Each year NHS Tayside produces a Corporate Plan. The Corporate Plan is drawn from the following sources: national targets
and measures set out within the Local Delivery Plan; from national strategy and policy including Better Health, Better Care;
specific locally initiated plans to develop and improve services; and the work plans of the two regional planning groups.
This is an End of Year Report correct as at 12 April 2011. Inevitably there are certain areas, in particular Local Delivery Plan
targets, where performance data is not available for March 2011. The report will therefore be updated again in July when
March performance can be recorded - with the exception of two targets: smoking cessation and reduction in emergency bed
days 65+, where performance will not be available until later in the year.
The End of Year Report consists of:
‘At A Glance Performance’ for each target/outcome. Performance has been defined as:
Achieved
☺
Performance on Line with Achievement
Not Achieved or Limited Progress Made
Performance Not on Line with Achievement
A Summary of the End of Year Position for each target/outcome. Where performance has not met the specified
outcome/target, a brief explanation is provided.
Achieve the target of 50% key frontline staff in mental health and substance misuse services, primary care, and accident and emergency
being educated and trained in using suicide assessment tools/ suicide prevention training programmes by December 2010.
Achieve the target of 440 cumulative interventions to deliver agreed completion rates for child healthy weight intervention programme
by 2010/11.
Achieve the target of 33.3% to increase the proportion of new-born children exclusively breastfed at 6-8 weeks from 26.6% in 2006/07 to
33.3% in 2010/11.
Achieve the target of 11,500 cumulative screenings to complete the agreed number of screenings using the setting-appropriate
screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11.
Achieve the target of 6,316 cumulative successful quits to support 8% of Tayside’s smoking population in successfully quitting (at one
month post quit) over the period 2008/9 – 2010/11.
Achieve the target of 1,491 cumulative health checks to deliver the agreed number of inequalities targeted cardiovascular Health
Checks during 2010/11.
Achieve the target that information on levels of competence and identified training needs must be available through recording
Achieve the target of 72.5% to deliver improved efficiencies in the day case rate by March 2011.
Achieve the target of 4.5 days to deliver improved efficiencies in the average length of stay for inpatients by March 2011.
Achieve the target of 7.9% to achieve a 10% reduction rate in the first outpatient appointment DNA rate between 2007/08 and 2010/11.
Achieve the target of 0.70 towards a 10% reduction in pre-operative stays over three years – 2010/11 to 2012/13.
Achieve the target of 90% of new GP outpatient referrals into consultant led secondary care services are managed electronically by
December 2010.
Achieve the target to: Operate within agreed revenue resource limit and to meet cash requirement.
Achieve the end of year trajectory 603,488 (GJ) against the target to reduce energy consumption by a year-on-year efficiency target of
1% each year to 2015/16.
☺
Achieve the end of year trajectory that by December 2010, 90% of clients referred to drug treatment will receive a date for assessment that falls within 4 weeks of referral received and 90% of clients will receive a date for treatment that falls within 4 weeks of their care plan being agreed towards a target of 3 weeks by March 2013.
Achieve the target that by 2010/11 at least 90% of patients respond that they were able to book a consultation with a GP more than 2
working days in advance.
Achieve the end of year trajectory of 90% against the target that from the quarter ending December 2011, 95% of all patients diagnosed
with cancer to begin treatment within 31 days of decision to treat.
Achieve the end of year trajectory of 95% against the target that from the quarter ending December 2011, 95% of those referred urgently
with a suspicion of cancer to begin treatment within 62 days of receipt of referral.
Achieve the end of year trajectory of 95% against the target for admitted/non-admitted performance and admitted/non admitted
completeness towards delivery of the 18 week referral to treatment from 31 December 2011.
☺
Achieve the target of 0 that to deliver 18 weeks referral to treatment from 31 December 2011, no patient will wait longer than 9 weeks
from being placed on a waiting list to admission for an inpatient or day case procedure from 31 March 2011.
☺
Achieve the end of year trajectory of 1,450 attendance rate per 100,000 population against the target to support shifting the balance ofcare by achieving agreed reductions in the rates of attendance at A&E, between 2007/08 and 2010/11 and between 2011/12 and 2013/14.
Achieve the target of 124 annual cases for staphylococcus aureus bacteraemia to reduce all staphylococcus aureus bacteraemia by
30% by March 2010 and to achieve a further reduction in cases of 15% by March 2011.
Achieve the target of 0.98 infections annually per total occupied bed days for C.diff to reduce the rate of C.diff infections in patients
aged 65 years and over by at least 30% by March 2011.
Achieve the target of 15% - Angus
30% - Dundee 26% - Perth & Kinross
to increase the level of older people with complex care needs receiving care at home.
☺
☺
Achieve the target of 3,582 people with a diagnosis of dementia registered on QOF to achieve agreed improvements in the early
diagnosis and management of patients with a dementia by March 2011.
Achieve the target of 2,788 bed days per 1,000 population aged 65+ to reduce by 2010/11 the emergency inpatient bed days for
people aged 65 and over, by 10% compared with 2004/05.
Achieve the target of 8,837 bed days per 100,000 population of a 5% reduction in the rates of bed days of patients with a primary
Develop measures to make sure that it is possible to plan and review mental health and wellbeing services for the people within Tayside.
Demonstrate that the standard is achieved that there is effective working between primary care and specialist mental health services for the treatment and care of people with complex needs by: specialist mental health services providing assessment of advice on the management of patients provided within primary care; treatment and care for time limited disorders and for those with severe and enduring needs 75% compliance by March 2011 and 100% compliance by September 2011.
Put in place protocols that lay out the criteria and process for the transition between general, community, rehabilitation and old age
psychiatry services of older people with a mental illness.
Have in place a plan to introduce on a rolling basis, screening for people with mental health problems across the acute sector.
Meet the standard that: patients presenting with a diagnosis of a common mental disorder (eg, depression and/or an anxiety disorder) will have an assessment of symptom severity and of the associated impairment of function using assessment tools validated for use in primary care; and on the basis of the assessment patients will be offered effective, appropriately targeted treatment interventions,
including if required, onward referral to specialist services for further assessment or treatment - 75% compliance by March 2011 and 100% compliance by September 2011.
Develop models for the assessment and care of older people in primary care (including liaison with Medicine for the Elderly services)
which will reduce admissions to hospital and to residential care.
Develop a scheme with the voluntary sector and other partners that maximises the independence of older people by improving access
to services and tackling social isolation.
Produce a formal framework for the review of elderly patients receiving four or more medicines to address possible adverse effects on
Develop and put into place an agreed model of intensive case management for people diagnosed with dementia in Perth & Kinross as
a ‘beacon site’ prior to roll-out within Tayside.
Achieve the standard that all people with complex needs will receive on admission to an acute hospital a multi disciplinary geriatric assessment in line with British Geriatrics Society Best Practice Guidance (and as part of improving the pathway for the care of older people.)
Put in place a system that will provide people with dementia and their carers with high quality information on the illness and the services
available to them throughout the course of their care.
Develop proposals to improve the management of dementia in care homes (including the management of medicines).
☺
Put in place arrangements to make sure that the appropriate level of support services are in place by developing robust measures of
outcomes for children affected by parental substance misuse.
Reprovide the Seymour Lodge Child Protection Facility on the Kings Cross site (12-month project)
☺
Develop measures to evidence improvements to the delivery of appropriate specialist children’s services within secondary care.
Put in place a protocol that sets out the criteria for the identification of all looked after children and young people and care leavers.
Produce a feasibility study on the option to reprovide child and adolescent mental health services on the Perth Royal Infirmary site
All people newly-diagnosed with Type 2 diabetes to have access to structured education within three months of that diagnosis.
☺
(Following development and testing) a tool will be introduced across Tayside to support with a refined risk prediction the proactive
identification of people with a long term condition.
☺
Case management will be adopted by all community nursing teams (this has already been started but is accelerated to be completed
by the end of the financial year).
A system will be put in place to make sure that information on anticipatory care plans agreed with patients and their carers can be
shared between different professionals.
☺
Deliver a programme of training for staff to enable people to manage their Long term Conditions.
All people with diabetes to be managed in line with agreed “Tayside Care Pathway for Patients with Diabetes” which will support a shift
in the balance of care into primary care for all patients with uncomplicated Type 2 diabetes.
Develop a response to the national strategy ‘NHS Scotland Coronary Heart Disease and Stroke Care’, and the National Care Standards
for both Coronary Heart Disease and Stroke to help identify priorities for future service improvement.
Put in place a protocol covering shared care, referral and discharge to make sure that there is a smooth transition between primary careand specialist services of children and young people with asthma.
Put in place the standard that all children and young people with a diagnosis of asthma are offered a structured annual clinical review.
Pilot the national social marketing toolkit in Tayside for future implementation across Scotland in 2011/12 (timetable agreed with Scottish
Achieve 350 quitters within 2010/11 through the Quit4U Initiative.
Increase the uptake of the Give It Up For Baby Initiative –50 in Angus; 60 in Dundee; 60 in Perth & Kinross.
Support 220 clients through the ‘Working Towards Health’ Initiative in 2010/11 to help them to overcome their health conditions and to
assist them towards meaningful employment.
Achieve a target of 60 or more per 1,000 females of reproductive age being prescribed intrauterine and implantable contraceptives
(subject to confirmation of current position)
☺
Establish baseline positions to enable whether interventions support or result in an improvement in sexual health and the reduction in the rate of teenage pregnancies against –
• The percentage of those attending sexual health services not using contraception who are commenced on an appropriate method of contraception.
• The percentage of under 25s as a proportion of the total attending the sexual health service. • Numbers attending sex and relationships cross-agency training.
• Numbers attending and completing the Speakeasy parenting programme. • A reduction of 20% in teenage pregnancy in 13-15 year olds by 2010.
Implement the Hearty Lives Programme in Dundee to focus on the prevention of heart disease –
• Deliver (in GP practices) 500 health checks within the 40-44 age group targeted in geographical areas.
• Test a range of appropriate settings, working in partnership with ethnic minority communities, community groups and workplaces, to deliver opportunistic health checks within the community.
• Develop a model for the provision of specialist services for cardiovascular and complex cardiovascular risk in a community setting.
Produce an Implementation Plan for approval by NHS Tayside Board that will set out the key actions and timescales arising from the
Health Equity Strategy for subsequent delivery during 2011/12.
Number of persons commenced on antiviral therapy will be increased to: 50 in 2009/10
76 in 2010/11
Develop a new policy on the role of NHS Continuing Care for each care group (older people, dementia, learning disability and mental
health) that will inform the scale, distribution and quality of facilities required in the future.
Achieve the target of 60% of general practices to be commissioned for the extended hours Direct Enhanced Services.
Develop a clinical governance system that will make sure that clinical decision making conforms to available evidence and appropriateprocesses are followed in the recruitment of clinical staff, and which is a core part of the executive function, independent, directly to linked improvement work and aligned to service planning.
Address the main issues for patients and visitors to hospital by updating travel plans for Ninewells and Perth Royal Infirmary and
introducing those for Murray Royal, Stracathro and Whitehills Health & Community Care Centre.
Continue dialogue with the local community in Rannoch and Tummel with a view to ensuring effectiveness of new out of hoursarrangements.
Achieve the Investing in Volunteers National Quality Standard within NHS Tayside.
Put in place a plan to enable NHS Tayside to respond to the implementation of the Patients’ Rights Bill (to follow Parliamentary approval
Establish new arrangements for NHS Tayside’s participation in community planning and Single Outcome Agreements covering a
refreshed vision for NHS Tayside’s aims for engagement, governance and performance management arrangements, and the respective roles of each part of the organisation.
Put in place a Single Equality Scheme that will combine the six equality groups of Disability, Race, Gender, Age, Sexual Orientation and
Religion/Belief.
Achieve a sustained improvement in the sickness absence rate that will result in an ongoing reduction to a level below 4.5%.
Achieve a reduction to 2.42% in the long-term sickness absence rate.
Put in place a system to provide robust and usable workforce data to inform organisational decision making.
Put in place an agreed Governance Framework for vacancy management to support the achievement of £4M efficiency savings.
☺
Deliver a programme of appropriate integrated education and training (developed from the Education & Training Strategy) based on
patient and population profiles to sustain the delivery of safe and effective care.
Improve the match between capacity in outpatient clinics with actual service need to remove overcapacity by focusing on Do Not
Attends (DNAs) and review appointments.
☺
Review the flow of elective surgical patients to increase the rate of day case surgery and same day admissions.
☺
Complete a programme to produce workforce efficiency savings of £9.2m (principally through improved management of on-call rotas, vacancy control, supplementary staffing (agency, locum, bank and overtime) redeployment and protection, and a review of the costs of corporate functions).
☺
Complete a programme to produce efficiency savings of £1.85m by improved management of medicines.
☺
Deploy the infrastructure to make the Clinical Portal/Electronic Patient Summary (EPS) available to all GP practices in Tayside.
All general dental practices in Tayside to be linked to the N3 NHS Network Service.
Develop a plan for the procurement of bariatric surgery for the residents of Tayside. (To be developed in conjunction with work through
the National Planning Forum to make sure there is a consistent position with other Scottish Boards.)
☺
Develop a plan for the procurement of trans-catheter aortic valve implantation (TAVI) for the residents of Tayside. (To be developed inKey frontline staff being educated and trained in using suicide assessment tools/ suicide prevention training programmes by
December 2010.
50%
43.4%
49.5%
50.4%
N/A
Completion of cumulative interventions for child healthy weight intervention programmes from 2008/09 to 2010/11.
440
61
82
340
449
Increase the proportion of new-born children exclusively
breastfed at 6-8 weeks from 26.6% in 2006/07 to 33.3% in 2010/11.
35.3%
26.1%
26.2%
26.5%
Not Available
Explanatory Note: The LDP 2010/11 stated that NHS Tayside would achieve a 2% increase from the baseline figure in 2006/7 by March 2011. Performance from 2006/07 has remained on or below the baseline figure.
Work has progressed to improve the support and experience women have with the initiation and continuation of breastfeeding. A meeting has taken place with the Board Nursing Director and senior midwives who have a key role in supporting breastfeeding in NHS Tayside. The meeting addressed specific areas: the importance of support workers/volunteers in order to ensure women continue to breast feed at least until six weeks; continued work around educating and encouraging women to breast feed their baby and then providing the right support in hospital and early postnatal period; the high numbers of women who ceased to breastfeed at or around day 10 with a focus on key times in the postnatal period when a woman might decide to give up
breastfeeding, with agreement that attention would be given to facilitation of women to continue breastfeeding after discharge from the midwife; and the important t role of support workers/volunteers in helping women to continue women to breastfeed at that time. Further work is underway to investigate ways of increasing this input.
Improvement initiatives have also been undertaken through the Perth & Kinross CHP. Complete the agreed number of screenings using the
setting-appropriate screening tool and setting-appropriate alcohol brief
intervention from 2008/09 to 2010/11.
11,500
Through smoking cessation services, support 8% of Tayside’s smoking population in successfully quitting (at one month post
quit) over the period 2008/9 – 2010/11.
6.316
2,780
3,166
3,514
4,012 (Feb)
Explanatory Note: The LDP 2010/11 stated that NHS Tayside would achieve 75% of the target by March 2011 and 100% by September 2011. A revised forecast outturn for March 2011 of the achievement of 65% of the target was presented to the Chair’s Scrutiny Group in January. Final validated figures for March 2011 from the Information Services Division (ISD) will not be available until later this year. The above local performance data however shows that NHS Tayside has achieved 4,012 quits as at February 2011, which is 65% of the target. It is estimated that through the number of people recruited to a smoking cessation service during March that a further 200 successful quits will be recorded towards the target. In addition, figures are yet awaited on the successful quits recorded through the Local Enhanced Service for Q4 January to March. It is anticipated that these estimated figures will result in approximately 70% achievement of the target at March 2011.
Deliver the agreed number of inequalities targeted cardio-vascular health checks during 2010/11.
1,491
676
1,303
1,864
2,186 (Feb)
Information on levels of competence and identified training needs to be available through recording summary information of
personal development reviews on eKSF by March 2011.
80%
2%
5%
28%
74%
Explanatory Note: At 12 April, 5% of PDPs were currently awaiting sign-off by the reviewer or staff member resulting in 79% achievement of the target. It is anticipated that the remaining 1% will be completed by the end of April.
Deliver improved efficiencies in the day case rate by March 2011.
72.5%
Deliver improved efficiencies in the average length of stay (days) for inpatients by March 2011.
4.5
3.9
3.2
3.3
3.5 (Feb)
Achieve a 10% reduction rate in the first outpatient appointment DNA rate between 2007/08 and 2010/11.
7.9%
8.7%
8.2%
12.2%
10.1%
Explanatory Note: See reference to Summary End of Year Position on the local outcome’ Improve the match between capacity in outpatient clinics with actual service need to remove overcapacity by focusing on Do Not Attends (DNAs) and review appointments’
Achieve a 10% reduction in pre-operative stays over three years – 2010/11 to 2012/13.
The definition for this target is the number of pre-operative days (for elective inpatients and surgical specialities only) divided by the number
of patients who have a procedure (episodes).
0.70
0.67
0.53
0.53
0.46 (Feb)
New GP outpatient referrals into consultant led secondary care services are managed electronically by December 2010.
90%
86.6%
85.52%
90.56%
91.09%
Reduce energy consumption (GJ) by a year-on-year efficiency target of 1% each year to 2015/16.
603,488
90% of clients referred to drug treatment will receive a date for assessment (A) that falls within 4 weeks of referral and treatment (T) that falls within 4 weeks of assessment received by December
2010 (target of 3 weeks by March 2013).
90%
79% (A)
98% (T)
90.6% (A)
98.8% (T)
89.0% (A)
97.3% (T)
Not Available
At least 90% of patients respond that they were able to book a consultation with a GP more than 2 working days in advance by
March 2011.
90%
2009/10
77.2%
2010/11
Not Available
Explanatory Note: The National GP Practice Experience Survey for 2009/10 showed NHS Tayside as performing below the Scottish average with regard to achievement of this target. The results of the Survey for 2010/11 will not be published until June this year.
Agreement was reached to engage with GPs on a wide range of quality issue and with the involvement of the Chief Executive, this is being planned.
This target will cease to be measured nationally in 2011/12. From the quarter ending December 2011, 95% of all patients
diagnosed with cancer to begin treatment within 31 days of
decision to treat.
95%
100%
97.5%
97.7%
97.2% (Feb)
From the quarter ending December 2011, 95% of those referred urgently with a suspicion of cancer to begin treatment within 62
days of receipt of referral.
95%
98.6%
98.6%
97.1%
100% (Feb)
Towards delivery of the 18 week referral to treatment from December 2011 -
Admitted Performance Non-Admitted Performance Admitted Completeness Non- admitted Completeness
No patient will wait longer than 9 weeks from being placed on a waiting list to admission for an inpatient or day case procedure
from 31 March 2011.
0
10
0
96
35 (Feb)
Explanatory Note: It is predicted that the target of 0 will be achieved when March performance figures become available. Support shifting the balance of care by achieving agreed
reductions in the rates of attendance per 100,000 population at
A&E, between 2007/08 and 2010/11.
1,450
1,571
1,569
1,377
1,322 (Feb)
Achieve a reduction in the annual cases of staphylococcus aureus bacteraemia towards a reduction in the rate of cases by
30% in March 2010 and a further reduction of 15% by March 2011.
124
145
151
153
146
Explanatory Note: Regular reporting on progress with achievement of this target is presented separately to NHS Tayside Board. Achieve a reduction in infections annually per total occupied
bed days for C.diff towards a reduction in the rate of C.diff infections in patients aged 65 years and over by at least 30% by
March 2011.
0.98
0.88
0.67
0.55
0.49
Achieve the agreed percentage of people with a diagnosis of dementia registered on QOF by March 2011.
60%
Increase the level of older people with complex care needs receiving care at home.
Angus Dundee Perth & Kinross
15%
30%
26%
12.20%
29.80%
23.29%
12.20%
29.42%
24.80%
12.30%
-
-
29.70% (Feb)
25.40% (Feb)
Explanatory Note: The Board has received reports on the progress in Angus to meet this target. The Angus Partnership had signed up in the Local Delivery Plan 2010/11 to achieve 15% by March 2011. From the above position it is not expected that the 15% target will be met. While the overall rate of people with complex needs has stayed constant, there has been movement in the number in each of the three categories of numbers receiving intensive support 10+ hours; number of residents in care homes; and numbers in continuing care beds over the period April to September. Figures for October to December are currently awaited.
Reduce by 2010/11 the emergency inpatient bed days for people aged 65 and over, by 10% compared with 2004/05.
2,788
3,026
3,042
3,026 (Oct)
Not Available
Explanatory Note: Final validated figures for March 2011 from the Information Services Division (ISD) will not be available until later in the year. By the end of 2009/10 NHS Tayside had more or less stayed level with a 0.8% reduction since 2004/05, although from 2006/07 to 2008/09 the rate had increased noticeably before falling back last year (2009/10) to much the same level as before. Over the same period (2004/05-2009/10), the average Scottish rate fell by 3%.
For the first seven months of 2010/11 (for which ISD information is currently available) the rate in Tayside declined by 1.8%. This is due to a number of initiatives, particularly the redesign of Medicine for the Elderly Services in Dundee and Angus, work on long term conditions management and action to reduce delayed discharges (including length of delay).
Achieve a 5% reduction in the rates of bed days per 100,000 population of patients with a primary diagnosis of COPD, asthma,
diabetes or CHD from 2008/09 to 2010/11.
8,837
Develop measures to make sure that it is possible to plan and review mental health and wellbeing services for the people within Tayside.
The national development and validation of the Warwick Edinburgh Mental health and well being Scale (WEMWEBS) has not proceeded. It had been anticipated that the local
application of this tool would provide the necessary measures.
Additional relevant measures became available through the national mental health benchmarking project in March 2011 which will be used in local reporting as follows:-
1. Number of people claiming incapacity benefit where a mental health problem is cited. – A broad indicator of the prevalence of mental health problems.
2. The incidence of severe and enduring mental health problems and the risk of death among this group.
These are in addition to the existing measure of the suicide rate (measured as a five year rolling average)
Reporting on local activity on the provision of support to develop healthy lifestyles among those with a severe and enduring mental health problem is under development.
Demonstrate that the standard is achieved that there is effective working between primary care and specialist mental health services for the treatment and care of people with complex needs by: specialist mental health services providing assessment of advice on the management of patients provided within primary care; treatment and care for time limited disorders and for those with severe and enduring needs 75%
compliance by March 2011 and 100% compliance by September 2011.
This work was taken forward as one component of the wider strategic improvement programme for Mental Health project within Steps To Better Healthcare.
Our ability to measure performance is reliant on the use of the electronic patient record introduced via MIDIS.
Put in place protocols that lay out the criteria and process for the transition between general, community, rehabilitation and old age psychiatry services of older people with a mental illness.
Protocols are in place that set out the process for transition between child and adolescent services and general adult services and between General Adult and Psychiatry of Old Age Services.
Ensuring the effective management of care within and between the various elements of the service is a key component of the strategic improvement programme for mental health and processes will be monitored and improved where this is required.
Have in place a plan to introduce on a rolling basis, screening for people with mental health problems across the acute sector.
This was an interim outcome that has not been progressed to date. The focus for work relating to mental health in the acute sector has been on patients with dementia.
The future development of a plan to introduce screening across the acute sector will require to be considered and prioritised by the relevant Joint Clinical Boards.
Meet the standard that: patients presenting with a diagnosis of a common mental disorder (eg, depression and/or an anxiety disorder) will have an assessment of symptom severity and of the associated impairment of function using assessment tools
validated for use in primary care; and on the basis of the assessment patients will be offered effective, appropriately targeted treatment interventions, including if required, onward referral to specialist services for further assessment or treatment - 75% compliance by March 2011 and 100% compliance by September 2011.
No significant progress has been made in introducing new or additional arrangements for monitoring of the compliance with use of assessment tools. Primary care continues to achieve high levels of compliance with the existing QOF standards for the assessment of depression. (requires confirming with end of year QOF figures).
The development of such systematic approaches to the diagnosis and treatment of mental illness are key components of the mental health strategic and implementation plans
Develop models for the assessment and care of older people in primary care (including liaison with Medicine for the Elderly services) which will reduce admissions to hospital and to residential care.
The Medical Division incorporated this work within the development of the Medicine for the Elderly Care Pathway. The development of the patient pathway flow chart was fully
consulted on. The pathways objective was to streamline documentation, offer alternatives to admission, clarify the correct and reduced points of entry for admission, establish triage through appropriate consultants and aid communications between services and service users. Their focus began by supporting the availability of community medicine for the elderly and enhanced community APH resources.
Enhancing the quality of care was the primary objective of the project. Looking for points in the process where the patient’s experiences can be enhanced, in particular providing care for the patient in their home environment.
Develop a scheme with the voluntary sector and other partners that maximises the independence of older people by improving access to services and tackling social isolation.
Produce a formal framework for the review of elderly patients receiving four or more medicines to address possible adverse effects on people’s physical and mental well-being.
A review of elderly patients is now part of Steps to Better Healthcare. The following has been achieved:
Up to the start of March 2011, 28 GP practices (41%) have agreed to carry out level 3 face-to-face medication reviews with people on multiple medicines.
The tests of change include uni-disciplinary reviews (GP or locality pharmacist) and multidisciplinary reviews (GP, locality pharmacist and Medicine for the Elderly consultant). Once electronic data collection on a Tayside wide basis is developed, the different models will be compared to establish the most effective process.
Patient stories or post-review questionnaires are being collected as part of the tests of change. Informing, engaging and consulting work has been carried out. The public response has been generally positive.
A Tayside guideline to support the work is in development.
Develop and put into place an agreed model of intensive case management for people diagnosed with dementia in Perth & Kinross as a ‘beacon site’ prior to roll-out within Tayside.
Achieve the standard that all people with complex needs will receive on admission to an acute hospital a multi disciplinary geriatric assessment in line with British Geriatrics Society Best Practice Guidance (and as part of improving the pathway for the care of older
people.)
A redesign of the Medicine for the Elderly (MfE) Service for Dundee and Angus patients was completed in October 2010.
The service now allows for a more efficient and equitable patient pathway with a 24/7 consultant-led medicine for the elderly multi-disciplinary team at the very front of the patient journey to enable a clearer process for assessment. Discharge plans are developed from the time of admission to resolve those factors which extend the time patients stay in hospital. The implementation of agreed changes to Royal Victoria and Ninewells Hospital have resulted in older people who require to be admitted are now placed in the most appropriate
environment for their care and managed by Medicine for the Elderly Teams. Continuing the planned roll out of the comprehensive assessment process will ensure patients admitted to other clinical specialties, such as orthopaedics, are treated equitably.
Put in place a system that will provide people with dementia and their carers with high quality information on the illness and the services available to them
throughout the course of their care.
A Post Diagnostic Support Illustrative Framework was prepared that outlined current
communication systems and information sources. Patient, carers and voluntary organisations input to this process ensured their experience was reflected.
Given the recognised difficulties experienced by individuals with dementia in care homes, their carers and the staff themselves, work on the framework was extended to include these individuals. This highlighted the need for care home intervention, support, education and a liaison service. Work related to these improvements is now incorporated within the Steps to Better Healthcare dementia workstream project plan.
Develop proposals to improve the management of dementia in care homes (including the management of medicines).
Antipsychotic prescribing in care homes is included within the Steps to Better Healthcare prescribing work-stream.
A test of change has been completed in Westgate Practice/Riverside Care Home in Dundee and this work has been presented at a recent Dundee PLT. A resource pack has been
developed to support the spread to other practices and further joint work with specialist services in Dundee will be progressed.
Specialist reviews for all patients identified from Nursing Home LES practices in Angus are in progress and an audit has been carried out to identify all patients on antipsychotics in EMI homes in Angus with follow up reviews planned.
Work is also in progress to spread this work to the Strathmore, Perth City and North Perthshire localities.
Joint working between primary and secondary care specialist services has been essential in progressing this work and this will be key to the spread across Tayside. This work-stream will be embedded in the dementia work-stream in future to give a whole systems approach to dementia care.
Put in place arrangements to make sure that the appropriate level of support services are in place by developing robust measures of outcomes for children affected by parental substance misuse.
The three Tayside ADPs have invested in Substance Misuse Information Tayside (SUMIT) to identify the number of children affected by parental substance misuse (CAPSM).
Four Children 1st staff working with adult substance misuse services to provide support to
children and families.
Strengthening Families Programme (to increase resilience and reduce risk factors for alcohol and substance misuse) will commence Summer 2011.
Tayside Substance Misuse Service RIE Improvement Plan to be implemented early in 2011. Focus on Alcohol Project (Dundee) commenced early 2011 and will run for 2 years. Needs Assessment of young people’s own substance misuse/identify gaps in provision conducted late 2010. Action Plan under development.
Training Needs Analysis for staff in Angus to identify gaps in knowledge.
Reprovide the Seymour Lodge Child Protection Facility on the Kings Cross site (12-month project)
The building programme with Mansell Construction is on schedule to meet the planned completion date in August 2011. The final agreement on lease arrangements remains to be signed off; dialogue between the CLO and Council solicitors is ongoing.
The new facility will be known as “Seymour House”.
Develop measures to evidence improvements to the delivery of appropriate specialist children’s services within secondary care.
The aim of the National Delivery Plan (NDP) for Children and Young People’s Specialist Services for Scotland was to improve the outcomes for children and young people. The implementation of the NDP plan is approaching the end of its three year phase with additional resource
funding specialist posts within Children’s services including, Consultants, Specialist Nurses, AHPs, Technical, Pharmacy, Psychology and Administration posts. The outcomes and benefits to children of these extra posts are reported to Scottish Government via the North of Scotland Planning Group on a quarterly basis. Many NHS Tayside staff are also now involved in setting up and contributing to Regional and National Clinical Networks for children.
Put in place a protocol that sets out the criteria for the identification of all looked after children and young people and care leavers.
An Identification and Tracking Process and Pathway has been developed by the Looked After Children Group - LAC Nurses and Community Paediatricians from the three CHP areas and has been in place across Tayside from January 2011.
Produce a feasibility study on the option to reprovide child and adolescent mental health services on the Perth Royal Infirmary site (transfer from Pitcullen House).
A paper was submitted to the Property Strategy Group. The relocation of Pitcullen House CAMHS Service into the current Paediatric Department within PRI was agreed.
A Project group was formed with staff from both CAMHS and Paediatrics and accommodation and environment changes agreed.
All people newly-diagnosed with Type 2 diabetes to have access to structured education within three months of that diagnosis.
All practices continued to have access to refer patients to Tayside Diabetes Education Programme (TDEP).
During 2010/11 education available within one month of diagnosis.
Numbers of people booked into TDEP increased from 816 in 2009/10 to 888 in 2010/11.
The percentage of people newly diagnosed with Type 2 diabetes booked into TDEP increased from 44% in 2009/10 to 49% in 2010/11 (as at December 2010).
It is recognised that group education is not suitable for everyone. Local evidence would suggest 50% of patients do not wish to participate in group education. Alternative mechanism in place for those not attending group education: production and provision of information packs for people newly diagnosed; training available for practice staff.
Short term funding through Local Enhanced Service for Diabetes ends 31 March 2011. Long term funding agreed by Finance and Resources Committee in February 2011.
(Following development and testing) a tool will be introduced across Tayside to support with a refined risk prediction the proactive identification of people with a long term condition.
The Peony II Algorithm was tested with 12 GP Practices involving a cohort of 49,000+ patients during the summer of 2010.
Further developments to the user interface were made by December 2010.
Case management will be adopted by all community nursing teams (this has already been started but is accelerated to be completed by the end of the financial year).
A Complex Care Training Plan Driver Diagram for District Nurses with associated measures which encompasses:
Principles for Case Management LEAN Methodology
Health behavioural Change
Anticipatory / Advanced Care Planning Self Management awareness
The training has been rolled out through the CHPs and is ongoing. CHPs are now actively testing the Virtual Ward model of care.
Electronic standardisation and sharing of Virtual Ward documentation through MiDIS system is in development.
The number of patients being cased managed by District Nursing teams in Tayside as at February 2011, is 183.
A system will be put in place to make sure that information on anticipatory care plans agreed with patients and their carers can be shared between different professionals.
A Complex Care Training Plan Driver Diagram for District Nurses with associated measure encompasses Anticipatory / Advanced Care Planning (ACP) produced.
Patient Held Passport approved and being rolled out to aid transitions of care.
Successful eHealth bid to fund testing of an electronic ACP and shared with Out Of Hours via National eKIS programme.
Further work to be progressed to achieve one agreed format for ACPs Pan Tayside. There are currently four forms for ACP from areas such as palliative care, nursing homes and long term conditions.
Deliver a programme of training for staff to enable people to manage their Long term Conditions.
A comprehensive programme of training for staff and colleagues in NHS Tayside and partner organisations has been (and continues to be) delivered to meet the needs of managing Long Term Conditions (LTC). Priority groups were identified i.e. Community Nursing, “Staff Working with Clients with LTC”. The primary and secondary drivers have been identified and measures for improvement and an evaluation study on the impact of the training programmes has been undertaken. During the period 2008/10 288 staff have attended (HBC) Health Behaviour Change training programme – 77% from NHS; 23% from partner agencies (9 courses are planned to be delivered during 2011 with a maximum of 16 places on each programme).
All people with diabetes to be managed in line with agreed “Tayside Care Pathway for Patients with Diabetes” which will support a shift in the balance of care into primary care for all patients with
uncomplicated Type 2 diabetes.
Implementation of the Tayside Care Pathway for People with Diabetes and a shift in the balance of care has been supported by the implementation of a Local Enhanced Service for Diabetes.
During 2010/11, 5112 people with Type 2 diabetes were cared for in line with the care pathway as part of the Local Enhanced Service (as at December 2010).
The percentage of people newly diagnosed with Type 2 diabetes attending the specialist diabetes service reduced from 12% in 2007 when the Local Enhanced Service was introduced to 1% in 2010/11.
Develop a response to the national strategy ‘NHS Scotland Coronary Heart Disease and Stroke Care’, and the National Care Standards for both Coronary Heart Disease and Stroke to help identify priorities for future service improvement.
A response has been completed for “Better Heart Disease and Stroke Care Action Plan” and NHS QIS Heart Disease Standards 2010. NHS QIS Clinical Standards for Heart Disease 2010
Evaluation Tool was completed in November 2010, and feedback from the National evaluation panels is anticipated to be received in April 2011. Initial actions have been shared with Acute Cardiology Management Groups and CHP cardio-vascular clinical leads, to begin a planned monitoring of progress.
These plans are enhanced by staff educational events in relation to CHD and its management, through educational activities offered by the CHD MCN Education subgroup. These include a twice yearly (15-25 delegates) 4 day current perspectives in CHD course, an annual
ACS/cardiac event (Feb 2011- 90 delegates, April 2011 80 delegates), PLT sessions and
specific study days. An annual symposium related to arrhythmias and their management is also offered.
Put in place a protocol covering shared care, referral and discharge to make sure that there is a smooth transition between primary care and specialist services of children and young people with asthma.
A protocol was agreed at the Paediatric MCN meeting on 16 March 2011. Lead Clinicians have since reviewed their work plans to allow for joint adult and paediatric transitional clinics, and to test the model proposed.
Put in place the standard that all children and young people with a diagnosis of asthma are offered a structured annual clinical review.
Pilot the national social marketing toolkit in Tayside for future implementation across Scotland in 2011/12 (timetable agreed with Scottish Government).
NHS Tayside, in conjunction with the Scottish Government, successfully developed a Scottish Social Marketing Toolkit. The web based toolkit and planning guide can be accessed at
www.socialmarketing-scottishtoolkit.com The toolkit is now being hosted and managed by Health Scotland, they are also facilitating further training across NHS Scotland.
NHS Tayside Executive Team supported embedding the principles of Social Marketing within the improvement work of NHS Tayside (Dec 2010).
Local training to support the development of skills and capacity has been arranged through Tayside Centre of Organisational Effectiveness (TCOE) and will cover half day master class sessions with full day practitioner sessions.
Advice, guidance and consultancy regarding applying social marketing principles is available via the Directorate of Public Health and Modernisation & Development Team.
Achieve 350 quitters within 2010/11 through the Quit4U Initiative.
599 successfully quit in 2010/11. This figure far exceeds results from the rest of the UK. This Government-funded pilot project has exceeded all of its planned outcomes and NHS Tayside will continue to invest in 2011/12 pending the production of the evaluation report in March 2012. Given its success it is likely that it will continue to be funded in the longer term.
Increase the uptake of the Give It Up For Baby Initiative – 50 in Angus; 60 in Dundee; 60 in Perth & Kinross.
Uptake of Give it up for Baby (GIUFB) in March 2011 is: Angus 52
Dundee 59 Perth & Kinross 96
Support 220 clients through the ‘Working Towards Health’ Initiative in 2010/11 to help them to overcome their health conditions and to assist them towards meaningful employment.
In 2010/11, 294 clients have been supported by the WTH initiative. There has been a significant increase in the MCMC population (16-24 age group) – in 2008/2009 there were 11.4% of these clients engaged, compared with 2010/2011 it has increased to 19.4% of total clients referred to the project. There are challenges ahead for both the workless population and the WTH project, as the change of Westminster Government brings a change in Welfare Reform, and the
introduction of Universal Credit (one benefit for all). The project and clients continue to benefit from co-location at Discover Opportunities Centre, this has been used as a “best practice” example by Scottish Government and Ministers and has attracted various Senior Officials to visit.
Achieve a target of 60 or more per 1,000 females of reproductive age being prescribed intrauterine and implantable contraceptives (subject to confirmation of current position)
Information is not yet available for the full year 2010/11. However, the data from PRISMS for the first two quarters of 2010/11 show that prescribing of Implanon has continued to rise with IUS prescribing remaining steady.
58.4 women per 1,000 were prescribed intrauterine and implantable contraceptives in 2009/10, which represents a 10% improvement on 2008-09.
There is a strong commitment to providing vLARC in primary care, uptake in this setting is expected to increase further with the introduction of inter-practice referral as part of the Locally Enhanced Service in 2011/12.
Training is being provided to enable vLARC to be provided by the directly employed GP service in Whitfield from September 2011.
Establish baseline positions to enable whether interventions support or result in an improvement in sexual health and the reduction in the rate of teenage pregnancies against –
• The percentage of those attending sexual health services not using contraception who are
commenced on an appropriate method of contraception.
• The percentage of under 25s as a proportion of the total attending the sexual health service. • Numbers attending sex and relationships
cross-agency training.
• Numbers attending and completing the Speakeasy parenting programme.
• A reduction of 20% in teenage pregnancy in 13-15 year olds by 2010.
Baseline positions have been established for all elements as well as for the additional measures included in the QIS Sexual Health Services peer review.
The 20% reduction target by 2010 is 8.8 per 1,000. Local data on teenage conceptions extracted from clinical information systems shows a continued reduction in rates across all ages. For under 16 the rates were: Apr – Mar 2007-8 rate 11.8; Apr – Mar 2008-9 rate 11.6; Apr – Mar 2009-10 rate 8.5 per 1,000.
Two scoping reviews on the factors relating to Teenage Pregnancy and on the effectiveness of interventions completed and primary research with young people, parents and professionals in Dundee is due to start in May 2011. The Healthy Community Collaborative will start across Tayside in summer 2011.
Agreement reached with Scottish Government for NHS Tayside to be the second test site for the Family Nurse Partnership.
Number of persons commenced on antiviral therapy will be increased to:
50 in 2009/10 76 in 2010/11
The following numbers of people were commenced on anti-viral therapy for HCV: 2009/10 = 76
2010/11 = 78
NHS Tayside has consistently met all the Hepatitis C Action Plan targets and continues to be amongst the top performing Boards.
Develop a new policy on the role of NHS Continuing Care for each care group (older people, dementia, learning disability and mental health) that will inform the scale, distribution and quality of facilities required in
Implement the Hearty Lives Programme in Dundee to focus on the prevention of heart disease –
• Deliver (in GP practices) 500 health checks within the 40-44 age group targeted in geographical areas.
• Test a range of appropriate settings, working in partnership with ethnic minority communities, community groups and workplaces, to deliver opportunistic health checks within the community. • Develop a model for the provision of specialist
services for cardiovascular and complex cardiovascular risk in a community setting.
Keep well health checks have been delivered by General practice and the Keep well outreach nurses. 632 people between the ages of 40 - 44 year old and living in deprivation category 6 or 7 have benefited from this check between 1st April 2010 and 28th Feb 2011. The
check includes a comprehensive cardiovascular health check and further referral for health coaching or clinical management where necessary or appropriate.
Hearty Lives Dundee have delivered a cardiovascular health check opportunistically (no appointment – drop in) and using an appointment system in a number of different settings, working in partnership with Healthy Working Lives, Working Health Services Dundee,
Workplaces, shopping venues, and within ethnic communities – visiting places like the
Gurdwara Sikh Temple. 905 people have benefited from this health check between 1 April 2010 and 31 March 2011.
The two specialist clinics of Hearty Lives Dundee have developed based on the Community Heart model, where clinical services are delivered in alternative settings in local communities. Locations used include community centres, community pharmacies, Kings Cross Health and Community Centre and General Practice.
The Community cardiology clinic has continued to develop, delivering the clinic in non NHS settings. It is run in partnership with a consultant cardiologist, offering an alternative to
traditional hospital services. A new model is to be piloted on 18th April 2011 where the team will
work with a network of other community partners including health professionals and volunteers. It is hoped to have a ‘community champion’ to work in partnership with the team to promote services within local communities. The usual referrals to this clinic will still be seen within this model.
Produce an Implementation Plan for approval by NHS Tayside Board that will set out the key actions and timescales arising from the Health Equity Strategy for subsequent delivery during 2011/12.
The HES Project Board has been reinstated to drive forward the Optimisation Plan. There are six workstreams currently being implemented i.e.
CHP Action Plans.
Segmenting the data (initially with Coronary Heart Disease). Learning from Keep Well/Equally Well.
A draft Organisational Development Plan which will go to Executive Team in April 2011. Implementation of the Family Nurse Partnership initiative.
Continued working with the Acute sector regarding application of Health Equity Strategy principles.
Achieve the target of 60% of general practices to be commissioned for the extended hours Direct Enhanced Services.
As of 31 March 2011 - 70% of GP practices across Tayside have been commissioned for extended hours DES. 15% in Angus, 26% in Dundee and 29% in Perth & Kinross.
The extended hours DES is to be reviewed nationally and at this stage a new target has not been set until national discussions have been concluded.
Develop a clinical governance system that will make sure that clinical decision making conforms to
available evidence and appropriate processes are followed in the recruitment of clinical staff, and which is a core part of the executive function, independent, directly to linked improvement work and aligned to service planning.
A Review of Evidence was presented in a paper that was approved by NHS Tayside Improvement & Quality Committee in November 2010.
A follow up paper describing the revised executive structure is presented to NHS Tayside Board for approval at its meeting on 21 April. Revised executive structure – Clinical Quality Group - to hold its first meeting on 28 April should the paper receive approval from NHS Tayside Board.
Address the main issues for patients and visitors to hospital by updating travel plans for Ninewells and Perth Royal Infirmary and introducing those for Murray Royal, Stracathro and Whitehills Health & Community Care Centre.
Ninewells and PRI travel plans are updated as an ongoing process.
A travel plan for Murray Royal has been completed as part of the new development requirements for local authority planning approvals and as part of the site development project.
Angus localities, including the arrangements for Arbroath Infirmary, are currently being progressed in conjunction with the CHP Manager for Angus.
Continue dialogue with the local community in Rannoch and Tummel with a view to ensuring effectiveness of new out of hours arrangements.
Community dialogue ongoing via Reference Groups – February 2010, May 2010, November 2010, February 2011. The next Reference Group is planned for April 2011.
Community Council representatives requested to identify additional members. No feedback has been received, despite repeated requests.
Increase in provision of First Responders Schemes in whole North West Locality – one established in Aberfeldy area and another one planned for Aberfeldy (centre).
Achieve the Investing in Volunteers National Quality Standard within NHS Tayside.
Following assessment, NHS Tayside achieved the Investing in Volunteers Awards in 2010 reflecting NHS Tayside’s Boards’ commitment to the volunteers who support the delivery of effective patient care. Certificates were presented by Volunteer Development Scotland at volunteers receptions held in each CHP area.
Put in place a plan to enable NHS Tayside to respond to the implementation of the Patients’ Rights Bill (to follow Parliamentary approval of legislation).
As the Bill has now passed through Parliament (February 2011), Work has begun on drafting the Implementation Plan. However, the Bill comes into force in stages and it is expected that secondary legislation will follow in Summer 2011. The final Implementation Plan is dependent on this evolving legislation and will be published once the secondary legislation has passed
through Parliament.
Establish new arrangements for NHS Tayside’s participation in community planning and Single Outcome Agreements covering a refreshed vision for NHS Tayside’s aims for engagement, governance and performance management arrangements, and the respective roles of each part of the organisation.
The Board has agreed to new arrangements for formal representation on the Community Planning Partnerships in Dundee and Perth & Kinross (Board meeting on 26 August).
A request for a similar set of arrangements for the Angus Community Planning Partnership has been sent to the Chief Executive of Angus Council and it is likely that there will be agreement to this from the Angus Community Planning Partnership.
Following these decisions, a review of NHS Tayside’s internal arrangements for its participation in community planning will be undertaken using the Audit Scotland Best Value Review analysis of partnership working as a template for identifying issues.
The review commenced in October and proposals will be put to the Board in January 2011. The proposals will respond to current or future gaps identified in the governance arrangements for NHS Tayside emerging from the review.
Put in place a Single Equality Scheme that will combine the six equality groups of Disability, Race, Gender, Age, Sexual Orientation and Religion/Belief.
The Single Equality Scheme and Action Plan for 2010 – 2014 were approved by the Improvement and Quality Committee at its meeting on 29 June 2010.
Governance arrangements are now in place to monitor, measure and evaluate the outcome of the Action Plan.
Achieve a sustained improvement in the sickness absence rate that will result in an ongoing reduction to a level below 4.5%.
Having experienced a significant spike around in-year sickness absence driven by short term issues, NHS Tayside absence rates overall are currently 4.92% [reported against latest available ISD figs Feb 2011].This movement in short term absence has been driven by increases in rates of cold/flu/virus-type illness.
(a) Policy & Priority: A revised strategic approach to promoting attendance/sickness absence has been signed off at Executive Team, including tactical amendments to current policy. (b) Reporting: Reintroduction of by-directorate performance targets and the scrutiny of management performance against these to underpin absence as a core business issue. (c) Test of change: Piloting of the NHS Lanarkshire ‘EASY’ absence case management model in Angus CHP, with a pilot period ending October 2011.
Achieve a reduction to 2.42% in the long-term sickness absence rate.
NHS Tayside has achieved a reduction in long term absence rates overall, with a current rate of 2.09% [reported against latest available ISD figs Feb 2011].
While the organisation believes there is still scope for further improvement, achievement of the current target has centred on an active approach to early rehabilitative return, together with an increased line management focus on both case management and underlying cause.
Put in place a system to provide robust and usable workforce data to inform organisational decision making.
The Workforce Implementation Group (WIG) is an established Group which includes finance, payroll and workforce, and is the governance forum to monitor and improve data quality across NHS Tayside. An internal data portal has been established.
Put in place an agreed Governance Framework for vacancy management to support the achievement of £4M efficiency savings.
Against a revised vacancy management establishment equivalent reduction target of 240-250wte [reduced from an original estimated 494 wte], NHS Tayside achieved an establishment equivalent reduction of 242.4 wte [as reported at March 2011, latest figs. available]. This was secured in partnership through practical intervention to reduce ‘back office’ costs, and proactive management of redeployment through a refreshed ‘Skills Register’ deployment model.
Deliver a programme of appropriate integrated
education and training (developed from the Education & Training Strategy) based on patient and population profiles to sustain the delivery of safe and effective care.
The Education and Training Strategy has been taken forward. The actions are based on population indicators and aligned to workforce planning.
The progress will be reported within the Annual Workforce Plan in June 2011.
Improve the match between capacity in outpatient clinics with actual service need to remove
overcapacity by focusing on Do Not Attends (DNAs) and review appointments.
During 2010/11, the Referral & Outpatient Programme has worked with a number of specialties across the Delivery Unit to understand demand, capacity, activity and queue. The information packs provided also detailed level of DNAs for new and return patients at sub-specialty level. Improvement plans have been formed by the specialties to work towards reducing the number of clinics held where required and ensure that DNAs are reduced and only appropriate review patients are seen in consultant-led outpatient clinics.
A test of change within the ENT Booking is progressing with early indication from the
performance measures that the level of DNA is improving for new patients. This has also had an effect on the numbers of patient waiting.
The Renal Service has piloted a reminder system which has demonstrated a reduction in DNA rates.
Review the flow of elective surgical patients to increase the rate of day case surgery and same day admissions.
The Surgical Directorate has embarked on a programme of ambitious activity, redesign and innovation which will achieve a viable reconfiguration of surgical services to improve equity of patient access to services associated with modern acute surgical practice.
Under the aegis of Steps to Better Healthcare, an improvement plan that focused on maximising opportunities for efficiency and productivity for elective surgical patients to increase the rate of day surgery and same day of admission was progressed in 2010/11. The improvement plan to date has focused on building the necessary capacity and capability in both testing and planning the implementation of a standardised pre-assessment process across Tayside. This has enabled early optimisation of patients for elective surgery and provided a robust basis for comprehensive clinical risk management. Standardised processes have been developed and agreed by Clinicians across all three acute hospital sites and these processes are underpinned by standard pre-assessment documentation.
This foundation of pre-assessment permits the roll out of ‘same day surgery’ which for many elective surgical conditions has been found to be an effective way of delivering services. Individual advances in diagnosis, surgical practice, anaesthesiology, and post-operative recovery have aligned so that ‘same-day surgery’ now has the potential to be the ‘norm’ for many procedures.
The project has established robust pre-assessment processes for elective surgery which have been embedded across the whole system in NHS Tayside. This has not only enhanced patient safety and their experience but made the planning of surgery and anaesthesia more robust. The outcomes of pre-assessment inform decision making regarding the most appropriate facilities (day case or inpatient) and site for service delivery based on and customised to the specific needs of the individual patient. This has also enable an increase in the numbers of patients being managed safely as day case surgery where uncertainty previously existed about existing co-morbidities.
Improve the delivery of laboratory services to improve turnaround times for tests and to reduce unnecessary investigations.
This work is dependent upon the configuration and deployment of the Sunquest ICE system. Configuration of the system from the service provider point of view has proven challenging to the departments with conflicting time pressures on staff time due to accreditation processes, and the emerging requirement in some cases to change processes to enable the
implementation. Technical issues arose around compatibility of 2000+ label printers, which took some time to resolve.
There have been multiple providers involved in the development of the required interfaces that has led to further complexity. Inter-dependencies of various interfaces (CH, RIS Clinisys
Traceleine) impacting on with the main system have led to the complexity and extended development time to deliver the end to end testing and implementation. The aim to use interoperability functions of ICE to feed the new Clinical Portal has required further
development time and realignment of the project. This is a positive benefit of the delay. The decision to roll out the system in entirety to more users than planned through the portal, across a shorter time frame, has meant that more configuration work has had to go into the system involving additional input from future users of the system and staff within the laboratories. There will be some further delay in the blood transfusion requesting, while requesting interfaces are further developed and discussions with providers around the requesting process to ensure MHRA compliance.
Major issues have been addressed. System now available in the live environment with databases now being populated with CHI data to enable requesting and reporting of laboratory request to be rolled out.
Early Implementer sites to commence UAT and go live in April 2011. Wider roll out across the summer in parallel with portal roll out.
Complete a programme to produce workforce efficiency savings of £9.2m (principally through improved management of on-call rotas, vacancy control, supplementary staffing (agency, locum, bank and overtime) redeployment and protection, and a review of the costs of corporate functions).
Complete a programme to produce efficiency savings of £1.85m by improved management of medicines.
The efficiency savings target was made up as follows:-
Cost-effective prescribing WoS therapeutic and formulation changes - £0.475m ScriptSwitch implantation - £0.316m
Angus Variation - £0.475m
Although the ScriptSwitch accumulative cost benefit is at present slightly lower than the planned trajectory, NHS Tayside is currently on course to achieve the overall target.
Improve the management of referrals into mental health teams to achieve greater consistency of care, reduction in unnecessary admission and improved patient access.
No update provided at time of finalising report.
Deploy the infrastructure to make the Clinical
Portal/Electronic Patient Summary (EPS) available to all GP practices in Tayside.
Infrastructure to support the delivery of the electronic patient summary / portal has been deployed successfully.
All general dental practices in Tayside to be linked to the N3 NHS Network Service.