FINAL VERSION

Report on the Grampian Health and Care Framework Event

May 2011

Final Version

Report Contents

Pages Numbers

Report Summary03

Background to the Health and Care Framework07

Introduction to the Event 08

Grampian’s Emerging Framework10

Applying the Framework in Practice12

Group Discussion on the Framework and Future Implementation17

Lunchtime Information Sessions21

Feedback Session22

Next Steps and Opportunities for further Engagement24

Next Steps for the Health and Care Framework25

Appendices

  1. Event Programme26
  2. Delegate List28
  3. Delegate Evaluation Feedback31

Report Finalised 31May 2011

Electronic copies of this report, supporting reports and presentations can be found at

Report Summary

Purpose of this Report

The purpose of this report is to provide a summary of the Health and Care Framework (H&CF)Event held on the 3rd March 2011, by outlining the:

  • Background of the H&CF
  • Key themes from both the presentations and the group discussions held during the event
  • Delegate evaluation
  • Next steps to be taken

This report does not aim to give an explicit account of the presentations or discussions had during the event, but merely to provide an overview of the key themes and proposed next steps.

Purpose of the Health and Care Framework (H&CF)

The aim of the proposed H&CF is to set out detailed plansto support the implementation of the strategic direction set out in Grampian Health Plan,which focuses on the delivery of a good quality, sustainable and affordable model of health and care which meets current and future population needs and ultimately improves health.

The development of the H&CF is the Grampian NHS Board’s response to feedback from members of staff, the public and partners during the development and consultation phase of the Grampian Health Plan, whereby people said that they supported the strategic direction and key priorities set out in the plan, but told us that NHS Grampian required to be clearer on the detail of how the strategy and priorities would be delivered. During the consultation, people also told us that the existing model of health and care is unlikely to be sustainable in the future, particularly with the various demographic and financial challenges ahead

In April 2010, the Grampian NHS Board agreed a three year Grampian Health Plan for 2010 to 2013¹. In October 2010, the Grampian NHS Board agreed plans for the development of the H&CF², which focussed on a staged bottom-up approachinvolving staff, members of the public, communities and partners.

Both the Grampian Health Plan and the H&CFcontinue to support the principles set out in ‘HealthFit’³, which was developed in 2002. In summary,Healthfit conveyed that care should be provided on the basis that people in Grampian should gain prompt access to high quality care and treatment, in the most appropriate setting (home, GP practice, community setting etc), by the most appropriate professional, with the right knowledge and skills.

Outcomes of the Health and Care Framework Event

The event was deemed a success with 137 delegates in attendance. Delegates represented the public, patient representatives, staff, clinicians and managers from both NHS and partner organisations. The delegate list is outlined in appendix 2.

There were two main aims of the event, these were to:

  • communicate the culmination of the various engagement activities undertaken as part of the H&CF development process
  • gain an understanding from stakeholders on the emerging model, underpinning principles and the key actions which are required to deliver the proposed H&CF.

Overall there was a feeling that the direction and key principles of the emerging model as outlined in the ‘possible’ future for 2020 discussion paper circulated ahead of the event were appropriate, but it was acknowledged that further development in certain areas such as the model is too NHS centric, medicalised and professional, with more clarity required on strategies for implementation e.g. needed for planning change; empowering communities and integration. It is suggested that wider engagement and debate is needed to develop mechanisms jointly, particularly for joint agency working, integration between primary and secondary care and resourcing. Policies and plans will be needed to support staff and new providers through changes. More clarity is needed on the resource assumptions, particularly affordability of changes. The role and function of each provider, including communities is necessary for planning and implementation. Finally a change in language is needed throughout the framework to demonstrate a move away from organisational boundaries, and to create a more balanced partnership for health.

It was also proposed that the description of the possible future for 2020 should also be communicated from the public’s perspective, in addition to the current description from a system/staff perspective.

During this event, a great deal of valuable discussion and feedback on actions to be considered and taken forward were generated. Such suggestions are outlined and detailed within this report under the respective sections.

The event highlighted that a significant amount of exemplary work has taken place in Grampian which already lays good foundations in working towards implementing theemerging model and description set out in the discussion paper. It was recognised that these developments and practice will require to be applied across the system as already demonstrated in a number of services across Grampian. It was recognised that we still have some way to go before the emerging model is implemented across the wholesystem, but it is also evident that stakeholders continue to be enthusiastic and committed to making such changes by jointly working with the public, communities and partners to deliver a good quality, sustainable and affordable model which meets the needs of the Grampian population, which is fit for the future.

Proposed Next Steps

In order to progress this and maintain the momentum created by the event on the 3rdMarch 2011, the initial next steps have been endorsed by the NHS Grampian H&CF Steering Group.

Ref. / Initial Next Steps / Lead Responsibility
1. / Produce and circulate a report on the H&CF event by the end of May 2011. / Dr Lesley Wilkie/L Scott
2. / Develop stage one of the H&CF which sets out a description of the model and areas for detailed planning as informed by the feedback from those who attended the H&CF Event and other groups engaged in the development of the H&CF. / Dr L Wilkie/G Smith/L Scott
3. / Convert the description of the model for health and care in 2020 from a member of public’s perspective. / Dr Lesley Wilkie/L Scott
4. / Develop a detailed H&CF Action Plan with staff, the public, communities and partners which supports the H&CF as agreed by the Grampian NHS Board. This will require to be submitted to the Grampian NHS Board for approval in October 2011. / NHS Grampian Strategic Management Team

On the whole, it is felt that this event was of value and has gone a long way to fulfilling the events objectives by:

  • engaging with 137 people who represented staff, clinicians, managers, patients, the public and partner organisations.
  • Generally gaining support for the emerging model of care and the proposed ‘possible’ description for health and care in 2020, highlighting the progress made to date and the current key drivers for change.
  • generating numerous suggestions and potential actions to take forward and support the development of the H&CF Action Plan to be produced in the coming months.
  • clarifying the support and commitment for driving forward the H&CF and the strategy as set out in the Grampian Health Plan for 2010-13. This was evident through both discussions on the day and also within the delegate evaluation feedback.

It requires to be recognised that although this event has been crucial in gaining wide engagement on the development of the H&CF, this is part of an ongoing wider engagement process which commenced in 2008 as part of the review of Healthfit and the development of the recent Grampian Health Plan.

Thanks go to the speakers, group facilitators and scribes, the team behind the scenes in organising the event and of course to everyone who attended and contributed to such a successful event.

Key Points
  • 137 delegates attended the event representing patients, the public, staff, clinicians, managers and partner organisations.
  • The purpose of the event was to communicate the culmination of the various engagement activities undertaken as part of the H&CF development process and gain an understanding from stakeholders on the emerging model, underpinning principles and the key actions which are required to deliver the proposed H&CF.
  • The event was deemed a success with positive delegate feedback (see appendix 3).
  • Overall there was a feeling that the direction and key principles of the emerging model as outlined in the ‘possible’ future for 2020 discussion paper were appropriate, but it was acknowledged that further development in certain areas is required.
  • A number of suggestions and actions have been generated which will support and inform the development of the H&CF Action Plan.
  • It is clear Grampian has made good progress towards implementing the Healthfit vision, but it is also acknowledged that there is still a lot of work to be done before the 2020 description is fully implemented.
  • This document outlines the key themes identified and the next steps to be taken based on the outcomes from this event.

Background to the Health and Care Framework Event

Purpose of the Health and Care FrameworkEvent

The overall purpose of the event was to engage a large number of people - staff, clinicians, managers, patients, the public and partner organisations, in the development of the Health and Care Framework (H&CF).

There were two main aims of the event, these were to:

  • communicate the culmination of the various engagement activities undertaken as part of the H&CF development process
  • gain an understanding from stakeholders on the emerging model, underpinning principles and the key actions which are required to deliver the proposed H&CF.

Purpose of the Health and Care Framework

The aim of the proposed H&CF is to set out detailed plans in order to support the implementation of the strategic direction set out in the Grampian Health Plan and ensure a good quality, sustainable and affordable model for health and care is delivered which meets current and future population needs and ultimately improves health.

The development of the H&CF is the Grampian NHS Board’s response to feedback from members of staff, the public and partners during the development and consultation phase of the Grampian Health Plan, whereby people said that they supported the strategic direction and key priorities set out in the plan, but told us that NHS Grampian required to be clearer on the detail of how the strategy and priorities would be delivered. During the consultation, people also told us that the existing model of health and care is unlikely to be sustainable in the future, particularly with the various demographic and financial challenges ahead

In April 2010, the Grampian NHS Board agreed a three year Grampian Health Plan for 2010 to 2013¹. In October 2010, the Grampian NHS Board agreed plans for the development of the H&CF², which focussed on a staged bottom-up approach with staff, members of the public, communities and partners.

Both the Grampian Health Plan and the H&CF continue to support the principles set out in ‘HealthFit’³. In 2002, NHS Grampian developed the ‘HealthFit’ strategy, which outlined the 10 year vision and priorities for health within Grampian. In summary, this vision conveyed that care should be provided on the basis that people in Grampian should gain prompt access to good quality care and treatment, in the most appropriate setting (home, GP practice, Community Hospital etc), by the most appropriate professional, with the right knowledge and skills.

For further information on Healthfit, the Grampian Health Plan and the H&CF can be accessed via

Introduction to the Health and Care Framework Event

Report on the Event

The H&CF Event held on the 3rdMarch 2011 was deemed a success by both the Strategic Management Team and the Service Strategy and Redesign Committee. This has been further supported by the feedback received by the delegates who attended the event, which is summarised in appendix 3 of this report.

As can be seen from the event programme (please see appendix 1), the event comprised of both presentations and group discussion.

The remainder of this report focuses onsummarising the:

  • key points from the presentations which took place
  • key themes from the groupdiscussion sessions and the proposed actions to be taken forward,
  • concluding remarks, and the immediate next steps.

Opening Address- David Cameron

David Cameron, Chair of NHS Grampian opened the event by welcoming both delegates and speakers. He acknowledged the level of attendance and the diversity of the representation of delegates. The key points from his speech were:

  • Healthfit emerged in 2002 and a significant amount of progress and change has taken place in relation to working towards the vision set out at that time.
  • In 2008, we reviewed Healthfit and reaffirmed that the direction setout in 2002 was still appropriate for future years.
  • In April 2010, the Grampian NHS Board approved a three year Grampian Health Plan which set out the strategy and key priorities for the next three years and beyond. This was based on extensive consultation and many individuals present todaycontributed to the development of this.
  • Many of those who contributed to the consultation of the Grampian Health Plan told us that we need to provide more detail on how the Health Plan will be delivered – this is what the H&CF will do.
  • The development of the H&CF began in October 2010 and will continue to be developed in partnership with the public, local authorities and the third sector. Partnership working is something we do on a day to day basis but we need to continue to improve this.
  • Our strategy strives for a healthy population and when people are ill or require support we need to ensure they receive the right care at the right time, in the right place and by the right person with the right skills.
  • We have numerous examplesof improvements related to Healthfit. Some of you will be aware of the Dental Healthfit event that was held to tackle the poor dental health of the Grampian population - we have since seen a significant improvement of dental health, based on the plan agreed at that event.
  • We should not re-invent the wheel – we have a lot of excellent services and good practice but we need to learn from these and apply this across Grampian as appropriate.
  • The main purpose of the day is outlined in the programme with a number of presentations and time to discuss the emerging H&CF and the key actions to take this forward.
  • The main point of today is to get a group of stakeholders from many areas and organisations to discuss and debate the way forward.

Put Yourself in My Shoes…

David Cameron introduced the first session,advising that delegates would hear two real patient and family stories in relation to their contact with NHS Grampian services. He advised that it is always important to listen and remind ourselves that patients and people are at the centre of what we do.

Dr Cameron stressed that the stories are focussed on peoples experiencesand these individuals did not want to complain or criticise the care they received, but to communicate how they felt about their contact and care. The purpose of these are to set the context of the day and we need to reflect on these throughout the day.

Grampian’s Emerging Framework

Richard Carey, Chief Executive and Dr Roelf Dijkhuizen, Medical Director of NHS Grampian outlined Grampian’s emerging Framework.

Mr Carey opened the session by reflecting on the patient experiences just played and the need for the H&CF. The main points of his speech are outlined below.

  • By sharing these patient experiences reflects the organisations openness and courage to communicate examples of then things go wrong. This reflects NHS Grampian’s values of listening, seeking to improve and caring.
  • We want people to reflect on these patient experiences in your discussion groups and consider how important it is to focus on patient centeredness.
  • Our work and systems need to aspire to meeting the needs of the individual and we need to accept that sometimes we don’t get this right, but we need to get it right more often. It will be challenging to focus on individual needs consistently across the system due to the size and complexities internally and particularly when we are working with multiple organisations.
  • There are a number of challenges facing us, such as demographic changes, continuous advances in technology, financial, in addition to the societal challenges affecting communities.
  • NHS Grampian, along with others will have to change and adapt in order to continue to deliver quality, sustainable and affordable services which meet the needs of those we service – this was a clear message from the Health Plan consultation.
  • You also said that leadership, direction and organisational resolve is necessary to make these changes and difficult decisions or we will not be able to continue to deliver quality, sustainable and affordable services to meet future population needs.
  • In developing the H&CF over the last few months, you said that radical change is necessary and it needs to be large scale implementation. We have many good examples of such change which has significantly improved patient outcomes, patient experience and made services sustainable and affordable – examples are mental health and learning disability services, reduced waiting times and increased dental registrations.
  • The Health and Care Framework Discussion Paper circulated prior to event talks about a number of principles that the future system requires to have in order to best manage the many current and future challenges. These are:
  • Integration of health, social and individualised care – how do we get this to happen as this is not just the domain of the NHS. Palliative care packages cover a wide range of people, services and agencies.
  • Better professional integration across the spectrum of care - multidisciplinary team working is critical and the opportunities are endless.
  • Health improvement and health inequalities focus – the NHS speaks a good game on this but we don’t always match up to the rhetoric.
  • Targeting resources to disadvantaged populations should be the focus but this principle will ultimately compromise the provision of universal care which is a difficult message for people to deal with.
  • Replicating good practice – we have a large number of examples of services which deliver high quality, sustainable and affordable care but we recognise these components of good practice are not applied consistently across Grampian and therefore we do not get the level of benefit we should from this. Examples of this are telemedicine in emergency care and to island populations, Maud Resource Centre and the proposed AberdeenHealthVillage where resourcesare for communities and not just health service delivery and community access to specialist care.
  • David Cameron in his opening address said that we are not starting from nothing, we have already achieved a significant amount since the Healthfit vision was developed in 2002.
  • We need to also be realistic in that there will be no additional resources for sometime, therefore we create our own certainty on how things are done and improved and part of that will mean a greater focus on need.
  • Although this is a challenging time for all, with this comes opportunities which will bring with it many positive changes. So far I sense that many of those who have contributed to the development of the H&CF process are ready for the challenges ahead and see the potential benefits for patients.

Dr Dijkhuizen focussed in his presentation on the key messages that could be learned from the patient experiences that were shared with the audience. The emerging framework will build on the good components of care and eradicate the areas where care was not so good.