Foreword from the Chair and Chief Executive (to be drafted) Who we are and what we do (drafted)

Appendix 1: Healthcare Improvement Scotland Draft Content for Annual Report 2010 2011 15 August 2011 Contents Foreword from the Chair and Chief Executive (to be drafted) Who we are and what we do (drafted) Our work Evidence (drafted) - SIGN application - Obesity - Stroke rehabilitation Improvement (drafted) - Scottish Patient Safety Programme - Intensive Psychiatric Care Units - Neurological services Scrutiny (drafted) - Endoscopy services - Healthcare Environment inspectorate (HEI) - Participation Standard Involving the public (including a progress report on the Scottish Health Council) (drafted) Appendices (to be drafted) - Board membership - Finances - Our outputs - About our publications Produced by: KM Page 1 of 15

Who we are and what we do Our vision To deliver excellence in improving the quality of the care and experience of every person in Scotland every time they access healthcare. Who we are Healthcare Improvement Scotland was set up on 1 April 2011 as a national health body that supports healthcare providers in Scotland to: deliver high quality, evidence-based, safe, effective and person-centred care, and scrutinise services to provide public assurance about the quality and safety of that care. We took over the responsibilities of NHS Quality Improvement Scotland (NHS QIS) and our organisation includes the Healthcare Environment Inspectorate, Scottish Intercollegiate Guidelines Network, the Scottish Health Council, the Scottish Medicines Consortium and the Scottish Health Technologies Group. We also take a lead role in co-ordinating the work of the Scottish Patient Safety Programme. In addition, Healthcare Improvement Scotland has responsibility for the regulation of independent healthcare services in Scotland, previously the responsibility of the Care Commission. What we do Our work programme supports Scottish Government priorities, in particular those arising from the Healthcare Quality Strategy for NHSScotland. Our work encompasses all three areas of the integrated cycle of improvement (below) with patient focus and public involvement at the heart of all that we do. Produced by: KM Page 2 of 15

Our strategic objectives We have four strategic objectives. These are to: support innovation and improvement in the delivery of high quality healthcare planned and designed with the patients, their families and the public at the centre of everything we do provide assurance of the safety and quality of healthcare services to the people who use them and to the public in Scotland through risk-based proportionate scrutiny of those services provide authoritative, evidence-based advice and guidance on high quality treatment and care, and best practice in public engagement, and influence national policies to improve the quality of healthcare. Our Annual Report 2010-2011 This document reports on both the activity of our predecessor organisation NHS Quality Improvement Scotland during 1 April 2010 to 31 March 2011 and how Healthcare Improvement Scotland has taken this work forward. The report highlights examples of work under the headings of the integrated cycle of improvement: Evidence Improvement Scrutiny. A comprehensive list of what was produced during 2010-2011 is included at the back of this report. Produced by: KM Page 3 of 15

* Reference to annual review/annual review letter to be included * Produced by: KM Page 4 of 15

Evidence We develop evidence-based advice, guidance and standards to support improvements in the quality of healthcare people receive. Working with national and international experts, we identify, develop and share evidence for improvement. This evidence is available to healthcare professionals to support them in providing safe and effective care, and to the public to inform them of the quality of care they can expect to receive. We also assess new technologies in healthcare through the Scottish Health Technologies Group, and the clinical and cost effectiveness of newly licensed medicines through the Scottish Medicines Consortium. Our approach ensures that our work is based on the best available evidence. For example, the national clinical standards we develop are informed by Scottish Intercollegiate Guidelines Network (SIGN) guidelines and may also draw on evidence notes (short summaries we produce of the published clinical and/or cost-effectiveness for a particular technology, device or service organisation), health technology assessments and systematic reviews, as well as sources such as National Institute for Health and Clinical Excellence (NICE) guidelines. Following publication of our standards, we continue to work with NHS boards, the independent healthcare sector and voluntary organisations to support their implementation. Some examples of work in 2010-2011 include: SIGN application SIGN developed a groundbreaking application (app) for smartphones and tablet computers. The free app provides a quick and easy way of accessing SIGN guidelines, which provide recommendations for effective and consistent practice in the management of clinical conditions. Currently the app includes the most popular SIGN guidelines, which cover a range of topics including diabetes, rheumatoid arthritis, eczema, and the management of asthma and psoriasis. In addition to making guidelines more accessible, the app has delivered environmental benefits and significant savings by reducing the costs associated with printing, transporting and storing hard copies of guidelines. Since its launch, downloads for the app are nearing 20,000, from a diverse range of countries across the globe including Australia, Botswana, Madagascar, Vietnam, and the USA. At one point, the app was the third most popular medical app available on itunes. The app will continue to be updated as more clinical guidelines are produced. Produced by: KM Page 5 of 15

Obesity Scotland has one of the highest levels of obesity among developed countries and it is estimated that by 2030 the total cost of obesity to Scottish society could range from 0.9 billion to 3 billion 1. An evidence note was produced that summarises recent evidence on the clinical and cost effectiveness of weight management programmes for adults. Overall, the evidence suggests that a combination of diet, physical and behavioural therapy is more effective in achieving weight loss compared with diet alone or standard care. This beneficial effect may last up to two years or longer. An evidence note was also produced on bariatric surgery (a branch of general surgery which enables obese patients to lose weight) in adults. Both evidence notes support the SIGN guideline on obesity which was published in February 2010. Stroke rehabilitation Stroke is the third most common cause of death and the most frequent cause of severe adult disability in Scotland. Seventy thousand people are living with stroke and its consequences. Those who survive a stroke can find their lives affected by a wide range of impairments, limitations and complications. Rehabilitation involves complex interventions that often must be tailor-made to the individual patient. A revised guideline was published in June 2010, stating that the effectiveness of stroke units has led increasingly to patients who are better able to respond positively to post stroke rehabilitation. However it also called for more research to be undertaken to evaluate the effectiveness of rehabilitation techniques that can aid the recovery of patients and allow results to be compared across studies. The guideline emphasises the importance of the first 12 months following a stroke and focuses on: general management (including body positioning and exercise to aid recovery following a stroke) rehabilitation the prevention and management of complications discharge planning, and provision of information. 1 The Scottish Government. Preventing overweight and obesity in Scotland: a route map towards healthy weight. 2010 [cited 2010 Apr 9]; Available from: http://www.scotland.gov.uk/resource/doc/302783/0094795.pdf Produced by: KM Page 6 of 15

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Improvement A key part of both Healthcare Improvement Scotland and our predecessor s role is to encourage and support continuous improvement in healthcare practice. We help healthcare professionals to make improvements happen by using: our evidence-based advice guidance and standards international evidence for improvement, and information from our scrutiny work. We work collaboratively with healthcare providers, partner organisations and the public to drive improvements which can be sustained and measured. Examples of work in 2010-2011 include: Scottish Patient Safety Programme Healthcare Improvement Scotland is leading the Scottish Patient Safety Programme, which is a country-wide approach to improving patient safety. The programme involves more than 30 hospitals from all 14 territorial NHS boards across Scotland (and the Golden Jubilee National Hospital), with each board implementing evidence-based changes to practice under five workstreams: Leadership, Critical Care, General ward, Medicines management and Perioperative (before, during and after surgery). The overall aim of this work is to reduce adverse events (unintended consequences of care e.g. an infection) by 30% and mortality rates (the number of deaths in Scotland s hospitals) by 15% by December 2012. In line with the main programme aims, in 2010 11 boards have been addressing a number of areas including: the redesign of mortality and morbidity meetings, which help healthcare professionals to review adverse events and prevent them happening again quicker identification of patients whose condition is deteriorating, and a more proactive approach to preventing harm to patients. These activities are resulting in improvements across NHSScotland including: no central venous catheter related blood stream infection diagnosed in NHS Borders for 700 days all patients admitted to NHS Dumfries and Galloway s Care of the Elderly ward have their medication prescriptions checked within 24 hours of admission, and a reduction in Ventilator Associated Pneumonia (VAP) across Scottish Intensive Care Units (see figure below). Produced by: KM Page 8 of 15

VAP Rate (VAPs per 1000 ventilator days) Scottish Patient Safety Program (SPSP) VAP Rate March 2008 through December 2010 (Goal: 0 VAPs) 20 18 16 14 12 10 8 6 4 2 0 T1 Median = 8.4 T2 Median = 4.6 (45% decrease) Following the successful extension of this programme into Paediatric care last year (in 2010?), work is now underway to develop aims, goals and measures relating to the care of new born and premature babies in neonatal intensive care units. Intensive Psychiatric Care Units Intensive Psychiatric Care Units (IPCUs) provide a place of safety, care and treatment for people who pose a risk to themselves, or others, because of mental health or behavioural problems. There are 14 of these units in Scotland, however there has been little published data about the experiences of people who use these services. Working with partners including the Mental Welfare Commission and service user led organisation VOX (Voices of experience) Scotland, current and former patients, and carers were consulted to identify what improvements can be made to make services more person centred. The resulting national overview, published in June 2010, recognises that there is a high degree of well-structured and compassionate care provided in these units, and reported a number of key findings including: everyone in Scotland should be able to easily access an IPCU if they need to and their length of stay should only be as long as necessitated by their clinical needs carers should be supported and provided with information that will assist them in their caring role. The needs and views of carers should be taken into account as much as possible when decisions about care and treatment are made, and Produced by: KM Page 9 of 15

service users should be provided with information that they can understand and be involved in the planning and review of their care as much as possible. We are now working with partners to address the national improvement areas identified in this report. Neurological Services A two-year implementation and improvement plan commenced which builds on the Neurological Services standards produced in 2009 and is helping to improve neurological services across Scotland. During the first year of the programme, which was launched in January 2010, support has been focused on assisting boards to develop service plans, improve patient information, and collect and act upon patient feedback. Advise was given to health boards to develop an infrastructure to support local improvements. Consequently every board now has a Neurological Services Improvement Lead and a neurology improvement network to drive local improvements. Boards have completed a self evaluation of the standards which has helped to identify national and local priorities. In addition, we have identified a range of criteria from the standards which will serve as key indicators of quality improvement and lead to a safer, more effective and person-centred service. We are working closely with the Neurological Alliance of Scotland and some of their member organisations and promoting the partnership working to implement the standards. A series of events focusing on the condition specific standards have been held with people living with neurological conditions, the voluntary sector and service providers. These have resulted in a greater understanding of the priorities for people living with neurological conditions. As the second year of the programme progresses, we expect boards to make a range of measureable improvements in line with their local needs. Produced by: KM Page 10 of 15

Scrutiny Public assurance about the quality and safety of healthcare is provided through scrutiny of the NHS. Independent reporting and publishing of findings on performance demonstrates accountability of these services to the people who use them. This makes a positive impact on the healthcare outcomes for patients, their families and the public, and feeds into the improvement cycle by providing further evidence for improvement. Healthcare Improvement Scotland has built on the scrutiny and assurance done by NHS Quality Improvement Scotland and this work now includes: the Healthcare Environment Inspectorate independent healthcare regulation the scrutiny of the Participation Standard by the Scottish Health Council, and Scottish Health Council assessment of major service change consultations We are also developing a new model for scrutiny which will be applicable to both the independent sector and the NHS in future years. Examples of work in 2010-2011 include: Endoscopy services Endoscopy is a medical procedure used to observe the inside of the body without performing major surgery. The procedure involves use of a long flexible tube with a lens at one end and a magnifying eyepiece at the other. An endoscopy can help to provide an accurate diagnosis and ensure that patients get the right treatment as soon as possible. In recent years NHS Quality Improvement Scotland has supported NHS boards by leading on an accreditation scheme that promotes improvement in both the patient experience, and endoscopy services. This involved assessing the performance of endoscopy units in Scotland against UK wide standards. During 2010, 26 of the 45 operational endoscopy units were visited in Scotland. Visits so far highlight three main issues: most units need to improve decontamination (cleaning) of equipment staff need access to specialised training and their time protected to attend, and respect and dignity for patients needs to be a priority. This includes access to toilets and arrangements in mixed-sex areas. NHS boards have developed action plans in response to the recommendations and have submitted these to us for review and follow up. Healthcare Improvement Scotland will Produced by: KM Page 11 of 15

continue this work and visit the remaining endoscopy units in 2011 and follow up on NHS board action plans to make sure progress is being made. Healthcare Environment Inspectorate (HEI) HEI is a key part of Healthcare Improvement Scotland and was set up in 2009 with a focus to reduce the Healthcare Associated Infection (HAI) risk to patients through a rigorous inspection framework. This is being done by undertaking at least one announced and one unannounced inspection to all acute hospitals across NHSScotland every 3 years. HEI s aims are to: provide public assurance and protection, to restore public trust and confidence contribute to the prevention and control of HAI contribute to improvement in the healthcare environment including infection control, cleanliness and hygiene and the broader quality improvement agenda across NHSScotland. In its first year (September 2009 to September 2010), most HEI inspections were announced (where NHS boards are given at least 4 weeks notice of the inspection) but after September 2010 there has been a greater focus on unannounced inspections (where NHS boards are not given any advanced warning of the inspection). From 1 April 2010 to 31 March 2011 HEI: completed 32 inspections to 29 acute hospitals in 10 NHS boards across Scotland. made 174 requirements and 143 recommendations. Of the 32 inspections HEI carried out, 16 were announced, 12 were unannounced and four were follow-up inspections. Overall, HEI has found that most hospitals are generally clean and improving, and patients and the public can be assured that independent inspections are driving improvement to ensure hospitals are safe and clean. More information on HEI can be found at www.healthcareimprovementscotland.org/hei.aspx or from its own annual report which is published separately. Participation Standard The Scottish Health Council is also a key part of Healthcare Improvement Scotland and it has developed a Participation Standard, which measures what NHS boards do to ensure that people can influence the care they receive and shape how services are designed. The introduction of the standard in November 2010 means that, for the first time, comparable information on how NHS boards involve patients and the public has been collected and analysed. Produced by: KM Page 12 of 15

Every NHS board in Scotland was asked to assess how well they performed by completing a self assessment form. The Scottish Health Council has been analysing the submissions, which were provided by all NHS boards, in order to agree the levels reached, and has included advice on what is required to demonstrate further improvement against the Standard. NHS boards will be asked to prepare improvement plans for 2011-2012, based on the self-assessment reviews. Reports, outlining the level of achievement for each NHS board and highlighting specific examples of good practice will be published later in 2011. Produced by: KM Page 13 of 15

Involving the public Healthcare Improvement Scotland aims to be regarded as a leader in patient and public involvement and to do this we are building on the experience of involving people in NHS Quality Improvement Scotland s work. A diverse range of people are involved in our evidence, scrutiny and improvement work through our Involving People Network. This network includes volunteers who help inform our work, for example as members of inspection teams, and representatives of voluntary and community organisations who contribute to our project groups. In June 2010 we attained the Investing in Volunteers quality standard, which recognises our commitment to our volunteers and ensures that we have demonstrated that we have the right processes and support in place to sustain and develop volunteering across the organisation. Other examples of how we involve people in our work include: voluntary organisation staff and members who help us design our advice and guidance and support our scrutiny teams public partners (volunteers) who we train and support to provide a public perspective to our work associate patient focus inspectors (volunteers) who participate in HEI inspections and ensure that they focus on the things that matter most to patients, and participants in consultation activities (e.g. focus groups and surveys). The Scottish Health Council The Scottish Health Council continue to promote greater public involvement in the NHS and build on the work it has undertaken as part of NHS Quality Improvement Scotland. The Scottish Health Council promotes public involvement in a number of ways including: supporting NHS boards to share good practice, exchange ideas and develop new approaches on how to involve people in health services assessing and reporting on how well NHS boards involve people in the development of services, and working with NHS staff and communities to improve how patients, carers and the public are involved in health services. In April 2010 the Scottish Health Council introduced a new structure, aiming to provide a more consistent service across Scotland by establishing the following functional teams with national responsibilities. Community Engagement and Improvement Support which helps NHS boards to involve local communities and reach out to seldom heard groups through its network of 14 local offices. Produced by: KM Page 14 of 15

Performance Review which assesses NHS boards against the Participation Standard and helps them to demonstrate progress in how they work with patients and the public. The Service Change Team which provides specialist advice and support to NHS boards on involving people in service change, and shares good practice across Scotland. The Participation Network which supports healthcare professionals by sharing good practice and new approaches to improving patient and public participation. The network uses a variety of approaches including developing guidance and sharing information through newsletters, policy briefings, networking events and conferences. One of the Scottish Health Council s key outputs in 2010-2011 was the Participation Toolkit which includes tools and techniques to help public, private and voluntary organisations adopt best practice in public involvement. Further information about the Scottish Health Council can be found at www.scottishhealthcouncil.org For more information about how to get involved in Healthcare Improvement Scotland work visit www.healthcareimprovementscotland.org Produced by: KM Page 15 of 15