NHS GRAMPIAN

Health and Care Framework Update

Aim

  1. This paper submits the report of the Health and Care Framework stakeholder event to the Board and provides a brief update on the work of the pathfinder projects.

Strategic Context

  1. The Health and Care Framework (H&CF) is being developed to provide a plan for the practical implementation of the Health Plan. The actions being taken forward within the H&CF process are consistent with the Grampian NHS Board approval of the initial stages of the H&CF in April 2011.

Discussion

  1. The H&CF process has developed a range of proposals through comprehensive involvement and engagement over the past six months. This culminated in the major stakeholder event held on 3 March 2011 which formed the proposals submitted to the Board meeting in April. 137 people - staff, public representatives and representatives from partner agencies - attended the stakeholder event and a wide range of issues were discussed. The report of the event prepared by Lorraine Scott, Service Planning Lead, is attached for consideration by Board members (see annex 1).
  1. One of the aims of the H&CF is to develop and agree a consistent model of care that can be applied across Grampian, adapted as necessary for differences in need and population distribution. The pathfinder projects have been valuable in testing different ways of working as well as informing the public on the opportunities and constraints that exist, and involving them in the detailed planning. The pathfinders have also raised issues that will result in specific decisions being made in the coming months which may require Board approval. A brief summary of the work of the pathfinders is set out below:
  1. Forres: the work of the Forres pathfinder has attempted to develop a consensus on the model of care for the community with the involvement of staff, GPs, Moray Council and a large number of public representatives. The emerging model (summarised at annex 2) has been developed at five stakeholder events and a high degree of consensus has been achieved in relation to how most of the services should be organised for the community of approximately 16,000 people. The issue which remains to be agreed is the way that 24 hour healthcare will be provided. At the last public meeting held on 23 May it was agreed that a more formal process should be developed to reach agreement on the matter. A range of different methods of meeting the needs were identified at the meeting and will be explored further. It will be through this process that the future of Leanchoil Hospital will be considered i.e. Leanchoil will be considered as one of the possible ways of meeting the needs as well as enhanced care at home and the use of care home capacity. The Scottish Health Councilhave been engaged in the process so far and the relevant guidance on the management of change will be applied as appropriate, including a period of formal public consultation.
  1. Inverurie: A similar process has been undertaken atInverurie to assess the needs and consider the model for the populations usingInverurie based services across 3 broad areas – GP services,21,000 (projected to increase to 34,000 by 2021), in-patient beds currently admitting from a population of 47,400, and diagnostic and treatment services(DTS) which could be accessed by all of Central Aberdeenshire which carries a population of 68,000. TheInverurie exercise has therefore considered the implications of different catchment populations as part of an approach to tier healthcare services which require a different critical mass of population. In common withForres the need for 24 hour (inpatient) healthcare is an issue inInverurie and work is being done to ensure that a common definition is agreed and applied within Grampian as a whole. Work will be done to conclude the first stage of the pathfinder inInverurie by the end of June. This will permit the move to a more formal process to develop specific options and a business case for the replacement ofInverurie Health Centre and the future configuration of community health resources. The aim will be to complete a formal business case by the end of the 2011 for submission to the Scottish Government.
  1. Maternity Services: The first stages of the option appraisal have been concluded and details are being finalised prior to submission to the Board in August. Lessons will be taken from the Maternity Review process and applied to other Grampian wide services reviews as appropriate, including the work done in the Review in relation to the population size relating to specific services, and the implications of the geography and population distribution of Grampian in planning services and public health initiatives.
  1. Re-shaping Older People’s Services in AberdeenCity: This work is being progressed in collaboration with all partners (including the public, local authority, voluntary sector and private sector) involved in the delivery of services for older people in Aberdeen. During recent weeks a consultation and involvement framework has been prepared and a number of consultation workshops have been held including the Public Forum, Older People’s Consultation and Monitoring Group, the Carer’s Centre, ACVO, the city Integrated Strategic Management Team and CHP and care of the elderly colleagues. The re-design will also involve the implementation of the Re-shaping Older People’s Services Partnership Agreement (November 2010) with Aberdeen City Council and the 2011/12 National Change Fund Plan for the City (see annex 3). A set of overarching principles are being developed to guide the re-design. In addition, plans to relocate the acute geriatric service to ARI in 2012 are underway in collaboration with acute services and agreement has been reached with the geriatricians to look at relocating their main base away from Woodend Hospital to the Health Village in 2013/14, with an acute base at ARI and rehabilitation/intermediate care beds in e.g. Rosewell House, the Links Unit and, in the interim, at Southblock, Woodend Hospital.
  1. Fraserburgh Early Years Pathfinder: Particular areas of work taken forward locally include diet, alcohol issues including teenage antisocial behaviour,together with adopting a systematic approach to identifying vulnerable families and developing tailored appropriate support. This project also complements existing work to tackle health inequalities such as healthpoints, Keep Well, the Reaching Out Project (regeneration project), anticipatory care planning and a wide range of Community Planning Projects focusing on financial inclusion and employability.Currently work is ongoing to develop an integrated plan to deliver agreed service changes and mobilise multi-agency and community action around health inequalities. The Banff & Buchan Local Community Planning Group have agreed to act as overall advisory group for the project, and theFraserburgh Children’s Services Network (CSN) are also key to success. TheCSN have committed to supporting the project and plan to incorporate specific actions within its 2011/12 development plans.

Stakeholder Involvement

  1. As indicated above a wide range of stakeholders have been involved in the process overall as indicated in the report of the stakeholder event and will continue to be involved in the pathfinder projects.

Impact Assessment

  1. One of the aims of the H&CF is to provide a more equitable approach in the improvement of health and the delivery of healthcare. This is a feature of all of the pathfinders and is a significant influence on the development of actions.

Resource implications

  1. The H&CF process recognises the resource constraints applied to all public services and seeks to develop a sustainable health system within Grampian based on the resources that are expected to be available.

Key Risks

  1. There is a risk that the process does not address the needs of the population for improved health and health care services within the resource constraints that apply.
  1. Linked to the above there is a risk that the engagement of the public and stakeholders in not successful in gaining a consensus to take forward the change that is necessary.

Conclusion

  1. The H&CF continues to be developed with wide involvement of the public and stakeholders. The Pathfinder projects are developing different models of care with the aim of contributing to the development of more consistency of approach across Grampian whilst dealing with major practical challenges in a strategic way.

Recommendation

  1. The Board is asked to note the report of the stakeholder event and the update on the pathfinder projects.

Executive Lead

Dr Lesley Wilkie, Director of Public Health and Planning

Graeme Smith

Head of Service Development

30 May 2011

Annex 1 – Stakeholder Event Report

see separate document

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Re-Shaping Care for Older People in Aberdeen – Programme Structure

Re-Shaping Care for Older People in Aberdeen – Programme Structure

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