TOMORROW’S HEALTH TODAY 2006/2007 - NHS … healthplan.pdf · TOMORROW’S HEALTH TODAY...
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TOMORROW’S HEALTH TODAY 2006/2007
Transcript of TOMORROW’S HEALTH TODAY 2006/2007 - NHS … healthplan.pdf · TOMORROW’S HEALTH TODAY...
TOMORROW’S HEALTH TODAY2006/2007
Contents
The need for change 4
The Grampian response 6
Changing for the better 10
Delivering services locally 26
Planning in partnership 32
Making affordable choices to improve the service 34
Detailed plans and documents 40
The need for
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NHS Grampian is the organisation responsible for leading efforts to improve the health of the people of Grampian, and for providing the NHS health care services which people need. Like every Health Board in Scotland, we are adapting our services to meet the future health needs of our population. The reasons for change have been documented in previous Health Plans1 and include an ageing population, the growth in long-term conditions such as diabetes, improving access to treatment, advances in medical and surgical practice, rising costs and a widening gap in life expectancy between the affluent and the disadvantaged.
We aim to increase our emphasis on improving health through strengthening local preventative services, with more support for self-care, more intensive case management for people with serious long-term conditions, and more capacity for diagnosis and treatment locally. This will enable our acute hospitals to focus on providing complex care, improving access and ensuring the most effective use of skills within the health service.
Evolving model of careGeared towards long-term conditions
Embedded in communities
Team based
Continuous care
Integrated care
Preventive Care
Patient as partner
Self care encouraged and facilitated
Carers supported as partners
High tech
Current View
Geared towards acute conditions
Hospital centred
Doctor dependent
Episodic care
Disjointed care
Reactive care
Patient as passive recipient
Self care infrequent
Carers undervalued
Low tech
The Future Model of Health Care 2
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Healthfit the
Grampianresponse
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In 2002 we began a new approach to developing a way forward for the health service in Grampian, and how we might achieve it. Members of the public were involved with doctors, nurses, other health professionals and managers in thinking about how health services should be improved and developed across Grampian. We have used this method since then and we call it Healthfit3. It is encouraging to see that the results from our Healthfit are the same as the messages in the recent Scottish report, Delivering for Health, so the way forward nationally is consistent with our local thinking.
Healthfit 2010 key targets to deliver change across the system:
Where do we want to be?A service delivered by people for people: the public should be involved at the outset of changes to the pattern of healthcare services. Patients are key partners and should be involved in deciding their own healthcare.
How we will know if we have got there?
• From 2006/07 we aim to involve patients with long-term conditions in structured self-care programmes beginning with Diabetes, Coronary Heart Disease (CHD), Cancer and Mental Health.
• We will set specific targets during 2006/07.
Where do we want to be?Deliver care in local communities wherever possible: treating patients in primary or community settings (GP practices, health centres and community hospitals) will be the preferred choice. Treatments will only take place in specialist acute hospitals (Aberdeen Royal Infirmary, Woodend Hospital, Cornhill and Dr Gray’s) when complex care/facilities are required. Any changes that take place must take account of patient safety, the best clinical standards, availability of the right clinical staff and provide sustainable services.
How we will know if we have got there?
• By 2008 we aim to reduce health inequalities by increasing the rate of improvement for our most deprived communities by 1�% across CHD, cancer, adult smoking, smoking during pregnancy, teenage pregnancy and suicides in young people.
• By 2008 we aim for 2�% of inpatient activity currently undertaken in specialist hospitals to be managed in alternative settings by Community Health Partnerships.
• By 2010 we aim for 40% of overall outpatient activity to be managed in alternative ways through for example Community Health Partnership based services and self-care supported by technology such as telemedicine.
• By 2009 we aim to reduce the proportion of older people (6�+) who are admitted as an emergency inpatient 2 or more times in a single year (baseline 04/0�) by 20%.
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Where do we want to be?Further integrate the NHS (including the contribution of hospitals, general practice teams, social care providers, patients and their carers) to meet the challenges: Community Health Partnerships act as a focus to integrate health and social services at a local level and deliver health improvement for their communities. The focus is on the patient and their journey of care, the system working in partnership rather than separate departments/organisations. Managed Clinical Networks are being strengthened to support the development of integrated services across Grampian, the North of Scotland and nationally.
How we will know if we have got there?
• By 2008 no one will wait more than 6 weeks to be discharged from hospital into a more appropriate care setting. This will be achieved through a �0% year on year reduction.
• By 2010 we aim to replace hospital long stay elderly beds with community based alternatives in partnership with the local authorities, the voluntary and private sectors.
Where do we want to be? Complex specialist care in centres of excellence: Acute hospitals will focus on complex care, improving access and ensuring the most effective use of specialist skills within the health services. More cases will be managed on a day-case basis and in intermediate care facilities. The number of follow-up outpatient appointments will be reduced to create capacity for more new patients to be seen.
How we will know if we have got there?
• By 2010 we aim to have: 8�% of planned surgical admissions on the day of surgery 7�% of all planned activity undertaken on a day case basis
• The average new to follow-up appointment ratio will be 1:1
• Improved admission, discharge and rehabilitation arrangements to reduce length of stay over 4 days by an average of 1 day by 2010.
• We will also aim by 2008 to be at 9�% occupancy of elective (or planned) beds and 80% occupancy for emergency beds.
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Shifting the Balance of Care
With referrals increasing by �0% and queues growing at a rate of 200 per month the Orthopaedic Service participated in the Community Outpatient Pilot. A review of referrals found that 9�% were appropriate, but only 4�% required to be seen by an orthopaedic consultant. As part of the project a physiotherapy-led service was established for Back Pain. This new service reduced referrals to the orthopaedic service by 47%, reduced GP consultations for patients with lower back pain by 38.�% and reduced the waiting time for physiotherapy by 4�%.
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• By the end of December 2007 no patient should have waited longer than: 18 weeks for a first outpatient consultation or between outpatient and admission for any subsequent treatment, 62 days from urgent referral to treatment for all cancers and 16 weeks for treatment if a heart specialist recommends it, 9 weeks for any MRI or CT scan and other key diagnostic tests.
Where do we want to be?Make greater use of technology: to improve the standard and access to care through the use of technology such as the Electronic Patient Record. From 2006 through engagement with other NHS Boards, NHS Grampian will facilitate the establishment of the Scottish Centre for Telehealth.Develop new skills to support local delivery of services: working as a multi-professional team enhancing skills to deliver new roles.
How we will know if we have got there?
• By 2009 increase overall productivity across the health system in Grampian by 1% per annum. Baseline to be established in 2006.
Our vision requires us to work differently if we are to take account of changes that will continue to happen such as advances in technology and an ageing population. Difficult choices must be made; we can only do more of one thing if we do less of another. Therefore this Plan must be seen as a package if we are to deliver services fit for the future within available resources.
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Delivered by people for people
The delivery of the Health Plan has led to an increased emphasis on multi-professional teams working across organisational and professional boundaries. As Doctors within both primary and secondary care concentrate on activities requiring their unique skills, other members of the clinical team are undertaking new roles. We have 99 practitioners with special interest in a range of areas for example dermatology, orthopaedic surgery, minor surgery, cardiology, neurology and ENT. These multi-professional teams have worked together to increase capacity and access to our services.
Changing for the
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Our programme 4 to redesign services is made up of eight projects that we will take forward over the short and medium term. Local frontline clinical teams drawing on the best available learning have developed these projects. They have been designed through the patient’s eyes shifting our focus from isolated episodes of care to a journey of care – one that may last for the rest of the patient’s life if they have a long-term condition. A high quality service is possible only if all members of the team and all elements of the health system work together effectively. These projects should not be viewed as isolated pieces of work, but as a programme of change to deliver our vision of more person centred, accessible, safer and efficient services. Our Community Health Partnerships in Aberdeen City, Aberdeenshire and Moray will take forward these projects in their communities reflecting local need.
3.1 Closing the Health GapHEALTHFIT SAID:There are five national measures of performance � to assess our progress in closing the gap in health status between people who are disadvantaged economically, socially or for other reasons, and those who live in affluent areas. Our local statistics show that health is not improving as fast in our most disadvantaged areas as it is in the most affluent areas 6. So what we call the inequality gap has widened. An example the inequality gap within Aberdeen City is highlighted in table 1 7.
You ToLD uS:
• To provide high profile leadership to focus efforts on the local health improvement priorities of obesity, mental well being, smoking, substance misuse and sexual health identified through the Health Improvement Healthfit 8.
• We should refer to tackling identified health need rather than labelling health inequalities making sure we deliver services to those who need them most.
• The NHS should lead by example for delivering Healthy Working Lives (including Scotland’s Health at Work).
WE WILL:
• Drive the implementation of the health improvement priorities through the Grampian Public Health Network ensuring inclusion in partnership planning and resource allocation processes.
• Undertake a pilot ‘Health Check’ project 9 in the Seaton community to gain a better understanding about the barriers to accessing health services and use the evidence gathered to inform service redesign.
• Take forward the implementation of Scotland’s Health at Work in three areas: the Acute Sector, the Moray Community Health and Social Care Partnership and Corporate Headquarters in addition to supporting local workplaces.
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Average Household Gross Annual Income
£45,751 £20,503
% Below Scottish Average % Above Scottish Average
�3 Incidence of alcohol related/attributable hospital admissions 93
�7 Estimated smokers 40
70 Incidence of teenage pregnancy 136
3 Deaths - Cancer 31
87 Hospital Admissions - Suicide/deliberate self harm 197
92 Children in workless households 7�
64 Adults with no qualifications 32
Table 1 Data: Community Health and Well-being Profile 2004
Scotland’s Health at Work
Scotland’s Health at Work in Grampian has 3�0 registered organisations, giving access to 104,329 employees. This means that 4�% of the working population have the opportunity to improve their health while at work.
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3.2 Self-careHEALTHFIT SAID:People with long-term, chronic health problems are becoming experts in their own conditions. Having the knowledge and skills to help manage their own condition has a very positive effect on people’s quality of life and confidence. Evidence suggests visits to GPs can reduce by 40% for high-risk groups and outpatient visits can be reduced by 17% 10. Above all, complications from chronic diseases reduce. Self-care can apply to us all by looking after ourselves, eating healthily, not smoking, being active, knowing how to care for minor ailments and what to do in an emergency.
You ToLD uS:
• The term self-care continues to mean different things to different people.
• We should start with services for those with long-term conditions and lifestyle and care advice upon discharge.
• To develop self-care in partnership including the voluntary sector and carers.
WE WILL:
• Participate in the national Community Health Partnership self-assessment toolkit for Long Term Conditions (2007) 11 and use the findings to construct an action plan to further improve services.
• Continue to develop and implement programmes of self-care such as Smoking Advice Service 12, cardiac rehabilitation and Dose Adjustment for Normal Eating (DAFNE) training for patients with type 1 Diabetes in Grampian 13.
• Publish our Self-care Strategy, developed in partnership, in 2006.
Helping you to help yourself
The Smoking Advice Service, launched in 2000, provides free face to face support to smokers who want to stop smoking across the region. The service can be accessed using the free phone 0�00 600 332, through community pharmacies and general practitioners or when in hospital. Last year the service supported nearly 6,000 smokers in their attempt to quit through either a six-week group support programme or brief advice.
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3.3 Unscheduled CareHEALTHFIT SAID:Unscheduled care is the term given to health care provided when needed urgently, including emergencies, which can happen at any hour of the day or night. Our aim is to provide a 24-hour rapid and smooth response by a joined up service which involves primary care, hospital services and partner organisations such as the Scottish Ambulance Service, NHS 24, the voluntary sector and with our regional partners. There is plenty of evidence to show that a whole-system approach to unscheduled care can result in a better experience for the patient (and carer), more effective use of staff timeand fewer unnecessary admissions to hospital.
You ToLD uS:
• More public awareness of what advice is available where and the impact of inappropriate use is required.
• To build on the successes of each service (G-MED, Accident and Emergency, Acute Medical Assessment Unit) when we bring these together in the integrated Emergency Centre.
• As part of the redesign we must change the way we currently practice to one that supports an efficient flow of patients through the system, improving the patient and carer experience.
WE WILL:
• Increase our efforts to raise public awareness of how people should use emergency health services.
• Take account of the consultation feedback to revise the outline business case for the new Emergency Centre 14 on the Aberdeen Health Campus and approve by May 2006. The Centre will be ready for occupation during 2008/09.
• Actively participate in the national Unscheduled Care Collaborative 1�.
• Work with the Grampian Integrated Care Group to deliver the challenging delayed discharge targets of a �0% reduction by April 2007 by:
- Proactive management of delayed discharge
- More patients going home with an extensive care package
- Working through Community Health Partnerships to develop step-down or intermediate care facilities
- The Joint Equipment Project – sharing procurement and management of equipment.
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Responding Out-of-Hours
During the 200�/06 festive period two consecutive long weekends, over 7,000 patients contacted our out-of-hours service G-MED. Patients waited less than 30 minutes from attendance to be seen thanks to the flexible working of staff in the services and our partners at NHS 24.
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3.4 Planned CareHEALTHFIT SAID:Planned care includes planned appointments, treatments and operations. As part of re-design across our whole health system, highly specialised acute hospitals will concentrate on providing services or procedures for patients who require those specialist skills or facilities. This will enable us to re-organise services at Aberdeen Royal Infirmary, Woodend and Dr Gray’s hospitals so that we manage patient flows and, eventually, eliminate queues.
Data suggests that up to 40% of planned outpatient activity dealt with in our acute hospitals could, in future, be treated in an alternative way for example Community Health Partnership based services, self-care and telemedicine. With financial support from the Scottish Executive we established Community Outpatient Pilots to further develop this model. The pilots aimed to develop new ways of working to manage demand, improve patient booking, re-shape the workforce through extending professional roles and ultimately to improve the service whilst also reducing waiting times.
By the end of December 2007 no patient should have waited longer than 18 weeks for a first outpatient consultation or for any subsequent treatment, 62 days from urgent referral to treatment for all cancers and 16 weeks for treatment if a heart specialist recommends it.
You ToLD uS:
• In response to Delivering for Health there is a need to assess the impact of the proposed removal of any neurosurgical procedures from Aberdeen in more detail.
• As we ‘release’ beds, we must make sure that these are not filled by increasing emergency admissions due to pressures elsewhere in the system.
• There is a perceived discord between our desire to deliver services in local communities and the need to concentrate some services at a more central location due to forces beyond our control (e.g. clinical standards, not being able to recruit suitably trained people).
Number of out-patients waiting over 18 weeksGrampian
4,000
3,�00
3,000
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2,000
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0April0�
May0�
June0�
July0�
August0�
Sept0�
March06
April06
June06
June06
Sept06
Dec06
March07
June07
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Actual
Planned Trajectory
Table 2 Faster Access
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WE WILL:
• Participate fully in further debate on the future provision of neurosurgery in Scotland. NHS Grampian believes that neurosurgery should be planned centrally, delivered in a combination of a highly specialised centres and a number of local units, one of which should be in Aberdeen 17.
• Build on our success of achieving the interim December 200� waiting time targets agreed with the National Waiting Times Unit by producing a cost-effective demand and capacity plan for all services covering the period up to 2008.
• Improve efficiency of Acute Services by:
– Taking forward four of the Ten High Impact Changes 18:
Increasing the number of people who are treated as day cases (target 7�% currently 49%)
Avoiding unnecessary follow-ups for patients (new to follow-up ratio)
Reducing the length of stay in hospital
Improving our management of waiting lists by using best practice on managing ‘queues’, for example, referring patients to a speciality instead of a named consultant.
– Achieving 80% of our services in the top quartile for performance compared to other UK specialist centres. We call this Best in Class19.
• Roll out best practice from the Community Outpatients pilots in ENT, Orthopaedics, plastic surgery, dermatology and neurology 20,21,22,23,24.
• Publish and implement our Healthcare Associated Infection Strategy2� building on the success of the cleanliness champions programme, ‘Wash your Hands’ awareness activities with staff, patients and visitors and decontamination plan 26.
• Implement the national cleaning specification and associated monitoring framework.
ENT project
To provide a more equitable service across the region and to make best use of clinical time the ENT project developed an intermediate care approach to service delivery. Those requiring specialist treatment were referred to the specialist service others were treated by an appropriately trained professional - GPs with special interest in ENT, nurse specialists and speech and language therapists. A fully equipped service was established in Stonehaven providing over 600 appointments in the community in consultant and nurse – led clinics. Through the project the waiting time reduced from 63 weeks in some areas to no patients waiting more than 26 weeks. Following the success of the pilot project, investment in equipment has enabled this service to be provided in community clinics in areas of high need across the region.
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3.� Intermediate CareHEALTHFIT SAID:After careful consideration of the needs of the patient, evidence of good practice and the opportunities afforded by the new contractual arrangements within NHS Grampian, we are developing a new approach to care with clinicians, patients and others. We call this intermediate care. This is because the aim is to provide enhanced services in the community for patients who require more support than is normally provided at GP practice level, but who do not require the specialist services of the acute hospitals.
We undertook an assessment of the number of patients currently occupying an acute care bed, who could be cared for in an alternative setting. This Intermediate Care Audit27 identified that a minimum of 2�% of patients could be cared for in an alternative setting such as home care with support or a nurse or GP led facility.
You ToLD uS:
• There is support for redesign of services in Aberdeenshire to improve local diagnostic facilities and services for older people, however there is a need to demonstrate how the closure of midwife led delivery units would improve antenatal and postnatal care28.
• You support the findings of the Intermediate Care Audit and we should undertake an audit with in our 19 community hospitals in Grampian.
• To think creatively about the use of facilities not owned by the NHS in the community from which to deliver intermediate care.
WE WILL:
• Use the findings of the Intermediate Care Audit to enable a shift of 2�% of in-patient activity from acute hospitals to community based services managed by the Community Health Partnerships.
• By March 2007 complete an Intermediate Care Audit in our 19 Community Hospitals.
• Reinvest resources released by having fewer hospital beds into intermediate and community care services.
• During 2006, relocate the Aberdeen specialist Geriatric Assessment Unit to Aberdeen Royal Infirmary aligning more closely with other medical specialities.
• Create capacity for Aberdeen City Community Health Partnership to develop intermediate care services on the Woodend site.
• Work with the Regional Transport Partnership to develop a transport strategy which supports our change programme.
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Transporting Patients 33
Making sure patients can get to their appointments on time has become even more complex with the increasing number of clinics in community locations. Last year, over 200,000 patients arrived at their destination using the Patient Transport Service. Our data suggests that 1 in 3 of these patients could have travelled unassisted or by car. We also know that improving public transport and car parking is a must. Our transport partnership will work with the developing regional transport partnerships NESTRANS, HITRANS to tackle this issue in the coming year.
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Working Smarter
The Dermatology service as part of the Community Outpatient Pilot sought to change the way they delivered their service to ensure patients were seen faster, by an appropriately qualified practitioner, in an appropriate location and at a time when their skin condition required intervention. The team became more multi-disciplinary with nurse practitioners and GPs with special interest. Nurse practitioners supported self-care through patient education programmes. A telephone helpline was established for patients and professionals. Patients can re-refer themselves to the service through the helpline. Of those using the helpline 6�% required telephone advice only. The remainder were fast tracked to a nurse or consultant depending on the nature of their condition. The project has reduced waiting times in Aberdeen from 66 to 6 weeks. One patient with chronic eczema previously had 3-4 admissions to hospital per year. With the new service and more timely intervention this patient has had no admissions this year.Info
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3.6 Developing Clinical InfrastructureHEALTHFIT SAID:If we are to shift the balance of care into the community, and at the same time ensure clinical quality of our services, we must invest in the technology and systems which support this such as the electronic health record, picture archiving and communications Systems and mobile diagnostic facilities. We know we can reduce the need for tests by removing duplication from the system. Patients are then less likely to be admitted to hospital for tests alone, waiting times are shorter, and patients have more choice about when and where they have their appointments.
You ToLD uS:
• There is a need to increase investment in Information Technology, but this investment must be matched with a change in culture if we are to improve information/intelligence to inform planning of future services and delivery of existing ones.
• You support the implementation of the electronic patient record (2007/10) and roll out of picture archiving and communications systems (2007/08).
• To share our actions to safeguard patient safety.
WE WILL:
• Increase the range of locally available diagnostic services and achieve diagnostic waiting time commitments by active participation in the North of Scotland Diagnostic Network and, subject to a successful bid, the Centre for Change and Innovation Collaborative Diagnostics programme 29.
• Install two new Cardiac Catheter Laboratories in Aberdeen Royal Infirmary by the end of 2006
• Lead the establishment from 2006 of the Scottish Centre for Telehealth.
• Develop an efficient and effective IT system for primary care to improve communication between general practice and hospitals and to provide robust information for planning of services.
• Work with our Business Partnership to review and revise our E-health Strategy 30.
• By May 2006 publish our Patient Safety Strategy 31.
Timed Period
Grampian Planned Trajectory Scotland
Maximum Radiology waiting times: CT scan Grampian vs Scotland
2�
20
1�
10
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0April0�
May0�
June0�
July0�
August0�
Sept0�
Oct0�
Nov0�
Dec0�
Jan06
Feb06
March06
April06
May06
March09
April09
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(wee
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Improving Technology
NHS Grampian has been awarded national funding to replace the Positron Emission Tomography (PET) imager enabling state of the art tracking and treating of cancer. The equipment will be replaced by March 2006 in Aberdeen enabling Grampian to continue to provide a PET service for the whole of Scotland for the next 18 months.
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3.7 Aberdeen Health Campus DevelopmentHEALTHFIT SAID:Work has been going on to look at the health facilities and services which are located in Aberdeen, but which act as a regional centre for specialist and trauma services and to date have provided intermediate care services for Aberdeen and to a lesser extent Aberdeenshire. We know that there will need to be some change and modernisation if we are to provide reasonable access to quality and affordable premises to support the delivery of modern health and social care throughout Grampian and the North of Scotland.
You ToLD uS:
• In some areas our on-going maintenance expenditure has not kept pace with deterioration of the building fabric giving some staff, patients and visitors an impression of poor cleanliness standards and poor care.
• Car parking on the Foresterhill Site remains problematic.
• You welcome the plans to develop a blueprint for the long-term reconfiguration of Aberdeen Royal Infirmary.
WE WILL:
• By June 2006 agree a ten-year plan for Aberdeen hospital sites (Woodend, City, Woolmanhill/Denburn and Foresterhill and Cornhill).
• Commence implementation of the blueprint for Aberdeen Royal Infirmary32 to develop the hospital as a specialist acute treatment and care facility.
• By September 2006 complete the development of the Dental undergraduate and postgraduate facilities.
• By 2008/09 in partnership with the University of Aberdeen complete the Matthew Hay project32 to provide high quality teaching and learning facilities.
• By end of 2008 improve the amenity of the Foresterhill site by the provision of a patient hotel, car parking, leisure and retail facilities.
• Continue to prioritise investment in our buildings to minimise risks and ensure refurbishment of older buildings proceeds in tandem with service plans.
Improving Oral Health 32
NHS Dental services in Grampian are experiencing severe pressure due to the reduction in available places throughout the region. As part of the package of measures to improve oral health we are building a new Aberdeen Dental Institute on the Health Campus. Opening in September 2006, the centre will house eight final year students from Dundee Dental School and provide 4 additional surgeries for NHS treatment. We hope the students will choose to stay and work with us once qualified.
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Future development on Foresterhill site
1. David Anderson Building 2. Patient/Staff Accomodation and Leisure Facilities 3. Car Parking 4. Retail, NHS Office Accommodation �. Matthew Hay Teaching and Learning Facility 6. MRI/Catheter Labs 7. Aberdeen Dental Centre
8. Life Sciences 9. Car Parking 10. Foresterhill Health Centre 11. Emergency Care Centre 12. Laundry, SSD, Facilities, Transport, Waste 13. Space for future development 14. New Primary Care Centre
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3.8 Workforce DevelopmentHEALTHFIT SAID:We will develop new roles for staff, recognising the need to make best use of existing skills, and the scarcity of other skills. We will extend and support the contribution that nurses, pharmacists, physiotherapists (to name a few) can make to treatment and care. This may mean that you will see an appropriate practitioner rather than a doctor when you receive treatment and care. We will involve the education and training organisations in Grampian and the North of Scotland in supporting these new ways of working.
You ToLD uS:
• Members of the public have accepted the change from always seeing a doctor to being treated by a nurse or other trained health care professional.
• That we must ensure existing staff are given the time and support to develop the required new skills and to maintain these skills.
• Technology can help address the shortage in available workforce.
WE WILL:
• Continue our programme to train practitioners with special interest with skills in long-term conditions and services with demanding waiting time targets such as orthopaedics, minor surgery and emergency medicine.
• Achieve service benefits from the national NHS pay modernisation programme 34.
• As part of the national programme, complete a nursing workload and workforce project addressing the under and over staffing levels between specialities using the information gathered during this project 3�.
• Complete the staff survey to gather data to support this Plan.
• Explore the development of new roles such as Physician Assistants 36, Rehabilitation Assistants.
• Implement the Organisational Development Plan37 to support the implementation of this Health Plan.
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Working together
The new General Opthalmic Service comes into force from 1st April 2006. This ensures an NHS eye examination for all those who require it. Optometrists are now able to examine, on the NHS, for a wide range of conditions, such as sore or red eyes. GPs and pharmacists will be encouraged to direct all eye-related problems to a local optometrist where thorough examination with specialist equipment will be available. Optometrists will become the primary contact for all eye related problems and with the help of GPs and local pharmacists will ensure, prompt and appropriate treatment which will result in many conditions being treated in the community rather than having to attend hospital eye clinics. This multi-professional approach will improve access to services for those with visual problems.
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NHS Grampian has established three Community Health Partnerships (CHPS) – Moray, Aberdeenshire and Aberdeen City – to work with local authorities and other partner organisations, communities, voluntary sector and other parts of the NHS. The Community Health Partnerships will work to improve health and reduce inequalities, join up health service planning for their population, and deliver community health and care services. The Community Health Partnerships will play a central role in re-designing and developing services across the health system and will support the development of General Medical Services within their patch. Responding to locally identified needs the CHPs will take forward the following programmes:
Moray Community Health and Social Care PartnershipBrings together Dr Gray’s Hospital (acute) and community- based health services with social services through a unique partnership with The Moray Council. Work includes 38:
The unscheduled care network continues to strengthen the multi-disciplinary response to patients who need help out of hours through the Emergency Care Centre and Virtual Medical Ward. We will undertake an evaluation of the service reporting back in summer 2006. The three-year Hospital at Night project 39 commenced in 200� is building multi-disciplinary teams to deal with unplanned clinical emergencies that arise in Dr Gray’s. In Moray these teams treat patients in the hospital and community settings.
For Planned Care work has been completed to quantify needs, the current provision, the volume of activity required for clinically safe services and forecasted usage. To maintain services and training opportunities Dr Gray’s must become part of a managed clinical network for the North-east. Priorities include diagnostic and treatment services,ENT, cardiology, paediatrics and obstetrics.
To provide intermediate care a ‘virtual’ medical ward and care home network across hospital and care home sectors has been established managing health and social care beds as one system. This has allowed more patients to be treated, shortened hospital stays and increased the number of patients who are treated as day cases. The collaborative has developed operational policies to ensure patients see the appropriate professional in an appropriate setting and have developed supported care to enable patients to make the transition from hospital to home. During 2006 the network will be reviewed and a new joint agreement developed between the partners.
Access to dental health care remains a challenge across the region but particularly in Moray. By September 2006 we will extend dental practices in Elgin and Buckie with a further increase in capacity in Elgin and Lossiemouth planned for 2007. By March 2008 we will also have extended our Community Dental Service provision in Elgin, Buckie and Keith 40.
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Aberdeenshire Community Health PartnershipThis geographically spread Community Health Partnership (which covers the three areas of South, Central and North Aberdeenshire) has undertaken extensive public and partner consultation on plans for three interconnected areas of service redesign – Older Peoples Services, Diagnostic and Treatment Services and Maternity Services. Focus groups, 13 public meetings, a Citizens panel questionnaire and partner and staff engagement has shaped the final plan which can be summarised as follows 41:
Redesign of Maternity Services will include the enhancement of community based home birth, antenatal and postnatal care across Aberdeenshire including 24-hour advice and support providing a consistent service across the CHP.
We will increase our public health programme for mothers, for example by supporting those who wish to stop smoking, those who suffer domestic abuse or those who need extra help to establish breastfeeding.
We will also provide flexible, local access to postnatal beds for mothers who require medical care once they have given birth to their baby.
The redesign of midwife led delivery units is necessary because of the falling number of births in the area in recent years, a changing approach to risk assessment, and the fact that 88% of women have their baby in specialist Maternity Units in Aberdeen and Elgin. This has resulted in one of the midwife led units delivering two babies per week at most. The remaining units deliver approximately 1 baby per week. These units require to be fully staffed twenty four hours a day and it is difficult for staff to maintain their skills, giving rise to recruitment and retention problems.
We recognise the strength of public feeling to retain rural midwife led units and we considered a range of options. After careful consideration of the options, patient safety and different viewpoints, the CHP proposes to try to increase the number of deliveries at a redesigned North Aberdeenshire midwife led maternity service based in Peterhead (to 1�0 per year by 2008) to make it sustainable in the longer-term. The CHP has recommended to the NHS Grampian Board that the Huntly Unit remains closed and that deliveries or intra partum care is ceased at Aboyne, Banff and Fraserburgh Units.To enhance community based home birth, antenatal and postnatal care some staff from these Units will be redeployed.
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Prior to taking a final decision we will be working with the Scottish Health Council during April and May to review the consultation process and take any further action required to complete the process. A further report and recommendations will be presented to the NHS Grampian Board in June 2006 and to the Minister for Health and Community Care thereafter.
Implementation of the older People’s Strategy 42 with continued shift from long-stay hospital care to community based support, rehabilitation at home and in hospitals and preventative services, developed in partnership with Aberdeenshire Council, private and voluntary organisations. The development of these community-based services will result in the planned closure of long-stay beds. This includes the closure of Campbell Hospital in Portsoy and Maud Hospital. A new hospital and health centre will be developed at Banff (2010). It is proposed as part of the package of redesign to move the psychogeriatric services from Maud to Fraserburgh Hospital and develop a Community Health Resource Centre and an enhanced community-based ‘housing with care’ facility for older people in Central Buchan. This will be progressed in partnership with Communities Scotland and Aberdeenshire Council. Elsewhere, there will be a shift from hospital to community based care and from long-stay hospital care to rehabilitation beds that enable us to respond to the request by older people to be supported in their own homes.
Diagnostic and Treatment Services increase the range of, and give equal access to, services delivered locally by practitioners with special interest, as part of the development of intermediate care. Ten community hospitals will act as a network to gradually increase the range of services provided in North Central and South. A number of services have already been developed with services such as ultrasound scanning, endoscopy, cardiac assessment clinics and oral chemotherapy planned in the next three years.
The above three elements of the Aberdeenshire Change and Innovation Plan are interdependent and must be considered as a package in order to deliver a realignment of activity to meet the strategic objectives of this Plan and ensure effective healthcare delivery across Aberdeenshire.
Mental Health and Well-being
As a result of careful planning and preparation, the Mental Health Act44 has been successfully implemented in Grampian and as a result has significantly improved the lives of people with mental health problems and their carers. For example, with funding from the Centre for Change and Innovation, three Primary Care Mental Health Workers4� were appointed to provide rapid initial assessment and a brief intervention service for patients with mild/moderate depression. Depression is the most common reason for GP consultation in Scotland with 9�% of people with a depressive illness seen in Primary Care. Patient feedback has been very positive ‘ being able to talk at length about my problems was very therapeutic, GPs don’t have time to do this and I don’t talk to friends and family about my problems’.
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Aberdeen City Community Health PartnershipDue to being close at hand, and the need for efficiency in the delivery of services, the Aberdeen City CHP has a more integrated relationship with the Aberdeen hospitals that form the Acute Sector. This means that several of the key priorities for the CHP 43 involve the Acute Sector.
Closing the Health Gap: the health experience of some communities is significantly worse than others with the rate of illness two or three times greater than the City average. Implementation of the Joint Health Improvement Plan through the Community Planning Partnership has commenced. The focus is on the Healthfit priorities in particular mental health and obesity and will be delivered through for example the Middlefield Healthy Hoose.
For Planned Care the CHP has identified four priority areas in which to improve knowledge, skills and access to diagnostics for the wider primary care team. These include rolling out the successful physiotherapy led lower back pain service, a podiatry led foot and ankle triage service, quantification of current provision of minor surgery in general practice and assessment of need, participation in the referral management project and implementation of the Diabetic Clinical Accord.
Implementation of the older Peoples’ Strategy with its partner organisations, the CHP will continue to modernise and develop services for older people as part of the development of intermediate care. This will include the advancement of the joint future integration of services, redevelopment of Tor-na-dee site and increasing provision of ‘housing with care’. To support the development of intermediate care facilities in Aberdeen the CHP will, using the Links Unit model, develop nurse/GP led intermediate care in Woodend Hospital following the move of the Aberdeen specialist Geriatric Assessment Unit to Aberdeen Royal Infirmary.
Infrastructure Development: support the development of facilities to deliver appropriate services for special interest groups including people with drug problems (Integrated Drug Centre 2008), homeless people (Homeless Centre 2006) and sexual health facilities (2008).
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Developing anticipatory care
The Seaton Health Check project seeks to identify, through the community health worker, people who may be failing to access health services and to offer ‘health checks’ in their homes. Data indicates that whilst deaths from cancer are 37% above the Scottish average, admissions to hospital for cancer are 10% below the Scottish average suggesting a failure to access health services. With support from Pfizer Foundation this pilot project aims to support over 880 people aged 16 to 70 years to access appropriate prevention and treatment services.
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We know that life in the NHS can be pressurised, busy and often exhausting. We know that the case for change is compelling. We need to stand back and think about how to do things differently, to build on our successes and learn lessons from elsewhere. We must plan change as a whole health system. This takes time and the following highlights three of our projects that are currently in early development and which will feature more prominently in future Health Plans.
Development of Primary Care: In collaboration with the two universities in Aberdeen we will take a long-term review of primary care services, looking at the effect of the forecast population changes and workforce shortages. The aim is to plan to provide as many services in primary care as is safe and effective, ensuring that they are sustainable, and that they respond to the needs of patients. We will consider for example the potential of the new pharmacy contract, the roll out of the Middlefield ‘Healthy Hoose’ concept, in which a range of services are available on a ‘walk-in’ basis for the local community and the impact of new professional roles and commuting/patient choice on location of services.
Managed Clinical Networks are defined as a linked group of professionals and organisations working in a co-ordinated manner, unconstrained by existing professional and NHS Board boundaries, to ensure equitable provision of high quality clinically effective services. Networks have been established around certain conditions such as diabetes, or programmes of care such as Accident and Emergency telemedicine, on a regional basis such as for cancer and nationally such as neurosurgery. The networks have made significant progress in the improvement of service delivery. It is time to take stock in light of the service redesign, to clarify the role of the networks, the performance review and governance arrangements and the areas that would deliver greatest benefits from this approach.
Regional PlanningAbout 3% of hospital activity in Grampian is for the treatment of people who do not live in Grampian. In addition some Grampian residents are treated outside the area for more specialist services. We include organisations across Scotland in our planning process, in particular our neighbouring boards. The six northern NHS Boards (Western Isles, Highland, Orkney, Shetland, Tayside and Grampian) have developed a regional plan 46 identifying areas where there are benefits working beyond NHS boundaries e.g. some of our services are only sustainable if provided on a regional basis. Priorities for the group include the development of a Medium Secure Unit for the North 47, Diagnostics and Imaging, remote and rural health, maternal and child health and workforce planning and redesign.
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6.1 Getting the Right Balance
This plan sets out priorities for change to improve services and the anticipated benefits for our population. It is impossible to reflect the full range of work and operational activity that happens routinely throughout NHS Grampian. We have agreed corporate objectives (Table 1) with performance targets for the change and innovation programme (in blue) and operational delivery 48. We use these to assess our performance across the health system providing regular reports to NHS Grampian Board.
NHS Scotland recently introduced the requirement for NHS Boards to agree a Local Delivery Plan (LDP) 49 with the Scottish Executive Health Department. This records planned improvements in performance against 32 performance measures over a 3-year period. The measures are the same for all NHS Boards and performance will be tracked on a regular basis with an Annual Review of progress taking place each year in public. The LDP performance measures have been incorporated into the NHS Grampian targets as set out in our Corporate Scorecard 48.
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Table 1
Perspective Corporate objective
Improving Health To maximise improvements in health status and outcomes
Implement agreed health improvement priorities To develop all parts of NHS Grampian and its Partners as Public Health OrganisationsReduce Health Inequalities in Priority AreasProtect the population from hazards which damage their health
Financial To achieve strong and sustainable financial performance
Meet financial targetsMeet revenue efficiency targets Redistribute resource in line with Health Plan
Service Delivery And organisation To achieve delivery of effectivehealthcare, promote innovation and improve quality
Co-ordinate approach to 24 hour unscheduled careImprove access to planned healthcare Develop a range of intermediate care services to deliver treatment for patients who do not require the specialist services of acute hospitalsDevelop integrated health and social care to shift balance from hospital to communityMeet appropriate clinical standards and ensure patient safetyProvide modern infrastructure to support clinical servicesSupport and influence development of national and regional approaches to service planning and delivery
PeopleTo involve the public and partners and meet their needs
Ensure that the public is involved, engaged and consulted in service planning and deliveryDevelop effective joint working with partnersPromote and encourage self-careImprove Customer Satisfaction
Learning & Growth To equip the organisation with the knowledge and skills to deliver the strategy
Ensure Effective Staff Involvement to achieve a healthy and positive work experience for StaffEnsure right numbers of staff with right skills, in right placePromote the development of a flexible, creative, learning organisation
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6.2 Listening to our CommunitiesGetting feedback from patients, communities and partners helps us to continually improve what we do. Last year 99.�% of patients were happy with the service they received with 0.�% (or 1,88�) of patients making a complaint about an aspect of the service. Recent consultation events highlighted areas where some of you thought we could do better. These included:
GP Services: 7�% of our general practices achieve 90% of the maximum points in the Quality and Outcomes Framework �0 for general medical services. Five practices achieved maximum points. The feedback you gave us about the care you received was also positive. All our practices achieve the national performance target for anyone contacting their GP surgery to have guaranteed access to a GP, nurse or other health care professional within 48 hours. However you expressed concern about the system in some practices of only releasing appointments in the morning for patients who want to be seen urgently and this is felt to be unsatisfactory as it is difficult to get through by phone and when you do appointments are often fully booked. Our Director of Primary Care is reviewing this situation.
Inpatient/Outpatient Services: feedback received about the care from hospital based staff was positive overall. You highlighted two common themes transport and maternity services. We have signalled our commitment to address in partnership the transport issues including car parking at our larger hospital sites. We undertook a review of cleanliness and environmental standards at Aberdeen Maternity Hospital (AMH). The number of complaints (five) and failure rate for monitoring checks (7.91%) for AMH over the last year is marginally higher than for the Foresterhill site, but not significantly so. The review concluded that the main problem is fabric and decoration rather than cleanliness �1. A prioritised investment programme is underway to improve the environment.
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6.3 Within available resourcesHealthfit is a dynamic long-term process and we will not achieve our plans for service change overnight. NHS Grampian spends £760 million on health in Grampian and independent reviews demonstrate that we have a good track record of providing high-quality services and for making best use of our money. However, year on year the people of Grampian have growing expectations of their health and health care services. In previous years to enable us to meet these expectations one off sources of funding allowed about 9% more services to be provided than our budget from the Scottish Executive would permit. But this cannot continue and we have:
• Embarked on a process to prioritise the services we provide - Healthfit
• Put in place mechanisms to manage the financial impact of issues that we have no direct control over for example new technologies, changes in working practices – five year financial strategy �2
• Strengthened our financial controls to ensure services are delivered efficiently and within budget – financial recovery plan �3
This year we received £40 million more than we did last year. We know that we will need this extra money to pay for the cost of the national pay award for all staff, to cover increased costs of drugs and medical supplies prescribed on the NHS and the cost of providing high quality primary care services. Any investment required to change services and infrastructure must therefore be from within available resources - staff, facilities and money. Difficult choices will have to be made — choosing to develop some services and not others. It requires us to continue to develop ways that we work with the people we serve — giving you the chance to influence and to contribute to change - working together to deliver tomorrow’s health today.
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Financial Balance
To ensure our spend matches our income we must reduce our spend by 2.6% or £20 million.
Making best use of resources
We are working with other NHS organisations in Scotland to negotiate the best price for goods and services through national procurement, part of the Efficient Government Programme. In the first year of operation NHS Grampian has saved £800k on purchasing supplies. This will increase to some £2.� million over the next two years. Further reductions in our costs will result from the National Shared Services Project, designed to centralise support services that can be delivered even more cost effectively on a national basis such as payroll and finance.
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Actualspend
Actualbudget
£ 760m
£ 740m
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The following documents give greater detail about the actions set out in this Health Plan. You can read them by going to the website www.nhs.grampian.org Alternatively you can contact the Healthpoint, details of which are on page 42.
1. Healthfit Tomorrow’s Health Today, NHS Grampian, June 200�2. Delivering for Health, Scottish Executive, November 200� www.scotland.gov.uk3. Healthfit Report, NHS Grampian, April 20024. Change and Innovation Programme Plan, NHS Grampian, March 2006 Part 1 Part 2�. NHS Scotland, Performance Assessment Framework www.scotland.gov.uk6. Annual Report of the Director of Public Health 2004/0�, NHS Grampian, January 2006 7. Aberdeen City 200�-08 Joint Health Improvement Plan, The Aberdeen City Alliance, 200�8. Health Improvement Healthfit A progress report of the Health Improvement Healthfit programme including a conference report 2004, NHS Grampian, March 200�9. Seaton Health Check Project, Pfizer UK Foundation Application, NHS Grampian 200�10. Self Care – a real choice: Self Care support – a practical option, Department of Health, 200� www.dh.gov.uk11. Long Term Conditions: CHP Self-assessment Toolkit, Scottish Executive Health Department January 2006 (in development)12. Grampian Tobacco Control Strategy and Action Plan 200�, Public Health Unit, NHS Grampian, 200�13. DAFNE (Dose Adjustment for Normal Eating) training for patients with type 1 diabetes in Grampian Business Case, NHS Grampian, January 200614. Emergency Care Centre, Outline Business Case, NHS Grampian, February 20061�. An introduction to the Unscheduled Care Collaborative Programme, Scottish Executive, February 200�16. Annual Report 2004-0�, Joint Agency Resource Group, Moray Health and Social Care System, 200�17. Position Statement – Neurosurgery, NHS Grampian, March 200618. The 10 High Impact Changes for Service Improvement and Delivery. NHS Modernisation Agency, 2004 www.dh.gov.uk19. Acute Sector Outline Project Initiation Document, NHS Grampian, November 200�20. Redesigning Ear Nose and Throat Outpatient Services in Grampian Project Evaluation, NHS Grampian, February 2006
Detailed plans and
documents
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21. Physiotherapy-led Back Pain Service, Aberdeen City Community Health Partnership, NHS Grampian 200�22. Orthopaedic Outpatient Pilot, NHS Grampian, 200623. Skin Action Scotland, NHS Grampian Project Evaluation, January 200624. Redesigning Neurology Outpatient Services in Grampian, a Plan for the Future, A nine month progress report, December 200�2�. Healthcare Associated Infection Strategy, NHS Grampian, April 2006 26. NHS Grampian Decontamination Plan and Progress Report. Appendices27. Intermediate Care Audit, An assessment of the number of patients, currently occupying an acute care bed, that could be cared for in an alternative setting, NHS Grampian, September 200�.28. Aberdeenshire Community Health Partnership Change and Innovation Plan, NHS Grampian, April 2006 (in development)29. Diagnostics Collaborative Programme, NHS Grampian submission, March 200630. E-health/IM&T strategy for Grampian 2004-2008, NHS Grampian 200431. Patient Safety Strategy, NHS Grampian, May 200632. Implementing Healthfit, Health Campus Development Programme Initial Agreement, NHS Grampian, January 2006 33. Analysis of Transport Issues in Supporting Access to Development of Health Care Services within Grampian, NHS Grampian. (in development)34. Pay Modernisation Benefits Delivery Plan and Progress Report, NHS Grampian March 20063�. Workforce and Workload Project, NHS Grampian, November 200�36. Pilot Project on the use of Physician Assistants in NHS Scotland, NHS Grampian bids, February 200637. Board Organisational Development Plan 2006-08, NHS Grampian, March 200638. Moray 20/20, The Moray Health and Social Care Partnership Project Initiation Document, NHS Grampian, March 2006 39. The Implementation and impact of Hospital at Night pilot projects, Department of Health, August 200� 40. Dental Services Fact Sheet, NHS Grampian, January 200641. Aberdeenshire Community Health Partnership Outline Project Initiation Document, NHS Grampian 200642. Ageing with Confidence, a Joint Strategy for Older People in Grampian, December 200143. Aberdeen City Community Health Partnership Outline Project Initiation Document, NHS Grampian 200644. Mental Health Act (Care and Treatment) (Scotland) 2003.4�. Doing Well by People with Depression, Aberdeen City Community Health Partnership, February 200646. North of Scotland Planning Group Workplan 200�/06, North of Scotland Planning Group, 200� 47. Integrated Development of North of Scotland Regional Medium Secure and Tayside Low Secure Services, North of Scotland Planning Group, April 200648. Corporate Balanced Performance Framework, NHS Grampian, March 2006. 49. Local Delivery Plan, NHS Grampian, March 2006.�0. Quality Outcome Framework �1. Aberdeen Maternity Hospital – Cleanliness/environmental standards, NHS Grampian, October 200��2. Five Year Financial Strategy, NHS Grampian, 2006. Part 1 Part 2 �3. NHS Grampian Financial Recovery Plan 2006 - 2009, NHS Grampian, 2006
Design Corporate Graphic Design, NHS Grampian
Photography Department of Medical Illustration, University of Aberdeen Corporate Communications, NHS Grampian Aberdeenshire Council
© NHS Grampian 2006
If you would like:
• More information on specific issues and initiatives
• Copies of other documents referred to in the Plan
• This Plan in an alternative format e.g. large type, audio
• To give us your views
OR further information on
• improving health
• health conditions and procedures
• sources of support
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Please contact:
Healthpoint
Visit or Mail : Aberdeen Indoor Market 239 High Street Aberdeen Elgin AB11 �NX IV30 1DJ
Telephone: 0500 202030
E-Mail: [email protected] www.nhsgrampian.org.uk
If you need this, or any other NHS Grampian publication in an alternative format (large print, audio tape etc) or in another language please contact Corporate Communications: Telephone: 01224 ��4400email: [email protected]
Please ask for publication CGD 060168
