NHS BulletinIssue 10: February 2007 News & events from inside the Scottish Executive Health Department Andy Kerr MSP Minister for Health & Community Care We believe good communication is essential to providing the highest quality of healthcare for the people of Scotland. The intention of this Bulletin is to keep NHS employees informed about what is happening in the Scottish Executive Health Department and how it will affect them. It will also provide an opportunity to share examples of good practice from around Scotland and keep you updated on the progress being made on implementing Delivering for Health. Lewis Macdonald MSP Deputy Minister for Health & Community Care 2007 promises to be an exciting year for NHSScotland and we look forward with anticipation to the challenges it will bring, as we continue to work together to develop and improve our health services. During the past few weeks we have had the opportunity to visit a number of services to launch new developments and have enjoyed the opportunity to see for ourselves the important work being carried out and celebrate with staff their successes. Our visits have included opening new dental facilities in Glasgow, Grampian and Highland. These state-ofthe-art centres will not only provide excellent training facilities for our students but, importantly, will allow many more patients to access the dental services they need and make a real difference to oral health in Scotland. The winter always brings with it extra pressures, and we have been impressed by the way in which you have responded to, and dealt with planning and resourcing the demands on the service during the Christmas and New Year holiday period. Implementation of Delivering for Health, our action plan for the NHS, is well underway and with your help we are on target to making the vision a reality. We wish you and your families a very happy New Year. Germs wash your hands of them - Launch of National Hand Washing Campaign Last month we launched Scotland s National Hand Hygiene Campaign, which is being led by Health Protection Scotland at the request of the Healthcare Associated Infection (HAI) Task Force. We have been impressed by the support we have received from the professional bodies and, crucially, the strong messages of support from the public who recognise that this is a hugely important public health issue and one with a simple solution at the heart of it. We are happy to see that the campaign has already started a debate and begun to make people think about how washing their hands can make a difference to their own health and the health of others. Index Page 1 & 2 Health Ministers Message Pages 3-6 News from the Chief Executive Pages 7-8 Messages from the Chief Professional Officers Pages 9&10 Update: Delivering for Health Although the Campaign was conceived from the drive to tackle HAIs, such as MRSA, and improve patient safety, its messages clearly have a much wider application in helping to reduce avoidable illness among the general public, such as colds, flu and tummy bugs. We are delighted with the work Health Protection Scotland has done in overseeing the development and delivery of the Campaign, which launched in January with TV adverts and a poster campaign.
The Campaign runs until March 2008 and you can visit the official website www.washyourhandsofthem.com for more information. How the campaign is implemented locally will be central to its success in terms of reducing HAIs. To help with this, funding has been provided to each NHS Board to employ a Co-ordinator until the end of March 2008. The Co-ordinators will be responsible for developing and delivering an implementation strategy for their Board area, including the use of the hand hygiene audit tool which was developed as part of the Campaign. We hope the Campaign will get people to take on board the message Germs - wash your hands of them and make it part of their daily routines. Whether at work or home we all need to realise that infection control is everyone s business and we can all make a difference just by making sure our hands are clean. Consultation launched on smoking prevention Tobacco control remains at the centre of the Scottish Executive s health improvement drive. In the last 3 years we have been encouraging a range of measures as set out in A Breath of Fresh Air for Scotland. These measures are: helping people to quit; protecting the public from the risks posed by environmental tobacco smoke; and persuading as many people as possible not to start smoking. A huge amount of progress has been made. NHS Boards have established a national network of smoking cessation services and in March last year we successfully introduced laws banning smoking in most indoor places, signalling a major cultural change. We believe the third big challenge is increasing efforts to stop young people becoming smokers. We are therefore currently consulting on the recommendations contained in the report Towards a Future without Tobacco produced by the Smoking Prevention Working Group, chaired by Dr Laurence Gruer, Head of Public Health Science with NHS Health Scotland. The report contains 31 recommendations for protecting or dissuading youngsters and deterring adults from encouraging or enabling them to smoke. One of the key recommendations is that the age limit for buying cigarettes should be raised from 16 to 18. Please take the opportunity to contribute to this debate which which started on 7 th December and finishes on 28 th February. Details are available at http://www.scotland.gov.uk/publications/2006/12/07153221/0 and http://www.scotland.gov.uk/publications/2006/12/07154302/0 Back to index
Kevin Woods Chief Executive NHSScotland & Head of Scottish Executive Health Department Scotland to Get an Annual Health Check Improving health and tackling health inequalities remains a priority for the Scottish Executive and the NHS. Last December the First Minister launched the report Delivering a Healthy Scotland: Meeting the Challenge at a meeting of the World Health Organization in Edinburgh where the social factors involved were discussed. The report provides details of the Government s approach to improving standards of health in Scotland. It also provides details of progress in key programmes and features case studies which highlight the differences being made to people s lives. At the launch the First Minister announced plans for an annual public review of the state of the nation s health involving a wide range of organisations and experts. This will assist in the publication of a further report to assess what has been achieved and suggest future strategy. The Health Department is in the process of developing methods for better cooperation on regular health checks for Scotland. Further information on how to become involved in the process will be explained in the Spring. A copy of the report Delivering a Healthy Scotland: Meeting the Challenge can be found at: http://www.scotland.gov.uk/publications/2006/ 11/29141927/0 WORKFORCE National Workforce Plan The National Workforce Plan 2006 was published in December. It is the first annual assessment prepared for NHSScotland, and sets out the potential workforce supply, including those already in training, and training numbers for doctors, nurses and midwives for 2007/08. The Plan is based on information supplied in NHS Boards and Regional Workforce Plans. Next year s pre-registration nursing and midwifery student intake targets will be kept at the previous high level of 3325. Specialty training posts for doctors will increase by almost 50%, from 1674 to 2493, as implementation of Modernising Medical Careers continues. An additional 50 places are also being created in the GP training programme. The number of dental students has already risen to ensure an output of at least 135 graduates per year from 2006/07. The Plan includes key messages and actions to be implemented at local, regional and national levels. NHS Boards have been asked to produce three year costings for all staff groups and to estimate demand for nurses, midwives and GPs for the next 5 years and doctors and dentists over 10 years. Copies of the National Workforce Plan have been widely distributed and it can be accessed on the Scottish Executive website at www.scotland.gsi.gov.uk. Further hard copies are available from David Reid in the National Workforce Planning Unit, tel:0131 244 1837 or e-mail at david.reid2@scotland.gsi.gov.uk Promoting Careers in the NHS Highlighting the number and scope of career opportunities in NHS Scotland and the positive contribution made by staff are the chief aims of the renewed NHS career recruitment campaign currently underway. A new television advertisement featuring staff from within NHSScotland has been running, supported by radio, cinema, press and online broadcasts. The aim is to encourage more people to consider a career with NHS Scotland and to show how the organisation is changing with more services being switched from hospitals into communities and helping people to lead healthier, longer lives. When the initiative was first run last March, it generated in excess of 4,000 enquiries and helped to improve the public s perception of working in NHSScotland. It is now widely known that there are more than 130 different
careers in the NHS and many different functions delivering healthcare to patients. As part of the careers and awareness drive, the 2007 NHS Awareness Week started on 22nd January. With its theme of innovation and technology Awareness Week celebrated pioneering ways of caring for patients. In addition NHSScotland also took part in the second Daily Record Hot Jobs Fair held in Glasgow. To find out more about a career in the NHS, log on to www.infoscotland.com/nhs or contact the NHS Scotland careers helpline on 0845 601 4647. You can also use the textphone facility by calling 0141 204 2945. Job Satisfaction Up Among Doctors I was delighted to see the results of the recent survey on working conditions and job satisfaction among doctors. The survey shows that job satisfaction among consultants, GPs, staff and associate specialists has increased significantly. The survey was carried out by the Health Economics Research Unit at Aberdeen University and was the first of it kind since 2001. The majority of consultants and GPs commented favourably on their new contracts, and reported that they are able to spend more time on clinical work. The full report is available at www.paymodernisation.scot.nhs.uk. Managing Winter Pressures Already this winter NHS staff have had to respond to a huge increase in demand for services. A number of viruses are in circulation and these have been causing respiratory problems for many people. While most of those affected do not require a hospital bed and can care for themselves at home, there has been an unprecedented demand for out-of-hours services. Over the 4- day Christmas and New Year periods NHS 24 received more than 93,000 calls, an increase of 15% on the equivalent period last year. Despite this, NHS 24 s response was greatly improved with calls, on average, being answered within 10 seconds compared with 30 seconds twelve months ago. Early in the New Year hospitals experienced a surge in admissions with many NHS Boards reporting higher admission rates. NHSScotland once again has demonstrated its strength in accommodating these peaks in demand my thanks to everyone involved. Scottish Ambulance Service and NHS 24 Working Together to Improve the Patient Experience The Scottish Ambulance Service and NHS 24 are working closely together to improve the service they provide for the people of Scotland. Currently they are reviewing how to improve the transfer of calls between them to ensure patients receive appropriate care. From this spring the details of lower priority 999 calls will be transferred electronically by the ambulance service to NHS 24, for assessment and advice This system will be introduced initially in the south east of Scotland on a trial basis, and if successful, will be extended across the country later in the year. Launch of the Community Eyecare Strategy Lewis Macdonald MSP, Deputy Health Minister, released the final report of the Community Eyecare Review recently at a meeting of the Parliamentary Cross Party Group on Visual Impairment. The study was commissioned in March 2004 to encourage the development of integrated, high quality, efficient eyecare services in local settings, and brings together the following series of linked initiatives: the introduction of free eye examinations in April 2006 encouraging greater involvement of community optometrists, both with relevant hospital departments and with members of local eyecare networks; a study of inter-agency working in three localities in Scotland; a re-appraisal of the outdated system for certifying and registering blindness and partial sight; a report on the particular needs of visually impaired children and their families; an examination of clinical pathways in the diagnosis and treatment of sight loss; and the establishment of a framework of service standards. The review suggests a series of changes to how community eyecare services are coordinated and the Deputy Minister announced that 2 million would be made available to help finance the process. Copies of the report are available on the Executive s website at
www.scotland.gov.uk/topics/health/health/eye care. For further information and for copies of the report in accessible formats, contact Mike Cairns on 0131 244 3752. Delivering for Mental Health Improving mental health is a high priority for the Scottish Executive. We are committed to improving the care and treatment of people with mental health problems and in Delivering for Mental Health, published in December 2006 the Executive sets out its targets and commitments for change between now and 2010. These include: prevention; improved crisis care; young people s services; reducing the number of suicides; cutting re-admissions; and reviews of prescribing practice. To help the NHS to implement the plan a National Support Programme has been set up and a National Improvement Programme and a Leadership Initiative are to be established. You can access Delivering for Mental Health at: www.scotland.gov.uk/publications/2006/11/30 164829/0 Developing Community Hospitals A focus for the NHS In A Partnership for a Better Scotland we made a commitment to develop a strategy for sustaining small, rural and community hospitals where they are safe and effective. Following the work of a review group involving a range of stakeholders, in December the Deputy Minister for Health & Community Care launched Developing Community Hospitals - a strategy for Scotland. The new strategy goes far beyond the original commitment and sets out a new model of community hospital which will help us achieve our vision for the future provision of health services in Scotland as set out in Delivering for Health: bringing about a shift in the balance of care, with a commitment to embedding services within our local communities. Developing Community Hospitals - a strategy for Scotland provides a blueprint for NHS Boards and their Community Health Partnerships to develop modern, locally sustainable community hospital services that are responsive to local community needs in a wider range of settings than currently exist. It moves beyond the vision for community hospitals in rural areas and acknowledges the role that community hospitals have in urban settings. The strategy requires all NHS Boards to take a fresh look at community health services and recommends that Boards and Community Hospitals should: provide a range of planned services and where appropriate out of hours services; plan services in partnership with local people, stakeholders and the support of others such as SAS and NHS24; provide integrated holistic care enabling patients to be cared for as close to home as possible as part of a local resource centre; and work within existing Board clinical governance framework using NHS QIS standards and guidelines. The strategy aims to ensure that community hospitals remain at the heart of local healthcare and continue to develop their important role in delivering services within extended primary care. The strategy can be accessed at: http://www.scotland.gov.uk/publications/2 006/12/18142322/0 Scottish Grocers Federation Healthyliving Programme Overview The Scottish Grocers Federation (SGF) Healthyliving Programme is funded by the Scottish Executive to help increase the availability of healthy foods in neighbourhood shops, especially in low income communities. This is a key commitment in Eating for Health: Meeting the Challenge (2004) and fits in to the Executive s overall strategy to improve the nation s diet and to reduce coronary heart disease, type two diabetes, obesity and similar conditions. While supermarkets have largely replaced local outlets as the place where people buy their groceries, they mainly serve car-owning customers. So it is often difficult for those without transport in poorer districts to gain access to quality fresh produce. The SGF s Healthyliving Programme was developed to meet their needs. The Programme, which was previously known as the Neighbourhood Shops Initiative, began in 2004 and has been developed in partnership with the trade body, the Scottish Grocers Federation. A strong campaign and active promotion has led to an increase in sales of produce such as fruit and vegetables in participating stores. This has made phases 1 and 2 of the Programme an unqualified success. Phase 3 was launched by the Minister for Health and Community Care, at
the end of last year in Blantyre, with the aim of expanding the Programme as widely as possible. There are approximately 250 shops already involved, but this number is expected to increase as owners realise the value of participation in terms of status and sales. National Standards for Dental Services New National Standards for Dental Services have been developed to ensure people receive the highest quality of care and attention. Published in December, they set out what patients can expect and how concerns should be raised. A number of important issues are covered including staffing, and infection control. Developed jointly by the Scottish Executive and NHS Quality Improvement Scotland (QIS), they apply to both the private and NHS sectors, the former being monitored by the care commission and the latter by NHS QIS). Both these organisations will work closely to develop assessment methods. Walk The Talk - Nominate Promising Practice in Young People s Health Walk the Talk is a national initiative designed to address the inequalities in young people s health and to improve health services for the young. The Walk the Talk website is a facility for practitioners working to improve young people s health and includes information about the initiative, a range of relevant resources and events, as well as current and back copies of the Walk the Talk newsletter. Also available is an online directory of examples of good practice but there is room for more ideas, suggestions and advice from all over the country. These can be submitted for possible inclusion using the form available on the website. To nominate good practice, visit http://www.walk-thetalk.org.uk/bestpractice or contact Candice Dillen at Candice@fastforward.org.uk. Back to index The Standards have been published and can be found online at: www.scotland.gov.uk/health/standardsandspo nsorship. Audit Scotland s Report on NHS Catering The quality of catering services is an important part of patients overall experience of hospital. Audit Scotland has recently published its report, Catering for Patients a follow up report. It concludes that in many ways services are better but also identifies scope for further improvement. We are currently developing catering standards for the NHS and implementation guidelines will be published in April. These will encourage further improvement in areas such as: number of courses and choices; provision of snacks; composition of manufactured products (salt, sugar, fats); and portion sizes. The report can be found at http://www.auditscotland.gov.uk/index/06pf09ag.asp
Messages from the Chief Professional Officers Dr Harry Burns Chief Medical Officer WINTER FLU Surveillance Data The latest evidence available suggests that we are now well into our usual flu season and are within the normal range. This has not been the case since 2003/4 as totals for the intervening years have been lower. The rate of influenzalike illness (ILI) presentations for week 2 of 2007 as recorded by the spotter scheme, was 158 cases per 100,000 population, the normal range being 50-600 cases per 100,000 population. The number of cases was expected to increase to peak at the lower end of the normal range. For comparison, in 1999/2000 there were 800 cases of ILI per 100,000 at the seasonal peak. Virology Samples obtained from GPs participating in the Scottish Enhanced Respiratory Virus Surveillance Scheme (SERVIS) showed that 5 of 7 samples (71%) tested in week 02/07, and 9 of 28 (32%) checked in 01/07 were positive for influenza A. Further analysis showed a type of virus which is a component of this season s vaccine. As a result a good match was anticipated. During recent weeks there have been a number of other respiratory viruses, including RSV, human metapneumovirus, parainfluenza and rhinovirus, causing ill health, many of which are evidence of flu. Flu Vaccine and Uptake The annual influenza vaccination campaign was launched in October 2006. Due to manufacturing problems across Europe, the arrival of vaccine was delayed by approximately one month. The delivery of supplies (1.3 million doses) has now been completed in Scotland. We also have a contingency of 80,000 doses. As a result of delivery being over a longer period, there was a lower uptake of vaccination at the end of December compared with last year 65.9% for people aged 65 and over, the target being 70%. More figures are currently being collated. Additional publicity using local press and radio advertising was run from 8 January encouraging those not yet vaccinated to go to their GPs. Use of Antivirals Now that there is evidence influenza is circulating at levels about the baseline, antiviral medication for treating it in the community is available as a therapeutic option for those aged 65 years and over or in an at risk group. The use of such treatments should follow the recommendations made by NICE and endorsed by QIS. A CMO letter has been issued emphasising the NICE/QIS guidelines. Paul Martin Chief Nursing Officer SCN Review and Clinical Quality Indicators for Nursing and Midwifery The Scottish Executive Health Department and the NHS Board Directors of Nursing have been leading on both these projects which have been progressing over the last couple of months. The aim of the Senior Charge Nurse (SCN)/Ward Sister Review is to clarify and explain the modern role of this group of staff, while the Clinical Quality Indicator Project (CQI) aims to develop a set of Indicators for Nursing & Midwifery that will support the delivery of safe and effective nursing and midwifery practice. The similarities and links between the two projects will ensure NHSScotland has the information to measure the impact of the modern Charge Nurse role on both organisational and clinical effectiveness. It will also allow frontline staff to make the best possible contribution to ensuring safe and effective patient care while also enhancing the patient experience. The projects have taken account of the views from a wide range of stakeholders and their input has generated a number of potential clinical indicators that the project board are currently considering. The views have also informed the development of the SCN role.
The anticipated outcome of both projects is to improve care at the bedside by developing the SCN/Ward Sister role around four key functions; ensuring safe and effective practice; enhancing the patients experience; managing and developing the performance of the team; and ensuring an effective contribution to the delivery of the organisations objectives. This month the Scottish Executive will start funding and leading a 6 month pilot phase to inform the final recommendations from both projects. NHS Fife, NHS Forth Valley, NHS Grampian. NHS Greater Glasgow and Clyde and NHS Lanarkshire have been designated as pilot areas. They will receive funding for a clinical facilitator to support the pilot within their area, to link up with other pilot areas to exchange ideas and to develop a tool kit that will support SCNs in the modernised role. The other Boards will be involved throughout the project. They will also be allocated funding, this time for a part time clinical facilitator, to help develop a national network that will help successfully implement the final recommendations across NHS Scotland. For further information contact Eileen McKenna (Eileen.mckenna@scotland.gsi.gov.uk) Back to index
Delivering for Health The Delivering for Health Implementation Board met on 1 February. The group considered progress on the Planned Care workstream and the cross-cutting Volumes and Outcomes project. Planned Care Delivering for Health describes a future model of healthcare designed to meet the challenges of the changing population of Scotland. The successful delivery of the plans described will be dependent upon the development of an integrated NHS, where patients can experience a smooth and quick journey of care wherever and however they access services. In Planned Care this will result in continued reductions in waiting times and is delivered by actions that improve access for patients, make the best use of facilities, reduce cancellations, improve the predictability of workflow and optimise the supply and demand of services across local and national dimensions. Delivering for Health requires NHS Boards to develop 3 year plans to systematically introduce five simple changes beginning in 2006/2007 to ensure that patient pathways are planned in advance and patients experience seamless joined up service, speeding up access to care, sharing best practice and making NHS Boards accountable for raising their performance. The five simple changes are at the core of the programme activities, they are: Treat day surgery as the norm for planned procedures; Improve referral and diagnostic pathways; Actively manage admissions to hospital; Actively manage discharge and length of stay; and Actively manage follow up. The Planned Care Improvement Programme was officially launched on 29 th of September by the Minister for Health and Community Care. Initial funding and programme guidance was released in August 2006 in order to initiate local projects, recruit key project members, develop local project plans and to collect baseline capacity, demand and benchmarking data. The remaining funds were released by Christmas 2006 following submission of local project plans that fully detailed the scope of local projects to deliver the five simple changes. The Planned Care Improvement Programme is focused on how to implement the five simple changes identified in Delivering for Health in a manner that supports the delivery of key national access targets, in particular 18 week access targets and the ongoing development of whole patient journey time targets, focused on implementation of evidence based changes. Volume and Outcomes The Volume and Outcomes project has made progress in addressing its challenging task. The Expert Working Group was established in June 2006, and it held a successful workshop in November. These interactions have enabled the Group to produce a paper discussing the major issues and setting out a plan for future action. Volume and Outcomes is a complex area of work that cuts across all the Delivering for Health workstreams. The project is looking at how the number of healthcare procedures carried out by a particular professional, team or hospital affects the quality of patient care. This information can help NHSScotland to build a picture of which services can safely be made available at the local level, and which complex procedures need to be provided in a more concentrated way, for example from larger hospitals. The project looks at how NHSScotland should collect and understand information on volume and outcomes and how this can be balanced with other factors in quality care. The project will not attempt to provide ready solutions for healthcare configurations, but will focus on a framework in which volume and outcome information can be interpreted and understood. The Group also propose to encourage more systematic collection, use and interpretation of data, using technological and organisational opportunities to quickly and effectively provide information to NHSScotland.
The Volume and Outcomes Group is recruiting a health researcher within NHS Quality Improvement Scotland in order to support their work. In the short to medium term the group intends to: Assist NHSScotland in making better use of existing information on volume and outcomes of healthcare; Develop clearer guidance on use of volume information in relation to other factors in service provision; Facilitate informed debate about future information gathering; Encourage further development of relevant clinical and patient-centred outcome measures for NHS Scotland; Investigate how the governance loop can be closed; broadly speaking this can be defined as: provide service, measure, analyse, plan future services; and Examine data currently available, and scope how it can be used more effectively. As this work goes forward it should help those in NHSScotland involved with planning services to better understand how volume of healthcare services affects quality. Back to index Comments to: nhsbulletin@scotland.gsi.gov.uk