Changing for the Better
MidHighland CHP
Health 2012
DeliveryPlan2009/2010
Contents Table
Number / Title / Page1.0 / Introduction
1.1 / Shifting the Balance of Care - Improve the health of people in Highland by making a shift to preventative and continuous care delivered locally
1.2 / Corporate Objectives
2.0 / Executive Summary
2.1
/Improvement Area – Better Health
2.2
/Improvement Area – Better Care
2.3
/Improvement Area – Better Value
2.4
/ Changing for the Better Improvement Programme3.0 / NHS Highland 10 Priority Areas for Service Improvement
3.1 / Dementia
3.2 / Patient Safety
3.3 / Anticipatory Care/Emergency Admissions
3.4 / Community Hospitals
3.5 / Theatres
3.6 / Same Day Surgery
3.7 / Outpatients: New to Returns
3.8 / Booking (A&C) and Access
3.9 / Demand Management
3.10 / Delayed Discharge and Discharge Planning
4.0 / Shifting the Balance
5.0 /
Service Redesign
5.1 /Skye & Lochalsh
5.2 /Ross, Cromarty & West Ness
5.3 /Lochaber
5.4 /Highland Hub incorporating Out of Hours, NHS Highland Nursing & Midwifery Bank and NHS24 Satellite Centre
6.0 / Health Improvement6.1 / Health & Nutrition
7.0 / Hospital Acquired Infections
8.0 / Management of Risks
9.0 / Pharmacy/Prescribing
10.0 / Finance
Appendix 1 / Health 2012
Appendix 2 / Mid CHP Service Improvement Team 10 Priority Reporting Template
Appendix 3 / Useful electronic links etc
Appendix 4 / CELs, HEAT targets etc to support cross referencing
1.0Introduction
The NHS in Scotland is working to the policy document, Better Health, Better Care and this delivery plan describes the actions in train and proposed by Mid Highland Community Health Partnership in order to implement the national strategies as well as delivery on the Health, Efficiency, Access and Treatment (HEAT) targets and the NHS Highland Local Delivery Plan.
Mid Highland Community Health Partnership is one of 4 CHPs in NHS Highland who, together with RaigmoreHospital plan, deliver, improve and monitor services for the population of Highland. Mid Highland covers the Localities of Lochaber, Skye and Lochalsh, Ross, Cromarty and West Ness.
NHS Highland’s vision is to provide ‘Quality Care to every person every day’ and works to three key aims of Better Health, Better Care, Better Value.
NHS Highland seeks to continuously improve the quality of care that it delivers and to tackle the causes of ill health as detailed in the Local Delivery Plan (LDP), which is agreed with the Scottish Government on an annual basis. These improvements are set against a challenging financial position and as well as improving local services within the current resources available through re design, there is a requirement to make efficiency savings. It is therefore vital that the components of the triple aim of better health, better care, better value are always linked and should not be taken in isolation. This will inevitably mean that there will be changes in both the way that we deliver services and in where these are provided.
In 2009/10, NHS Highland produced a framework for change which had 11 elements. Mid Highland CHP addressed each of these and much of this work is ongoing and reflected in this plan. NHS Highland Board has approved the Strategic Framework 2010-11, (appendix 5) which builds on and develops the themes in the previous framework. The key components of this framework, shown in the diagram below are:-
Clinical and Quality Strategy
Financial Plan
Workforce Plan
Engagement Framework
Re design and Efficiency Programme
E Health Strategy
The Mid Highland Delivery Plan will adapt to ensure that it reflects the outcomes required from the NHS Highland Strategic Framework as it develops.
The staff in Mid Highland CHP are working to the ambition of tangibly improved health, care and value for money by 2012, and meet to review progress and share learning at CHP wide Health 2012 events.
1.1Shifting the Balance of Care -Improve the health of people in Highland by making a shift to preventative and continuous care delivered locally
The NHS in Scotland is moving towards services that are more local where possible, easier and faster to access, and flexible. There is a need to shift the focus from acute hospital services to more locally provided services that are designed to better meet the needs of people who suffer from long term conditions, to support older people for longer in their own homes, to prevent unnecessary hospital admission and to support discharge home earlier when admission is unavoidable. The NHS of the future will be team based and traditional models will require tochange to fit better with the new ways of delivering the services.To do this, the Community Health Partnership will work with their Partners in Specialist services, the Local Authority, Voluntary and Independent sector, to build on existing good practice and work through General Practices and Extended Community Care Teams to develop a wider range of more locally based services. They will be responsible for the resources that are available for the population they serve and for the best use of those resources. This will mean that existing patterns of referral and treatment will be closely examined over the next few years and changes will be made to ensure that patients see the right member of the team at the right time and that as much as possible of the diagnostic and treatment process will happen in local centres which might be Health Centres and Community Hospitals rather than Raigmore or other Hospitals. The funding available to NHS Highland is finite and there will be a need to release resources from some parts of the organisation in order to develop the care and services that people need. These decisions will be taken together with the local communities and staff and an integrated resource framework will be developed to support the shift in the balance of care as well as the delivery of key targets such as the 18 week Referral to Treatment, and the aspirations of the Long Term Conditions and Mental Health Collaborative.
1.2Corporate Objectives 2009-10
Better HealthImprove the health and wellbeing of the NHS Highland population. / Better Care
Maximise the delivery of quality healthcare in the most appropriate setting. / Better Value
All services are efficient and cost effective. / Changing for the Better
Improvement Programme
Annual Priorities 2009-10
BH.1 Healthy life expectancy is improved especially for the most disadvantaged people / BC.1 Individual patients are at the centre of their own treatment and care planning and decisions / BV.1 Working systems and practices are redesigned to be fit for purpose / CfB.1 Planned Care
(theatres, day cases, bed use, surgical review, discharge planning, patient focussed booking)
BH.2 The health and independence of older people is maximised / BC.2 Patients experience no harm from healthcare services / BV.2 Productivity increases through working smarter, not harder / CfB.2 Anticipatory Care
(community hospitals, discharge planning, supporting people with dementia, hospital beds)
BH.3 Attitudes and behaviours towards alcohol and other drugs are changed and supported by better prevention and treatment services / BC.3 Services are based on scientific knowledge / BV.3 Services provide value for public money / CfB.3 Unscheduled Care
(ambulatory care, demand management, A&E attendances, OOH care, community hospitals, discharge planning, supporting people with dementia, bed use)
BH.4 The cycle of deprivation is broken through intervention in early years / BC.4 Healthcare and treatments are provided to consistent standards / BV.4 Maximum benefit for every patient from every public pound / CfB.4 Equity, quality, consistency & standards of care (demand management, unscheduled care, Scottish patient safety programme)
BH.5 The impact of poverty and disadvantage is reduced / BC.5 Rapid access to safe, quality assured treatment and care / BV.5 Provide resources for improvements in patient care by reducing waste and inefficiencies / CfB.5 Efficiency programme
(redesign corporate services, use of IT, non essential clinical services, tertiary referrals, income retrieval, workforce efficiency)
2.0Executive Summary
This summary gives an overview of activity in all areas. For more in-depth information please refer to the relevant chapter/page identified.
Dementia(Section 3.1, page)
Improvement in the early diagnosis and management of patients with dementia will be achieved through redesign of the referral and diagnostic processes within the Memory Clinic environment. Caseload management and review structures supporting patients undergoing treatment and care will also contribute. Strategies for improving the recognition and recording of patients with dementia will contribute to the HEAT target.
Patient Safety (Section 3.2, page)
Covers the Scottish Patient Safety Programme piloted successfully in the Belford, clinical quality indicators, part of the Senior Charge Nurse Review, all infection control and prevention measures and quality improvements, including monitoring of patient complaints, clinical incidents and risk management through robust clinical governance/risk management processes.
Anticipatory Care/Prevention of Emergency Admissions(Section 3.3, page)
This includes the identification of patients most at risk from hospital admissions through case finding, preparation of health care professionals working in the community to support case management, self care management and the development of anticipatory care plans in collaboration with the patient and primary care team which support effective discharge planning.
Community Hospitals/Resource Hubs(Section 3.4, page)
1)Standardised admission criteria for Community Hospitals
The CHP policy is in development stage, to be agreed by the Service Improvement Team. It aims to provide clear guidance on admission
criteria from acute hospital and community NHS settings and is in accordance with the Highland wide Joint Admission, Transfer and Discharge Policy. It intends to ensure patient’s interests as central to the admission, transfer and discharge planning process.
2)Improved access to Community Rehabilitation Services
Examples are the development of re-ablement services in Lochaber and Ross and Cromarty, rehabilitation facility in PortreeHospital and the intermediate care facility in Abbeyfield Care Home in Ballachulish. The closure of Ward 2c in Raigmore required specific development for alternative care and rehabilitation provision in Invergordon/Dingwall e.g. with augmented AHP and nursingservices in the community. This work is supported by the Rehabilitation Framework, Highland Council’s re-ablement service/responsive home care service, all vital to ensure a reduction in unnecessary admissions and to facilitate effective hospital discharge and reduce length of stay.
3)Establish monitoring system for review of admissions/CommunityHospitalactivity
Hospital Operation Teams/Multi Disciplinary Teams are expected to review information and admissions. Building on existing operational procedures,joint discharge planning meetings are required, with the Senior Charge Nurses taking a lead role in a solution focused approach to this function. This will be integral to the Standardised Admission Criteria for Community Hospitals.
4)Understand referral patterns by GP Practices to Community Hospitals
The collation and review of data with each Locality Clinical Lead/GP practice is in progress and will assist with the identification of referral patterns. Identification and development of alternative approaches to consultant referrals such as the orthopaedic triage service and practitioners with specialist interests e.g. COPD, Angina and Cardiac Care will ensure the provision of effective admissions.
5)Transfer specific interventions/therapies from Acute Services to Community Hospitals
Introduced successfully in Invergordon hospital with significant activity in IV therapies and blood transfusions well established, previously undertaken in the acute hospital setting for oncology and orthopaedic patients. The appointment of a clinical skills facilitator across Raigmore, Mid and SE CHP has provided therequired support and skills development programme and work continues to develop an outpatient antibiotic therapy service. In Lochaber, IV medical treatments are being provided in the community and chemotherapy service is well established in both the Belford and BroadordHospitals.
6)Improved use of Community Hospitals as Resource Hubs
The ongoing maintenance of the community hospitals directory ensures that knowledge of the available skills and resources available are understood and utilised, with the on going review of services designed to deliver care as local as possible is ongoing within the localities, with a focus on rehabilitation. The role of the Senior Charge Nurse is critical to the developing the vision and future development of community hospitals as resource hubs and national programmes such as the Review and Releasing Time to Care provide a good foundation to build upon.
Theatres(Section 3.5, page)
Aims to increase theatre utilisation and support waiting list initiatives by improving efficiency of theatre usage, booking, scheduling and use of resources, including achieving reductions in DNAs.
Same Day Surgery(Section 3.6, page)
Linked with more efficient use of theatres, this workstream improves management of capacity and demand, decreases length of stay and ensures timely discharge of patients following surgery.
Outpatients: New to Returns(Section 3.7, page)
Aims to ensure most effective and efficient use of consultant time which impacts on ability to achieve waiting time targets. Actions include reduction in variation across specialties, reduction in return appointments and DNA rates.
Booking (A&C) and Access(Section 3.8, page)
The implementation of the Patient Access Policy across Mid HighlandCHP will improve the use of available resources, and support the delivery of a number of other HEAT targets on Access and Efficiency.
Demand Management(Section 3.9, page)
Managing the demand in general practice is key to shifting the balance and reducing unscheduled referrals. General Practice has a major part to play in this, and constant reviewing and discussion to heighten awareness and change culture within general practice is essential.
Delayed Discharges & Discharge Planning(Section 3.10, page)
Through the development and use of various tools, techniques and process reviews Mid Highland CHP will, together with Local Authority partners, address delays in discharge and optimise length of stay for all patients admitted to hospitals in the CHP.
Shifting Balance of Care(Section 4.0, page)
Improving patient outcomes by shifting the balance of care (SBC)is essential to achieving better health, better care and better value. Key outcomesincludeflexible, responsive care closer to home; integrated team working and health and social care for those at risk; reduced emergency admissions and better capacity and flow for planned care through development of anticipatory care planning. Use of non-medical staff skills to deliver care in primary and communitycare settings, better access to care in remote and rural areasincludinguse of telehealthcare will all improve services andresource use. Strong links exist between SBC, rehabilitation and anticipatory care.
Service Redesign(Section 5.0, page)
Skye & Lochalsh(Section 5.1, page)
Ross, Cromarty & West Ness(Section 5.2, page)
The focus of service redesign in the localities of Skye & Lochalsh and Ross, Cromarty West Ness are;
- Exploring, with the community, the identification of future health service delivery needs for the population of Skye and Lochalsh
- Redesigning the inpatient rheumatology service in light of changes in available treatment principally drug therapies and equity of access to the service for all patients.
- In Ross, Cromarty & West Ness redesigning of the Mental Health services for older adults in light of the demographic change expected and the need for earlier recognition and treatment planning.
- Implementing the Rehabilitation Framework to increase the local service capacity to support those with long term conditions in their communities and avoid unnecessary admission to hospital.
- Supporting the modernisation of nursing in the community agenda to transform the service to meet the challenges of providing access to a range of local services based on assessment of need.
Lochaber(Section 5.3, page)
Local service redesign is aimed at making most efficient and effective use of resources to support improved more structured patient pathways in Belford Hospital, shifting the balance of care between hospital and community, supporting patients with long term conditions in order to reduce unnecessary admissions, reducing costs and improving health outcomes.
Out of Hours(Section 5.4, page)
This area of work brings together a number of strands including workforce planning, unscheduled care and support for long term conditions/anticipatory care. Key results include development of a single point of co-ordination for unscheduled care response provision plusresponse and referral co-ordination for telehealth and telecare support for patients. This work is key in linking Highland Council, Social Services, Care at Home, NHS24 and Scottish Ambulance Service with NHS Highland.
Health Improvement(Section 6.0, page)
The goal of improving wellbeing and/or preventing ill-health is one which is implicit in almost every healthcare contact. Health improvement is the business of staff at all levels in both hospitals and communities. It may be supported through empowering patients to play a role in managing their own health and healthcare, or it may be tackled through targeted interventions which impact on individuals, families and communities, or the wider determinants of health. Effective health improvement requires a jigsaw of complementary interventions and approaches, from work with individuals to community-led initiatives, and will generally involve a range of agencies and staff. The outcomes are better health for individuals and populations, and effectiveness must be assessed at the level of populations as well as individuals.
The key targets for the NHS and the CHP are set by Scottish Government are incorporated in the HEAT targets and in relevant Chief Executive’s Letters.
Other issues include sexual health; adult healthy weight; workplace health; wellbeing of elderly people; anticipatory care, and supporting patients toself-manage long-term conditions. A thread which should run through all health improvement interventions is the need to tackle inequalities in health and to be aware of the potential for increasing the health inequalities gap.