Final 16th March 2012

NHS Grampian’s Contribution to Single Outcome Agreements (SOAs) 2012–13

Introduction

NHS Grampian is a partner in the delivery of three Single Outcome Agreements (SOAs) covering Aberdeenshire, Aberdeen City and Moray. Delivery of the agreement is the responsibility of all Community Planning Partners (CPP), as joint signatories. It reflects the journey to create a more integrated health and care system, reflected in Vision 20:20.

Vision 20:20

NHS Grampian agreed its Health Plan and has embarked on its Health and Care Framework (H&CF) process to determine in detail how health and care will change over the next 5-10 years. Vision 20:20 indicates the level of detail that is necessary to move forward. This includes a vision for the transformation in roles and responsibilities for health between the public and professionals, as well as transformation in the balance of care provided between community and acute services. At its conclusion the health system in Grampian aims to reflect fully the high level aspirations of the first Healthfit in 2002 and in subsequent health plans. The vision is achieved by our staff working jointly with the public, communities, local authorities and other partners by being clear and honest about the challenges, the needs of the population, the opportunities available and working together to agree and deliver the changes required.

In all of this NHS Grampian is committed to the key dimensions of the Quality Strategy to provide the right care, in the right place, at the right time, taking account in all of its planning to address the various demographic and economic challenges optimally; across the three Community Health Partnerships (CHPs).

Each Grampian Community Health Partnership is different. Priorities for action reflect the needs of the respective populations. Each of the three separate templates reflects a distinct critical issue and addresses at least one or more of the 4 national priorities:

·  Health inequalities

·  Early years

·  Tackling poverty and socio-economic inequality

·  Economic recovery

The templates are underpinned by our corporate focus on Vision 20:20, supporting and refining our approaches to health and care; ensuring NHS Grampian and its partners are health improving and inequalities sensitive. This requires us to mainstream tackling health inequalities and improving health within the planning of health and care, supporting sectors and partners to build an increasingly coherent, quality, sustainable and affordable approach.

Vision 20:20 and its implementation through the Health and Care Framework provide the context for each of the critical issues - Reshaping care for older people in Aberdeen City; Tackling deprivation and inequalities in (Fraserburgh) Aberdeenshire, and Tackling alcohol and drug misuse in Moray. Each of the critical issues also informs components of the evolving framework to promote health and well-being, as well as care, in the community.

Aberdeen City’s critical issue also addresses health as well as care, and reflects the overall ambition of Vision 20:20 as implemented through the Health and Care Framework to address the complex health, demographic and fiscal challenges of an aging population. In support of the national outcome for longer, healthier lives, and tackling the significant inequalities in Scottish society, Aberdeen City’s local outcome is to improvepeople's health and wellbeing, promote inclusion and independence. This reflects the partnership's vision of older people as an assetand of a servicefocus on maintaining the physical and mental well-being of older people, anticipating any decline before it becomes acute.

Aberdeenshire’s critical issue continues to be a pathfinder within the Health and Care Framework for a targeted community approach to health inequalities. Work has progressed over 2011/12 to deliver on the recommendations of the Early years Equally Well project and to link this work with overall tackling poverty and inequalities through the CPP and use of the Fairer Scotland Fund. Reducing health inequalities remains a key strand of the use of the FSF within Aberdeenshire.

As a pathfinder, Aberdeenshire’s critical issue, Tackling deprivation and inequalities in (Fraserburgh) Aberdeenshire, informs the ways in which NHS Grampian can articulate a vision for health within the economic and social vision for the community, ensuring the necessary leadership, evidence, action and evaluation to provide confidence in ways forward, milestones in progress and support for partners who are focusing on complementary components of the social gradient. The pathfinder will provide the focus for further developing anticipatory care and empowering individuals and communities to improve and sustain their health, especially in the identified disadvantaged communities. This is a necessarily ambitious programme and national outcomes include living longer, healthier lives, tackling the significant inequalities in Scottish society; children having the best start and are ready to succeed; taking pride in a strong, fair and inclusive identity, realising our full economic potential with more and better employment opportunities especially those in disadvantaged communities. Local outcomes in support are: improving health and wellbeing through empowerment; reducing harm caused by misuse of alcohol and drugs; ensuring Aberdeenshire’s children have the best start in life; improving quality of life in the most deprived communities; reducing deprivation; and ensuring appropriate skills to meet the future needs of the economy.

Moray’s critical issue similarly contributes to our Vision 20:20, the evolving focus on promoting health in the community and its implementation through the Health and Care Framework The three Alcohol and Drug Partnerships (ADPs) in Grampian benefit from the overarching leadership from NHS Grampian and each balances its particular priorities according to local need, as a matter of emphasis rather than as a unique approach. A Moray Alcohol and Drugs Partnership (MADP) needs assessment is in completion. The Moray ADP links formally to the Community Planning Partnership through clear roles, responsibilities, accountability arrangements, priorities and resources between partner organisations. In support of the national outcome for longer, healthier lives, Moray’s local outcome is reducing the impact of alcohol and substance misuse

Performance Management

Performance management arrangements within each CHP have developed to meet the individual needs of that CHP, whilst being in line with the NHS Board’s overall performance management framework and that of the individual local authorities. Each CHP has a performance scorecard linking the CHP to delivery of NHS Grampian’s strategic themes and corporate objectives. The scorecard is used to review performance by the Chief Operating Officer. This integrated approach ensures that SOA commitments are reviewed with targets specific to NHS Grampian. CHP management participate fully in the NHS Grampian’s Operational Management Team and Cross System Performance Review process which ensures progress in line with plans and targets. The Board’s Performance Governance Committee receives assurance on performance from the Chief Executive and Chief Operating Officer and in turn reports to the NHS Board. As part of NHS Grampian’s Assurance Framework, Performance Governance Committee also receives a risk based performance template from each CHP Committee following each of its meetings.

NHS Board Local Delivery Plan 2012 – 2013
Contributions to Single Outcome Agreements
1. / NHS Board: / Grampian
2. / Community Planning Partnership: / Aberdeen City
3. / Summary of Critical Issue: / Reshaping Care For Older People - the principal policy goal is to increase and optimise independence and wellbeing of older people at home or in a homely setting. The implications of the current financial situation and the demographic changes make this a challenging task/critical issue, as improved services and or support need to be provided for an increasing number of people using a diminishing level of resources. Therefore radical transformational change is necessary to achieve and sustain better outcomes for older people. The aim is to work in partnership to shift the focus of care from institutional to community/ home settings while improving quality, value and outcomes through cohesive partnership working across health and social care and between statutory and non-statutory bodies. This will result in older people and their carers feeling safe and valued, receiving timely and responsive care, support leading to improved mental & physical health and wellbeing, a greater ability to self manage and better anticipate care, leading to better quality of life for older people, a reduction in avoidable emergency admissions and reduction in bed days through more effective acute and community care. (T6, T12)
4. / Community Planning Partnership Outputs: / To address the issue the CHP submitted with Partners to the Scottish Government via The Aberdeen City Alliance (now known as Community Planning Aberdeen) and the CHP Committee, a Change Plan for 2011/12. This was successful and £2.738m was allocated to the Aberdeen Partnership. Thirty one projects were subsequently funded and are now being implemented. These have included multi agency reviews of medication of residents in sheltered housing; the establishment of a Social Enterprise for Older People; Expansion of the Community Geriatric Service; the Establishment of a Falls (Prevention) Lead for Aberdeen.
Promoting financial Inclusion – Cash In Your Pocket Partnership (CIYPP) - income maximisation advice continues to be made available through Keep Well programme.
Four wellbeing co-ordinators have been employed by the Aberdeen City Council (ACC) Social Work directorate (older people’s services) and commence January 2012. Posts have a remit to optimise the independence and wellbeing of older people in the community.
Mental Health Counselling services funded through Fairer Scotland Fund (FSF).
Maps for ranger walks in Aberdeen City have been widely distributed via primary care and within the community and this has resulted in much higher participation.
5. / Local Outcome(s): / To see older people as an asset not a burden.
Shifting the focus from services, towards supporting people to retain and maximise their independence e.g. held over 65’s Sports Games on 11th/12th June 2011. The Change Fund has purchased ‘Technogym’ equipment for older people including those with dementia and this has already received very wide and positive media coverage. There is now much wider support for wellbeing in Aberdeen and this has been positively noted at national level.
To improve the overall health, wellbeing and independence of the people of Aberdeen City through focusing on the factors that is harmful to health and wellbeing and in particular by supporting those most vulnerable. Aberdeen has now established an Older People’s Wellbeing Network and held two Annual Events.
Anticipating any decline before it becomes acute e.g. development of Anticipatory Care Plans by GPs for those most at risk of hospital admission (see no. 7 below).
Increase in proportion of older people living at home (as opposed to institutional care).
Increases in housing related support. Aberdeen City Council has now completed a very large scale review of all sheltered housing.
Improved support for unpaid carers e.g. Change Fund and NHS Grampian Carer Information Strategy have been used to develop carer support.
ACC implemented the Re-ablement Service in 2011 providing a maximum of 6 weeks service following discharge from hospital or other institutional settings to enable people to develop their independence in daily living.
To provide a range of more integrated community-based services to support older people to live safely in their communities for longer e.g. Emergency hospital admissions for over 75s has fallen by 14% from September 2009-October 2011. Aberdeen continues to meet the national delayed discharge standard at census times.
6. / National Outcome(s): / National Outcome 5: Our children have the best start in life and are ready to succeed.
National Outcome 6: We live longer, healthier lives.
National Outcome 7: We have tackled the significant inequalities in Scottish society.
National Outcome 8: We have improved the life changes for children, young people and families at risk.
National Outcome 9: We live our lives safe from crime, disorder and danger.
National Outcome 15: Our public services are high quality, continually improving, efficient and respond to local people’s needs.
7. / Please detail the specific contribution of the NHS Board in tackling this critical issue? / The following list of specific contributions will provide clear evidence of the broad range of inputs led, co-ordinated, delivered and performance reported by NHS Grampian in relation the delivery of the Alcohol and Drug Partnership strategic priority actions:
·  NHS Grampian Health Plan
·  NHS Grampian Health & Care Framework
·  CHP Delivery Plan
In the past 12 months GP practices have been aligned into 4 clusters within Aberdeen City. Each cluster is supported by a senior manager from the CHP’s Senior Management Team (SMT); a GP cluster lead and multi-disciplinary team. Representation from ACC social work directorate (in particular from older people’s services) in each cluster team has resulted in closer communication between primary care and social work services. The GP cluster lead and CHP senior manager together lead on priority themes for the City which includes joint work with social work older people and adult services; pathway development with acute care and health inequalities. Collectively, senior managers provide representation of allied health professions; nursing, primary care and public health within the CHP cluster management team.
Acute services for elderly people within Woodend Hospital are being redesigned and developed around the intermediate care agenda and development of the new Emergency Care Centre in Aberdeen.
The community nursing service in Aberdeen CHP has been redesigned to build capacity and skill mix within existing resources to enable a sustainable service.
In 2011, as part of the Change Fund, Aberdeen CHP has introduced a structured approach to early planned intervention, initially for at risk patients over 75 years. This is managed by way of enhanced contracts with local GP practices and the majority of practices in Aberdeen City have signed up. This approach will complement the alignment of geriatricians with clusters of GP practices.
NHS Grampian submitted its implementation plan for mainstreaming of Keep Well from March 2012 to Scottish Government in November 201111. Currently 20 GP practices participate in delivery of preventative health checks to eligible 45-64 year olds through an enhanced contract. Further mainstreaming of Keep Well will be progressed through the four clusters of general practices providing further opportunity to embed preventative activity within primary care and the community.
Aberdeen CHP has received approval for the outline business case for the Health Village; the full business case is scheduled to be submitted for approval in March 2012.
Carer involvement
8. / Please illustrate the ways in which the NHS Board is working in collaboration with Community Planning Partners to tackle the critical issue? / As a partner NHS Grampian is working in collaboration with Community Planning Aberdeen to effectively plan, develop, deliver and performance report on the following key inputs:
·  The Integrated Strategic Management Team is chaired by the Director of Social Care & Wellbeing and has the Aberdeen CHP General Manager as Vice Chair. This team includes housing, independent and third sector.
·  Electronic Single Shared Assessment (SSA) for access to care services.
·  Utilisation of the Fairer Scotland Fund and the Health Improvement Fund to support ongoing programmes, projects and initiatives during 2011
·  Active participation and support for Community Planning Partnership strategic review to agree joint priorities and actions.
·  Participating in three Total place pilots within Aberdeen City
·  NHS representation on Safer and Stronger community planning forum.
·  CHP Committee represents the Healthier community planning forum in Aberdeen City Council (ACC); Chair of the Committee is currently chair of NHS Grampian.
9. / Please explain how the NHS Board is performance managing its contribution to tackling this critical issue? / Covalent monitoring of the Single Outcome Agreement.
HEAT Framework and CELs.
Health and Care Framework.
OMT.
Regional Cross System Performance Review.
NHS Grampian and sector Balanced Scorecard.
Aberdeen Integrated Strategic Management Team Performance Management.
National Bench Marking.
10. / Please explain how the NHS Board will demonstrate continuous improvement in the course of tackling this critical issue? / NHS Grampian Health Plan.
Health and Care Framework.
NHS Grampian Delivery Plan.
In line with NHS Grampian culture of Continuous Service Improvement (CSI), a range of CSI methodologies and approaches will be applied ie PDSA and A3.

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