Getting Better in Fife

2012-2017

Version 12.10 (12/09/2012)

Contents

1.CHIEF EXECUTIVES’ FOREWORD

2.NHS FIFE’S STRATEGIC OVERVIEW

2.1Context

2.2The Position in NHS Fife

2.3Working in Partnership

2.4Responding to the Coming Challenges

2.5Moving toward 2020 – NHS Fife’s Vision

2.6Maximising NHS Fife’s Estate

3MOVING FORWARD – GETTING BETTER IN FIFE

3.1What are we trying to accomplish?

3.2Delivering Getting Better in Fife; A Programme of Improvement Projects

3.3Improving Flow and Emergency Access- the Right care in the Right Place at the Right Time

3.4Improving Elective Flow –Care where it counts, care when it counts

3.6Safe and Accessible Mental Health Services

3.7Safe and Effective Medicines Management

3.8Examples of improvement projects and tests of change

4IMPROVEMENT APPROACHES

4.1Quality Improvement Methodology

4.2Programme Management Office

5HOW WILL WE KNOW WHEN CHANGE IS AN IMPROVEMENT

5.1Measures for Improvement

6ALIGNING RESOURCES TO SUPPORT THE PRIORITIES

6.1Building Capacity and Capability for Sustainable and Effective Quality Improvement

6.2Quality Improvement Hub

7WHAT DOES THIS MEAN FOR THOSE WE CARE FOR AND OUR STAFF?

Appendix 1

1.CHIEF EXECUTIVES’ FOREWORD

In 2002 Fife Health Board embarked upon an ambitious programme of service redesign across all the strands of healthcare in Fife. This plan became known as “Right for Fife” and anticipated many of the issues which have caused all healthcare systems to review how services can be provided. The success of “Right for Fife” has put NHS Fife in a good position to move forward.

Much of “Right for Fife” was structural and has resulted in improved in-patient facilities for patients at St Andrews, Adamson, Stratheden, Lynebank, Randolph Wemyss and Victoria Hospitals, and new community facilities for example in Anstruther and Dunfermline and across Fife in respect of dental access centres. Importantly, it also encompassed new models of care and patient pathways resulting in reduced lengths of stay, reduced waiting times and reduced numbers of hospital attendances through developments of increased “one stop” clinics and services provided on an ambulatory, or day case, basis.

So, ten years on we have achieved much, but there is still more to do. My goals over the next five years are to:

  • Recognise the need for continuous improvement and to enable staff to redesign services they provide while continuing to provide safe and effective care in a changing environment.
  • Build on the good work of “Right for Fife”, ensure we finish what we started and further improve clinical care.

I want NHS Fife to be a place where:

  • Staff are able and encouraged to make changes to reflect patient needs in their area and to ensure care is person centred.
  • The culture is that we are always looking at how we can do things better.
  • The culture that patients feel safe, valued and well looked after.
  • Staff feel able to raise issues and suggest improvements.
  • People are prepared to make changes and to think about the “how to” and not the “why not”.

This plan – Getting Better in Fife – sets out the processes to make this happen and the priority areas in which we will invest time and resources to make it happen. We will also continue to provide the wide range of services to the people of Fife and meet our performance targets

This plan is not an end product – it is the start of a process which will evolve over time.

John Wilson

Chief Executive, NHS Fife

2.NHS FIFE’S STRATEGIC OVERVIEW

2.1Context

NHS Fife works with and on behalf of the citizens of Fife to improve their health and healthcare.

The Scottish Government set out the national framework for improving Scotland’s health and healthcare in its Quality Strategy[1] which sets out NHSScotland’s vision to be a world leader in healthcare quality, described through 3 quality ambitions: effective, person centred and safe. These ambitions are articulated through the 6 QualityOutcomes that NHSScotland is striving towards:

  • Everyone gets the best start in life, and is able to live a longer, healthier life;
  • People are able to live at home or in the community;
  • Healthcare is safe for every person, every time;
  • Everyone has a positive experience of healthcare;
  • Staff feel supported and engaged;
  • The best use is made of available resources.

The Quality Strategy builds on Better Health, Better Care[2] and, together with subsequent supporting publications; they provide the overall strategic context.

Since 2002, NHS Fife Board has been delivering an ambitious programme of development and modernisation designed to improve the range and quality of healthcare services and to improve the quality of the premises from which services are provided - the implementation in Fife of the Quality Strategy and of Better Health, Better Care.

Within the national framework, NHS Fife has prime responsibility for the protection and improvement of its population’shealthand for the delivery of frontline healthcare services. It does this through services it provides itself, through primary care contractors, through joint working with other agencies and NHS Boards and through public participation and patient focus. Services are provided in people’s own homes and from a range of locations and premises across NHS Fife. All NHS Boards work together for the benefit of the people of Scotland; NHS Fife works principally with NHS Lothian and NHS Tayside to provide specialist and other healthcare to the people of Fife.

Because social and economic participation is vital to good health and economic growth, NHS Fife also works closely with its Community Planning Partners - Fife Council, Fife Constabulary, the Further Education Colleges located in Fife and the voluntary sector, all of whom come together as part of the Fife Community Planning Partnership.

Fife’s Community Plan and Single Outcome Agreement demonstrate how the Partnership will contribute towards delivering the Scottish Government’s National Outcomes in order that:

  • We tackle the significant inequalities in Scottish society;
  • Our children have the best start in life and are ready to succeed;
  • We improve the life chances for children, young people and families at risk;
  • We live longer, healthier lives;
  • Our public services are high quality, continually improving, efficient and responsive to local people’s needs;
  • We reduce the local and global environmental impact of our consumption and production; and
  • Our people are able to maintain their independence as they get older and are able to access support when they need it.

2.2The Position in NHS Fife

Since 2002, NHS Fife has significantly changed the way it contributes to the health and healthcare of the population. Over the decade we have transformed a very large part of the way NHS care is provided. The paragraphs which follow offer some key headlines from a much longer story.

In terms of health improvement and primary prevention we are for example:

  • Strengthening the ability of General Practice
  • By supporting chronic disease management, developing and strengthening our community and public health nursing, podiatry, speech and language, physiotherapy and occupational therapy services, increasing direct access to diagnostic services and through investment in modern premises, including the refurbishment of Rosyth and Kirkcaldy Health centres, the redevelopment of Cupar Health Centre and the development of Skeith and Linburn Health Centres.
  • Strengthening the ability of General Dental, Ophthalmic and Pharmaceutical Services
  • Through investment in premises- 10 new dental services centres, by further improving links to specialist care (e.g. the eye care project) and in the introduction of a range of pharmacy based services including the roll out of the new community pharmacy contract, and a range of local services based on need. For example, we have a network of palliative care community pharmacies, ‘Just in Case’ boxes to meet the anticipatory medication needs for patients at the end stages of life.
  • Implementing and sustaining a range of health improvement programmes
  • Including smoking cessation, alcohol brief interventions and weight management, mental health – facilities, therapies, earlier diagnosis and interventions for dementia and better collaboration across services.

In terms of helping to meet the needs of the most vulnerable members of our community we have strengthened some services and redesigned others. Examples include:

  • Children

We have centralised inpatient paediatric services within Victoria Hospital, increased service provision for the care of children in the community, redesigned services and health improvement work in the monitoring and delivery of the child healthy weight programme and developed an integrated care pathway for vulnerable under 2 year olds. We have further developed and are delivering an integrated model of care across council and health – pathways and implementation of ‘Getting it right for every child’ across the Fife partnership.

  • NHS Fife is one of the first Boards to implement the Family Nurse Partnership (FNP). FNP is evidence based, preventative programme offered to young mothers having their first baby. It begins in early pregnancy and is orientated to the future health and well-being of the child. It is a nurse-led, intensive, home visiting programme and supports universal services in supporting teenage families. FNP is a licensed programme with structured inputs and well tested theories and methodologies. Creating the right environment to deliver the FNP is important and challenging. The aims are achieved by maintaining fidelity to the programme license which is essential if the benefits identified in the research are to be realised.

These benefits of this are:

  • Improving the outcome of pregnancy by supporting women to improve their prenatal health;
  • Improving child health and development by supporting parents to provide more competent care of their children in the first 2 years of life;
  • Improving families’ economic self-sufficiency by supporting parents to develop a vision of the future, accomplish goals by planning timing of pregnancies and staying in school/finding work.
  • People with Learning Disabilities

NHS Fife participates in a national accreditation programme to ensure staff are highly trained in this speciality area and additional investment has been made in Community Based Care with additional specialists in post to deliver the care and enable the development of the Learning Disabilities Unit and the Regional Learning Disabilities unit at Lynebank.

In terms of improving care, we are for example:

  • Strengthening the workforce by
  • Training and developing highly specialised clinicians e.g. Advanced Nurse Practitioners, Specialist Nurses and other Allied Health Professionals
  • Using Redesign, Organisational Learning and Development resources, In-house and external training programmes and organisation-wide implementation of the electronic Knowledge and Skills Framework to provide our workforce with the skills required to deliver 21st century healthcare
  • Moving to new ways of delivering care for example by
  • Implementing the Scottish Patient Safety Programme methodology including the use of care bundles, use of Day Surgery where possible and appropriate, shorter waits for investigation and treatment, one stop clinics, state of the art facilities, increasing use of IT e.g. electronic prescribing, telehealth, telecare and video conferencing including Telepresence, electronic patient referral processes and ordering of investigations
  • Redeveloping premises including
  • The new wing at the VictoriaHospital, the Learning Disabilities Assessment and Treatment Unit based at LynebankHospital, two new mental health wards at Stratheden hospital, the new community hospital in St Andrews and redevelopment of AdamsonHospital and Randolph Wemyss.

2.3Working in Partnership

Community Planning is a process which helps public agencies to work together with the community to plan and deliver better services which make a real difference to people's lives. NHS Fife is a major contributor in this work in Fife. Partners identify the priorities for joint working and align/pool resources around projects where they identify an advantage in doing so. The breaking down of barriers between organisations and the requirement to achieve more with the resources available should foster innovation and new ways of working in partnerships.

Single Outcome Agreements are an important part of this drive towards better outcomes. They are agreements between the Scottish Government and Community Planning Partnerships which set out how each will work towards improving outcomes for the local people in a way that reflects local circumstances and priorities.

The Fife Partnership is responsible for community planning in Fife and is made up of representatives from local agencies.

Fife’s Health and Wellbeing Alliance comprises NHS Fife, Fife Council and Fife’s Voluntary sector and works to reduce health inequalities and improve health and wellbeing for the people of Fife.

The Fife Health and Social Care Partnership (FHSCP) is a partnership between NHS Fife and Fife Council and its Social Work and Health Committee. The partnership works closely together to plan and integrate the care provided for the people of Fife. This closer joint working enables more effective and efficient use of partnership resources, maximises opportunities and facilitates the delivery of higher quality and more responsive services. The FHSCP Service Delivery Plan[3] sets out how the joint service will deliver health and social care for:

  • Older people
  • People with learning disabilities or autism spectrum disorder
  • People with and affected by mental ill health
  • People with physical disabilities or sensory impairments
  • People with and affected by drug and alcohol dependency

The processes of continual improvement in our services are ongoing. Working with Council partners and using the Older People’s Change Fund – a government initiative – we are changing the approach to the care of older people. Residential care, whether in a care home or a hospital, is becoming the last resort rather than the first choice. A wide range of re-ablement rehabilitation services will enable people to stay healthier and stay at home longer, and the developing “virtual ward” approach will mean even when actually ill, many people will be able to stay at home.

In May 2012, the Cabinet Secretary for Health, Wellbeing and Cities, Nicola Sturgeon, launched a consultation document outlining proposals to integrate adult health and social care across Scotland. The aim is to improve care for patients byovercoming some of the 'disconnects' between different parts of public sector services including primary care, social work, community health and some acute hospital services. While it is recognised that progress has been made across Scotland, more needs to be done in partnership to meet the future needs of the population. The specific proposals outlined in the consultation are to establish a health and social care partnership which will take a joint local responsibility for the delivery of adult health an social care in eachCouncil area.

We have made significant progress across Fife with the existing partnership arrangements. We have been at the forefront of many significant service improvements and have led innovation across services for older people, mental health services and in the development of community based service for people with a learning disability. We believe the development of a health and social care partnership in Fife, working as part of a whole system, will help us take that joint working a step forward to ensure that we provide seamless care for the people of Fife.

2.4Responding to the Coming Challenges

While services have changed and continue to change, the challenges facing the NHS continue to grow. As a society, we are getting older, with more people living longer and fewer people in the workforce. Lifestyle diseases such as obesity are generating new healthcare demands and advancing technology, including new drugs, means the NHS can do more to help more people.

The NHS can only reconcile that growing need with the reality of contained resources by doing more with less. Our investment programme, in new community facilities as well as new hospitals, has put us in a strong position already but we need to do more.

By looking to nationally recognised evidence and best practice we must work to provide harm free care and identify unwarranted (wasteful or harmful) variation and waste in the system. We must challenge out dated traditional ways of organising and delivering services and redesign them to provide an up-to-date and highly efficient and safer health service. We must identify productive opportunities and use them.

Our vision for 2020 is that everyone is able to live longer healthier lives at home, or in a homely setting.

We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. Primary Care has a key role in helping the healthcare system as a whole make improvements. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.