a healthcare system that supports the development of an integrated health and social care system which has a focus on prevention, anticipation and supported self-management. With the appropriate use of health and care services, we can ensure that patients are able to stay healthy at home, or in a community setting, as long as possible, with hospital admission only occurring where appropriate. During 2015 and 2016, Lanarkshire NHS Board collaborated with patients, carers, staff and its partners to refresh the vision as to how services should and could change over the next ten years. We recognise and acknowledge the valuable role played by carers and this is reflected in our ambitions for the future. We carried out a three-month consultation on the content of the draft Healthcare Strategy. There were some strong themes which came from the consultation, for example with respect to supporting carers and improving transport links, and these led to changes to the strategy. A summary of that consultation and its conclusions is described in section 9, and is reflected in significant revisions to the strategy document itself. “Achieving Excellence” summarises our future plans, which will play an important role in improving health and social care alongside - and integrated with - the two Strategic Commissioning Plans for Health and Social Care North Lanarkshire and South Lanarkshire Health and Social Care Partnership. Other key influences on this work are both The National Clinical Strategy for Scotland, and the Health and Social Care Delivery Plan, both published by the Scottish Government in 2016. The key stages to implementing these plans are described in section 7. Our foremost ambition is to ensure we are successful in turning this strategy into positive changes for the communities of Lanarkshire. Finally we would like to thank those who have helped shape the strategy, the people who responded to the consultation, and the many staff involved in developing the workstreams. Mrs Neena Mahal, Chair of Lanarkshire NHS Board Councillor Harry McGuigan, Chair of North Lanarkshire Joint Integration Board Councillor Jackie Burns, Chair of South Lanarkshire Integration Joint Board 2 Achieving Excellence: Healthcare Strategy The Case for Change 1 Foreword 3 1 THE CASE FOR CHANGE Introduction In Scotland, just as in the rest of the developed world, health and social care services are facing a rising tide of demand which is driven by demographic changes, advancing medical science and new technologies, at a time of constrained resources. As people live longer, healthy life expectancy is not advancing at the same pace. This means that we will have more people, many of whom are older, living with multiple long-term conditions and often complex needs, who will be reliant on support and intervention from health and social care services. If we do not change our approach by shifting the balance of care away from acute hospital-focused care to one where there is a greater emphasis on prevention and community-based intervention, then NHS Lanarkshire would need an additional 500 acute hospital beds by 2025 – equivalent to a fourth district general hospital in the county. This is not achievable, affordable or desirable given that the people of Lanarkshire have clearly stated that1, where it is safe to do so, they would like to receive their care at home. These circumstances mean that all public sector services need to adapt and innovate in order to ensure that the highest standards of treatment and care continue to be delivered. Scottish Government has commissioned a number of strategic reviews, including the Christie Commission2; the Healthcare Quality Strategy for Scotland3; Everyone Matters: 2020 Workforce Vision4, the National Clinical Strategy for Scotland (2016)5; the Health and Social Care Delivery Plan6 and the Carers (Scotland) Act to provide a road map to support future public service reforms that ensure safe, effective, person-centred and sustainable services are delivered through a workforce that has the right skills and competencies and is able to achieve the best possible outcomes for our patients. Aim Our aim in Lanarkshire is to develop a healthcare strategy that supports the development of an integrated health and social care system which has a focus on prevention, anticipation and supported self-management. With the appropriate use of health and care services we can ensure that patients are able to stay healthy at home, or in a community setting, as long as possible, with hospital admission only occurring where appropriate. This healthcare strategy is one part of a trilogy of plans, with essential co- dependencies between this and the Joint Strategic Commissioning Plans produced by the North and South Lanarkshire Health and Social Care Partnerships (HSCPs). The Chief Officers of the HSCPs and NHS Lanarkshire are co-authors of this strategy (see section 3 for more information). The plans are based on the assessed needs of our communities and are designed to ensure that the right mix and volume of services are delivered to best meet the changing needs of our population. At the same time as focusing on local priorities, the Lanarkshire healthcare strategy will take full account of the National Clinical Strategy and the Health and Social Care Delivery plan which set out the principles that will underpin clinical service changes across Scotland. Future services, locally and nationally, will have: 4 Achieving Excellence: Healthcare Strategy • system-wide drive for improvement across disease prevention, early professional intervention, supported self-care and improved rehabilitation • primary care with a more prominent role, treating more people without the need to refer to hospital • secondary care organised in ‘centres of excellence’ and networks of hospitals providing specific clinical services (as opposed to all clinical services as at present) thus making best use of skilled staff and specialised facilities and equipment to produce excellent outcomes • a new clinical paradigm which will ensure that patient value is enhanced by proceeding with minimally disruptive, realistic medicine. Lanarkshire Quality Approach NHS Lanarkshire is committed to delivering world-leading, high-quality, innovative health and social care that is person-centred. Our ambition is to be a quality-driven organisation that cares about people (patients, their relatives and carers, and our staff) and is focused on achieving a healthier life for all. Through our commitment to a culture of quality we aim to deliver the highest quality health and care services for the people of Lanarkshire. Our focus on quality is not new, but sometimes it has meant different things to different people. We have therefore developed a Strategic Framework called the Lanarkshire Quality Approach. It will underpin all of the work that the organisation does. It will ensure that the decisions the organisation takes, the services we provide and the way in which in which we do so, align with the values at its core. This means that when we plan and redesign our services, the organisation’s key principles will inform any changes we make. It provides the structure and values to drive healthcare improvements such as those described in this Strategy. People at the Heart of our Approach The Lanarkshire Quality Approach sets out core values and principles and will ensure these reflect our aim to provide assurance to the public, the Board and Ministers that as a quality organisation we demonstrate: • A caring and person-centred ethos that embeds high quality, safe and effective care • That we continually strive to do the best individually and collectively • That we accept individual accountability for delivering a service