Local Delivery Plan 2016–2017

Local Delivery Plan 2016–2017

Driving Improvement in Health and Social Care

© Healthcare Improvement Scotland 2016

First published July 2016

All images contained within this publication were sourced from the

NHSScotland Photo Library and are covered by © Crown copyright.

The contents of this document may be copied or reproduced for

use within NHSScotland and our partner organisations, or for

educational, personal or non-commercial research purposes only.

Commercial organisations must obtain written permission from

Healthcare Improvement Scotland before copying or reproducing

any part of this document.

www.healthcareimprovementscotland.org

3

Contents

Introduction 4

How we work – our principles 5

Our unique strategic advantages 6

Our seven strategic contributions to support the

transformation of health and social care in Scotland 7

Our Work Programme 2016–2017 8

Measurement and evaluation 26

Best use of resources 28

Appendix 1: 2020 Workforce Vision –

local implementation plan (2016–2017) 29

4

Introduction

This Local Delivery Plan 2016–2017 sets out our intent to support the

transformational change to public services that is taking place in Scotland. In

particular, our plan supports the Scottish Government’s ambition to build a safer,

healthier and fairer society and it sets out the contributions that we can make to

achieve the Scottish Government’s 2020 Vision for health and social care.

This is an ambitious plan which updates our Driving Improvement in Healthcare

Strategy (2014–2020) by positioning our role and our work across public services

and specifically within health and social care services in Scotland.

We have identified seven strategic contributions that demonstrate the role that

Healthcare Improvement Scotland (HIS) can play in supporting the significant

redesign of health and social care services in Scotland. We have incorporated key

principles from the National Clinical Strategy1, such as putting communities at the

centre of design and delivery of services that are evidence based, effective and

sustainable.

This plan also signals our move from measuring outputs to delivering outcomes.

We have mapped our work in the Local Delivery Plan to our seven contributions

and our evaluation framework, which is aligned with the nine national health

and wellbeing outcomes2, to ensure that all of our activity is linked to achieving

national outcomes and demonstrates progress.

1 Scottish Government. A National Clinical Strategy for Scotland. 2016. http://www.gov.scot/Resource/0049/00494144.pdf

2 Scottish Government. National Health and Wellbeing Framework. 2015. http://www.gov.scot/Resource/0047/00470219.pdf

http://www.gov.scot/Resource/0049/00494144.pdf

http://www.gov.scot/Resource/0047/00470219.pdf

5

How we work – our principles

We are uniquely placed as a national organisation to make a very substantial

and positive impact in supporting improvements in the quality of health care in

Scotland. As an integrated organisation, our blend of roles and functions offers a

highly effective, efficient and cohesive approach to supporting high quality care.

We will support the achievement of Scottish Government’s ambitions by adhering

to the following principles:

• Establishing the evidence for what will work best to integrate services and what high quality care would look like

• Supporting the redesign of services to achieve and sustain higher quality and increasingly integrated care

• Reviewing the current provision of services and supporting the commissioning and redesign of new services

• Working with citizens to ensure that their voice is heard in the design, and provision of health and social care.

• Ensuring that we have meaningful clinical and practitioner engagement and involvement across all of our work

• Working in Partnership with our stakeholders in NHS boards, Integration Authorities, Local Authorities and Government to drive improvement in health care across public services

• Assuring the quality of care that people are receiving and reporting our findings and recommendations without bias

• Ensuring that we can measure and demonstrate the impact of our work in support of the health and wellbeing outcomes and reducing inequalities

• Managing our resources efficiently and effectively and by achieving value for money

6

Our unique strategic advantages

There is a need for a strong and bold reshaping of care that places individuals

at the centre of the future model of service provision, but which also recognises

the need to tackle duplication, inappropriate variation and waste. It is about

preventing and tackling ill health and delivering a health and social care system

that consistently puts service users, carers and citizens first and supports self-

management wherever possible.

We have at least two unique strategic advantages:

1. We support both health and social care services to deliver higher quality care. We offer a strong and visible contribution to health and social care services in Scotland, in supporting their drive to be highly reliable organisations, providing consistently safe, effective and person-centred care.

2. The integrated and cohesive provision of a complementary range of functions which are aligned and mutually supportive.

These are substantial advantages, enabling us to provide a single gateway to a

range of strong, timely and effective mechanisms to support higher quality care,

for example:

• practical quality improvement support

• securing the voice of citizens in the design of services

• the latest good practice and evidence, or

• rigorous and independent external quality assurance

We will use our influence and our alliances with national organisations (United

Kingdom Improvement Alliance (UKIA), The Health Foundation and the Kings

Fund) and we will work alongside other improvement bodies to capitalise on

these strategic advantages, for example Advancing Quality Alliance (AQuA), Haelo

Innovation and Improvement Science Centre and Yorkshire and Humberside

Improvement Academy (YHIA).

7

Our seven strategic contributions to support the transformation of health and social care in Scotland

We have identified seven strategic contributions that we will offer to support the

transformational changes in health and social care in Scotland. These contributions

are unique to Healthcare Improvement Scotland and underpin the achievement of

the national health and wellbeing outcomes. The contributions are set out below.

Contribution 1 supporting person-centred care, empowering and enabling citizens

to have a meaningful say in the design, planning and provision of

health and social care services in Scotland.

Contribution 2 providing strong and comprehensive assessments of the quality

of health and social care in Scotland, which encapsulate wider

factors impacting on the quality of care such as leadership and

effectiveness.

Contribution 3 supporting the redesign of health and social care services to be

efficient and effective and to enable individuals to reliably receive

the services they need, when they need them.

Contribution 4 improving the analysis and assessment of inappropriate variation

in the quality of health and social care in Scotland, and identifying

the steps with services to eliminate unacceptable practices and

provision.

Contribution 5 providing independent external assessment of the sustainability

of service provision, including the design of health and social care

services which offer better outcomes and value for money.

Contribution 6 to play our part in raising the quality of health and social care, by

providing more proactive intervention and support underpinned by

robust, timely and integrated intelligence.

Contribution 7 supporting the leadership in NHS boards and in Health and Social

Care Partnerships to make the necessary changes to deliver a

sustainable culture of continuous quality improvement.

Each of these connected contributions should add value in supporting the

health and social care systems across Scotland in making the necessary steps to

deliver improvements against the nine national health and wellbeing outcomes.

We will particularly focus on reducing harm, inappropriate variation and waste

underpinned by evidence and public, clinical and practitioner involvement.

8

Our Work Programme 2016–2017

Our work programme presented as the Local Delivery Plan for 2016–2017 is

strategically aligned with our seven strategic contributions and reflects our

medium term outcomes. It clearly sets out what will be delivered and the

objectives that have been set.

Contribution 1: Supporting person-centred care, and empowering and enabling

citizens to have a meaningful say in the design, planning and provision of health

and social care services in Scotland.

Title Aim Objectives Lead Director

Personal

Outcomes

Improving

personal outcomes

Take forward the Personal

Outcomes Partnership with Thistle

Foundation offering facilitated

development to staff working with

people to enhance focus on assets

and personal outcomes.

Director of

Improvement

Support and

ihub

Scottish Health

Council (SHC)

Volunteering

Supporting

volunteering in

Scotland

Provide national leadership

and guidance to ensure long

term vision and consistency

of approach and support for

volunteering across NHSScotland.

This support may extend in time

to integration authorities.

Director of

Scottish Health

Council

SHC Service

Change

Quality assurance

of service change

in Scotland

Provide advice and support to

NHS boards on involving patients

and communities in service

change processes, in line with

Scottish Government guidance.

Director of

Scottish Health

Council

SHC Public

Involvement

Unit

Promoting

greater public

involvement

Continue to ensure HIS meets its

equalities duties and the Duty

of User Focus and generally

demonstrate good practice in

involving users, carers and the

public in its activities.

Director of

Scottish Health

Council

SHC Community

Engagement

and

Improvement

Support

Strengthening

community

engagement

Provide tailored advice and

improvement support to 21 NHS

boards/special NHS boards. Work

to develop and support local peer

networks and build capacity for

communities to be involved in the

design and delivery of health and

care services.

Director of

Scottish Health

Council

9


SHC Citizen

Voice Hub

Creating Our Voice

Hub

Ensure the roll-out of the Our

Voice Hub initiative to help

achieve a stronger voice for users,

carers and the public in health

and social care, maximising the

opportunities for alignment with

other work in HIS.

Director of

Scottish Health

Council

Person Centred

Health and Care

programme

Supporting the

development of

person-centred

practice within

health and social

care services

Providing support to health

and social care organisations to

build the capacity and skills in

using person-centred and co-

design approaches to improve

care experience, and design and

deliver services based on what

matters to people.

Developing the capacity within

HIS’ improvement programmes to

incorporate clear person-centred

and involvement principles in

their design and delivery.

Director of

Improvement

Support and

ihub

Co-Production

and Community

Capacity

Building

Building

community

capacity

Working with a range of partners,

including those in the third,

independent and housing sectors,

and supporting them to combine

the mutual strengths, capacities

and assets of statutory and

non-statutory organisations,

professionals, service users, carers

and communities to achieve

positive change and better

outcomes for individuals.

Director of

Improvement

Support and

ihub

10

Contribution 2: Providing strong and comprehensive assessments of the quality of

health and social care in Scotland, which encapsulate wider factors impacting on

the quality of care such as leadership and effectiveness.


Strategic

Inspection of

Adult Services

External quality

assurance of

jointly delivered

adult services

Undertake joint inspections with

the Care Inspectorate.

Ensure delivery of robust,

affordable proposals for the

future design of joint adult

inspections in collaboration

with the Care Inspectorate and

informed by engagement with

external stakeholders.

Director

of Quality

Assurance

Scrutiny of

Prisoner

Healthcare

Quality assurance

of health care

provided to

prisoners

Provide clinical expertise to the

inspection programme of prisons

in Scotland.

Director

of Quality

Assurance

Inspection of

Services for

Older People in

Acute Hospitals

(OPAH)

Driving better care

for older people in

hospital

Continue to undertake inspections

of the care of older people in

acute hospitals and agree detailed

proposals for the extension of the

methodology to include non-acute

healthcare facilities, including

specialist dementia units.

Director

of Quality

Assurance

Joint Inspection

of Children’s

Services

Driving better care

for children

Led by the Care Inspectorate,

HIS works in partnership

with Education Scotland and

Her Majesty’s Inspectorate of

Constabulary Partners in the

multi-agency strategic inspections

of services for children. In

addition to being part of the

core team, ensure strong and

effective clinical assurance of the

inspection.

Director

of Quality

Assurance

11


Healthcare

Environment

Inspectorate

(HEI)

Inspections

Promoting safer

and cleaner

hospitals

Undertake further HEI inspections

under the revised Healthcare

Associated Infection (HAI)

Standards, including theatres.

Manage and carry out wider

assessment of the progress in

the delivery of Lord Maclean’s

recommendations arising from the

Vale of Leven Inquiry.

Director

of Quality

Assurance

Medical

Revalidation

National

assessment of the

revalidation of

medical doctors

Undertake further national

assessment of the progress in

medical revalidation in Scotland.

Director

of Quality

Assurance

Management

of Controlled

Drugs

(Governance)

Ensuring Safe

Management of

Controlled Drugs

Maintain and publish the register

of controlled drugs accountable

officers in Scotland and provide

external quality assurance of the

governance arrangements in place

within each designated body

in Scotland to ensure the safe

management of controlled drugs.

Director

of Quality

Assurance

Regulation of

Independent

Healthcare

Driving better

bare and services

provided by the

independent

healthcare sector

Ensure effective and successful

extension of regulatory powers to

include independent clinics, with

all independent clinics registered

by 31 March 2017.

Continue programme of

inspections for independent

hospitals which includes hospices

and private psychiatric hospitals.

Director

of Quality

Assurance

Human

Tissue Bank

Accreditation

Ensuring a safe

network of Human

Tissue Banks

Undertake accreditation of the

regional tissue banks and external

quality assurance of the satellite

boards.

Director

of Quality

Assurance

12


Assessment

of referral

from National

Confidential

Alert Line

(NCAL) and

concerns

passed to

HIS under

the Public

Information

Disclosure Act

(PIDA)

Assessment

of referral

from National

Confidential Alert

Line (NCAL) and

concerns passed

to HIS under the

Public Information

Disclosure Act

(PIDA)

Actively review and where

necessary take action in relation

to concerns about safety of

patient care.

Director

of Quality

Assurance

Thematic

Reviews of

Major Priorities

Comprehensive

assessments of the

quality of care in

Scotland

Establish the detailed operational

methodology and infrastructure to

implement comprehensive quality

of care reviews in Scotland,

ensuring that such reviews

are aligned to wider national

priorities, including the National

Clinical Strategy.

Director

of Quality

Assurance

Quality

Assurance of

Mental Health

Care Services in

Scotland

Driving

improvements in

mental health care

in Scotland

Within the context of quality of

care reviews, establish a robust

approach to the external quality

assurance of mental health

services in Scotland, working in

partnership with other agencies

such as the Mental Welfare

Commission.

Director

of Quality

Assurance

Review of

National

Screening

Programmes

Establish

consistent high

quality approach

to screening in

Scotland

Undertake scrutiny and assurance

activity of national screening

programmes against national

standards.

Director

of Quality

Assurance

13


Cancer Quality

Performance

Indicators (QPI)

Review

Driving

improvement in

the quality of

cancer services

Carry out phased review of QPI

data and publish the national

findings in order to assure

NHSScotland, Scottish Government

and the public that tumour-

specific services are developing

and improving.

Director

of Quality

Assurance

Sudden

Unexpected

Death in

Infancy (SUDI)

Provide support

for the SUDI

programme

on behalf of

the Scottish

Government

Continue to provide support

for this programme on behalf

of Scottish Government, with a

view to transferring it to a more

appropriate agency determined

by Scottish Government by March

2017.

Director

of Quality

Assurance

14

Contribution 3: Supporting the redesign of health and social care services to be

efficient and effective and to enable individuals to reliably receive the services

they need, when they need them.


Primary Care

Strategy

and Phase 1

Implementation

Driving

improvement

in the quality

of primary care

services

Complete strategy to inform

the capability and capacity

building needed to enhance the

pace and scale at which HIS

collaborates with and supports

healthcare organisations to drive

improvements in integrated

primary care services.

Executive

Clinical Director

National Review

of Out-of-

Hours Services

Quality & Safety

Programme

Driving

improvement to

deliver consistent,

high quality out-

of-hours services

HIS is scoping work aimed at

enabling NHS boards to become

self-sufficient in knowing how

their urgent care services are

performing against agreed

standards, what they need to

focus on improving, and have

the knowledge and skills to then

deliver and sustain the desired

improvements.

Executive

Clinical Director

Older People

in Acute Care

Improvement of

Care

Driving

improvement in

the quality of care

for older people

Build on work to date, which

supports improvement work

at a local level and promotes

local ownership, spread and

sustainability of change.

Critically, during 2016–2017 to

ensure an increasingly aligned

approach between scrutiny and

improvement.

Director of

Improvement

Support and

ihub

15


Mental Health

Access

Supporting swifter

access to mental

health care

The Mental Health Access

Improvement Support Team

(MHAIST) has been established

to support improved access

to both psychological therapy

interventions and Child and

Adolescent Mental Health

Services. The team will work

with NHS boards and Health

and Social Care Partnerships to

support a ‘deep dive’ diagnostic

to understand the barriers to

meeting the target of treatment

within 18 weeks of referral and

– on the basis of this – to then

agree an improvement plan to

enable reliable delivery of this

access target.

Director of

Improvement

Support and

ihub

Strategic

Commissioning

Supporting

good practice in

commissioning

services that offer

better outcomes

Support Health and Social Care

Partnerships to improve the

effectiveness of their strategic

commissioning arrangements and

practice. In doing so, enable them

to achieve a better alignment

of investment and delivered

outcomes whilst ensuring

that personalised services

and supports, a co-production

approach and more robust and

consistent decision-making

become more strongly embedded.

Director of

Improvement

Support and

ihub

Home, Place

and Housing

Portfolio

Supporting more

people to lead

independent and

healthier lives at

home

The Home, Place and Housing

Portfolio aims to make key

improvements to strategic

planning of housing and related

services to provide people with a

home environment that supports

greater independence and

improved health and wellbeing.

Director of

Improvement

Support and

ihub

16


Living Well in

Communities

Enable more

people to spend

time at home

or in a homely

setting that would

otherwise have

been spent in

hospital

The Living Well in Communities

portfolio aims to support Health

and Social Care Partnerships to

test and spread new ways of

delivering services that enable

more people to spend time at

home or in a homely setting that

would otherwise have been spent

in hospital.

The portfolio includes

improvement support for high

resource individuals, palliative

care, anticipatory care planning,

intermediate care and reablement.

The portfolio will develop to

emerging improvement need.

Director of

Improvement

Support and

ihub

Focus on

Dementia

Supporting

improvement in

the quality of care

and experience

of people living

with dementia

across the whole

pathway

An improvement partnership

programme which aims to support

improvements in the experience,

safety and co-ordination of care

for people with dementia across

the whole pathway, including

diagnosis and post diagnosis

support, integrated care in the

community, acute hospital care,

specialist dementia care and

advanced care.

The emphasis is on supporting

people to stay well at home or

in a homely setting for as long

as possible. This recognises

that when hospital admission is

necessary that people are treated

with dignity and respect and in a

safe environment which protects

people’s human rights.

Director of

Improvement

Support and

ihub

17


National Care

Standards

Development

of consistent

National Care

Standards

Deliver in collaboration with the

Care Inspectorate, a set of general

and specialist standards linked to

the principles signed off in March

2016.

Director of

Evidence

Scottish

Intercollegiate

Guidelines

Network (SIGN)

Guideline

Programme

Driving

improvements in

care by developing

SIGN clinical

guidelines

Continue to develop evidence-

based guidelines for healthcare

professionals, seeking appropriate

ways in which information can be

more rapidly disseminated.

Director of

Evidence

Standards

and Indicators

Programme

Driving

improvements in

care by developing

standards and

indicators

Further develop the programme of

standards, including pressure ulcer

standards and screening services

to underpin inspection processes

and indicators, in areas such as

palliative care and heart disease,

which are used to facilitate

ready comparison of services in

a nationally consistent manner

and generate data that provides a

baseline for improvement.

Director of

Evidence

RARE-

Bestpractices

Programme

Conclusion of the

European RARE-

Bestpractices

Programme

Continue with the RARE-

Bestpractices programme to

reduce inequality in care for

patients with rare diseases across

Europe.

Director of

Evidence

18

Contribution 4: Improving the analysis and assessment of inappropriate variation

in the quality of health and social care in Scotland, and identifying the steps with

services to eliminate unacceptable practices and provision.


Death Certification

Review Service

Quality

assurance and

enhancing

the clinical

governance of the

death certification

process

Ensure the effective operation

of the Death Certification

Review Service and key

operational objectives are

consistently delivered.

Executive

Clinical

Director

Scottish Mortality

and Morbidity

Programme

(SMMP)

Maximising and

sharing learning

from the SMMP

Through the SMMP, ensure

an effective approach to

supporting the improved local

learning from deaths; improved

local action to reduce Hospital

Standard Morbidity Rates

(HSMR); thematic national data

for improvement; and improved

governance at local and national

level in relation to mortality

reviews.

Executive

Clinical

Director

Measurement and

Monitoring of

Safety Programme

Consolidate

learning

from testing

a conceptual

framework and

seek to support a

rounded approach

to safety

measurement

and monitoring

using leading

and predictive

measures

Spread and integrate the

framework for the measurement

and monitoring of safety across

Scotland. Work with UKIA

and partners across the UK

to further develop resources

and create a spread and

sustainability plan to support

others in their use of the

framework.

Executive

Clinical

Director

Scottish Patient

Safety Programme

(SPSP) Acute Adult

Driving

improvement in

safety for patients

in acute hospitals

Implement the new

arrangements arising from the

90-day process reviewing the

Acute Adult and Primary Care

safety programmes.

Director of

Improvement

Support and

ihub

19


SPSP Venous

Thromboembolism

(VTE)

Reduction of

incidence of VTE

Undertake a ‘deep dive’ with

one NHS board to understand

the factors mitigating against

reducing unwarranted variation

in the management of VTE, test

solutions and identify learning

for spread across Scotland.

Director of

Improvement

Support and

ihub

SPSP Mental

Health

Reduce harm for

patients with

mental illness

Support NHS boards to improve

outcomes for people with

mental illness through a focus

on reducing harm, including

restraint and seclusion,

improving medicine safety risk

assessment and safety planning

at key transition points.

Director of

Improvement

Support and

ihub

SPSP Primary Care Driving

improvements in

the quality and

safety of primary

care

Implement the new

arrangements arising from the

90-day process reviewing the

Acute Adult and Primary Care

safety programmes.=

Director of

Improvement

Support and

ihub

SPSP Pressure

Ulcers

Support for a

reduction in

incidence and

prevalence of

pressure ulcers

The programme will work

in collaboration with NHS

boards, Health and Social Care

Partnerships, Scottish Care and

care homes across Scotland to

reduce the incidence of pressure

ulcers for residents in care

homes.

Director of

Improvement

Support and

ihub

SPSP Maternity

and Children

Driving

improvement

in the safety

of care offered

to mothers and

children

Implement SPSP Maternity and

Children programme to improve

outcomes by providing a safe,

high quality care experience for

all women, babies and children,

in these settings in Scotland.

Director of

Improvement

Support and

ihub

20


SPSP Healthcare

Associated

Infections (HAI)

Support reduction

in HAI

Provide overall co-ordination of

all HAI-related activities within

HIS to ensure an integrated

and planned approach. Provide

improvement advice and

support to the NHS boards on

HAI issues.

Director of

Improvement

Support and

ihub

SPSP Pharmacy in

Primary Care

Driving

improvement in

safer prescribing

and dispensing in

primary care

Continue to improve reliability

of a number of processes,

including the prescribing,

monitoring and dispensing of

high risk medicines, medicines

reconciliation at discharge from

acute hospital, and developing a

safety culture.

Director of

Improvement

Support and

ihub

SPSP Medicines Reducing harm

from medicines

SPSP Medicines aims to reduce

harm from medicines through

supporting the medicines

streams within each of the SPSP

improvement programmes,

with a focus on medicines

reconciliation and high risk

medicines.

Director of

Improvement

Support and

ihub

Sharing

Intelligence for

Health & Care

Maximise the

sharing of

intelligence to

identify areas for

improvement

Build on the work of the Sharing

Intelligence Group to provide

a proactive and supportive

environment for collaboration;

regular opportunities to build

stronger working relationships

and understanding of roles;

a shared view of risks to

quality through our collective

intelligence; an early warning

mechanism of risks; and co-

ordinated action to drive

improvement.

Director

of Quality

Assurance

21


Effective Care

Programme

Supporting the

reduction of

inappropriate

variation

Through the Effective Care

Programme, agree care

processes to be prioritised to

support NHS boards to reduce

unwarranted variation in the

delivery of care interventions

so as to improve outcomes and

reduce costs.

Director of

Improvement

Support and

ihub

SPSP Mental

Health

Observations

Supporting

improvements

in observation

practice to

prevent harm

Aim to improve observation

practice through therapeutic

engagement with suicidal,

violent or vulnerable patients

to prevent them from harming

themselves or others at times of

high risk during their recovery.

Director of

Improvement

Support and

ihub

Learning from

Adverse Events

Advancing

learning from

adverse events

Build on the implementation

of the national framework

for learning from adverse

events, through reporting and

review, which supports service

improvements and enhances the

safety of our healthcare system

for everyone.

Ensure the appropriate

integration of elements of this

work with other work across

HIS.

Director

of Quality

Assurance

SPSP Dentistry Driving

improvement in

the quality and

safety of dental

care

The dental arm of the SPSP

Primary Care programme

seeks to embed quality

improvement processes into

every day practice. We will

do this by identifying areas

for improvement and raise

awareness of a safety culture

amongst practices.

Director of

Improvement

Support and

ihub

22

Contribution 5: providing independent external assessment of the sustainability

of service provision, including the design of health and social care services which

offer better outcomes and value for money.


Scottish Health

Technologies

Group (SHTG)

Appraisal and

provision of

evidence on new

non-medicines

technologies

Provide advice on the evidence

about the clinical and cost

effectiveness of existing

and new non-medicine

technologies likely to have

significant implications for

patient care in Scotland.

Implement key actions from the

Non-Medicines Technologies

Strategic Plan (2016–2018),

including the commissioned

work on landing zones for

advice within NHSScotland.

Director of

Evidence

Scottish Medicines

Consortium (SMC)

- Implementation

of New Medicines

Review

Recommendations

Support the

introduction of

recommendations

arising from the

review of access

to new medicines

Consider and implement

recommendations arising

from the ‘Montgomery review’

relating to the policy change for

new medicines.

Director of

Evidence

SMC Core Business Appraisal of new

drug therapies

to deliver safe,

clinically effective

and cost effective

medicines

Deliver robust SMC decisions

and continue to refine the

process.

Director of

Evidence

Scottish

Antimicrobial

Prescribing Group

(SAPG)

Ensuring safe and

evidence-based

provision of

antibiotics

Support the work of SAPG

in containing the spread of

Antimicrobial Resistance (AMR)

in Scotland and reducing

patient harm by maintaining

the national antimicrobial

stewardship agenda from HAI.

Director of

Evidence

23

Contribution 6: Play our part in raising the quality of health and social care, by

providing more proactive intervention and support underpinned by robust, timely

and integrated intelligence.


Tailored and

Responsive

Improvement

Support Team

(TRIST)

Provide practical

and timely

improvement

support to health

and social care

providers

Ensure the Tailored and

Responsive Improvement

Support Team (TRIST) is deployed

effectively to meet needs in health

and social care:

in response to proactive requests

from NHS boards and Health

and Social Care Partnerships for

improvement support to address

local key priority issues, and

to work with services to support

them in addressing key findings

from inspection/scrutiny reports.

Director of

Improvement

Support and

ihub

Strategic

Delivery Plan:

Medicines

Support delivery

of safer medicines

Through the Strategic Delivery

Plan: Medicines, improve safe

and effective use of medicines

through empowering people to

manage their own care and shape

services. This includes supporting

reliable spread and supported

implementation of best practice,

and assessing the quality and

safety of healthcare.

Executive

Clinical Director

Hospital

Standardised

Mortality Ratio

(HSMR)

Identifying

the causes of

unwarranted

variation in

mortality in

Scotland

Provide timely and practical

analysis and follow-up in respect

of the HSMR data provided by NHS

boards in driving improvement in

patient care.

Executive

Clinical Director

Evidence and

Evaluation for

Improvement

Team (EEvIT)

Provides analytical

support for

improvement work

across health and

social care

Support the design and delivery

of improvement programmes and

projects so that they are based on

current evidence and incorporate

approaches to monitoring and

measuring their impact. For health

and Social Care partners, support

from EEvIT is available through

TRIST.

Director of

Improvement

Support and

ihub

24


Improvement

Fund

Provide grant

awards to support

improvement for

Health and Social

Care Partnerships

Provide grant awards to applicants

with a strong proposal to either

test a change idea locally or

spread improvement nationally.

The aim of the fund is to invest in

and expand innovative practices

that demonstrate impact on the

national health and wellbeing

outcomes.

Director of

Improvement

Support and

ihub

Contribution 7: supporting the leadership in NHS boards and in Health and Social

Care Partnerships to make the necessary changes to deliver a sustainable culture

of continuous quality improvement.


Implementation

and

Improvement

Support of

Area and Drug

Therapeutic

Committees

(ADTCs)

Support ADTC to

implement best

practice

Following the Scottish Government

response to the Health and Sport

Committee inquiry into access

to new medicines in 2013,

continue to provide effective

support to the application of the

recommendations as they pertain

to ADTCs.

Executive

Clinical Director

Hospital

Electronic

Prescribing

and Medicines

Administration

(HEPMA) Phase

2

Support delivery

of cost effective

and safe

prescribing

Support a collaborative approach

to implementation of HEPMA

across NHS boards ensuring

lessons learned, minimisation of

risk, and securing overall benefits

of safer prescribing.

Executive

Clinical Director

Quality

Improvement

(QI) Skills

Development

Developing QI

capacity within

Board members

across Scotland

Develop the skills of staff working

across health and social care

services to support the work of

QI through funding 56 places a

year on the Scottish Improvement

Leaders course provided by NHS

Education for Scotland.

Director of

Improvement

Support and

ihub

25


Networks and

Knowledge

Exchange

Making effective

use of networks to

share learning

Develop and implement a

network strategy to support the

Improvement Hub and partners to

connect and share learning.

Director of

Improvement

Support and

ihub

QI for Board

Members

Developing QI

capability of

Board members

within Scotland

To create opportunities for

Board members to increase their

understanding of QI so that they

can lead and govern organisations

to continuously improve and

contribute to the nine national

health and wellbeing outcomes.

Director of

Improvement

Support and

ihub

Independent

Care Sector

Programme

Maximise the

contribution of

the independent

care sector to

improvements

in health and

wellbeing

Take forward the Independent

Care Sector Programme which

is designed to support the

development of this sector

as a full partner in delivering

improvements in health and

wellbeing at both strategic and

local levels.

Director of

Improvement

Support and

ihub

26

Measurement and evaluation

We have created a logic model which incorporates our seven strategic

contributions and has aligned them to the nine national health and wellbeing

outcomes. We are developing effective evaluation processes to better evidence the

outcomes, benefits and impact of our work. This includes developing indicators to

enable us to measure progress toward achieving our outcomes and a prioritisation

process to ensure strategic fit and that we are making best use of resources.

This work is developmental and, during the course of 2016–2017, we will

be testing and refining the model to ensure that it meets our needs and can

demonstrate impact.

We will also develop our performance management arrangements to improve

reporting of the progress that we are making with our work and any changes we

might need to make. This will include measuring and reporting of our work in

a matrix way to suit the most appropriate circumstances as clearly as possible,

for example by outcome, theme or programme. We believe that by incorporating

this flexibility of approach to reporting we will be able to identify the cross-

organisational value that is added to our work.

27

Fina

ncia

l re

sour

ce

Flex

ible

, en

gage

d an

d ap

prop

riate

ly

skill

ed

wor

kfor

ce th

at is

su

stai

nabl

e,

capa

ble,

fully

in

tegr

ated

and

su

ppor

ted

by

effe

ctiv

e le

ader

ship

Eff

icie

nt a

nd

effe

ctiv

e H

R,

Fina

nce,

IT a

nd

Com

mun

icat

ions

Inpu

ts

Act

iviti

es

R

each

O

utco

mes

1.Pe

ople

are

abl

e to

look

afte

r and

impr

ove

thei

row

n he

alth

and

wel

lbei

ng a

nd li

ve in

goo

dhe

alth

for l

onge

r

2.Pe

ople

, inc

ludi

ng th

ose

with

disa

bilit

ies o

r lon

gte

rm c

ondi

tions

, or w

ho a

re fr

ail, a

re a

ble

toliv

e, as

far a

s rea

sona

bly

prac

ticab

le,

inde

pend

ently

and

at h

ome

or in

a h

omel

yse

tting

in th

eir c

omm

unity

3.Pe

ople

who

use

hea

lth a

nd so

cial

care

serv

ices

have

pos

itive

exp

erie

nces

of t

hose

serv

ices

and

have

thei

r dig

nity

resp

ecte

d

4.H

ealth

and

soci

al ca

re se

rvic

es a

re c

entre

d on

help

ing

to m

ainta

in o

r im

prov

e th

e qu

ality

of

life

of p

eopl

e w

ho u

se th

ose

serv

ices

5.H

ealth

and

soci

al ca

re se

rvic

es c

ontri

bute

tore

duci

ng h

ealth

ineq

ualit

ies

6.Pe

ople

who

pro

vide

unp

aid c

are

are

supp

orte

dto

look

afte

r the

ir ow

n he

alth

and

wel

lbei

ng,

incl

udin

g re

duce

any

neg

ativ

e im

pact

of t

heir

carin

g ro

le o

n th

eir o

wn

healt

h an

d w

ellb

eing

7.Pe

ople

usin

g he

alth

and

soci

al ca

re se

rvic

es a

resa

fe fr

om h

arm

8.Pe

ople

who

wor

k in

hea

lth a

nd so

cial

care

serv

ices

feel

eng

aged

with

the

wor

k th

ey d

o an

dar

e su

ppor

ted

to c

ontin

uous

ly im

prov

e th

ein

form

atio

n, su

ppor

t, ca

re a

nd tr

eatm

ent t

hey

prov

ide

9.Re

sour

ces a

re u

sed

effe

ctiv

ely

and

effic

ient

ly in

the

prov

ision

of h

ealth

and

soci

al se

rvic

es

Pers

on-c

entre

d H

ealth

and

Car

e Pr

ogra

mm

e

Inap

prop

riate

var

iatio

n in

ca

re is

redu

ced

[4]

Impr

ovem

ent i

n he

alth

and

soci

al ca

re p

rovi

sion

is su

ppor

ted

by in

telli

genc

e led

pr

oact

ive

inte

rven

tion

[6]

Citi

zens

hav

e a

mea

ning

ful

say

in th

e de

sign,

plan

ning

an

d pr

ovisi

on a

nd d

eliv

ery

of h

ealth

and

soci

al ca

re

serv

ices

[1]

Hea

lth a

nd so

cial

care

se

rvic

es a

re su

stain

able

and

pr

ovid

e in

divi

dual

care

that

is

appr

opria

te a

nd ti

mel

y [3

]

Citi

zens

, boa

rds,

Scot

tish

Gov

ernm

ent a

nd c

are

prov

ider

s are

ass

ured

abo

ut

the

quali

ty o

f ser

vice

s [2]

Citi

zens

, boa

rds,

SG a

nd

care

pro

vide

rs a

re a

ssur

ed

abou

t the

sust

ainab

ility

of

serv

ices

[5]

Sust

ainab

le q

ualit

y im

prov

emen

t is d

eliv

ered

by

supp

ortin

g ch

ange

thro

ugh

effe

ctiv

e le

ader

ship

[7]

Com

mun

ity e

ngag

emen

t and

supp

ort

Can

cer/

scre

enin

g pr

ogra

mm

e Q

A

NH

S bo

ards

, in

tegr

ated

join

t bo

ards

, hea

lth a

nd

soci

al ca

re

partn

ersh

ips,

third

se

ctor

and

in

depe

nden

t sec

tor

Inde

pend

ent c

are

prov

ider

s

Our

staf

f

Publ

ic, p

atie

nts,

care

rs a

nd

com

mun

ities

Staf

f in

healt

h an

d so

cial

care

Scot

tish

Parli

amen

t an

d Sc

ottis

h G

over

nmen

t

Eff

ectiv

e C

are

Prog

ram

me

SPSP

QI C

apac

ity a

nd C

apab

ility

bui

ldin

g

Shar

ing

Inte

llige

nce

Qua

lity

of c

are

revi

ews

Insp

ectio

n pr

ogra

mm

es

TRIS

T

Our

Voi

ce

Pers

onal

outc

omes

Tech

nolo

gies

pro

gram

me

Prof

essio

nal r

evali

datio

n

IHC

regu

latio

n

Prim

ary

care

/OO

H

Priso

ner h

ealth

care

OPA

C

Adv

erse

eve

nts

Stan

dard

s

SAPG

EE

vIT

Logi

c m

od

el

28

Best use of resources

This Local Delivery Plan has been prepared as part of our integrated planning

process. This ensures that we work within our resources – people and finances –

and deliver a high quality work programme. We effectively manage our resources

through good governance processes and prioritisation of our work.

This plan incorporates an outline of our implementation plan for Delivering

Everyone Matters: 2020 Workforce Vision in Appendix 1.

29

Appendix 1: 2020 Workforce Vision – local implementation plan (2016–2017)

Our 2020 Workforce Vision local implementation plan (2016–2017) provides a

range of actions that support the achievement of our outcomes, and contribute to

the ongoing development of our organisation. The actions are outlined below:

Healthy organisational culture: we are developing promotional materials to

support employee understanding of their contribution to the workforce vision.

We are improving our measurement of staff engagement through full roll-out of

iMatter, and the use of pulse surveys. A co-ordinated approach to team briefing

across the organisation will be developed, and our monthly staff huddles are being

continuously improved following employee feedback. We are undertaking work

to gain a deeper understanding of the causes of unplanned absence in order to

inform the ways we can more effectively support our employees.

Sustainable workforce: we established a Change Management Board in 2015–

2016 that has oversight of all organisational change across HIS, including changes

in structure and service delivery. The Board considers how change impacts our

workforce, and how change in one area of our organisation can affect other areas

while ensuring appropriate action is taken to manage this. During 2016–2017,

the main focus of the Change Management Board will be to ensure oversight of

changes relating to our Improvement Support and Quality Assurance offerings,

as well as the development of Our Voice within the Scottish Health Council. This

activity will benefit from our learning around organisational changes implemented

in the past 12 months.

Capable workforce: we will be providing health inequalities awareness sessions

for all employees during 2016–2017 as well as exploring options for balancing

measures on inequalities as part of our Improvement Hub performance framework.

Employees will be supported to understand the benefits and challenges of using

social media for business purposes. Employee awareness raising of the critical role

of carers will be part of the internal communications that support the launch of

Our Voice. Also, there will be awareness activities planned and delivered detailing

how strategic inspections have a focus on the Partnerships Carers Strategy, Carers

Assessments and Outcomes for Carers.

30

Workforce to deliver integrated services: we will support development of quality

improvement capacity across health and social care by funding over 50 places on

the Scottish Improvement Leaders programme. We will work with other national

organisations including the Scottish Government, NHS Education for Scotland

and the Scottish Social Services Council to identify workforce implications across

Scotland attached to improvement and service redesign work, and develop

appropriate interventions that are solutions-focused. Our provision of practical

improvement support will be delivered through a mixture of planned programmes

and responsive support. In equipping our employees to support this work, we

will ensure awareness and understanding of the pressures health and social care

partnerships face, and address skills and experience gaps at individual and team

levels.

Effective leadership and management: our focus for 2016–2017 will be on

strengthening change leadership capacity and capability. This will be facilitated

through topic specific leadership discussion groups on adaptive leaderships,

complexity and emergence, and how these relate to cross-organisation and cross-

sector working. Promoting NHSScotland and HIS organisational values will be

supported by the development of values-based recruitment processes and the

establishment of values-oriented objectives built into leaders’ and managers’

2016–2017 work objectives. Performance management and iMatter training will

be provided to all managers to support open and honest discussions with our

employees. This should support them to maximise their contribution and agree

action plans to secure improvement. We will progress succession planning and

talent management discussion with the Executive Team to reach agreement on

a consistent approach. We will continue to provide support for facilitated team

building and development, targeted towards teams directly affected by change.

This includes ensuring understanding and awareness of the HIS approach to

organisational change management, and supporting managers to implement this

effectively, and be responsive to the need to continuously improve the way we

work.

Over the course of 2016–2017, we anticipate recruitment challenges with the

following staffing groups:

• Health Economists

• Improvement Advisors

• Inspectors, and

• Medical Reviewers.

31

All of the above staff groups are either specialist or highly specialist and are

critical to the success of our Local Delivery Plan. In the case of Health Economists,

there is a significant shortage of supply within Scotland. Moreover, the private

sector is continually able to attract the limited numbers of suitably qualified and

experienced individuals who are available with higher salaries than we currently

can offer via the Agenda for Change framework. To mitigate this, we have trialled

traineeships in order to attract newly qualified individuals, with dedicated

coaching and mentorship available to ‘fast track’ the acquisition of skills and

experience. This has had mixed success, and we intend to refocus on other ways to

mitigate the situation during 2016–2017.

Given our expanded remit in terms of facilitating improvement across health

and social care from 1 April 2016, there will be a significant requirement for

appropriately skilled and experienced Improvement Advisors drawn from both

health and social care backgrounds. We have a good track record in supporting

NHS boards with expertise and personnel to deliver improvement interventions.

There continues to be a national shortage of qualified and experienced

Improvement Advisors, and this represents a risk for us in the delivery of our

programmes in the short to medium term. The new integrated improvement

resource will be investing in Improvement Advisor and Associate Improvement

Advisor posts, with a strong focus on succession planning and retention to ensure

as much stability as possible is built into the structure. We are also creating

alternative ways of staffing national improvement programmes so as not to

simply take key individuals away from local delivery organisations. This includes

the development of our Improvement Associate framework, the use of joint

appointments where individuals work part-time nationally and part-time locally,

and the development of a grant making arm. Parallel to work on infrastructures,

skills mapping and skill gap analysis will be carried out to inform the workforce

development priorities. The Quality Improvement Framework along with the new

QI Development Diagnostic tool will be used as part of this process.

We have worked collaboratively with a range of stakeholders in the development

of our new Quality of Care reviews, which we believe will have a positive impact

on quality assurance across the service, and become an effective lead-in for

quality improvement. We are also building capacity in independent healthcare

inspection during 2016–2017. Both these important developments require skilled

and experienced Inspectors to support our operational capability. A barrier to

our ability to attract suitable talent from the social care sector is our terms and

conditions of service through the Agenda for Change framework. We will work to

find a solution to this barrier during 2016–2017 so that certainty can be brought

to recruitment processes, and the best possible terms and conditions can be

offered to prospective entrants.

32

The nature of the Death Certification Review Service requires Medical Reviewers

who are highly experienced medical professionals, drawn from the General

Practitioner and Consultant communities. This has required HIS to appoint

individuals on to differing terms and conditions that reflect their backgrounds, but

the same salary scale in order to avoid question marks over equal pay. A solution

to the terms and conditions situation is needed to bring clarity to our employment

offering, and we will fully participate in any discussions relating to the creation of

new contracts led by Scottish Government colleagues in 2016–2017.

Our employee age profile remains broadly consistent with previous years.

Compared to other NHS employers, HIS has proportionately less staff under

the age of 25. The main cause of this is the skills and experience required

for the majority of our posts. We recognise the important contribution that

under 25s can provide and that our current position is neither sustainable nor

desirable. During 2016–2017, we will develop a range of initiatives to encourage

youth employment, with the chief focus on Modern Apprenticeships within

administrative services.

During 2015–2016, there was a slight increase in sickness absence rates, but these

remain below the established 4% expectation. There continues to be work required

with people managers on improving the capture of unplanned absence causes.

However, there has been an increase in the numbers of employees indicating

anxiety, depression and stress, and this will be explored in detail in early 2016–

2017. One aspect of this exploration will be determining if there is any linkage

between increased absence levels and our approach to vacancy management.

A challenging budgetary environment in 2015–2016 required HIS, through the

established Change Management Board and process, to assiduously manage

vacancies and deliver headcount reductions. For 2016–2017, a vacancy factor of

7.7% has been agreed in order to accrue financial savings that will contribute to

a balanced budget. This will be closely monitored to ensure achievement of our

budgetary goals, and our people are supported in terms of manageable workloads

and performance expectations.

Levels of anticipated workforce growth during 2016–2017, particularly within the

Improvement Hub and the Directorate of Quality Assurance, require us to urgently

consider the application of agile working approaches for colleagues based within

our two main offices – Gyle Square (Edinburgh) and Delta House (Glasgow). The

ready availability of additional workstation space is particularly challenging in

Delta House. A subgroup of the Change Management Board has been considering

the situation and is coming forward with recommendations. These include

switching the majority of available workstations to ‘hot desk’ status, and ensuring

that all employees are provided with information communication technology that

facilitates cross-site and home-working whenever appropriate.

To be able to deliver on our work programme and achieve changes in the way we

work, we need a flexible workforce that is able to be responsive to changes in

the work plan due to changing context and to urgent unplanned work demands.

The Change Management Board is working to support the workforce to build

approaches to work more flexibly across the organisation so that we can respond

more efficiently to fluctuations in workload and optimise use of existing workforce

capacity and capability. This will require traditional team and directorate

structures to support an increased level of cross-organisational working. Members

of the Change Management Board have sought examples of flexible workforce

approaches from Audit Scotland and from Scott-Moncrieff and have presented

these models to Partnership Forum and Corporate Management Team as a way

of stimulating thinking about a model that would work for HIS. In addition we are

building case studies of pieces of work being carried out across the organisation

that are testing out ways of working more flexibly. We will build on these during

2016–2017 and use them to engage staff in taking forward changes in ways of

working.

33

Edinburgh Office

Gyle Square

1 South Gyle Crescent

Edinburgh

EH12 9EB

0131 623 4300

Glasgow Office

Delta House

50 West Nile Street

Glasgow

G1 2NP

0141 225 6999

www.healthcareimprovementscotland.org

You can read and download this document from our website.

We are happy to consider requests for other languages or

formats. Please contact our Equality and Diversity Advisor on

0141 225 6999 or email [email protected]

The Healthcare Environment Inspectorate, Improvement Hub, Scottish

Health Council, Scottish Health Technologies Group, Scottish Intercollegiate

Guidelines Network (SIGN) and Scottish Medicines Consortium are part of

Healthcare Improvement Scotland.

Local Delivery Plan 2016–2017

Documents