What are your Views on NHS Grampian s Proposed Key Priorities for the Next Three Years?

What are your Views on NHS Grampian s Proposed Key Priorities for the Next Three Years? Consultation Document Mid-October to Mid-December 2009

3 If you would like: more information on issues and plans mentioned in this publication someone to come and talk to your group about Healthfit or the Grampian Health Plan more information on how you, or your group, can get involved in helping us develop the best local health services possible to give us comments or suggestions on any part of the work of NHS Grampian please contact: Corporate Communications Team NHS Grampian Ashgrove House Foresterhill Aberdeen AB25 2ZA Tel: 01224 554400 Fax: 01224 550655 email: grampian@nhs.net This publication is also available in large print and other formats and languages, on request. Please call NHS Grampian Corporate Communications on (01224) 551116 or (01224) 552245 email: grampian@nhs.net Ask for publication CGD 090452 What is this document all about? NHS Grampian provides a wide range of high quality care and services with approximately 17,000 staff and a budget of around 900 million. This document sets out our (NHS Grampian) proposed key priorities for development of healthcare and services over the next three years. It also explains the challenges we face in improving the health of the Grampian population. Since 2002, our approach for delivering improved health (known as Healthfit) has consistently focused on: ensuring everyone has the same opportunities to live a healthy and long life supporting people to take greater responsibility for their health through selfcare and self-management, for example, keeping themselves healthy and knowing what to do when they are ill or have a chronic condition providing safe and effective care and services in partnership, when people need them and doing this locally, whenever clinically appropriate ensuring that only specialist and more complex care is provided in hospitals. As a public organisation, we have a duty to continue to spend taxpayers money wisely. This will be even more important in the future as we anticipate that the NHS will have lower funding increases over the next five to 10 years than in recent years. This is a result of the impact of the current world wide economic recession (known as the credit crunch). This means that we will need to continue to refine our plans for how we deliver care and services. In order to keep improving care and services and ensure that we use taxpayers money wisely, staff, patients, the public, carers and partners will all have to work together to do many things differently. This will mean that: all staff will have an important role in looking at different ways to improve care, but doing this in a more efficient and less costly way. We are meeting with our staff over the next few months to share ideas on how we can do this everyone will need to take greater responsibility for their own health and also the services they use, for example, cancelling appointments if they cannot attend or no longer require them, and only requesting repeat prescriptions if they still need them

4 5 we will regularly review our capital plan in line with the money we will have available, in order to decide the phasing of our building programme over the next five to 10 years as around 70% of our budget is spent on staff and associated costs, we will need to look at other ways of delivering safe, high quality care, in a cost effective way. This will mean for example, employing fewer staff than currently, by not always replacing staff who retire or leave the organisation we are not able to meet everyone s expectations and therefore we will need to be clear about what care and services we can provide with the resources available to us. As a public organisation, staff in NHS Grampian not only have a duty but also a strong desire to work together with the public, to agree how we will continue to improve health and health services. It is very important that you tell us what you think of the proposed priorities mentioned in this document and what is important to you. Page 23 tells you how you can have your say on these priorities. Specialised terms used in this document are explained on page 22. If you would like more information on Healthfit or on previous NHS Grampian Health Plans, please visit www.nhsgrampian.org/healthfit. What is NHS Grampian all about? NHS Grampian s Vision Is: Proudly working together to deliver the best possible services for a healthier Grampian. For you and your family, this will mean: helping you enjoy better health through understanding how to keep healthy supporting you to live a longer, healthier life developing with you safe, sustainable, high quality services, delivered in the right place, at the right time by suitably trained and skilled staff delivering services fairly for your improved wellbeing. What is the purpose of NHS Grampian? The purpose of NHS Grampian is to: improve the health of people in the North East of Scotland and beyond provide high quality services for our patients help people choose the best ways to look after their health. This will mean that we will: treat each individual with dignity and respect behave with integrity, consistency and compassion communicate clearly be open, honest and fair learn and improve lead by example be environmentally responsible celebrate success work in partnership with our staff, patients, carers, communities, the public and private sector organisations invest in our people, services and premises encourage innovation and build on the record of success in the North East.

6 7 What Does NHS Grampian Do? NHS Grampian provides a wide range of health improvement and healthcare services to over half a million people living in Grampian. We also provide specialist services to people from other parts of Scotland and the UK. Services range from advice on how to keep people healthy to life-saving operations. Services also cover all stages of life from pre-pregnancy to end of life. Care and services are provided in a range of places in the community, such as: people s homes and workplaces 84 GP practices across Grampian 17 community hospitals within Grampian. We also provide highly specialised care in our hospitals: Dr Gray s, Elgin Aberdeen Royal Infirmary Royal Cornhill Hospital, Aberdeen Royal Aberdeen Children s Hospital Aberdeen Maternity Hospital Woodend Hospital, Aberdeen (also provides community hospital facilities). NHS Grampian staff all play an important role in our ability to deliver the wide range of health improvement and healthcare services. NHS Grampian also works closely with a range of organisations such as NHS 24, other NHS Boards, Grampian Police, Scottish Ambulance Service, local authorities (councils), colleges and universities, and a range of voluntary and charitable organisations to improve people s health. What are the concerns of people in Grampian? Over the last year we have talked to members of the public, patients, staff and partners about what their concerns are, and what they feel are the things which may make it difficult for us to deliver the best services and care to improve people s health. You told us that: you and your family want quick access to safe and quality care, and services when you need them. Specifically highlighted were GP services and dentists we should provide adequate car parking for patients, staff and visitors we should give greater consideration to those who require transport to attend their appointments care should be more joined-up, for example, only attending the hospital once for all your tests or getting one check-up from your GP practice instead of having a check-up for each health problem you may have you are concerned about cleanliness and hospital-associated infections such as MRSA and Clostridium difficile (C. diff) we must communicate better with patients and the public on what services are available and where and how these can be accessed, including the development of information for non-english speaking members of our community carers need to be better supported you want to hear more about the good work being done in NHS Grampian we must improve communication between staff about patients care we need to improve how we communicate with people who have visual impairment, difficulty in hearing and difficulty in reading we need to improve two-way communication with staff around priorities so that we know what we must do better the population is changing and so are health needs, for example, an increasingly ageing population, people with more chronic conditions and an increasing number of people who consume harmful levels of alcohol the health gap between those people living in disadvantaged areas and those living in affluent areas is not reducing as it must we do not have the best available information technology to deliver better care and improve communication between doctors, nurses and other staff

8 9 you are concerned about how we will deliver the right care, in the right place, by the right staff because there will be fewer people of working age in the future we need to ensure patients, carers, the public and staff have a stronger voice and work together to improve health, care and services both staff and the public need to take more responsibility for looking after their own health technology and techniques are changing and so we need to change how we deliver care and treatments some of our buildings and premises are becoming old and require upgrading so that our staff can keep delivering the best care and as safely as possible we have finite resources and funding available and so we need to better prioritise how we use our resources for the benefit of the Grampian population. The above views and concerns reflect many of those areas which were highlighted by the survey undertaken in Grampian as part of the Better Together: Scotland s Patient Experience Programme. What You Told Us Were The Good and Not So Good Things About NHS Grampian 1,275 formal complaints were made between June 2008 and July 2009. The most common complaints were: 1. Poor communication or staff attitudes (28%) 2. Delivery of a patient s treatment (23%) 3. Environmental such as catering, cleanliness and premises (21%) 4. Waiting times (17%) 5. Parking and transportation (2%) 6. Other areas (9%) 305 formal compliments were received between June 2008 and July 2009. The main areas where NHS Grampian received positive comments were: 1. Delivery of patient s treatment (52%) 2. Staff attitudes and communication (32%) 3. Other areas (16%) This tells us that we do not get it right for all patients and therefore we need to keep improving. What Are The Current and Future Needs Of The Grampian Population? Grampian is, in the main, a place where most people enjoy good health compared to other parts of Scotland. This general picture of good health is not seen in all sections of our communities. When we look closely at our population we can see: those who suffer the poorest health tend to be those living in poverty high rates of children having accidents high rates of alcohol and drug misuse, particularly affecting our younger people higher numbers of children and adults overweight or obese risky sexual behaviour poor mental health, in particular depression that many more people are living with chronic conditions and they need the right support to help them to live well a growing number of older people who need support in order to have a good quality of life, despite any illness they may have, and we need to make sure we have the right services to support conditions more likely to occur with ageing such as dementia heart disease, cancer, stroke, smoking-related lung disease, and diabetes continue to be the main causes of illness and death in Grampian. A large part of these diseases can be prevented. In order to maintain and improve our current good health status within Scotland and be able to address the areas which are causing ill health in our communities, we must continue to prevent, detect and effectively treat ill health, while making it easier for people to make healthier lifestyle choices. Opportunities to promote and protect health occur at every stage of life starting at conception. Uptake of vaccination and attendance at screening programmes prevent illness and help to detect disease at an early stage therefore improving the chances of effective treatment. In particular, eating healthily, being active, sensible use of alcohol, not misusing drugs, having positive sexual relationships and taking action to address poverty are still the main ways we will help to improve our health today and secure better health for the future. (Information provided by the NHS Grampian Feedback Service)

10 11 What Are Our Proposed Priorities For The Next Three Years? Improving health and reducing health inequalities We have taken all of the information you have given us, along with the needs of the population, and have split these into five important areas: Improving health and reducing health inequalities. Involving patients, carers, the public, staff and partners towards mutuality. Delivering safe, effective and timely care in the right place. Developing the workforce and empowering staff. Getting the best from our resources. Everything we plan and develop in NHS Grampian needs to help us improve these five areas. This will help us to continue to improve health and health services across Grampian. Our front line staff and managers have very good ideas for improving services and we have a good record of positive service changes. We are now introducing something we are calling Continuous Service Improvement (CSI). This will ensure that we have a consistent approach across the whole of NHS Grampian, using a set of tools and techniques and providing training and support to staff to improve patient care and experience. The five key areas are outlined in the remainder of this document, along with some key actions to help you see what difference this will make to patients, the public and staff. Page 23 tells you how you can have your say on these priorities. We want to continue to improve the health of the Grampian population. This means focusing especially on those people who are disadvantaged and ensuring that they have opportunities to be healthy and have fair access to health information and services. We will help people live healthier and longer lives by: making changes in care and services which focus on improving the health of people, regardless of who they are or where they live, in order to ensure everyone has the same opportunities to live a healthy and long life helping people to better look after their own health by: ᎰᎰ improving access to good quality information on health, treatments and health services ᎰᎰ ensuring people have the right information and skills to effectively respond and manage chronic conditions, and therefore reduce health complications ᎰᎰ continuing to increase the number of dentists and the improvement of dental facilities so that people have better access to NHS dental care. We will also ensure, with help from parents in promoting good oral health, that at least 60% of 5 year old children in Grampian will have no signs of dental disease by March 2011 ᎰᎰ tackling the high levels of alcohol consumption by increasing awareness of the recommended limits on daily alcohol use. We will also identify those we believe are at risk of harming their health through alcohol, give them appropriate advice, and where required, ensure that they get quick access to treatment services ᎰᎰ providing support to more people to stop smoking and continuing to give advice and support to young people so that they do not start smoking ᎰᎰ delivering heart health checks to those people who are at most risk of serious preventable illnesses, and who live in the most deprived areas across Grampian ᎰᎰ supporting new mums to exclusively breastfeed their new born babies for at least two months, but ideally up to weaning at six months

12 13 ᎰᎰ increasing the number of children who are a healthy weight by working with families to develop a healthier lifestyle, and supporting people to regain a healthy weight ᎰᎰ encouraging and supporting people to attend prevention services such as immunisation and screening programmes for themselves and for their children. Screening for cervical, breast and bowel cancer, as well as disease before and after birth would be included. working with our partners on key areas to improve people s health by tackling those issues which lead to poor health, such as inadequate housing, unemployment and unhealthy workplace environments protecting the public by putting into action effective plans for: ᎰᎰ managing and containing risks to the public, such as E. coli O157, tuberculosis (TB), food poisoning outbreaks and other infectious diseases such as influenza A H1N1, (swine flu) pandemic ᎰᎰ preventing emergencies, and reducing / controlling the effect of an emergency, if one occurs. Involving patients, carers, the public, staff and partners towards mutuality We need to listen to the experiences of patients and carers who use NHS services to find out what is important to them and where we can improve. This will help ensure patients receive the best possible care, whatever service they come into contact with. We need to inform and involve patients, carers, the public, staff and partners when we plan and develop services, in order to improve the health of the Grampian population. Although we do involve people, we need to do much more to ensure we become a truly mutual NHS, working collaboratively and cooperatively with patients, carers, the public, partners and our staff. Working with patients, carers, the public and partner organisations, we aim to: encourage people to tell us about their experiences; encouraging positive feedback as well as making it easier for people to tell us when things go wrong take part in the Better Together Scotland Programme patient surveys and make changes to patient care as a result of the findings ensure all our main plans and projects have been informed and guided by those people most affected develop the role of the NHS Grampian Community Forum and the Public Partnership Forums to improve public involvement in decision making and increase the range of other ways people can get involved in our work improve our involvement and engagement with younger groups of the population by creating stronger links with existing youth forums and with colleges and universities continue to meet our statutory requirements as required by the Race, Gender and Disability Equality Schemes. In addition, we will continue to progress action plans for age, sexual orientation and religion / faith to ensure the views of all sectors of the population are considered when planning health services further improve communication with local ethnic communities by expanding interpretation and translation services further improve communication with disabled people by providing more portable induction loops and increasing the availability of accessible information continue to work with carers and carers organisations to ensure the needs and concerns of carers are addressed

14 15 develop our website as a resource for the public to access information and resources online relating to health and services offered by NHS Grampian, that is accurate, reliable, trustworthy, public focused and up-to-date work closely with the Scottish Health Council to try and ensure best practice in our public involvement work. With staff we aim to: ensure that they are all aware of NHS Grampian s vision and values and help make these a reality for patients and staff provide more opportunities for them to have their say on how care and services can be improved and tell others about the changes they have made which have improved patient care / experiences support them to ensure they involve patients, carers, the public and partners in the planning, delivery and review of services work with them to develop ways to improve communication. Delivering safe, effective and timely care in the right place We will strive to ensure that the care we provide is safe, effective and based on evidence which meets individual patient needs. Care will also be delivered at the right time and in the right place, whether in hospital, a GP practice, the community or a patient s home. Over the next three years we aim to: continue to improve patient safety by: reducing adverse (harmful) events by 30% and reducing avoidable in-patient mortality (death) by 15% by 2011, in line with the aims of the Scottish Patient Safety Programme reducing the number of people who are infected by Clostridium difficile (C. diff) and MRSA ensuring the work of the Scottish Patient Safety Programme becomes part of the daily routine in NHS Grampian by introducing: ᎰᎰ measurement and evaluation of the processes staff need to go through to prevent infections, to make sure they are carried out every single time ᎰᎰ the use of structured communication tools to improve the handover of patients between areas ᎰᎰ a pre-operative surgical checklist to reduce complications in the operating theatre. EXAMPLE OF WORKING WITH PATIENTS TO DELIVER SAFER CARE Patients at Dr Gray s Hospital in Moray helped develop a new patient safety leaflet called Caring for your Cannula as part of the Scottish Patient Safety Programme. A cannula is a small tube which is inserted into a vein by healthcare staff so that patients can be given fluids or medication. Following a hospital wide audit, it was found that patients didn t know what to expect from having a cannula in place and some were putting up with discomfort rather than telling their nurse. The ward staff and the Infection Prevention and Control Nurse talked to patients about cannulas and together developed a clear, friendly information leaflet for patients. This has been well received and helps patients to take an active role in contributing to their recovery. In addition it has improved cannula care and documentation within the hospital making the care provided by medical and nursing staff even safer.

16 17 improving ways of learning from incidents, complaints, investigations and sharing lessons learned with staff reducing inappropriate variation in our clinical practices by using evidence-based practice as a way of reducing errors and improving patient care. provide effective and timely care and treatments by ensuring that: patients are seen by an appropriate member of the GP practice team within 48 hours 98% of people who attend Accident and Emergency (A&E) units across Grampian will be treated, admitted to a hospital ward or discharged within 4 hours of arrival we reduce the number of unnecessary attendances to A&E by promoting and developing alternative services we provide early diagnosis and management of patients with dementia by March 2011 by the end of December 2011, 95% of people who have an urgent referral for suspicion of cancer are diagnosed and receive treatment within 62 days, and that all patients diagnosed with cancer will receive their first treatment within 31 days of decision to treat by December 2011, no patient will wait longer than 18 weeks from GP referral to treatment, in line with the national standard by the end of March 2013, people who have a drug or alcohol problem will receive treatment within 3 weeks of being referred we improve access to Child and Adolescent Mental Health Services we support prompt discharge from hospital, particularly for those people with chronic conditions who are most likely to be admitted as an emergency we develop a range of initiatives which help people understand what they can do for themselves to minimise the effect of their condition on their lives, keeping well for longer, reducing the need for hospital admission and being able to stay in their own homes. This will include people who have chronic conditions, for example, chronic respiratory disease, diabetes and chronic heart disease. EXAMPLE OF IMPROVING CARE FOR PEOPLE WITH A CHRONIC CONDITION An increasing number of people have one or more chronic conditions. Across Grampian, healthcare professionals are working closely with patients and carers to help better manage chronic conditions. An example is outlined below. An 81 year old lady living in sheltered housing who has a chronic respiratory condition called Chronic Obstructive Pulmonary Disease (COPD), has a history of numerous admissions to Aberdeen Royal Infirmary due to her COPD symptoms. Each hospital stay was around three weeks. She also attended her GP frequently due to her COPD symptoms. This lady received care from the Early Supported Discharge Project in North Aberdeenshire. She received a patient education programme supported by her district nurse. Her GP and district nurse developed an Anticipatory Care Plan (personal management plan) with her, so that she and the community healthcare team know what to do as soon as her symptoms get worse. This type of care has helped better manage this lady s COPD symptoms. As a result, she has had fewer admissions to hospital and has been able to receive care at home. When asked what she thought of the care, she said Anticipatory Care Plans are marvellous. I wish I had one of these years ago. support the delivery of care in the right place across Grampian by: providing more care and treatment closer to people s homes, where it is clinically safe to do so. This will also mean increasing the number of older people with complex needs receiving care at home continuing to develop the multi-disciplinary and multi-agency model of care to provide responsive, accessible joined-up care that meets the needs of local communities continuing to focus on the improvement and development of buildings, which is consistent with our long-term approach for health service delivery, population need and risk ensuring the Emergency Care Centre on the Foresterhill site is built and operational by the end of March 2012, that Chalmers Hospital in Banff is built and operational by autumn 2011 and the Energy Centre on the Foresterhill site is built and operational by Spring 2011 continuing to develop and agree plans and timescales for the delivery of the Aberdeen City Health and Care Village, a new Cancer Centre, the Forres Hospital and Health Centre and the Aberdeen Maternity Hospital continuing to develop, agree and implement the blueprints for Aberdeen Royal Infirmary, Dr Gray s Hospital in Elgin, Royal Cornhill Hospital and Woodend Hospital in Aberdeen.

18 19 Developing the workforce and empowering staff NHS Grampian employs approximately 17,000 people who all play an important role in NHS Grampian s ability to deliver a wide range of health improvement and healthcare services. Staff range from those delivering hands-on care, to those who help us maintain buildings and equipment which enables clinicians and other staff to provide healthcare services. Our staff are our most important resource. Over the next three years we will: ensure all staff are clear about how their roles contribute to the delivery of improving the health of the Grampian population continue to attract, retain and develop skilled and talented staff who will help improve and deliver the best care and services use the information we have about our population and future clinical practice, and develop a model for a sustainable workforce to ensure the continued provision of healthcare and health services both support and provide more opportunities for staff to make changes which improve people s health and healthcare, but do not require additional resources work with the education sector to support and train staff to work better with patients to improve patient care and experience continue to develop new roles for healthcare professionals which will allow us to keep improving how we deliver care and services work with other public sector organisations such as local authorities, universities, Grampian Police, voluntary and charitable organisations to improve the health and safety of the Grampian population. STAFF STORY After the birth of my second child six years ago, I needed to change from full-time to part-time working. With support from my manager and the NHS Grampian flexible working policy, I prepared a proposal which considered what I needed to deliver for my post, my team and the organisation. My working hours were cut considerably yet I was at work four out of five working days. This had a hugely beneficial effect on my work life balance as I felt I could perform well at work, as well as being a new mum. Since then, I have been able to re-negotiate my working hours as my career and home life have changed and I now work 35 flexible hours a week. The benefits of NHS Grampian s policy on flexible working have meant that I can enjoy my job and my family, I continue to grow professionally and my employer has retained an experienced, skilled and motivated employee.

20 21 Getting the best from our resources NHS Grampian has a duty to use public money wisely and to give the public confidence that we are using the taxpayer s money to the maximum effect, whilst ensuring that we are developing services over the longer term. Due to the world wide economic downturn, we expect to receive lower than normal funding increases from the Scottish Government over the next few years. This does not mean we cannot keep improving services and care but, to do this, we need to prioritise what we do and ensure everything that we do makes the very best use of the taxpayer s money. Over the next three years we will do this by: meeting our financial and efficiency targets set by the Scottish Government through better management of services ensuring the resources available to us over the next few years will provide the best care and treatment for the needs of the Grampian population working with patients and the public to reduce the number of outpatient clinic and GP appointments that are wasted when they are missed supporting the public to look after their health and when they are ill, ensuring the right information is available for them, so that they know where to access the right service / care working with our public sector partners such as local authorities, Grampian Police, Scottish Ambulance Service, universities, voluntary sector and other NHS Boards in sharing buildings, staff and equipment to get the best for the taxpayer s money and importantly, provide the best care and services being kind to the environment (greener) by reducing energy consumption, minimising the carbon footprint and recycling waste supporting staff to look after themselves at work and at home, so that they feel and stay healthy. By doing this, it will help us to improve services as staff sickness absence will be reduced prioritising what buildings require to be built or upgraded dependent on greatest need and the funding available from the Scottish Government. Where new buildings are built we will make sure these are modern and designed to provide the best care and services. These will also be green which will help reduce energy bills and reduce the carbon footprint comparing how we deliver care and services with other areas, as this will allow us to work towards being one of the best performing NHS Boards in Scotland. DID YOU KNOW? During the period of 1 April 2008 to 31 March 2009, a total of 37,720 outpatient appointments were not attended by patients in NHS Grampian. This meant that other patients had to wait longer than necessary for an outpatient appointment. This cost NHS Grampian the equivalent of approximately 3.5 million in lost time. We are currently developing and implementing ways to reduce the number of missed appointments by: improving NHS Grampian s appointment systems helping patients to remember their appointments, for example, sending reminders ensuring patients have the right information about the purpose and nature of their appointment and the importance of attending examining where and when services are delivered to better meet patients needs

22 23 Explanation of terms This documuent uses a few words and phrases that may not be familiar to you. This section explains what they mean. Word / Phrase Better Together Patient Experience Programme Efficiency Grampian Feedback Service Explanation Better Together is Scotland s Patient Experience Programme, using the public s experiences of NHS Scotland to improve health services. Delivering more (outputs) for the same resources (inputs) or delivering the same (outputs) with fewer resources (inputs). Service which deals with comments, suggestions and complaints received from the public about NHS Grampian. How can you have your say? We want your views on the NHS Grampian vision and proposed priorities for the next three years, to ensure that they meet the needs of the people in Grampian. Your comments will help to inform the Grampian Health Plan for 2010 2013. Please send us your comments by Friday 11 December 2009, using one of the following options: 1. By post please complete the consultation questionnaire and return to: Grampian Health Plan Consultation FREEPOST NHS GRAMPIAN Healthfit Health Inequalities Mutuality NHS Grampian Community Forum Partners Patient Focus Public Consultation Public Partnership Forums Priorities Scottish Health Council Scottish Patient Safety Programme Standards Sustainability Wellbeing NHS Grampian s approach to delivering improved health in Grampian. Unfair differences in health between different population groups. When ownership and accountability is shared with the public and NHS staff. A group made up of patients, carers and members of the general public who have an interest in health services in Grampian. Partners are people and organisations who work together. A patient-focused NHS is a service that is designed to meet the needs and wishes of the individual receiving care and treatment. This means involving the public and asking for views on plans, policies or services and taking the results into consideration. Each Community Health Partnership is required to set up a Public Partnership Forum to be the main (but not the only) way it engages, communicates and consults with the local population. Areas which have been agreed as being of high importance. The Scottish Health Council s role is to ensure that NHS Boards take account of the views of patients, carers and members of the public when they make decisions about Scotland s health services. Focuses on improving the safety of hospital care right across the country. What we aim to deliver. These can be nationally or locally agreed. To be able to consistently deliver and maintain services to the agreed level. A person s level of health and happiness. 2. By letter send your comments in a letter to the address above. 3. By e-mail or online send your comments to nhsg.consult@nhs.net or visit www.nhsgrampian.org/healthfit to complete the questionnaire online. 4. By text send your comments to 07733 003216 (number active until 11 December 2009). 5. By attending an open meeting for the public public meetings will be held across Grampian. If you are interested in attending any of the meetings below, please contact us on 01224 558813. Date Time Venue 09 November 2009 Evening Aberdeen City 13 November 2009 Afternoon Inverurie 17 November 2009 Evening Elgin 19 November 2009 Afternoon Peterhead 23 November 2009 Evening Aberdeen City (for young people) 24 November 2009 Morning Banchory 01 December 2009 Afternoon Laurencekirk In addition to the public meetings, we will also be holding open sessions for staff. The dates of the staff sessions will be communicated via the Team Brief. Workforce All staff employed.

This publication is also available in large print and other formats and languages, upon request. Please call NHS Grampian Corporate Communications on (01224) 551116 or (01224) 552245 email: grampian@nhs.net Ask for publication CGD 090452