Local Delivery Plan 2016 2017 Driving in Health and Social Care
Healthcare Scotland 2016 First published July 2016 All images contained within this publication were sourced from the NHSScotland Photo Library and are covered by Crown copyright. The contents of this document may be copied or reproduced for use within NHSScotland and our partner organisations, or for educational, personal or non-commercial research purposes only. Commercial organisations must obtain written permission from Healthcare Scotland before copying or reproducing any part of this document. www.healthcareimprovementscotland.org
Contents Introduction 4 How we work our principles 5 Our unique strategic advantages 6 Our seven strategic contributions to support the transformation of health and social care in Scotland 7 Our Work Programme 2016 2017 8 Measurement and evaluation 26 Best use of resources 28 Appendix 1: 2020 Workforce Vision local implementation plan (2016 2017) 29 3
Introduction This Local Delivery Plan 2016 2017 sets out our intent to support the transformational change to public services that is taking place in Scotland. In particular, our plan supports the Scottish Government s ambition to build a safer, healthier and fairer society and it sets out the contributions that we can make to achieve the Scottish Government s 2020 Vision for health and social care. This is an ambitious plan which updates our Driving in Healthcare Strategy (2014 2020) by positioning our role and our work across public services and specifically within health and social care services in Scotland. We have identified seven strategic contributions that demonstrate the role that Healthcare Scotland (HIS) can play in supporting the significant redesign of health and social care services in Scotland. We have incorporated key principles from the National Clinical Strategy 1, such as putting communities at the centre of design and delivery of services that are evidence based, effective and sustainable. This plan also signals our move from measuring outputs to delivering outcomes. We have mapped our work in the Local Delivery Plan to our seven contributions and our evaluation framework, which is aligned with the nine national health and wellbeing outcomes 2, to ensure that all of our activity is linked to achieving national outcomes and demonstrates progress. 1 Scottish Government. A National Clinical Strategy for Scotland. 2016. http://www.gov.scot/resource/0049/00494144.pdf 2 Scottish Government. National Health and Wellbeing Framework. 2015. http://www.gov.scot/resource/0047/00470219.pdf 4
How we work our principles We are uniquely placed as a national organisation to make a very substantial and positive impact in supporting improvements in the quality of health care in Scotland. As an integrated organisation, our blend of roles and functions offers a highly effective, efficient and cohesive approach to supporting high quality care. We will support the achievement of Scottish Government s ambitions by adhering to the following principles: Establishing the evidence for what will work best to integrate services and what high quality care would look like Supporting the redesign of services to achieve and sustain higher quality and increasingly integrated care Reviewing the current provision of services and supporting the commissioning and redesign of new services Working with citizens to ensure that their voice is heard in the design, and provision of health and social care. Ensuring that we have meaningful clinical and practitioner engagement and involvement across all of our work Working in Partnership with our stakeholders in NHS boards, Integration Authorities, Local Authorities and Government to drive improvement in health care across public services Assuring the quality of care that people are receiving and reporting our findings and recommendations without bias Ensuring that we can measure and demonstrate the impact of our work in support of the health and wellbeing outcomes and reducing inequalities Managing our resources efficiently and effectively and by achieving value for money 5
Our unique strategic advantages There is a need for a strong and bold reshaping of care that places individuals at the centre of the future model of service provision, but which also recognises the need to tackle duplication, inappropriate variation and waste. It is about preventing and tackling ill health and delivering a health and social care system that consistently puts service users, carers and citizens first and supports selfmanagement wherever possible. We have at least two unique strategic advantages: 1. We support both health and social care services to deliver higher quality care. We offer a strong and visible contribution to health and social care services in Scotland, in supporting their drive to be highly reliable organisations, providing consistently safe, effective and person-centred care. 2. The integrated and cohesive provision of a complementary range of functions which are aligned and mutually supportive. These are substantial advantages, enabling us to provide a single gateway to a range of strong, timely and effective mechanisms to support higher quality care, for example: practical quality improvement support securing the voice of citizens in the design of services the latest good practice and evidence, or rigorous and independent external quality assurance We will use our influence and our alliances with national organisations (United Kingdom Alliance (UKIA), The Health Foundation and the Kings Fund) and we will work alongside other improvement bodies to capitalise on these strategic advantages, for example Advancing Quality Alliance (AQuA), Haelo Innovation and Science Centre and Yorkshire and Humberside Academy (YHIA). 6
Our seven strategic contributions to support the transformation of health and social care in Scotland We have identified seven strategic contributions that we will offer to support the transformational changes in health and social care in Scotland. These contributions are unique to Healthcare Scotland and underpin the achievement of the national health and wellbeing outcomes. The contributions are set out below. Contribution 1 Contribution 2 Contribution 3 Contribution 4 Contribution 5 Contribution 6 Contribution 7 supporting person-centred care, empowering and enabling citizens to have a meaningful say in the design, planning and provision of health and social care services in Scotland. providing strong and comprehensive assessments of the quality of health and social care in Scotland, which encapsulate wider factors impacting on the quality of care such as leadership and effectiveness. supporting the redesign of health and social care services to be efficient and effective and to enable individuals to reliably receive the services they need, when they need them. improving the analysis and assessment of inappropriate variation in the quality of health and social care in Scotland, and identifying the steps with services to eliminate unacceptable practices and provision. providing independent external assessment of the sustainability of service provision, including the design of health and social care services which offer better outcomes and value for money. to play our part in raising the quality of health and social care, by providing more proactive intervention and support underpinned by robust, timely and integrated intelligence. supporting the leadership in NHS boards and in Health and Social Care Partnerships to make the necessary changes to deliver a sustainable culture of continuous quality improvement. Each of these connected contributions should add value in supporting the health and social care systems across Scotland in making the necessary steps to deliver improvements against the nine national health and wellbeing outcomes. We will particularly focus on reducing harm, inappropriate variation and waste underpinned by evidence and public, clinical and practitioner involvement. 7
Our Work Programme 2016 2017 Our work programme presented as the Local Delivery Plan for 2016 2017 is strategically aligned with our seven strategic contributions and reflects our medium term outcomes. It clearly sets out what will be delivered and the objectives that have been set. Contribution 1: Supporting person-centred care, and empowering and enabling citizens to have a meaningful say in the design, planning and provision of health and social care services in Scotland. Title Aim Objectives Lead Personal Outcomes Improving personal outcomes Take forward the Personal Outcomes Partnership with Thistle Foundation offering facilitated development to staff working with people to enhance focus on assets and personal outcomes. Scottish Health Council (SHC) Volunteering Supporting volunteering in Scotland Provide national leadership and guidance to ensure long term vision and consistency of approach and support for volunteering across NHSScotland. This support may extend in time to integration authorities. Scottish Health Council SHC Service Change Quality assurance of service change in Scotland Provide advice and support to NHS boards on involving patients and communities in service change processes, in line with Scottish Government guidance. Scottish Health Council SHC Public Involvement Unit Promoting greater public involvement Continue to ensure HIS meets its equalities duties and the Duty of User Focus and generally demonstrate good practice in involving users, carers and the public in its activities. Scottish Health Council SHC Community Engagement and Support Strengthening community engagement Provide tailored advice and improvement support to 21 NHS boards/special NHS boards. Work to develop and support local peer networks and build capacity for communities to be involved in the design and delivery of health and care services. Scottish Health Council 8
Title Aim Objectives Lead SHC Citizen Voice Hub Creating Our Voice Hub Ensure the roll-out of the Our Voice Hub initiative to help achieve a stronger voice for users, carers and the public in health and social care, maximising the opportunities for alignment with other work in HIS. Scottish Health Council Person Centred Health and Care programme Supporting the development of person-centred practice within health and social care services Providing support to health and social care organisations to build the capacity and skills in using person-centred and codesign approaches to improve care experience, and design and deliver services based on what matters to people. Developing the capacity within HIS improvement programmes to incorporate clear person-centred and involvement principles in their design and delivery. Co-Production and Community Capacity Building Building community capacity Working with a range of partners, including those in the third, independent and housing sectors, and supporting them to combine the mutual strengths, capacities and assets of statutory and non-statutory organisations, professionals, service users, carers and communities to achieve positive change and better outcomes for individuals. 9
Contribution 2: Providing strong and comprehensive assessments of the quality of health and social care in Scotland, which encapsulate wider factors impacting on the quality of care such as leadership and effectiveness. Title Aim Objectives Lead Strategic Inspection of Adult Services External quality assurance of jointly delivered adult services Undertake joint inspections with the Care Inspectorate. Ensure delivery of robust, affordable proposals for the future design of joint adult inspections in collaboration with the Care Inspectorate and informed by engagement with external stakeholders. of Quality Assurance Scrutiny of Prisoner Healthcare Quality assurance of health care provided to prisoners Provide clinical expertise to the inspection programme of prisons in Scotland. of Quality Assurance Inspection of Services for Older People in Acute Hospitals (OPAH) Driving better care for older people in hospital Continue to undertake inspections of the care of older people in acute hospitals and agree detailed proposals for the extension of the methodology to include non-acute healthcare facilities, including specialist dementia units. of Quality Assurance Joint Inspection of Children s Services Driving better care for children Led by the Care Inspectorate, HIS works in partnership with Education Scotland and Her Majesty s Inspectorate of Constabulary Partners in the multi-agency strategic inspections of services for children. In addition to being part of the core team, ensure strong and effective clinical assurance of the inspection. of Quality Assurance 10
Title Aim Objectives Lead Healthcare Environment Inspectorate (HEI) Inspections Promoting safer and cleaner hospitals Undertake further HEI inspections under the revised Healthcare Associated Infection (HAI) Standards, including theatres. Manage and carry out wider assessment of the progress in the delivery of Lord Maclean s recommendations arising from the Vale of Leven Inquiry. of Quality Assurance Medical Revalidation National assessment of the revalidation of medical doctors Undertake further national assessment of the progress in medical revalidation in Scotland. of Quality Assurance Management of Controlled Drugs (Governance) Ensuring Safe Management of Controlled Drugs Maintain and publish the register of controlled drugs accountable officers in Scotland and provide external quality assurance of the governance arrangements in place within each designated body in Scotland to ensure the safe management of controlled drugs. of Quality Assurance Regulation of Independent Healthcare Driving better bare and services provided by the independent healthcare sector Ensure effective and successful extension of regulatory powers to include independent clinics, with all independent clinics registered by 31 March 2017. of Quality Assurance Continue programme of inspections for independent hospitals which includes hospices and private psychiatric hospitals. Human Tissue Bank Accreditation Ensuring a safe network of Human Tissue Banks Undertake accreditation of the regional tissue banks and external quality assurance of the satellite boards. of Quality Assurance 11
Title Aim Objectives Lead Assessment of referral from National Confidential Alert Line (NCAL) and concerns passed to HIS under the Public Information Disclosure Act (PIDA) Assessment of referral from National Confidential Alert Line (NCAL) and concerns passed to HIS under the Public Information Disclosure Act (PIDA) Actively review and where necessary take action in relation to concerns about safety of patient care. of Quality Assurance Thematic Reviews of Major Priorities Comprehensive assessments of the quality of care in Scotland Establish the detailed operational methodology and infrastructure to implement comprehensive quality of care reviews in Scotland, ensuring that such reviews are aligned to wider national priorities, including the National Clinical Strategy. of Quality Assurance Quality Assurance of Mental Health Care Services in Scotland Driving improvements in mental health care in Scotland Within the context of quality of care reviews, establish a robust approach to the external quality assurance of mental health services in Scotland, working in partnership with other agencies such as the Mental Welfare Commission. of Quality Assurance Review of National Screening Programmes Establish consistent high quality approach to screening in Scotland Undertake scrutiny and assurance activity of national screening programmes against national standards. of Quality Assurance 12
Title Aim Objectives Lead Cancer Quality Performance Indicators (QPI) Review Driving improvement in the quality of cancer services Carry out phased review of QPI data and publish the national findings in order to assure NHSScotland, Scottish Government and the public that tumourspecific services are developing and improving. of Quality Assurance Sudden Unexpected Death in Infancy (SUDI) Provide support for the SUDI programme on behalf of the Scottish Government Continue to provide support for this programme on behalf of Scottish Government, with a view to transferring it to a more appropriate agency determined by Scottish Government by March 2017. of Quality Assurance 13
Contribution 3: Supporting the redesign of health and social care services to be efficient and effective and to enable individuals to reliably receive the services they need, when they need them. Title Aim Objectives Lead Primary Care Strategy and Phase 1 Implementation Driving improvement in the quality of primary care services Complete strategy to inform the capability and capacity building needed to enhance the pace and scale at which HIS collaborates with and supports healthcare organisations to drive improvements in integrated primary care services. Executive Clinical National Review of Out-of- Hours Services Quality & Safety Programme Driving improvement to deliver consistent, high quality outof-hours services HIS is scoping work aimed at enabling NHS boards to become self-sufficient in knowing how their urgent care services are performing against agreed standards, what they need to focus on improving, and have the knowledge and skills to then deliver and sustain the desired improvements. Executive Clinical Older People in Acute Care of Care Driving improvement in the quality of care for older people Build on work to date, which supports improvement work at a local level and promotes local ownership, spread and sustainability of change. Critically, during 2016 2017 to ensure an increasingly aligned approach between scrutiny and improvement. 14
Title Aim Objectives Lead Mental Health Access Supporting swifter access to mental health care The Mental Health Access Support Team (MHAIST) has been established to support improved access to both psychological therapy interventions and Child and Adolescent Mental Health Services. The team will work with NHS boards and Health and Social Care Partnerships to support a deep dive diagnostic to understand the barriers to meeting the target of treatment within 18 weeks of referral and on the basis of this to then agree an improvement plan to enable reliable delivery of this access target. Strategic Commissioning Supporting good practice in commissioning services that offer better outcomes Support Health and Social Care Partnerships to improve the effectiveness of their strategic commissioning arrangements and practice. In doing so, enable them to achieve a better alignment of investment and delivered outcomes whilst ensuring that personalised services and supports, a co-production approach and more robust and consistent decision-making become more strongly embedded. Home, Place and Housing Portfolio Supporting more people to lead independent and healthier lives at home The Home, Place and Housing Portfolio aims to make key improvements to strategic planning of housing and related services to provide people with a home environment that supports greater independence and improved health and wellbeing. 15
Title Aim Objectives Lead Living Well in Communities Enable more people to spend time at home or in a homely setting that would otherwise have been spent in hospital The Living Well in Communities portfolio aims to support Health and Social Care Partnerships to test and spread new ways of delivering services that enable more people to spend time at home or in a homely setting that would otherwise have been spent in hospital. The portfolio includes improvement support for high resource individuals, palliative care, anticipatory care planning, intermediate care and reablement. The portfolio will develop to emerging improvement need. Focus on Dementia Supporting improvement in the quality of care and experience of people living with dementia across the whole pathway An improvement partnership programme which aims to support improvements in the experience, safety and co-ordination of care for people with dementia across the whole pathway, including diagnosis and post diagnosis support, integrated care in the community, acute hospital care, specialist dementia care and advanced care. The emphasis is on supporting people to stay well at home or in a homely setting for as long as possible. This recognises that when hospital admission is necessary that people are treated with dignity and respect and in a safe environment which protects people s human rights. 16
Title Aim Objectives Lead National Care Standards Development of consistent National Care Standards Deliver in collaboration with the Care Inspectorate, a set of general and specialist standards linked to the principles signed off in March 2016. Evidence Scottish Intercollegiate Guidelines Network (SIGN) Guideline Programme Driving improvements in care by developing SIGN clinical guidelines Continue to develop evidencebased guidelines for healthcare professionals, seeking appropriate ways in which information can be more rapidly disseminated. Evidence Standards and Indicators Programme Driving improvements in care by developing standards and indicators Further develop the programme of standards, including pressure ulcer standards and screening services to underpin inspection processes and indicators, in areas such as palliative care and heart disease, which are used to facilitate ready comparison of services in a nationally consistent manner and generate data that provides a baseline for improvement. Evidence RARE- Bestpractices Programme Conclusion of the European RARE- Bestpractices Programme Continue with the RARE- Bestpractices programme to reduce inequality in care for patients with rare diseases across Europe. Evidence 17
Contribution 4: Improving the analysis and assessment of inappropriate variation in the quality of health and social care in Scotland, and identifying the steps with services to eliminate unacceptable practices and provision. Title Aim Objectives Lead Death Certification Review Service Quality assurance and enhancing the clinical governance of the death certification process Ensure the effective operation of the Death Certification Review Service and key operational objectives are consistently delivered. Executive Clinical Scottish Mortality and Morbidity Programme (SMMP) Maximising and sharing learning from the SMMP Through the SMMP, ensure an effective approach to supporting the improved local learning from deaths; improved local action to reduce Hospital Standard Morbidity Rates (HSMR); thematic national data for improvement; and improved governance at local and national level in relation to mortality reviews. Executive Clinical Measurement and Monitoring of Safety Programme Consolidate learning from testing a conceptual framework and seek to support a rounded approach to safety measurement and monitoring using leading and predictive measures Spread and integrate the framework for the measurement and monitoring of safety across Scotland. Work with UKIA and partners across the UK to further develop resources and create a spread and sustainability plan to support others in their use of the framework. Executive Clinical Scottish Patient Safety Programme (SPSP) Acute Adult Driving improvement in safety for patients in acute hospitals Implement the new arrangements arising from the 90-day process reviewing the Acute Adult and Primary Care safety programmes. 18
Title Aim Objectives Lead SPSP Venous Thromboembolism (VTE) Reduction of incidence of VTE Undertake a deep dive with one NHS board to understand the factors mitigating against reducing unwarranted variation in the management of VTE, test solutions and identify learning for spread across Scotland. SPSP Mental Health Reduce harm for patients with mental illness Support NHS boards to improve outcomes for people with mental illness through a focus on reducing harm, including restraint and seclusion, improving medicine safety risk assessment and safety planning at key transition points. SPSP Primary Care Driving improvements in the quality and safety of primary care Implement the new arrangements arising from the 90-day process reviewing the Acute Adult and Primary Care safety programmes.= SPSP Pressure Ulcers Support for a reduction in incidence and prevalence of pressure ulcers The programme will work in collaboration with NHS boards, Health and Social Care Partnerships, Scottish Care and care homes across Scotland to reduce the incidence of pressure ulcers for residents in care homes. SPSP Maternity and Children Driving improvement in the safety of care offered to mothers and children Implement SPSP Maternity and Children programme to improve outcomes by providing a safe, high quality care experience for all women, babies and children, in these settings in Scotland. 19
Title Aim Objectives Lead SPSP Healthcare Associated Infections (HAI) Support reduction in HAI Provide overall co-ordination of all HAI-related activities within HIS to ensure an integrated and planned approach. Provide improvement advice and support to the NHS boards on HAI issues. SPSP Pharmacy in Primary Care Driving improvement in safer prescribing and dispensing in primary care Continue to improve reliability of a number of processes, including the prescribing, monitoring and dispensing of high risk medicines, medicines reconciliation at discharge from acute hospital, and developing a safety culture. SPSP Medicines Reducing harm from medicines SPSP Medicines aims to reduce harm from medicines through supporting the medicines streams within each of the SPSP improvement programmes, with a focus on medicines reconciliation and high risk medicines. Sharing Intelligence for Health & Care Maximise the sharing of intelligence to identify areas for improvement Build on the work of the Sharing Intelligence Group to provide a proactive and supportive environment for collaboration; regular opportunities to build stronger working relationships and understanding of roles; a shared view of risks to quality through our collective intelligence; an early warning mechanism of risks; and coordinated action to drive improvement. of Quality Assurance 20
Title Aim Objectives Lead Effective Care Programme Supporting the reduction of inappropriate variation Through the Effective Care Programme, agree care processes to be prioritised to support NHS boards to reduce unwarranted variation in the delivery of care interventions so as to improve outcomes and reduce costs. SPSP Mental Health Observations Supporting improvements in observation practice to prevent harm Aim to improve observation practice through therapeutic engagement with suicidal, violent or vulnerable patients to prevent them from harming themselves or others at times of high risk during their recovery. Learning from Adverse Events Advancing learning from adverse events Build on the implementation of the national framework for learning from adverse events, through reporting and review, which supports service improvements and enhances the safety of our healthcare system for everyone. of Quality Assurance Ensure the appropriate integration of elements of this work with other work across HIS. SPSP Dentistry Driving improvement in the quality and safety of dental care The dental arm of the SPSP Primary Care programme seeks to embed quality improvement processes into every day practice. We will do this by identifying areas for improvement and raise awareness of a safety culture amongst practices. 21
Contribution 5: providing independent external assessment of the sustainability of service provision, including the design of health and social care services which offer better outcomes and value for money. Title Aim Objectives Lead Scottish Health Technologies Group (SHTG) Appraisal and provision of evidence on new non-medicines technologies Provide advice on the evidence about the clinical and cost effectiveness of existing and new non-medicine technologies likely to have significant implications for patient care in Scotland. Evidence Implement key actions from the Non-Medicines Technologies Strategic Plan (2016 2018), including the commissioned work on landing zones for advice within NHSScotland. Scottish Medicines Consortium (SMC) - Implementation of New Medicines Review Recommendations Support the introduction of recommendations arising from the review of access to new medicines Consider and implement recommendations arising from the Montgomery review relating to the policy change for new medicines. Evidence SMC Core Business Appraisal of new drug therapies to deliver safe, clinically effective and cost effective medicines Deliver robust SMC decisions and continue to refine the process. Evidence Scottish Antimicrobial Prescribing Group (SAPG) Ensuring safe and evidence-based provision of antibiotics Support the work of SAPG in containing the spread of Antimicrobial Resistance (AMR) in Scotland and reducing patient harm by maintaining the national antimicrobial stewardship agenda from HAI. Evidence 22
Contribution 6: Play our part in raising the quality of health and social care, by providing more proactive intervention and support underpinned by robust, timely and integrated intelligence. Title Aim Objectives Lead Tailored and Responsive Support Team (TRIST) Provide practical and timely improvement support to health and social care providers Ensure the Tailored and Responsive Support Team (TRIST) is deployed effectively to meet needs in health and social care: in response to proactive requests from NHS boards and Health and Social Care Partnerships for improvement support to address local key priority issues, and to work with services to support them in addressing key findings from inspection/scrutiny reports. Strategic Delivery Plan: Medicines Support delivery of safer medicines Through the Strategic Delivery Plan: Medicines, improve safe and effective use of medicines through empowering people to manage their own care and shape services. This includes supporting reliable spread and supported implementation of best practice, and assessing the quality and safety of healthcare. Executive Clinical Hospital Standardised Mortality Ratio (HSMR) Identifying the causes of unwarranted variation in mortality in Scotland Provide timely and practical analysis and follow-up in respect of the HSMR data provided by NHS boards in driving improvement in patient care. Executive Clinical Evidence and Evaluation for Team (EEvIT) Provides analytical support for improvement work across health and social care Support the design and delivery of improvement programmes and projects so that they are based on current evidence and incorporate approaches to monitoring and measuring their impact. For health and Social Care partners, support from EEvIT is available through TRIST. 23
Title Aim Objectives Lead Fund Provide grant awards to support improvement for Health and Social Care Partnerships Provide grant awards to applicants with a strong proposal to either test a change idea locally or spread improvement nationally. The aim of the fund is to invest in and expand innovative practices that demonstrate impact on the national health and wellbeing outcomes. Contribution 7: supporting the leadership in NHS boards and in Health and Social Care Partnerships to make the necessary changes to deliver a sustainable culture of continuous quality improvement. Title Aim Objectives Lead Implementation and Support of Area and Drug Therapeutic Committees (ADTCs) Support ADTC to implement best practice Following the Scottish Government response to the Health and Sport Committee inquiry into access to new medicines in 2013, continue to provide effective support to the application of the recommendations as they pertain to ADTCs. Executive Clinical Hospital Electronic Prescribing and Medicines Administration (HEPMA) Phase 2 Support delivery of cost effective and safe prescribing Support a collaborative approach to implementation of HEPMA across NHS boards ensuring lessons learned, minimisation of risk, and securing overall benefits of safer prescribing. Executive Clinical Quality (QI) Skills Development Developing QI capacity within Board members across Scotland Develop the skills of staff working across health and social care services to support the work of QI through funding 56 places a year on the Scottish Leaders course provided by NHS Education for Scotland. 24
Title Aim Objectives Lead Networks and Knowledge Exchange Making effective use of networks to share learning Develop and implement a network strategy to support the Hub and partners to connect and share learning. QI for Board Members Developing QI capability of Board members within Scotland To create opportunities for Board members to increase their understanding of QI so that they can lead and govern organisations to continuously improve and contribute to the nine national health and wellbeing outcomes. Independent Care Sector Programme Maximise the contribution of the independent care sector to improvements in health and wellbeing Take forward the Independent Care Sector Programme which is designed to support the development of this sector as a full partner in delivering improvements in health and wellbeing at both strategic and local levels. 25
Measurement and evaluation We have created a logic model which incorporates our seven strategic contributions and has aligned them to the nine national health and wellbeing outcomes. We are developing effective evaluation processes to better evidence the outcomes, benefits and impact of our work. This includes developing indicators to enable us to measure progress toward achieving our outcomes and a prioritisation process to ensure strategic fit and that we are making best use of resources. This work is developmental and, during the course of 2016 2017, we will be testing and refining the model to ensure that it meets our needs and can demonstrate impact. We will also develop our performance management arrangements to improve reporting of the progress that we are making with our work and any changes we might need to make. This will include measuring and reporting of our work in a matrix way to suit the most appropriate circumstances as clearly as possible, for example by outcome, theme or programme. We believe that by incorporating this flexibility of approach to reporting we will be able to identify the crossorganisational value that is added to our work. 26
Logic model Inputs Activities Reach Outcomes Financial resource Flexible, engaged and appropriately skilled workforce that is sustainable, capable, fully integrated and supported by effective leadership Efficient and effective HR, Finance, IT and Communications Person-centred Health and Care Programme Our Voice Personal outcomes SAPG Community engagement and support Inspection programmes Prisoner healthcare Professional revalidation IHC regulation Quality of care reviews Cancer/screening programme QA Primary care/ooh Adverse events Sharing Intelligence Effective Care Programme TRIST OPAC SPSP QI Capacity and Capability building Technologies programme Standards EEvIT Public, patients, carers and communities Staff in health and social care NHS boards, integrated joint boards, health and social care partnerships, third sector and independent sector Independent care providers Scottish Parliament and Scottish Government Our staff Citizens have a meaningful say in the design, planning and provision and delivery of health and social care services [1] Health and social care services are sustainable and provide individual care that is appropriate and timely [3] Inappropriate variation in care is reduced [4] in health and social care provision is supported by intelligence led proactive intervention [6] Sustainable quality improvement is delivered by supporting change through effective leadership [7] Citizens, boards, Scottish Government and care providers are assured about the quality of services [2] Citizens, boards, SG and care providers are assured about the sustainability of services [5] 1. People are able to look after and improve their own health and wellbeing and live in good health for longer 2. People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community 3. People who use health and social care services have positive experiences of those services and have their dignity respected 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services 5. Health and social care services contribute to reducing health inequalities 6. People who provide unpaid care are supported to look after their own health and wellbeing, including reduce any negative impact of their caring role on their own health and wellbeing 7. People using health and social care services are safe from harm 8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide 9. Resources are used effectively and efficiently in the provision of health and social services 27
Best use of resources This Local Delivery Plan has been prepared as part of our integrated planning process. This ensures that we work within our resources people and finances and deliver a high quality work programme. We effectively manage our resources through good governance processes and prioritisation of our work. This plan incorporates an outline of our implementation plan for Delivering Everyone Matters: 2020 Workforce Vision in Appendix 1. 28
Appendix 1: 2020 Workforce Vision local implementation plan (2016 2017) Our 2020 Workforce Vision local implementation plan (2016 2017) provides a range of actions that support the achievement of our outcomes, and contribute to the ongoing development of our organisation. The actions are outlined below: Healthy organisational culture: we are developing promotional materials to support employee understanding of their contribution to the workforce vision. We are improving our measurement of staff engagement through full roll-out of imatter, and the use of pulse surveys. A co-ordinated approach to team briefing across the organisation will be developed, and our monthly staff huddles are being continuously improved following employee feedback. We are undertaking work to gain a deeper understanding of the causes of unplanned absence in order to inform the ways we can more effectively support our employees. Sustainable workforce: we established a Change Management Board in 2015 2016 that has oversight of all organisational change across HIS, including changes in structure and service delivery. The Board considers how change impacts our workforce, and how change in one area of our organisation can affect other areas while ensuring appropriate action is taken to manage this. During 2016 2017, the main focus of the Change Management Board will be to ensure oversight of changes relating to our Quality Assurance offerings, as well as the development of Our Voice within the Scottish Health Council. This activity will benefit from our learning around organisational changes implemented in the past 12 months. Capable workforce: we will be providing health inequalities awareness sessions for all employees during 2016 2017 as well as exploring options for balancing measures on inequalities as part of our Hub performance framework. Employees will be supported to understand the benefits and challenges of using social media for business purposes. Employee awareness raising of the critical role of carers will be part of the internal communications that support the launch of Our Voice. Also, there will be awareness activities planned and delivered detailing how strategic inspections have a focus on the Partnerships Carers Strategy, Carers Assessments and Outcomes for Carers. 29
Workforce to deliver integrated services: we will support development of quality improvement capacity across health and social care by funding over 50 places on the Scottish Leaders programme. We will work with other national organisations including the Scottish Government, NHS Education for Scotland and the Scottish Social Services Council to identify workforce implications across Scotland attached to improvement and service redesign work, and develop appropriate interventions that are solutions-focused. Our provision of practical improvement support will be delivered through a mixture of planned programmes and responsive support. In equipping our employees to support this work, we will ensure awareness and understanding of the pressures health and social care partnerships face, and address skills and experience gaps at individual and team levels. Effective leadership and management: our focus for 2016 2017 will be on strengthening change leadership capacity and capability. This will be facilitated through topic specific leadership discussion groups on adaptive leaderships, complexity and emergence, and how these relate to cross-organisation and crosssector working. Promoting NHSScotland and HIS organisational values will be supported by the development of values-based recruitment processes and the establishment of values-oriented objectives built into leaders and managers 2016 2017 work objectives. Performance management and imatter training will be provided to all managers to support open and honest discussions with our employees. This should support them to maximise their contribution and agree action plans to secure improvement. We will progress succession planning and talent management discussion with the Executive Team to reach agreement on a consistent approach. We will continue to provide support for facilitated team building and development, targeted towards teams directly affected by change. This includes ensuring understanding and awareness of the HIS approach to organisational change management, and supporting managers to implement this effectively, and be responsive to the need to continuously improve the way we work. Over the course of 2016 2017, we anticipate recruitment challenges with the following staffing groups: Health Economists Advisors Inspectors, and Medical Reviewers. 30
All of the above staff groups are either specialist or highly specialist and are critical to the success of our Local Delivery Plan. In the case of Health Economists, there is a significant shortage of supply within Scotland. Moreover, the private sector is continually able to attract the limited numbers of suitably qualified and experienced individuals who are available with higher salaries than we currently can offer via the Agenda for Change framework. To mitigate this, we have trialled traineeships in order to attract newly qualified individuals, with dedicated coaching and mentorship available to fast track the acquisition of skills and experience. This has had mixed success, and we intend to refocus on other ways to mitigate the situation during 2016 2017. Given our expanded remit in terms of facilitating improvement across health and social care from 1 April 2016, there will be a significant requirement for appropriately skilled and experienced Advisors drawn from both health and social care backgrounds. We have a good track record in supporting NHS boards with expertise and personnel to deliver improvement interventions. There continues to be a national shortage of qualified and experienced Advisors, and this represents a risk for us in the delivery of our programmes in the short to medium term. The new integrated improvement resource will be investing in Advisor and Associate Advisor posts, with a strong focus on succession planning and retention to ensure as much stability as possible is built into the structure. We are also creating alternative ways of staffing national improvement programmes so as not to simply take key individuals away from local delivery organisations. This includes the development of our Associate framework, the use of joint appointments where individuals work part-time nationally and part-time locally, and the development of a grant making arm. Parallel to work on infrastructures, skills mapping and skill gap analysis will be carried out to inform the workforce development priorities. The Quality Framework along with the new QI Development Diagnostic tool will be used as part of this process. We have worked collaboratively with a range of stakeholders in the development of our new Quality of Care reviews, which we believe will have a positive impact on quality assurance across the service, and become an effective lead-in for quality improvement. We are also building capacity in independent healthcare inspection during 2016 2017. Both these important developments require skilled and experienced Inspectors to support our operational capability. A barrier to our ability to attract suitable talent from the social care sector is our terms and conditions of service through the Agenda for Change framework. We will work to find a solution to this barrier during 2016 2017 so that certainty can be brought to recruitment processes, and the best possible terms and conditions can be offered to prospective entrants. 31
The nature of the Death Certification Review Service requires Medical Reviewers who are highly experienced medical professionals, drawn from the General Practitioner and Consultant communities. This has required HIS to appoint individuals on to differing terms and conditions that reflect their backgrounds, but the same salary scale in order to avoid question marks over equal pay. A solution to the terms and conditions situation is needed to bring clarity to our employment offering, and we will fully participate in any discussions relating to the creation of new contracts led by Scottish Government colleagues in 2016 2017. Our employee age profile remains broadly consistent with previous years. Compared to other NHS employers, HIS has proportionately less staff under the age of 25. The main cause of this is the skills and experience required for the majority of our posts. We recognise the important contribution that under 25s can provide and that our current position is neither sustainable nor desirable. During 2016 2017, we will develop a range of initiatives to encourage youth employment, with the chief focus on Modern Apprenticeships within administrative services. During 2015 2016, there was a slight increase in sickness absence rates, but these remain below the established 4% expectation. There continues to be work required with people managers on improving the capture of unplanned absence causes. However, there has been an increase in the numbers of employees indicating anxiety, depression and stress, and this will be explored in detail in early 2016 2017. One aspect of this exploration will be determining if there is any linkage between increased absence levels and our approach to vacancy management. A challenging budgetary environment in 2015 2016 required HIS, through the established Change Management Board and process, to assiduously manage vacancies and deliver headcount reductions. For 2016 2017, a vacancy factor of 7.7% has been agreed in order to accrue financial savings that will contribute to a balanced budget. This will be closely monitored to ensure achievement of our budgetary goals, and our people are supported in terms of manageable workloads and performance expectations. 32
Levels of anticipated workforce growth during 2016 2017, particularly within the Hub and the ate of Quality Assurance, require us to urgently consider the application of agile working approaches for colleagues based within our two main offices Gyle Square (Edinburgh) and Delta House (Glasgow). The ready availability of additional workstation space is particularly challenging in Delta House. A subgroup of the Change Management Board has been considering the situation and is coming forward with recommendations. These include switching the majority of available workstations to hot desk status, and ensuring that all employees are provided with information communication technology that facilitates cross-site and home-working whenever appropriate. To be able to deliver on our work programme and achieve changes in the way we work, we need a flexible workforce that is able to be responsive to changes in the work plan due to changing context and to urgent unplanned work demands. The Change Management Board is working to support the workforce to build approaches to work more flexibly across the organisation so that we can respond more efficiently to fluctuations in workload and optimise use of existing workforce capacity and capability. This will require traditional team and directorate structures to support an increased level of cross-organisational working. Members of the Change Management Board have sought examples of flexible workforce approaches from Audit Scotland and from Scott-Moncrieff and have presented these models to Partnership Forum and Corporate Management Team as a way of stimulating thinking about a model that would work for HIS. In addition we are building case studies of pieces of work being carried out across the organisation that are testing out ways of working more flexibly. We will build on these during 2016 2017 and use them to engage staff in taking forward changes in ways of working. 33
You can read and download this document from our website. We are happy to consider requests for other languages or formats. Please contact our Equality and Diversity Advisor on 0141 225 6999 or email contactpublicinvolvement.his@nhs.net Edinburgh Office Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Glasgow Office Delta House 50 West Nile Street Glasgow G1 2NP 0131 623 4300 0141 225 6999 The Healthcare Environment Inspectorate, Hub, Scottish Health Council, Scottish Health Technologies Group, Scottish Intercollegiate Guidelines Network (SIGN) and Scottish Medicines Consortium are part of Healthcare Scotland. www.healthcareimprovementscotland.org