WEST DUNBARTONSHIRE COMMUNITY HEALTH PARTNERSHIP DEVELOPMENT PLAN 2007/ /10

WEST DUNBARTONSHIRE COMMUNITY HEALTH PARTNERSHIP DEVELOPMENT PLAN 2007/08 2009/10

Table of Contents Table of Contents...2 Introduction...4 West Dunbartonshire Community Health Partnership...5 Acknowledgements:...5 Glossary of Terms...6 The Health of West Dunbartonshire...7 Local Profile...7 Health Outcomes: An Overview...8 Comparative SMR 2003 2005...8 Health Inequalities: Wider Determinants...9 Health Inequalities: Lifestyle Risk Factors...10 Priorities for Local Action...11 West Dunbartonshire CHP: Roles and Responsibilities...13 Local Services...13 Health Improvement A Corporate Approach to Tackling Health Inequalities.14 Promoting Participation: Staff, patents and the public...15 CHP Committee...16 Professional Executive Group...16 Public Partnership Forum...17 Local Partnership Forum...17 Community Based Services...18 Partnership Working...18 Integrated Joined Up Services...18 Shifting the Balance of Care...18 Investing in and supporting our Staff...19 Delivering in Partnership...20 GG&C Acute Directorate...20 GG&C Rehabilitation and Assessment Directorate (RAD)...20 GG&C Mental Health Partnership...21 GG&C Managed Clinical Networks (MCNs)...21 West Dunbartonshire Council (WDC)...21 West Dunbartonshire Community Planning Partnership (CPP)...22 Worklessness and Employability...22 Strengthening Local Services: Primary Care...23 The General Practice Contract...24 Tackling Long Term Conditions...24 Developing Community Services...25 Community Older Peoples Teams...25 Primary Care Mental Health...26 Palliative Care...26 Dental Services...26 Optometry...27 Community Pharmacy...27 Working with Care Homes...27 Supporting Carers...28 Working with the Acute Sector...28 Hosted Services: Diabetes Retinal Screening Service...28 Strengthening Local Services: Older People...30 Strengthening Local Services: Mental Health...32 Capital investment on the Ailsa Ward (Dumbarton Joint Hospital)...32 Integration of Services...32 Reprovision of IPCU Beds...32 2

24 hour access...32 Mental wellbeing...33 Addictions...33 Services for People with Learning Disabilities...34 Services for People with Acquired Brain injury...35 Services for People with a Sensory Impairment...35 Physical Disability...36 Health and Homelessness...36 Homelessness Nurse...37 Strengthening Local Services: Children s Services...38 Universal Services...38 Specialist Children s Services...38 CHP Children s Plan...39 Child and Adolescent Mental Health Services (CAMHS)...39 Psychology Services...39 Looked After and Accommodated Children. (LAAC)...39 Allied Health Professional Services (AHP) to Clydebank and alignment of appropriate services within Clydebank...40 Additional Support for Learning Act...40 Child Development Centres and Paediatric Clinics...40 Specialist Children s School Nursing...41 Child Protection Inspection, HMIE Action Plan...41 Tackling Health Inequalities: The Health Improvement Team...42 Tobacco Control...42 Alcohol...42 Breast Feeding...42 Oral Health...42 Services for Young People...42 Sexual Health...43 Strengthening Human Resources...44 Workforce Planning...44 Staff Governance...45 Absence Management...45 Learning & Education...46 Induction...46 Management Development...47 Qualifications...47 Continuous professional and personal development...47 Organisational Development...48 Fostering a healthy culture...48 Single Equalities Scheme...49 Targeting Gender Inequalities...49 Finance...50 Indicative Revenue Annual Budgets for Financial Year 2007/08...50 Cost Pressure 2007/08...51 Cost Savings Plan 2007/08...52 Capital Programme 2007/08...52 Investment Priorities 2007/08...53 Appendix 1 - Finance...54 Appendix 2 - Board Corporate Objectives...60 3

Introduction As we move into the second full year of operation for West Dunbartonshire CHP, it is appropriate that we take this opportunity to set out for all the interested stakeholders in the area agencies, staff, patients, carers and the public at large - the objectives and priorities that we intend to deliver. The first year of the Partnership has seen the CHP at the forefront of a major assessment of the health needs of the whole population. Much of the content of this Plan sets out clear goals that we in the CHP, working with our Community Planning partners and with the support of our communities, intend to achieve in addressing the huge challenge to improve health in West Dunbartonshire. West Dunbartonshire now has the second highest all cause death rate of any local authority area in Scotland with the clear contributory factors of smoking, excessive alcohol consumption, drug abuse, poor diet and lack of physical activity at the core of the lifestyles challenges that confront our community. These factors when considered alongside other issues such as high unemployment set an obvious context within which our priorities must be set. However on a more positive note, the reality is that the CHP is already beginning to address many of these issues and our first year of operation has seen us firmly establish the support infrastructure and processes that will enable to tackle, with others, these major population health challenges. We should at this point recognise the successes that have already been achieved in this year: for example A successful and positive Inspection of the multi agency child protection arrangements in West Dunbartonshire Further investment in community mental health services particularly in the Dumbarton and Alexandria locality Action to integrate the two former NHS Board areas into a single system of working It is acknowledged that much remains to be done particularly in respect to the last point to deliver equal access to all in the area to a comprehensive range of NHS services. This plan for the next three years will hopefully see us move significantly towards delivering that service equity. At the same time as we set out these objectives and priorities, we must also set out our commitment to delivering them in away that enjoys the full support of the community that we serve. The CHP has from its inception endeavoured to work in a way that restores and adds to public confidence in the broader health system and in the CHP specifically. We recognise that public trust and confidence needs to be earned and hopefully by delivering what we set out in this development plan we will be able to enhance and improve the public perception of what we do not just at the times when they may be unwell but how we are working with others to improve the overall feeling of health and well being of everyone in the West Dunbartonshire area. R Keith Redpath Director 4

West Dunbartonshire Community Health Partnership Chair: Director: Clinical Director: Head of Planning & Health Improvement: Head of Health & Community Care: Head of Children s Services: Head of Mental Health & Partnerships: Head of Finance: Head of Human Resources: Rani Dhir R. Keith Redpath Dr Patrick Trust Soumen Sengupta Christine McNeill Annie Hair David McCrae Jeanne Middleton Serena Barnatt West Dunbartonshire Community Health Partnership Committee Members: Dr Alan McDevitt Dr Fiona Coulter Ms Margaret Hastings Ms Selena Ross Mr Ross McCulloch Ms Muriel Robertson Ms Rose Hutchison Mr Keith Redpath GP Clydebank Health Centre Consultant Psychiatrist, Lomond Head of Physiotherapy, Lomond Dunbartonshire CVS Local Partnership Forum Public Partnership Forum Public Partnership Forum Director Acknowledgements: We would like to thank all those staff and colleagues who have worked so hard throughout the last year. A great deal of effort and commitment has been demonstrated to produce this plan and we would like to record our thanks accordingly. If you have any enquiries, please contact: Mr Soumen Sengupta Tel: 01389 812 301 Head of Planning & Health Improvement E-mail: soumen.sengupta@ggc.scot.nhs.uk Hartfield Latta Street Dumbarton G82 2DS 5

Glossary of Terms ABI AHP APF ASL BMI CAMHS CATS CHCP CHD CHP CMHT COPD CPN CPP DAP GG&C GIES GIRFEC GMS GP HIME HISG IPCU IT LAAC LPF MCN MI MMRG NHS OD OHAT OT PEG PMS PPF PPP QIS QOF RAD RAH SIMD SIT SMR SNAP SOE SPARRA WDC Acquired Brain Injury Allied Health Professional Area Partnership Forum Additional Support for Learning Body Mass Index Child and Adolescent Mental Health Services Community Addiction Teams Community Health and Care Partnership Chronic Heart Disease Community Health Partnership Community Mental Health Team Chronic Obstructive Pulmonary Disease Community Psychiatric Nurse Community Planning Partnership Domestic Abuse Prevalence Greater Glasgow and Clyde Glasgow Integrated Eye Service Getting it Right for Every Child General Medical Services General Practitioner Her Majesty s Inspectorate of Education Health Improvement Strategy Group Intensive Psychiatric Care Unit Information Technology Looked after and accommodated children Local Partnership Forum Managed Clinical Network Myocardial Infarction Medicines Management Resource Group National Health Service Organisational Development Oral Health Action Team Occupational Therapist Professional Executive Group Primary Medical Service Public Partnership Forum Public Private Partnership Quality Improvement Scotland Qualities and Outcomes Framework Rehabilitation and Assessment Directorate Royal Alexandria Hospital Scottish Index of Multiple Deprivation Sensory Impairment Team Scottish Morbidity Rates Scottish Needs Assessment Programme Scheme of Establishment Scottish Patients at Risk of Readmission and Admission West Dunbartonshire Council 6

The Health of West Dunbartonshire Local Profile West Dunbartonshire is located in the West of Scotland, and has 22 electoral wards: 11 located in Clydebank (Whitecrooks, Dalmuir/Central, Mountblow, Parkhall, Linvale/Drummy, Kilbowie, Kilbowie West, Faifley, Hardgate, Duntocher, Bowling/Milton/Old Kilpatrick). 5 located in Dumbarton (Dumbarton East, Barloan/Overtoun, Dumbarton North, Dumbarton Central, Dumbarton West). 6 located in the Vale of Leven (Renton/Alexandria South, Alexandria, North/Tullichewan, Balloch, Haldane/Jamestown/Kilmarnock, Ronhill East and Riverside). The population estimate in 2005 was 91,400: 7.67% of the NHS Greater Glasgow and Clyde population. West Dunbartonshire population projection 1996 2015, all ages West Dunbartonshire has a similar age structure to the rest of Scotland. In 2005, there were more deaths than live births among West Dunbartonshire residents (1,153 deaths compared to 1000 births giving a natural fall of 153.) In addition there has been a net migration of people out of West Dunbartonshire in the recent period. Falls in the younger age groups outweighed gains in the older age groups and the population structure will increasingly become elderly in the future. Currently 23% of all households in West Dunbartonshire are pensioner households, which is about the same as the Scottish average. According to the 2001 census figures, 14.37% of West Dunbartonshire households are lone parent households compared to the Scottish average of 10.5%. West Dunbartonshire is predicted to increase its percentage of lone parent households as a percentage of all households with children from 29% in 2002 to 39% in 2016: this would be above the Scottish averages of 23% in 2002 and 33% in 2016, and the third highest in the West of Scotland Council areas after Glasgow City and North Ayrshire. It has also been reported that 17% of West Dunbartonshire residents consider themselves to be carers. 7

Health Outcomes: An Overview A boy born in West Dunbartonshire in the period 2000-2002 could expect to live on average 71.2 years and a girl 77.7 years. As in Scotland, life expectancy has tended to increase over time. However the life expectancy is consistently below the Scottish average by between two and three years for males and over a year for females.. It is estimated that on average a West Dunbartonshire male could expect to live for over 22 years with a limiting, long-standing illness and the average female nearly 22 years. The perinatal mortality rate in West Dunbartonshire varied between 6.5 and 12 per 1,000 live births since 2004 (higher than the Scottish rate in 2004 and 2005, but below the Scottish rate in 2006). The proportion of babies with low birth weight (i.e. under 2,500 grams) born to West Dunbartonshire residents varied between 6.4% and 8.2% of live births and remained higher than the overall Scottish proportion SMRs for West Dunbartonshire show an overall death rate of 12-15% higher than Scotland. These figures reflect significantly higher death rates in all periods for coronary heart disease and acute myocardial infarction and digestive diseases. Deaths from digestive diseases and alcoholic liver disease, cirrhosis, increased between the time periods, reaching statistical significance. Comparative SMR 2003 2005 8

Health Inequalities: Wider Determinants West Dunbartonshire is the second most deprived of thirty-two councils in Scotland for income-deprived population and third for employment-deprived population. The Carstairs deprivation scores for West Dunbartonshire indicate a greater level of deprivation than in Scotland in both 1991 and 2001. In addition, between the two censuses West Dunbartonshire has become slightly more deprived relative to Scotland. In 2001, one in three people living in private households in West Dunbartonshire were in households that did not own a car, compared to one in four Scotland-wide. Using the SIMD 2004, compared to Scotland, West Dunbartonshire has a similar percentage of the population in the most deprived 5% of data zones across Scotland (all around 5%). However it has nearly twice the proportion in the most deprived 20% of data zones across Scotland (37% in the council area compared with 20% Scotland-wide). Twenty one percent of the working-age population in West Dunbartonshire have no educational qualifications (marginally less than the Glasgow City figure of 22%); 51% of the working age population have three or more Highers (which is lower than the Glasgow City figure of 52%; and 8% of the working age population have a degree (which is the second lowest of the West of Scotland councils). Around 15% of West Dunbartonshire households have an occupancy rating of -1 or less this is measure of overcrowding. This is the fourth highest in Scotland after Glasgow, Dundee and Inverclyde. West Dunbartonshire has an estimated proportion of properties with rising/penetrating damp of 6.5% and an estimated proportion of properties with mould in any room of 9.5%, compared to Scottish averages of 6% and 11% respectively. The West Dunbartonshire economy has performed below that of the West of Scotland and Scotland as a whole over the last ten years. The mean gross weekly pay for all employees in West Dunbartonshire is 348 which is the lowest of the West of Scotland councils and 12.3% lower than the Scottish average. In 2004, approximately 58.2% (circa 18,205) of total employee jobs in West Dunbartonshire were based on full-time employment (this figure is lower than that of the national average of 67.8%). It has the second highest percentage of people who are employment deprived of the 9

West of Scotland Councils, with a figure of 19.8% compared to the Glasgow City figure of 23.1%. It has been estimated that 16,000 West Dunbartonshire residents were economically inactive in 2005 (economic inactivity refers to people who are not in work and are not seeking work; this group includes students). This level of economic inactivity is higher than the percentage for Scotland. 23.6% of West Dunbartonshire residents had all their income from state benefits compared to 26.8% in Glasgow. The proportion of working age people in receipt of out of work benefits is estimated to be 23% in West Dunbartonshire which is the third highest in Scotland. Furthermore 17.8% of working age households are in receipt of working family and child tax credit. More than twice as many people are in receipt of guaranteed Pension Credit in West Dunbartonshire around 27%, which is the third highest in Scotland after Glasgow and Eilean Siar. 60.3% of residents experience difficulty meeting household expenses compared to 42.3% in Glasgow. 24% of primary school pupils and 21% of secondary school pupils in West Dunbartonshire are entitled to free school meals. Of the economically inactive residents in West Dunbartonshire, 8,000 are claiming sickness or disability related benefits, i.e. 1 in 8 of the working-age population. West Dunbartonshire has the second highest rate of overall crime per 10,000 population of in the West of Scotland with a figure of 120 compared to Glasgow City s rate of 157. 87.8% of West Dunbartonshire residents have reported feeling safe in their own home compared to 92.1% in Glasgow; and 53.9% have reported feeling safe walking alone even after dark compared to 58.4% in Glasgow. Only a third of people stated that they didn t feel safe walking in their neighbourhood alone after dark in West Dunbartonshire (which was the same percentage as Glasgow City residents). West Dunbartonshire has the highest rate of domestic abuse incidents per 100,000 population in Scotland, with a rate of 1,409 compared to 1,339 for Glasgow. Health Inequalities: Lifestyle Risk Factors In 2005, a substantial Health and Wellbeing study was undertaken both within West Dunbartonshire and across GG&C. Its aim was to measure core health indicators associated with the Public Health White Paper. This work has provided us with valuable information on self-reported lifestyle behaviours of local residents. The findings are also comparable to the findings of the Health Survey of the West Dunbartonshire Community Planning Partnership s Citizen s Panel. Currently smoking rates for West Dunbartonshire are estimated as being 39.8%, compared to 37.2% in Glasgow. 18% of people reported smoking everyday and 4% reported smoking some days. The proportion of 13 and 15 year olds classed as regular smokers by gender in 2002 was 10% of boys and 17% of girls compared to 6% of boys and 11% of girls in Glasgow City. It is estimated that 62.5% of West Dunbartonshire residents are exposed to second-hand smoke most or some of the time compared to 54.9% in Glasgow. 24.8% of West Dunbartonshire residents are estimated to exceed recommended weekly units of alcohol compared to 17.7% in Glasgow. 13% of men and 11% of women reported drinking above the recommended weekly units of alcohol in the last week. The proportion of 13 and 15 year olds who had drunk alcohol during the last week by gender in 2002 was 26% of boys and 30% of girls. 10

West Dunbartonshire has the lowest breastfeeding rates in Scotland at first visit with 28.3%; and a rate of 25.8% at 6-8 week review compared to a Scottish average of 36.5%. 36% of West Dunbartonshire residents report taking at least 30 minutes of moderate exercise 5 or more times per week compared to 50.4% in Glasgow, with 49% of residents reportedly taking part in moderate exercise on most days of a typical week. 20.6% of West Dunbartonshire residents report taking at least 20 minutes of vigorous exercise 3 or more times per week compared to 28.1% in Glasgow, with 13% of residents reportedly taking part in vigorous exercise at least three times a week. 23.3% of West Dunbartonshire residents are reported to consume at least 5 portions of fruit and/or vegetables per day 23.3% compared to 30.2% in Glasgow; a separate survey found that a comparable 26% of residents reported consuming 5 or more portions of fruit and vegetables a day. 52% of West Dunbartonshire residents are estimated to have a BMI of 25 or over, compared to 42.2% in Glasgow. Among 3 year olds in West Dunbartonshire who were born in 1999, 23% were classed as overweight, including 11% obese, which in turn included 7% classed as severely obese. 64.4% of West Dunbartonshire residents who participated in the Health and Wellbeing stated that they perceived that their health was excellent or good (compared to 68.2% for Glasgow); and 74.9% reported a positive perception of general mental or emotional wellbeing (compared to 83.8% for Glasgow). Priorities for Local Action A substantial health needs assessment of the West Dunbartonshire populace was undertaken in 2006/07 by the Department of Public Health, Greater Glasgow and Clyde Health Board and the CHP. While the final report will be published during early 2007/08, the initial findings were made available at the end of February 2007 and substantiated the results of other local work. Key messages included: CHD, stroke, COPD, hypertension and diabetes are all more common in West Dunbartonshire than for Scottish counterparts Smoking, drinking and obesity are major public health problems Smoking in pregnancy and low breastfeeding rates have major implications for future health All agencies and groups need to prioritise health improvement work locally A key NHS priority is to manage chronic diseases in primary care 11

In order to tackle these effectively locally, all local stakeholders have to work collectively to make best use of their available resources to drive forward evidencebased action. Service changes and developments in the coming years within West Dunbartonshire, CHP will reflect these priorities across all areas of work including: Tobacco control Obesity (increasing physical activity and improving nutrition) Tackling alcohol misuse Increasing breastfeeding Reducing preventable repeat admissions to hospital 12

West Dunbartonshire CHP: Roles and Responsibilities The West Dunbartonshire Community Health Partnership (CHP) Scheme of Establishment was formally approved by the Scottish Executive in July 2005. This outlined the arrangements for the new organisation to enable it to develop a more consistent health service framework across West Dunbartonshire. Local Services The delegation of services now managed by the CHP includes a wide range of primary care and other community based services including: Community Nurses Health Visitors Relationships with primary care contractors Local Older People and Physical Disability Services Mainstream school nurses Chronic Disease Management programmes and staff Specialist Children s and Child Development Services Oral Health Action Teams Allied Health Professionals Palliative Care Addiction Services Learning Disability Services Community Mental Health Services Health Improvement The CHP holds contractual budgets for: General Practice Dentists Optometrists Community Pharmacy The CHP also: Hosts the Diabetic Retinal Screening Service Has a lead role on behalf of CH(C)Ps in relation to the Diabetes Managed Clinical Network Has a lead role on behalf of CH(C)Ps in relation to the Glasgow Integrated Eyecare Scheme (GIES) Hosts the management responsibility for the Clyde Condition Management programme. 13

Health Improvement A Corporate Approach to Tackling Health Inequalities The Scottish Executive has tasked CHPs with improving the health of the populations they serve. Health Improvement is a cross-cutting priority for CHPs and the degree to which they can accomplish this will be a key measure of their success. Reducing the disparity of health outcomes between those from the poorest communities and those from the most affluent areas remains a key priority for the CHP. West Dunbartonshire CHP is committed to effectively and pro-actively meeting its broader role in improving the health of the population and closing the inequalities gap. It does this as both: An effective partner within the Community Planning Partnership and other local multi-agency fora/networks. The CHP recognises it key local leadership in working with local stakeholders, principally as through the Health Improvement Strategy Group (HISG). Within the context of the Community Planning Partnership s wider development, over the course of the next three years, we will work with partners to: Strengthen the HISG as an effective driver for strategic multi-agency change Support the HISG to provide a greater focus for local evidence-based action, principally by its developing a new Joint Health Improvement Strategy. Embedding health improvement as a core characteristic of all its services. The CHP recognises that while significant health improvement in West Dunbartonshire cannot be delivered by any one organisation alone, CHP services and staff can and should make a significant contribution. In addition to the health improvement activity led within individual services and the work of its specialist Health Improvement Team, in year one we will: Begin a process of introducing a defined corporate health improvement objective into the work programmes of all practitioner staff It has recently been announced that West Dunbartonshire is to be part of the second wave of the Scottish Executive s Keep Well (formerly Prevention 2010) preventative care programme. The aim of Keep Well is to increase the rate of health improvement in deprived communities by enhancing primary care services to deliver anticipatory care: identifying and targeting those at particular risk of preventable serious ill-health; offering appropriate interventions and services to them; and providing monitoring and follow-up. The focus will be on cardiovascular disease and its main risk factors (e.g. smoking and blood pressure). In year one, we will: Develop an appropriate and co-ordinated suite of Keep Well services, building on the learning from the first wave areas. 14

Promoting Participation: Staff, patents and the public The CHP is also charged with establishing robust and constructive relationships with staff working within the area; and patients, carers and communities from across the area. The principal mechanisms for doing this are: The CHP Committee The Professional Executive Group (PEG) The Public Partnership Forum (PPF) The Local Partnership Forum (LPF) These Groups are now well established and working closely within the CHP in the delivery and development of services in West Dunbartonshire. Minutes from these key committees/groups are made available on the CHP website. In year one we will work with them to: Develop their role and contribution to service and corporate development prioritisation, planning and implementation (with a particular focus on action to tackle health inequalities). 15

CHP Committee The CHP Committee is a formal Committee of NHS GG&C, and has a significant role in the provision of local health services. Membership of this Committee is broad and inclusive, including: Representation from the PEG Representation from the PPF Representation from the LPF Representation from WDC This enables the Committee to consider community needs and service issues within a wide context taking account of local authority, community representation, clinical leads and service staff contribution to the discussions. The Committee has a governance and overall management role. Certain papers are presented to the Committee routinely (e.g. minutes from the PPF, LPF and PEG), with representatives highlighting issues for the particular attention of the Committee. In addition, there are routine finance reports, reports on complaints and also reports on service performance (e.g. on waiting times). The Committee also has a clear strategic role in determining the nature of local services and is well placed to address this responsibility within this broad context. Papers, including consultation issues and service proposals are presented and considered by this wide Committee representation thereby promoting involvement in developing the strategy for health care provision in West Dunbartonshire. The Committee meets a minimum 6 times per year, details of which are advertised widely. The venues are alternated for each meeting between Clydebank area and Lomond area and are held in public. The Committee Minutes are presented to NHS GG&C by the CHP Chairperson, and again any significant issues arising may be further discussed at that point. Professional Executive Group The PEG acts as an advisory body to the CHP, and is the primary mechanism for clinical engagement. The PEG has advised on all aspects of service design and development including: Mental Health Re-Design Immunisation Review Hall 4 Clinical Governance Risk Management Prescribing Policy The CHP Development Plan The PEG meets every six weeks and has become an integral part of the planning process. It will continue to provide clinical expertise and advice to the CHP in all aspects of service re-design in the coming months and years. 16

Public Partnership Forum The PPF is the primary mechanism for the CHP to engage with local service users, carers and members of the public on service developments and plans. The PPF meets every two months and has become a critical friend to the CHP, contributing to discussions on key areas including: The Vale of Leven Integrated Care Pilot Clyde Maternity Review The Mental Health Strategy for West Dunbartonshire The CHP Annual Development Plan Over the coming year a training needs analysis of PPF members will be carried out and a training programme will be drawn up to ensure the members are able to develop their skills and confidence to participate fully in dialogue with the CHP. Local Partnership Forum The LPF provides a mechanism for ensuring fair and consistent application of the Staff Governance standard for staff working within the CHP. The LPF meets every two months, with the types of issues addressed including operational issues which will impact on staff, and the broader development agenda within the CHP. Examples of items discussed are: Agenda for Change Workforce planning Local compliance with the NHS Staff Governance Standards The CHP Development Plan Future items include the Learning and Education Plan, the Organisation and Development Plan and the local Single Equalities Scheme Action Plan. 17

Corporate Themes The following sections in the Plan will outline our key priorities and future plans for 2007/08 2009/10 around the seven corporate themes for Greater Glasgow and Clyde NHS Board. These are summarised below: Focus resources on areas of greatest need Shift the balance of care Improve our use of resources and ensure we provide a professional service Modernise services and ensure they are full integrated Improve the health status of individuals Improve access to our services to ensure they are fully inclusive Create an effective organisation Key Themes Community Based Services Developing Community based approaches which focus on anticipating needs earlier and putting resources into preventing problems, many of the proposed service developments outlined in primary care and community services reflect these objectives Partnership Working Championing partnership working both with the CHP and other stakeholders. The CHP will continue the strong tradition of partnership working with the Local Authority and other stakeholders, including the Public Partnership Forum Integrated Joined Up Services The Plan outlines plans for further integration of services across Mental Health, Learning Difficulties, Addictions and Older People across West Dunbartonshire. Shifting the Balance of Care Hospitals and CHPS have a joint responsibility to plan and deliver good quality care and services for people. The CHP and Acute Divisions in West Glasgow and Clyde have shared objectives including reducing multiple admissions, and delayed discharges. We will ensure the mechanisms and Forums are established to enable us to set shared goals and objectives. Involving service users and carers in the planning re-design and delivery of Services We will ensure service users and carers are fully involved in the planning and delivery of services by working in partnership with the West Dunbartonshire Public Partnership forum and by consulting with a broad a range of community organisations and Patients Groups. 18

Investing in and supporting our Staff The CHP is committed to involving staff in the change process and will work through the Local Partnership Forum and the Organisation and Development group to ensure the necessary training and development opportunities are available and that they are empowered to effect and influence change. Developing an effective Performance Management System We will improve our performance management system and ensure we use the information we collate to improve and develop our services. We will also promote and support the streamlining of our systems with other Partners including the Acute Divisions in Clyde and West Glasgow and our Local Authority partners. 19

Delivering in Partnership Much of what the CHP is charged with delivering is dependent on good communication and honest co-operation with colleagues and services within other service deliverers (both within and outwith the NHS). There is a continuing need to develop stronger understanding and joint working between the distinct operational entities that make up NHS GG&C. On behalf of GG&C-wide CH(C)Ps, West Dunbartonshire CHP has been twinned with a number of specialist areas so that together we can take forward this process: Unscheduled (emergency) care (Acute Directorate) Oral Health Directorate Mental Health Partnership Diabetes MCN In addition to that work, over the course of the next three years, we will take forward developmental work with the following: GG&C Acute Directorate We will work with both Clyde and Greater Glasgow Acute divisions to: Provide shared input into the MCN planning process. Develop and consult on the Vale of Leven strategy Develop strategy in relation to integrated children s services Explore opportunities for health centres in Clydebank and Alexandria for reviewing patient pathways between the acute sector and community services Reduce multiple admissions via the use of SPARRA and other information sources Improve discharge planning arrangements across all sites Ensure a joint health improvement agenda across acute and community services GG&C Rehabilitation and Assessment Directorate (RAD) We will work with the RAD to: Agree joint areas of activity and cross system planning for rehabilitation services Undertake a comprehensive review of arrangements for hospital discharge including Discharge Planning Agreement, the function of integrated discharge teams and the elimination of delayed discharge Develop a community rehabilitation model, including plans for the integration of health and social care and of primary and secondary care services. The Balance of Care work which is ongoing with WDC through the Older People s Strategy group (which includes analysis of SPARRA data and repeated admissions) reflect the priority attached to developing comprehensive models of care in the community for older people in conjunction with colleagues in the RAD. 20

GG&C Mental Health Partnership We will work with the Mental Health Partnership on: Health improvement within specialist mental health services, including those directly managed by the Partnership and those in CH(C)Ps Health improvement within other health and social care services including general medical services in primary care Health improvement with broader operational providers e.g. employment dimensions of service provision, a wide range of community and voluntary organisations and settings Strategic influence on broader policy areas e.g. regeneration, public sector as employees Developing a framework for delivery and an agreed regime for monitoring performance, including identification of appropriate indicators Through the development and implementation of the Clyde Mental Health Strategy the CHP will continue to develop a framework for community mental health services which will connect with a wide range of initiatives across different agencies to improve the wellbeing of the population. GG&C Managed Clinical Networks (MCNs) The roles, remit and membership of each of the respective clinical networks have been revised in order to reflect the single system working across GG&C. During 2006 both the Diabetes and CHD MCNs have come together to form a merged Greater Glasgow and Clyde MCN under one clinical lead. Work will continue over the coming year and beyond on the harmonization programme and unified working across the new health board area. Workstreams have arisen out of that harmonisation work to be taken forward throughout 2007/08 (detailed within MCN Development Plans). We will work with the MCNs to: Take forward these workstreams through the appropriate subgroups. West Dunbartonshire Council (WDC) There is a strong history of local joint work with WDC: through joint planning structures and joint futures arrangements to improve service outcomes for community care; established children s services planning arrangements; and established committee arrangements through the Health and Social Justice Partnership Committee. Key areas of joint work include the Balance of Care activity through the Older People s Strategy Group, and the development of Joint Performance Frameworks for community care services. There has been successful development of a number of joint health and social care services, including Addictions, Learning Disability Services, Clydebank Community Older People s Team, and the Goldenhill Resource Centre. 21

In year one we will work with WDC to: Further integrate and develop these services and others across West Dunbartonshire with a clear emphasis on best value West Dunbartonshire Community Planning Partnership (CPP) Social deprivation and poverty are key indicators of ill health, and these are matters that demand collective responses. It is recognised locally that a holistic approach to tackling health inequalities is vital to improving the well being of people living in West Dunbartonshire. Improving wellbeing and challenging inequalities are part of the vision of West Dunbartonshire CPP, of which the CHP is an active member. In addition to the CPP Board, the CHP contributes to number of its strategic sub-partnerships (notably the HISG, the Community Safety Partnership and the Business Growth and Employability Strategy Group). Over the course of the three years, we will work with and through the CPP to: Ensure agencies within West Dunbartonshire co-operate to ensure greater efficiency and sustainable services to improve the lives of the local population Worklessness and Employability Workforce Plus has been established by the Scottish Executive as part of its commitment to reducing disadvantage and inequality in Scotland. It aims to provide additional support to assist people move from welfare back into work. At the local level, CPPs have been charged with the task of designing and implementing a comprehensive Action Plan that will be used in taking forward the Workforce Plus Framework within their respective Local Authority area. West Dunbartonshire CPP has prioritised employability as a key and cross-cutting theme, i.e. all other planning should contribute to the delivery of targets that focus on reducing worklessness (including supporting those on incapacity benefit back into meaningful activity or employment). The Business Growth and Employability Strategy Group has led on the preparation of this Action Plan, which was submitted to the Scottish Executive on the 31 st January 2007. As part of this process, the CHP has given considerable thought to how it can best play a role in contributing to this agenda; and consequently pro-actively proposed a range of potential activities to be implemented through the Action Plan, namely as: Partner Investor/procurer Service provider Care provider Health improver Volunteering opportunity Portal Progress the local Action Plan, particularly those elements relating to the NHS. 22

Strengthening Local Services: Primary Care Primary Care is an integral part of the delivery of community-based health and social care services within West Dunbartonshire. There are 20 Practices in the CHP area which between them register almost exclusively all of West Dunbartonshire s residents. The Practices range from single-handed practices with 2,500 patients to much larger multiple practices with as many as 9,000 patients. Of these 20 practices, 19 deliver their services under the new GMS Contract, with one delivering its services around the PMS (or 17C) Contract. All of them are required to undertake the basic provision of care, with many opting to undertake additional work. There are nine practices covering the Clydebank area; four practices are based at Alexandria Medical Centre; six provide services form Dumbarton Health Centre and a further practice operates from its own premises in Alexandria. A number of professions and staff work alongside GPs to deliver services to patients in multiple settings. In partnership with our Community Care colleagues we provide the following services: Assessment and Care Management Rehabilitation and Enablement District Nursing Allied Health Professional Services such as Podiatry, Dietetics, Physiotherapy and Occupational Therapy Older Peoples Services in partnership with WDC Chronic Disease Management Programmes Sensory Impairment Services Palliative Care Management of Long Term Conditions The Primary Care Role in Improving Health In response to the health needs assessment carried out in West Dunbartonshire which highlighted that smoking, drug and alcohol misuse and lack of exercise are major factors in causing disease [including Chronic Heart Disease(CHD), Stroke and Chronic Obstructive Pulmonary Disease(COPD)], we will ensure we develop our services to tackle theses health issues. A new contract and priorities for improving the health of our patients means that we are now able to identify patients who have risk factors associated with many common chronic conditions. These include CHD, cancer and Type 2 (non-insulin dependent) diabetes. General Practice now has a leading role in identifying and screening patients with risk factors. 23

In year one we will: Provide information to GPs and other contractors on the range of health improvement activities that we are developing to help them to refer their patients (including exercise referral, weight management and smoking cessation) Use the information about levels of disease to plan and develop our services The General Practice Contract The level and type of service provided by GPs is described in their contract with the NHS. The contract sets targets and priorities for general practice in providing access, identifying patients with long term conditions and difficulties such as being a carer or being housebound. In year one we will: Assist with monitoring these contracts and the performance of practices Support practices to meet the target of providing access to appropriate services within 48 hours Use the information which practices gather about levels of disease to develop our services Tackling Long Term Conditions Shifting the balance of care from hospitals to the community is a key theme over the next 3years. In the following sections we will outline our specific service changes and developments in primary care which will achieve this aim. Diabetes Most patients with Type 2 Diabetes are now cared for within Primary Care. Patients have access at their review to a range of services provided by GPs, Practice Nurses, Dietitian and Podiatrists. In year one we will: Continue to work with General Practice to deliver models of multi-disciplinary care, and look to extend this model to all GP practices in the area Coronary Heart Disease (CHD) In year one we will: With the Coronary Heart Disease MCN to develop services, and work to develop exercise referral, weight management and smoking cessation. With the Heart Failure Team to deliver services locally 24

Stroke In years two and three we will: Develop services in support of the specialist stroke units in the Acute Sector and the management of patients following stroke in communities. In particular we will work with the Physical Disability Team in partnership with our Older Peoples Teams and our Physiotherapy Service. Review our joint provision of OT services with WDC Chronic Obstructive Pulmonary Disease (COPD) Work with General Practice and with Asthma UK to improve our services for people with asthma Pilot a COPD programme with a local practice. Continue to develop links with Community Pharmacy to provide support for patients with COPD Developing Community Services There are a range of services provided by the CHP in the Community. These include Nursing, Physiotherapy, Dietetics and Podiatry. In year one we will: Support the ongoing training and education of staff particularly to develop multi-disciplinary working Develop their role in case/care management and continue to role out Single Shared Assessment and data sharing information systems Develop the role of all professions in anticipatory care Continue to audit caseloads and refine skill-mix Monitor and improve waiting times for access to community services and meet our waiting time targets Develop our direct access to Podiatry, Physiotherapy and Treatment Room services Community Older Peoples Teams Two models of Older Peoples Teams were developed prior to the unification of services across West Dunbartonshire. We intend to address this in accordance with our commitment to further integrate and join up services. In year one we will: Develop these teams as a single structure to work in partnership with WDC Social Work Services in providing time-limited assessment, rehabilitation and enablement. The teams will support community services to maintain older people at home and provide quick direct access to comprehensive packages of care. 25

Review the current care models Agree common care pathways and working arrangements. Agree unified management structure. Develop services out of hours in partnership with WDC Primary Care Mental Health In line with the corporate approach within the CHP to health improvement we will ensure health improvement is embedded within our mental health services and older people s services including links across all areas of Mental Health provision. In year one, we will work with colleagues in Mental Health to: Continue to develop Primary Care Mental Health Services (including Direct Access and Advice), and as part of the Mental Health Strategy for West Dunbartonshire look to develop these services across the CHP. Palliative Care Most patients and their families have Palliative Care services provided to them at home by their GP and local nursing teams. In year one we will: Continue to work with our colleagues in Marie Curie Cancer Care and the Macmillan Nursing Service to enhance our delivery of Palliative Care Provide additional training on symptom control and management to Community Nurses and General Practice Support the development of the Gold Standards Framework and pilot the Liverpool Care Pathway for patients requiring Palliative Care. Continue to develop links between the Community Service, Older Peoples Service and WDC Social Work Expand responsibilities for case management Review the delivery of Out of Hours Services in partnership with the Lomond Care Team and the Clydebank Community Older Peoples Team Dental Services The introduction of a new Dental Contract shortly will provide NHS Dentistry with the opportunity to work within a new framework to support dentists in the delivery of more pro-active oral health improvement and dental health care. These new arrangements for dentistry bring an increased emphasis on quality in terms of the process and the outcome of care. There will be a requirement for quality and contract visits to all practices on a more regular basis and the CHP will contribute to these reviews. 26

In year one we will: Support local dentists to provide access to patients within the NHS Provide additional support and training particularly for Dental Practice Staff Optometry The introduction of the new General Ophthalmic Services contract provides an opportunity to develop Community Optometry Services; and for them to work in partnership with Community Pharmacy and General Practice to develop primary eye care services. In year one we will: Work with colleagues in the Acute Sector to develop a local network providing primary eye care services within West Dunbartonshire Develop a Local Optometry Network Provide information to the public on the role of Community Optometrists in providing primary eye care services Support optometry with additional training Work with WDC and the Sensory Impairment Strategy Group to develop a network providing early access to Social Care Services, the Voluntary Sector and Social Care Networks, and to the Low Vision Aids Service. In years two and three we will: Pilot a partnership with the Acute Sector to deliver a primary eye care service, shared care and care pathways for anterior eye disease and some chronic conditions Community Pharmacy Community Pharmacy has an important role to play in providing primary care services to the public, and the introduction of a new Pharmacy contract presents opportunities for development. They provide support for the self management of conditions and support to General Practice in their prescribing. In year one we will: Develop multi-disciplinary training around choice of medicines Develop a CHP prescribing web page for advice and newsletters Work with Community Pharmacists to support supplementary prescribers such as Optometrists, Nurses and Dentists Working with Care Homes Care Homes provide a home for many people in West Dunbartonshire and we currently provide General Medical Services, Nursing Services and services such as Podiatry and Physiotherapy. Many of these residents have complex needs and we will work with local Care Homes to provide improved services in the future. 27

In year one we will: Work with the Nursing Homes Medical Practice to provide support to local care homes Include Local Care Homes in our CHP network and our training sessions Work with Local Care Homes to enable them to manage their patients effectively Supporting Carers Carers play an enormously important role in helping people to live with illness and disability at home. The new GP contract asks Practices to identify patients who have a role as a carer and recent legislation has entitled carers to have a Carers Assessment. We need to ensure that carers have access to good quality medical care and support. As part of our work of identifying patients at risk of admission (SPARRA) we need to identify those carers who are critical to supporting family members at home. In year one we will: Identify carers Support carers to receive a Carers Assessment. Pilot the identification of at risk care arrangements and what measures we could take to develop short- notice contingencies Working with the Acute Sector To properly integrate care we need to bring together all aspects of the patient s journey, including diagnosis, treatment, care, rehabilitation and health promotion. In year one we will: Improve the early diagnosis and treatment of bowel cancer Provide alternatives to admission for patients (particularly the elderly) by improving our services to care homes and out of hours. In years two and three we will work with colleagues in the Acute Sector to: Provide services that are easier to navigate, and improve communication and access Develop networks which will improve access to Primary Eye Care services using Community Optometrists, shared care protocols for long term eye conditions (e.g. glaucoma) and ensure rapid access to hospital services for sight threatening conditions Hosted Services: Diabetes Retinal Screening Service West Dunbartonshire CHP hosts the management of the Diabetic Retinal Screening Service on behalf of CHPs across Greater Glasgow and Clyde. This is an important Service to assess and manage potential eye disease for people with diabetes. 28