Glasgow City Community Health Partnership

Glasgow City Community Health Partnership Development Plan 2012/13 March 2012

Contents 1. Introduction 3 2. Glasgow City Community Health Partnership 4 3. Overview of progress in 2011/12 8 4. Planning Context 12 5. Key Priorities 2012/13 15 Planning Frameworks: 16 A. Adult mental health 16 B. Alcohol and drugs 23 C. Cancer 27 D. Child and maternal health 31 E. Long term conditions 50 F. Older people 54 G. Disability services 61 H. Primary care 69 I. Secondary care/acute hospital services 74 J. Sexual health 78 Policy Frameworks: 83 K. Employability, financial inclusion and responding to the recession 85 L. Health improvement 92 M. Quality creating a person centred and mutual NHS 102 N. Sustainability 107 O. Tackling inequality 110 P. Unpaid care 118 6. Effective Organisation 122 7. Finance and Workforce 129 Page 2

1. INTRODUCTION 1.1 Glasgow City Community Health Partnership (CHP) came into being in November 2010. This Development Plan sets out the key actions we intend to take forward in 2012/13 to improve the health and well being of the people of Glasgow, and improve the quality of services we provide. 1.2 The Plan updates the 2011/12 Development Plan produced last year, and has been informed by NHS Greater Glasgow and Clyde s corporate priorities as set out in the 2012/13 Planning Guidance. 1.3 The Plan follows the format laid down by the NHS Board. The Plan has been informed by discussions with our Staff Partnership Forum and our Public Partnership Forums. In the following section we give an overview of the CHP and our key challenges in 2012/13. The next section gives a summary of last year s performance and our key achievements. 1.4 In section four we outline the context within which this updated Plan has been developed and highlight some of the key demographic and socio-economic information that have influenced our planning. In section five, we set out how we will respond to the planning guidance produced by the NHS Board, and the specific actions in each service area we will take forward in 2012/13. 1.5 In section six, we explain how we will deliver the Plan working with staff and clinicians, and our governance arrangements to oversee and scrutinise our performance. Implementation of the Plan will rely upon the continuing efforts and contributions of all teams and individual members of staff. We recognise the need to communicate effectively, develop and support staff and clinicians in delivering the service improvements outlined in the Plan. 1.6 Finally in section seven, we set out our finance and workforce plans to deliver the outcomes and actions detailed in section five. Page 3

2. GLASGOW CITY COMMUNITY HEALTH PARTNERSHIP Introduction 2.1 Glasgow City CHP is responsible for the provision of primary care and community services to the people of Glasgow, and for improving health and well being. In addition, the CHP also has responsibility for specialist adult mental health and learning disability services for the Greater Glasgow and Clyde area, including in-patient services. 2.2 The CHP covers the geographical area of Glasgow City Council, a population of 588,470, and includes 154 GP practices, 136 dental practices, 186 pharmacies and 85 optometry practices. The CHP has 5,356.73 whole time equivalent staff, and a combined budget of approximately 644.4m. Services within the CHP are delivered in three geographical sectors: North East Glasgow with a population of 177,649; North West Glasgow with a population of 190,332; and, South Glasgow with a population of 220,489. 2.3 Sectors also have responsibility for specific area wide services such as specialist children s services and sexual health services. Purpose 2.4 The purpose of the CHP, as outlined in the Scheme of Establishment, is to: manage local NHS services; improve the health of its population and close the inequalities gap; drive the local implementation of the quality strategy ensuring person centred, safe and effective care; achieve better specialist health care for its population; ensure an effective NHS process to engage in community care and children s service planning; work closely with Glasgow City Council to deliver effective integrated services where appropriate lead NHS participation in joint and community planning in Glasgow City; modernise community health services; integrate community and specialist health care through clinical and care networks; deliver effective engagement with primary care contractors; work with local communities to ensure they influence decisions; and, ensure patients and frontline health care professionals are fully involved in service delivery, design and decisions. Page 4

Aims 2.5 The aims of the CHP are to: provide a unified focus for the NHS s relationship with the City Council and to have a more local focus for the management of services ensuring strong local connections; generate efficiency and consistency in support services and management costs, and ensure devolution of service delivery, health improvement, inequalities and planning activity; provide a strong basis for better connection with primary care contractors; better reflect the pattern of flows into secondary care services to provide a more robust platform for the engagement required to drive change across the primary and secondary care interface; and, achieve streamlined Committee arrangements which ensure appropriate overall governance in a consistent and efficient way. Key Challenges 2.6 The CHP faces a number of key challenges which are described in the detailed sections that follow. In summary, the key challenges for us in 2012/13 are to: make further progress in implementing NHS Board s primary care framework to improve access working with GPs, community health staff, secondary care clinicians and other primary care professions, in particular the development of localities as a focal point for engagement and local decision making; developing an approach to tackling poverty in collaboration with key partner agencies; implement a number of key service changes in: - older people s services through implementation of the Change Fund and reducing delayed discharges to meet national targets, and reducing the number of acute hospital bed days lost due to delays; - children s services - through implementing the requirements of Getting it Right for Every Child, delivering on the One Glasgow approach and contributing to the Board wide programmes. - district nursing services increasing the time spent in face to face contact with patients; and, - improving access to community and inpatient mental health services. take forward health improvement programmes with partners designed to tackle inequalities and achieve improvements in Glasgow s record on: - reducing smoking; - alcohol screening; Page 5

- child obesity; - reducing suicides; and - cardiovascular disease. meet the financial challenge by delivering a 3% efficiency savings and delivering financial balance; progress the implementation of the Board wide organisational programme Facing the Future Together; fully engage in the consultation process following the Health Secretary s announcement on proposals for the integration of health and social care services; develop responses to improve the mental health and well being of the population, including older people, following the publication of the NHS Greater Glasgow & Clyde Keeping Health in Mind report from the Director of Public Health; and, mainstream approaches within our services that promote equality and help tackle health inequalities. Joint Planning with Glasgow City Council 2.7 As a relatively new organisation we have, with Glasgow City Council Social Work Service Department, reviewed our joint planning arrangements, and have established a number of community care planning groups focused on the specific needs of key client groups (e.g. older people, mental health etc) and other groups focused on cross-cutting issues such as carers and employability. A particular focus for our work in 2012/13 will be taking forward the personalisation agenda or self directed support. All these groups include user and carer representation, and report to an Adult Services Planning Group, which in turn reports to the Joint Partnership Board. 2.8 The Joint Partnership Board is a joint Board comprising members of the NHS Board, councillors from Glasgow City Council, and the CHP Director and Social Work Services Director. The Joint Partnership Board is tasked with monitoring performance and budgets, and overseeing service planning. 2.9 Progress in joint planning with Glasgow City Council Social Work Services will be important in setting the context for our response to the forthcoming consultation on proposals for health and social work integration. 2.10 Separate arrangements exist for the joint planning of Children and Families services. These were revised and updated in 2011 with a more streamlined structure at both city and sector level reporting into the Children Services Planning Group which in turn also reports to the Joint Partnership Board. 2.11 The CHP also plays a full part in the Community Planning arrangements within Glasgow, and is represented both at City level planning groups and local Community Planning Partnership Boards, including local housing partnerships. The CHP sees its participation in these arrangements as crucial in taking forward both improvements in services for the people of Glasgow, and improvements in health and well being. Page 6

Engaging with Public Partnership Forums 2.12 The Public Partnership Forums (PPFs) in Glasgow have changed over the past year and now reflect the three Sectors in the CHP. There are three PPFs in Glasgow who work closely with Sector Management Teams on issues of local concern. The CHP also brings the three PPFs together for city-wide meetings, of which there have been three since the CHP was established. These meetings have considered the CHP Scheme of Establishment, CHP savings plans and this Development Plan. At the most recent city-wide PPF meeting it was agreed that there would be future sessions on prescribing and medicines management, and the forthcoming consultation on health and social care integration. It was also agreed that the CHP should undertake an assessment of the impact of welfare reform on health services. 2.13 The CHP will continue to actively support PPFs to fulfil their role effectively in influencing the delivery of health care services in Glasgow at both city and local level. Page 7

3. OVERVIEW OF PROGRESS IN 2011/12 3.1 During 2011/12 significant progress was made by the CHP in delivering improvements in key service areas. This was recognised at the October 2011 Organisational Performance Review with the NHS Board where progress was noted in the following areas: reducing the number of drug related deaths; working with maternity services to reduce the number of pregnant women smoking; achieving the target for child healthy weight interventions; increasing the number of cardiovascular inequalities health checks undertaken; promoting financial inclusion and employability; undertaking service redesigns in delayed discharges, Board wide continence services, nursing homes medical practice, and breastfeeding; establishing primary care locality groups within CHP sectors to improve GP and the wider primary care teams involvement and engagement. 3.2 The Organisational Performance Review also identified areas requiring particular focus in the months ahead, including: working with acute hospital services to reduce the number of people who do not attend hospital appointments (DNAs); continue to focus on interface working with Acute to ensure; a greater proportion of women are breastfeeding at hospital discharge; reducing the number of delayed discharges, and bed days lost due to delays; implementing fully the integrated assessment framework within Children s services; continue to provide support and advice to improve prescribing practices; progress actions via the Change Fund to improve services for older people. 3.3 The table below shows the 2012/13 national HEAT targets and standards, along with the CHP s performance against these in 2011/12, where local data exists. Page 8

Table 1 2012/13 HEAT Targets and Standards HEAT TARGET 2012/13 To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25% by 2014/2015. At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours. At least 60% of 3 and 4 year olds in each SIMD quintile to have fluoride varnishing twice a year by March 2014. To achieve 1,491 completed child healthy weight interventions over the three years ending March 2014. (NHSGGC target) NHS Scotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most deprived within-board SIMD areas over the three years ending March 2014. Reduce suicide rate between 2002 and 2013 by 20% NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement. NHS Scotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009. Deliver faster access to mental health services by delivering 26 weeks referral GLASGOW CITY CHP PERFORMANCE 2011/12 New HEAT target. No local data available for 2011/12. New HEAT target. No local data for 2011/12. Glasgow City CHP position is currently below interim target set for December 2011. 375 completers in Glasgow City CHP as at December 2011 since the programme commenced, against a local target of 447. (The local target increases incrementally over the 3 year period to allow for lead in time in year 1) Glasgow City CHP achieved target quits for the period April-December 2011 (3,458 quits after 4 week follow-up, against a target of 2,088). The CHP also achieved target quits within deprived areas for April- December 2011 (2,335 quits against a target of 1,506). 74 recorded suicides in Glasgow City in 2010, showing a rate per 100,000 of 12.5 (compared with 80 in 2009 and a rate of 13.6). Glasgow City CHP will deliver a balanced budget by March 2012. NHSGGC target. Cumulative position to August 2011 indicates net reduction in electricity usage across the CHP. Minimal change in CO2 admissions to date across CHP. No local data currently available for Psychological Therapies target (data being Page 9

HEAT TARGET 2012/13 to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013, reducing to 18 weeks by December 2014; and 18 weeks referral to treatment for Psychological Therapies from December 2014. By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between 2009/10 and 2014/15. No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013; followed by a 14 day maximum wait from April 2015. To improve stroke care, 90% of all patients admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013. Further reduce healthcare associated infections so that by March 2013 NHS Boards staphylococcus aureus bacteraemia (including MRSA) cases are 0.26 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 65 and over is 0.39 cases or less per 1000 total occupied bed days. To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14. GLASGOW CITY CHP PERFORMANCE 2011/12 extracted from multiple information systems). Good progress in reducing waiting times for CAMHS but still significant number waiting longer than the 26 weeks (76 people as at December 2011). However, progress being made to achieve full compliance within target timeframe. Glasgow City CHP currently achieving target (92.5% for period July-September 2011) The number of emergency admissions for Glasgow CHP residents aged 75 years and over increased by approximately 5% between 2009/10 and 2010/11. Glasgow City has the highest annual emergency admission bed day rate within Scotland per 1,000 population for patients aged 75 years and over. The target rate for NHSGG&C has yet to be agreed with Scottish Government. As at February 2012 census the CHP has 111 delayed discharges, of which 5 were delayed over six weeks. As at January 2012, Glasgow hospitals collectively achieving 70% against an indicative target of 76%. NHSGGC acute hospitals target (currently on target) Glasgow City CHP achieving indicative target rate, for the period March 2011 February 2012. Page 10

HEAT STANDARD 2012/13 95% of all patients diagnosed with cancer to begin treatment within 31 days of decision to treat, and 95% of those referred urgently with a suspicion of cancer to begin treatment within 62 days of receipt of referral 90% of planned / elective patients to commence treatment within 18 weeks of referral No patient will wait longer than 12 weeks from referral (all sources) to a first outpatient appointment (measured on month end Census) Provide 48 hour access or advance booking to an appropriate member of the GP Practice Team To respond to 75% of Category A calls within 8 minutes across mainland Scotland (Scottish Ambulance Service) 98% of patients will wait less than 4 hours from arrival to admission, discharge or transfer for accident and emergency treatment Maintain the proportion of people with a diagnosis of dementia on the Quality and Outcomes Framework (QOF) dementia register and other equivalent sources NHS Boards to achieve a sickness absence rate of 4% NHS Boards and Alcohol and Drug Partnerships (ADPs) will sustain and embed alcohol brief interventions (ABI) in the three established settings (primary care, A&E, Antenatal). In addition, they will continue to develop delivery of alcohol brief interventions in wider settings. GLASGOW CITY CHP PERFORMANCE 2011/12 January 2012 data shows NHSGGC meeting this standard, achieving 97% and 96.6% compliance for the 31 day and 62 day respective standards. NHSGGC standard: 90.3% as at January 2012. No patients waiting >12 weeks as at January 2012. No data available for 2011/12. (Glasgow City CHP GPs collectively showed 95.6% compliance in 2010/11 against a target of 90%). Scottish Ambulance Service standard. NHSGGC standard: 94.4% compliance at February 2012. Glasgow City CHP showing 91% compliance against notional target, as at February 2012. Glasgow City CHP rate of 5.3% for period February 2011-January 2012. Glasgow City CHP 3,592 ABIs undertaken between April and December 2011, against a target of 4,578. Page 11

4. PLANNING CONTEXT 4.1 The CHP is responsible for services to the people of Glasgow City; a total population of 588,470 as shown in the table below. Table 2 Glasgow City CHP population by sector North East North West South Glasgow City CHP Total Population 177,649 190,332 220,489 588,470 Age 0-15 29,538 28,402 38,743 96,683 Age 16-64 122,092 136,549 151,602 410,243 Age 65-74 13,810 12,911 15,622 42,343 Age 75+ 12,209 12,470 14,522 39,201 Figure 1 Glasgow City CHP population by sector 250,000 200,000 150,000 177,649 190,332 220,489 122,092 136,549 151,602 100,000 50,000 29,538 28,402 38,743 13,810 12,911 15,622 12,209 12,470 14,522 0 Overall Population 0-15 16-64 65-74 75+ North East North West South 4.2 From recent economic, health and social data, the following are key factors influence demand and access to our services: Page 12

Table 3 Key Economic, Health & Social Factors North East North West South Scotland Households assessed as homeless 2.6% 2.6% 2.6% 1.8% Adults claiming incapacity benefit/sever disability allowance 10.4% 7.9% 8.2% 5.6% Households in extreme fuel poverty 6.5% 6.5% 6.5% 7.5% Population income deprived 28.8% 23.5% 25.0% 15.1% Working age population - employment deprived 20.7% 15.9% 16.3% 11.6% Working age claiming - job seekers allowance 6.8% 5.8% 6.0% 4.4% Dependence on out of work benefits or child tax credits 64.2% 55.4% 62.8% 46.6% Source: Public Health Observatory Report, Refreshed 2010 4.3 In terms of deprivation, recent data from the Scottish Index of Multiple Deprivation (SIMD) shows the following; Table 4 Scottish Index of Multiple Deprivation Data 2004-2009 % Glasgow No. Data Zones Pop Year of SIMD Report City SIMD 2004 374 307,997 53.3% SIMD 2006 330 269,539 46.7% SIMD 2009 301 244,587 41.9% 4.4 Key issues from this data that impact on our services are as follows: There are now fewer areas in Glasgow that are in the 15% most deprived areas; But 43% of Glasgow data zones still remain in the 15% most deprived category; 301 Glasgow data zones are deprived, representing 41.9% of the City total; 244,587 Glaswegians live in a deprived area (approximately 42% of Glasgow s population); Glasgow accounts for 11% of the total population of Scotland but accounts for 31% of all deprived Scottish data zones, down from 38% in 2004; 147 of Glasgow s data zones are in the bottom 5% - this accounts for almost half the Scottish total (45%); 75 data zones in Glasgow have moved out of deprivation since 2004; 67,000 fewer residents now live in an area of deprivation, a fall of over one-fifth on the previous SIMD report; Page 13

Glasgow now accounts for 45% of all bottom 5% data zones in Scotland, down from 70% in 2004. 4.5 Significant issues remain however, and Glasgow still accounts for: 13 of 20 of the most deprived areas in Scotland; 31% of all income deprived neighbourhoods; 30% of all employment deprived areas; 33% of all health deprived neighbourhoods; and, 28% of all education deprived neighbourhoods 4.6 There have been significant changes in the black and minority ethnic (BME) population within Glasgow. The table below shows an estimate of the population changes between 2001 and 2008. There is a decrease in the percentage of white Scottish/British/Irish people living Glasgow, and an increase in the other groups. Table 5 Ethnicity 2001-2008 Ethnic Group TOTAL POPULATION White Scottish / British / Irish 2001 population % 2001 2008 population % 2008 Change as % of population 2001-2008 % change 577,869 100 584,240 100 1.1 1.1 536,015 92.76 517,355 88.55-4.21-3.5 Pakistani 15,330 2.65 20,587 3.52 0.87 34.3 Other White 10,344 1.79 19,739 3.38 1.59 90.8 Other Ethnic Group 2,036 0.35 4,998 0.86 0.51 145.5 Bangladeshi 237 0.04 709 0.12 0.08 199.2 Source: Glasgow City Council 4.7 It should be noted also that Glasgow has in recent years seen considerable migration from Eastern Europe following the expansion of the European Union, an a number of migrant communities have begun to settle in Glasgow. This information is not captured in the census data reported above. It is estimated that migration from Eastern Europe has increased the City s population by 5,000 (Bake Stevenson report, 2008). Page 14

5. KEY PRIORITIES 2012/13 5.1 Within this section we set out our key priorities and how we intend to deliver them. The priorities come from the planning and policy frameworks set out by Greater Glasgow and Clyde NHS Board. The actions below outline how we intend taking these forward in Glasgow City. More detailed implementation plans will describe specific actions to be progressed at Sector level. 5.2 The NHS Board Planning Guidance sets out a number of Planning and Policy Frameworks. These cover the following areas; Planning Frameworks: A. Adult Mental Health B. Alcohol and Drugs C. Cancer D. Child and Maternal Health E. Long Term Conditions F. Older People G. Disability H. Primary Care I. Secondary Care/ Acute Hospital Services J. Sexual Health Policy Framework: K. Employability, Financial Inclusion & Responding to Recession L. Health Improvement M. Quality Creating a Person Centred and Mutual NHS N. Sustainability O. Tackling Inequality P. Unpaid Care 5.3 The frameworks describe the key national and Greater Glasgow & Clyde policies and priorities for each planning/policy area, and highlight some of the key issues and challenges we face in each service area. The action plans that follow set out the outcomes which we aim to deliver, and specify a number of performance indicators against which progress can be measured. Our Plan sets out the actions that we will be taking forward within Glasgow to deliver the outcomes in each of the frameworks listed above. Each action plan also includes the key workforce and financial issues. Page 15

Planning Frameworks: A. Adult Mental Health Introduction A.1 The correlation between poor mental health and deprivation, including social and economic inequalities (health & well being survey 2008), presents particular challenges for Glasgow, including: It is estimated that approximately 115,000 people (28% of adult population) within the City are living in the community with a mental health problem (Mokrovich 2009). People with mental health problems are nearly three times more likely to be in debt. One in four tenants with mental health problems has serious rent arrears (ODPM SEU 2004). Around 25-30% of routine GP consultations are for people with a mental health problem (NAO 2007a; ODPM SEU 2004). A.2 Changes in the national planning context include:- Introduction of Access to Psychological Therapies HEAT Target to deliver faster access to mental health services by delivering 18 weeks referral to treatment for Psychological Therapies from December 2014. Depression/prescribing; readmissions; and suicide reduction are no longer HEAT targets but continue to be retained as Indicator Targets, and remain as part of GGC local priorities The Scottish Government is consulting on its proposed Mental Health Strategy (all ages) focusing on 4 areas of: improving access to psychological therapies; implementing the National Dementia Strategy; preventing suicide; and examining the balance between community and inpatient provision and the role of crisis services. The introduction of new legislation to prevent age discrimination (with potential impacts on the boundaries between AMH and OPMH provision) A.3 Within NHSGGC, the CHP now has management responsibility for mental health inpatient services serving the Glasgow City and surrounding catchments, and hosts the mental health improvement team on behalf of GGC. A.4 Joint Planning arrangements are now re-established with Glasgow City Council for adult mental health services. Work is progressing to develop a joint service and financial framework. Joint work will also take place with GCC to support the effective roll-out of self-directed support and personalisation, including the development of processes to identify the potential impact for services and patients. Performance in 2011/12 Adult Mental Health section Page 16

Consistently no adult mental health delayed discharges exceeding the 6 weeks target. CHP readmission rates on track with NHSGGC target. Slight reduction in the number / rate of suicides in Glasgow in 2010 compared with previous year, although relatively static position across 2002-10 (Target 20% reduction in rate by 2013). Meeting target for suicide prevention training as at Dec 2011. CHP on track to meet Citalopram/Fluoxotine anti-depressant prescribing indicator, and is meeting Escitalopram anti-depressant indicator. Contributed significantly to the service redesign processes, for implementation in 2012/13 through sector implementation plans and operational implementation plans. Strategic Priorities for 2012/13 A.5 The CHP s overarching strategic priorities for adult mental health in 2012/13 are: to develop comprehensive primary and community adult mental health services to provide both brief and ongoing support, underpinned by access to timely inpatient care when required; to work with partners to improve the overall mental health and well being of the population. This will involve taking forward No Health without Mental Health recommendations as part of mental health improvement programme, taking into account the likely increase in mental health issues arising from the wider economic situation. to help develop and deliver a range of service change and redesign measures to deliver financial savings targets, whilst minimising the impact of such changes for service users, and retaining an ongoing sustainable balance of care Adult Mental Health section Page 17

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator Delivery of effective treatment, care and support. Delivery of care on a timely basis in the right settings, which focuses on recovery. Efficient and effective deployment of resources to sustain the capacity of services to respond during a period of reducing budgets. - We will continue work in respect of the determination of pathways and measurement criteria for ensuring timely access to psychological therapies - We will continue to work with GPs to ensure antidepressant prescribing in is line with good practice and explore potential alternatives - We will implement agreed model for a reconfigured out of hours service ensure - We will continue to look to improve the interface with addiction services, particularly around the transition of patients between both services - We will review the care packages of the top 10 repeat attendees from each Acute hospital, with the aim of improving understanding of the patient pathway through primary, secondary and tertiary care. - We will contribute to the completion of the primary care and community mental health team reviews and implement findings - We will implement the findings of the review of crisis services - We will progress local savings plans in accordance with agreed budgets - We will contribute to a review of inpatient services - 18 wk RTT psychological therapies waiting time target (Dec 2014) - anti-depressant prescribing rates - ongoing sustainability post Modernising Medical Careers changes - Robust transition protocols in place - Reduction in the level of repeat attendances. - Increased compliance with Acute 95% (4 hours waiting time) standard - in accordance with sector implementation plans - readmission rates in line with target levels - services managed within agreed budgets and savings plans achieved - review against benchmarked model Adult Mental Health section Page 18

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator Improving the mental health and well being of the population. to ensure the optimum balance of care and efficient bed models:- Parkhead/ Stobhill/ Ruchill reconfiguration SGH/ Leverndale consolidation Overall acute configuration / rationalisation of sites Reconfiguration of IPCU and Rehabilitation services - We will progress plans to introduce a greater consistency in the deployment of nursing staff and skill mix across our inpatient wards, aligned to optimum ward sizes / bed numbers per ward. - We will contribute to the development of service specs & KPIs for all major service / team areas - We will work with HI&T to contribute to the development of mental health information systems, particularly to support service redesign and compliance with HEAT targets - We will implement agreed capital programmes to improve the quality of care and efficient use of resources. - We will continue to implement the recommendations within No Health Without Mental Health - We will work closely with Health Improvement to - readmission rates in line with target levels - Minimal patient boarding - review against benchmarked levels - as per capital plan Adult Mental Health section Page 19

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator Improve joint planning with GCC through the AMH Planning & Implementation Group and associated structures. ensure mental health activities are reflected in local action plans and to strengthen the interface with health improvement in the redesign of primary care team activities. - As part of wider mental health improvement action planning, we will develop a comprehensive suicide prevention programme, in conjunction with the multi-agency Choose Life planning arrangements, and including actions to maintain the level of designated front line staff trained in suicide prevention skills above 50% - We will devise and implement a programme of antistigma activity, in line with the multi-agency planning provided by the Anti-Stigma Partnership and its work-streams - We will contribute to the development of a joint service, workforce and financial framework - Agree processes to manage the implementation (GCC led) of SDS / Personalisation and identify the potential impact for services and individuals - Ensure the needs of people with mental health problems are reflected in the Local Housing Strategy and Housing Investment Plan - Ensure a co-ordinated approach to taking forward the recommendations within the national strategy for mental health (consultation phase) - Reduce suicide rate between 2002 and 2013 by 20% - Achieve target staff training numbers - Joint action plan and performance management arrangements being developed Adult Mental Health section Page 20

Financial update Ongoing challenge of delivering financial efficiencies whilst maintaining community capacity to support inpatient redesign. Pending final notification of financial targets for 2012/13, a nominally budget reduction of 3% in 2012/13 is planned for. Exploring enhanced effectiveness and productivity of services The major areas of work in relation to primary care services and crisis services have been agreed and will now be implemented. The approaches and phasing of the inpatient changes is the subject of discussion between the Board and the Scottish Government. Work progressing to develop joint financial framework with GCC to support joint planning Workforce implications We will work closely with staff side, particularly around the impact for staffing of service redesign programmes Review of medical staffing requirements in the context of the above community and inpatient service reviews and the evolving arrangements for medical training. Tackling inequalities Develop & ensure application of EQIAs to all major areas of service redesign, delivery & policy development Review the piloting of GBV sensitive inquiry within Leverndale wards to inform roll-out Progress activities that promote employability and financial inclusion, including staff awareness raising to support onward referral as necessary Promote the need to improve equality monitoring information in the design of data collection processes for the primary care team review and the psychological therapies access target Review the impact of the new legislation to prevent age discrimination, particularly any boundary issues with OPMH services that may impact on Adult Mental Health section Page 21

access to services. Continue to promote adherence to the accessible information policy and the use of other communication supports User and Carer involvement Continue to promote user and carer involvement in care planning, evidenced through care planning, local engagement groups, carer assessments (local authority led) Adult Mental Health section Page 22

B. Alcohol and Drugs Introduction B.1 There are significant underlying social challenges for many people with addiction problems, including deprivation, financial exclusion, mental health and well being, and against a backdrop of a general culture of excessive drinking. Examples of the scale of the challenges within the City include: Glasgow has the highest alcohol-related admissions rate to acute hospitals (1,488 per 100,000) in Scotland; Glasgow has the highest alcohol-related death rate (77.8 per 100,000) in Scotland; Glasgow has an estimated 13,256 problem drug users, a prevalence rate of 3.27%, and the highest in Scotland; Glasgow has higher than average rate of needle sharing; and, Glasgow has the highest number and the second highest rate of drug deaths per year in Scotland (0.18 per 1000 population). Performance 2011/12 3,592 ABIs undertaken against Glasgow target of 4,578 (as at December 2011); 79.9% of GP practices have agreed to deliver ABIs (against NHSGG&C average of 76.6%); Reduction in drugs deaths ( 94 in 2010 compared with 135 in 2009); 194 alcohol-related deaths, a rate of 41.6 per 100,000 ( compared to 37.1 per 100,000 in NHSGG&C); and, 92.5% referral to Treatment < 21 days, for drugs and alcohol referrals (against a new target of 90%). New Targets and Key Factors Influencing Delivery Implementation of recommendations within Glasgow City Alcohol & Drug Partnership s Prevention and Recovery Strategy 2011-14; and, Implementation of the review of Community Addictions Team in the light of the ADP Prevention and Recovery Strategy. This review is expected to report in May/June 2012 and it is anticipated that it will result in significant change in the culture and operation of Addictions services in Glasgow. Alcohol and Drugs section Page 23

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator Deliver efficient and economic services - Complete the comprehensive review of Addiction services and develop an implementation plan to take forward the recommendations coming from the review - Develop a performance framework as part of the implementation plan - Review completed - Implementation plan and associated performance framework produced Deliver care in the right settings - Continue to develop a range of community-based services Deliver better care through early intervention Focus on the most vulnerable people - Maintain current service delivery untill new models of service developed in line with the CAT review - Continue to promote ABIs across all services and GP practices - Review in-patient services as part of the review of Addictions services - The CAT review is expected to require greater focus on prevention early intervention and recovery - We will undertake an EQIA of the CAT review and the resultant service changes - It is expected that the review will encourage a more targeted approach with greater resources dedicated to the most vulnerable groups of clients. - We will continue to support clients in addressing gender based violence. - We will continue to develop close working links - Number of ABIs undertaken by GP practices - % GP practices signed up to deliver ABIs Alcohol and Drugs section Page 24

Outcome Actions 2012/13 between Addictions services and Children s Services to protect children affected by parental addiction Prevent ill health - We will continue to support better health among our clients as part of our holistic approach (including smoking cessation, sexual health and oral health) - We will continue to develop the naloxone programme and needle exchange. Improve Access - We will continue to organise services to ensure that we will meet the new access target for drug and alcohol services ( 90% referral to treatment in 21 days) Improve services - Our response to the review of CAT services will include improving the quality of our services Comprehensive drugs and alcohol prevention and education strategy - We will develop a workforce development plan that will include Training and OD for staff to support the necessary changes arising from the CAT review - We will contribute to the review of the drugs and alcohol prevention and education strategy that will be undertaken during 2012 and lead the establishment of the Education and Prevention sub-group of the City ADP. - We will continue to promote employability and financial inclusion for our clients - See Health Improvement Policy section for Change/ Progress/ Performance Indicator - Drug deaths - Referral to treatment figures against new HEAT target - Workforce development plan - Training and OD activity - Bridging service referrals and outcomes for addictions clients Alcohol and Drugs section Page 25

Outcome Ensure that all appropriate NHSGCC and partner staff can deliver an alcohol brief interventions and refer to services where required Actions 2012/13 contribution to prevention activity. - We will continue to promote alcohol brief intervention among CHP, primary care and voluntary sector partner staff Change/ Progress/ Performance Indicator Financial update Addictions Services will achieve the savings identified in the 3 year financial plan 2011-14 Workforce implications In response to the CAT review we will review our skill mix and produce a workforce development plan to support the required changes in service culture and delivery. Tackling inequalities An EQIA will be undertaken of the CAT review and resultant service changes. We will continue to ensure that equalities and inequality sensitive practice remains core to addictions services. We will continue to refer clients to employability support with a particular service within the Bridging Service for addictions clients. User and Carer involvement We will engage with service users on the recommendations coming from the CAT review. To support this process we will review our service user panel. We will continue the development of service user involvement in delivering after care support, building on the success of recovery advocates in South Glasgow. Alcohol and Drugs section Page 26

C. Cancer Introduction C.1 The overall aim of NHSGG&C continues to be the delivery of effective and high quality cancer services and to reduce health inequalities and improve the health of its population. C.2 In Glasgow City we have continued to deliver health improvement and promotion activities and screening programmes for those people who are suffering from cancer. We have developed and implemented local Palliative Care Action Plans. C.3 A number of other areas of work have been taken forward in 2011 2012 including: The development of a project in the North East of the city to increase the proportion of care provided to palliative patients in a homely setting, through the provision of a fast track discharge and initial support service. Supporting care homes across the city to implement the Liverpool Care Pathway by providing education and further awareness raising Continuation of the three year MacMillan Cancer Support Project with an evaluation due for completion early 2012 C.4 A key component of our work for 2012/13 will be the National Detect Cancer Early Programme. The aim of this initiative is to improve the overall five year survival for people in Scotland diagnosed with cancer. This will be rolled out across Scotland in early 2012 and there are a number of strands within this initiative which link directly to our actions for 2012/13. Cancer section Page 27

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator The incidence of cancer among the population is reduced through primary intervention, including: Improved public awareness of cancer risk Improved population lifestyles I.e. improved diet, increased exercise, reduced alcohol intake and smoking Patients survival rates and quality of life are improved by detecting cancer as early as possible, including: Improved public awareness about symptoms - Locally promote national cancer awareness campaigns (NO Smoke Day, Sun Awareness etc) - Deliver a range health improvement programmes/interventions including smoking, alcohol, physical activity, diet - (see HI section) - Continue to implement HPV programme across Glasgow - Continue to support the McMillan Cancer Care and the programme to roll out advice services across Glasgow. Consideration will be given to sustainability of Macmillan posts across CHPs in future - Use of SOLUS screens to promote bowel screening and posters will be made available to all practices - Sector CDs will monitor cervical screening and communicate with practices re low rates. Cervical screening rates will be discussed with practices at GI visits - Implement and continue to monitor: Bowel Screening Breast Screening - To achieve comparable cancer incidence rates with the lowest European quartile by 2015 - NHS QIS standards - NHSGGC PHSU Annual Report - HPV Uptake Rates - DCE HEAT Targets for breast, colorectal and lung cancers - National and local via Primary Care Partnership - Patients views patient experience programme - Bowel Screening National Target 60% - Uptake of Breast Screening National Target 70% - NHS QIS Standard of 80% uptake of Cervical Screening - NHS Quality Improvement Scotland Health Technology Assessment (HTA) Cancer section Page 28

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator Cervical Screening Patients with cancer have equity of access and improved access to services in the right place at the right time Patients with cancer have improved access to palliative care at the right time and in the right setting, and that meet or surpass the national standards Patients with cancer experience high quality services which are - Continue to work with Cancer Screening Group to develop cancer pathways. - Work to be done with practices re variations in referrals pathways to inform future actions - Continue to develop electronic systems to support service delivery - Ensure use of SCI Gateway to improve vetting of referrals - Deliver cancer access targets - LCP to be implemented across all nursing homes - Awareness raising to be organised and planned re DNACPR and ACP - Ensure Change Fund bid in partnership with Marie Curie and acute is monitored to enable identification of patients with palliative care needs who can be discharged from hospital and cared for at home. - Ensure staff receive appropriate training to support patients who are dying and their carers through communication and competency in providing good quality care including pain management in all care settings. - HEAT E7 - Referral Management Group Action Plan - Undertake referral audits - HEAT A9 and A10 - Demonstrate through Audit LCP in place and being used appropriately in all care settings - Audit use of SPAR, DNACPR and ACP over time in all care settings - Further review of living and dying well - Monitor palliative care plans across Glasgow City - Monitor uptake of training - Ensure CHP input to Palliative Care MCN - RCAG WOSCAN SCT frameworks and joint work plans in place Cancer section Page 29

Outcome Actions 2012/13 Change/ Progress/ Performance Indicator safe, effective and efficient: Effective planning systems in place Clinical audits undertaken and acted upon Service sustainability plans in place Cancer health inequalities between deprived and no deprived population are identified and reduced - Ensure CHP contributes to Cancer Services Screening Group - See HI Section - Equity of standardised care - Cancer plan to be developed Cancer section Page 30

D. Child and Maternal Health Introduction D.1 Glasgow City CHP provides children and family services in community settings (such as health visitors in GP surgeries and school nurses). In addition, the CHP hosts Specialist Children s Services on behalf of NHS Greater Glasgow and Clyde Health Board. The CHP leads for the Board on the planning and development of service re-design for Children s Services. D.2 In the community Children s Services there are approximately 935 whole time equivalent posts (including 585 in Specialist Children s Services). The total budget for Children s Services is 31m (including Specialist Children s Services). D.3 Children s health services plan and deliver services in partnership with a range of other services for children. These joint plans are outlined in the Children and Families Service Plan for Glasgow City. Joint planning in Glasgow City is overseen by the Children s Services Executive Group. Progress during 2011/12 D.4 The pilot for the new 30 month assessment was undertaken in four areas (including North East and North West Glasgow) and included seeking the views of staff and parents. The 30 month assessment is being continued in these areas so that any outstanding problems can be resolved prior to roll out Health Board wide. D.5 Triple P parenting programme continues to be delivered. We have completed the majority of the training for both NHS and non-nhs staff. The future focus will be to ensure that parenting education becomes embedded in the work of children and family teams and that we develop pathways into the parenting programme. D.6 Review of school health services This is a Health Board wide exercise looking at the extent to which we have the right type of school health services to meet the needs of school age children. Progress has been made by the review group in identifying the key areas for the service change. D.7 Engagement with staff has been undertaken both within the City and across all CHPs/CHCPs on key service re-designs. Two events were held with NHS and Social Work staff to look at the future of the Parents and Children Together (PACT) teams and we ran events with children and family teams from across the whole Board area to discuss the outcomes from the workforce survey. D.8 We have agreed a multi-agency action plan in response to the issues and concerns raised by the HMIE Inspection of Child Protection and progress has been made in taking forward these actions. It is likely that work to complete all the tasks will continue into 2012/13. D.9 Preparation has begun for introducing the national Releasing Time to Care and Leading Better Care programmes, in which teams work together to improve their efficiency and productivity and consequently allow them to focus on providing more care for the patient. Child and Maternal Health section Page 31

D.10 We have continued to improve our partnership working with key agencies. There are a number of initiatives underway to promote improved joint working with other services. For example, the CHP is working with maternity services in relation to a number of re-designs/reviews. D.11 In Specialist Children s Services the framework for the re-design of Tier 3 (Locality) Child and Adolescent Mental Health Services was completed. D.12 Performance for 2011/12 (based on Sharepoint data) Performance Measure Breastfeeding rates (exclusively breastfed) as at Dec 2011 Smoking in pregnancy (Jan to Dec 2011) Triple P Parenting Education (Nov 209 to Oct 2011) No. of completed integrated assessments (IAFs) No. of staff undertaking child protection training (as at Feb 2012) Percentage of children in P1 with no signs of dental decay (2009) Percentage of children registered with a dentist (Sep 2011) 60% of 3 and 4 year olds in each SIMD quintile to have fluoride varnishing twice a year by March 2014 Actual achieved (target in brackets where known) At birth 49% At discharge from hospital 37% At health visitor first visit 30% When baby is 6 to 8 weeks old 25% Within most deprived communities 15% Mixed breastfeeding at 6-8 weeks 37% (45%) 16% of pregnant women smoking (20%) 23% of pregnant women living in most deprived areas smoking No. of staff trained - 237 No. of sessions delivered - 3472 No. of parents starting and completing - 7377 We are still working with Social Work Services to ensure that there is a City wide approach to requesting input from the NHS into IAFs. Currently referrals are made differently by Social Work across CHP, therefore, we cannot report on a consistent dataset. 417 (734) Range was 49% - 52% across the old CHCP areas 88% 3 year olds range from 0.7% to 1.9% across SIMD (3%) 4 year olds range from 1.5% to 2.5% across SIMD (3%) Child and Maternal Health section Page 32