Final 25th March 2011
NHS Grampian’s Contribution to Single Outcome Agreements (SOAs)
Introduction
NHS Grampianis a partner in the delivery of three Single Outcome Agreements covering Aberdeenshire, AberdeenCity and Moray. Delivery of the agreement is the responsibility of all Community Planning Partners, as joint signatories. Within NHS Grampian each ofthe Community Health Partnerships (CHPs) has lead authority for this on behalf of NHS Grampian.
Each Grampian Community Health Partnership is different. Priorities for action reflect the needs of the respective populations. This annex, therefore, includes three separate templatesfor each of three approaches to distinct critical issues. Each issue addresses at least one or more of the 4 national priorities:
- Health inequalities
- Early years
- Tackling poverty and socio-economic inequality
- Economic recovery
Health and Care Framework
In 2010, NHSGrampiantook the decision to refresh its strategic approach to health and care: to ensure it was addressing the various demographic and economic challenges optimally; to maximise alignment and delivery of service with the direction of the Local Health Plan, across the three CHPs. Underpinning the evolving framework are general features and assumptions, prerequisites for delivering care which is effective, high quality, sustainable and affordable.The model focuses on health and care. Its development will build on current work with partners: individuals, carers and families, local communities and agencies comprising Community Planning Partnerships.
The following templates are underpinned by our corporate focus, supporting and refining our approaches to health and care; ensuring NHSGrampian and its partners are health improving and inequalities sensitive. This requires us to mainstream tackling health inequalities and improving health within the planning of health and care, supporting sectors and partners to build an increasingly coherent, quality, sustainable and affordable approach.
The Health and Care Framework provides the context for each of the critical issues - Reshaping care for older people in AberdeenCity;Tackling deprivation and inequalities in (Fraserburgh) Aberdeenshire, and Tackling alcohol and drug misuse in Moray. Each of the critical issues will also inform components of the evolving framework to promote health, as well as care, in the community.
Aberdeenshire’s critical issue is a pathfinder within the Health and Care Frameworkfor a targeted community approach to health inequalities. It will inform the ways in which NHSGrampian can articulate a vision for health within the economic and social vision for the community, ensuring the necessary leadership, evidence, action and evaluation to provide confidence in ways forward, milestones in progress and support for partners who are focusing on complementary components of the social gradient. The pathfinderwill provide the focus for further developing anticipatory care and empowering individuals and communities to improve and sustain their health,especially in the identified disadvantaged communities. This is a necessarily ambitious programme and national outcomes include living longer, healthier lives, tackling the significant inequalities in Scottish society; children having the best start and are ready to succeed; taking pride in a strong, fair and inclusive identity, realising our full economic potential with more and better employment opportunities especially those in disadvantaged communities. Local outcomes in support are: improving health and wellbeing through empowerment; reducing harm caused by misuse of alcohol and drugs; ensuring Aberdeenshire’s children have the best start in life; improving quality of life in the most deprived communities; reducing deprivation; and ensuring appropriate skills to meet the future needs of the economy.
Moray’s critical issue will similarly add to the Health and Care Framework and the evolving focus on promoting health in the community. The three Alcohol and Drug Partnerships (ADPs) in Grampian benefit from the overarching leadership of the Director of Public Health, and each balances its particular priorities according to local need, as a matter of emphasis rather than as a unique approach. Moray moved quickly to review and restructure following publication of Changing Scotland’s Relationship with Alcohol: A Framework for Action, forming one of Scotland’sfirst Drug and Alcohol Partnerships. The Moray ADP links formally to the Community Planning Partnership through clear roles, responsibilities, accountability arrangements, priorities and resources between partner organisations. In support of the national outcome for longer, healthier lives, Moray’s local outcome is reducing the impact of alcohol and substance misuse.
AberdeenCity’s critical issue also addresses health as well as care, and reflects the overall ambition of the Health and Care Framework to address the complex health, demographic and fiscal challenges of an aging population. In support of the national outcome for longer, healthier lives, and tackling the significant inequalities in Scottish society, AberdeenCity’s local outcome is to improvepeople's health and well being, promote inclusion and independence. This reflects the partnership's vision of older people as an assetand of a servicefocus on maintaining the physical and mental well-being of older people, anticipating any decline before it becomes acute.
Performance Management
Performance management arrangements within each CHPhave developed to meet the individual needs of that CHP whilst being in line with the NHS Board’s overall performance management framework and that of the individual local authorities. Each CHP has a performance scorecard linking the CHP to delivery of NHS Grampian’s strategic themes and corporate objectives. The scorecard is used to review performance by the Chief Operating Officer.This integrated approach ensures that SOA commitments are reviewed with targets specific to NHSGrampian.CHP management participate fully in the NHS Grampian’s Operational Management Team and Cross System Performance Review process which ensuresprogress in line with plans and targets. The Board’s Performance Governance Committee receives assurance on performance from the Chief Executive and Chief Operating Officer and in turn reports to the NHS Board. As part of NHS Grampian’s Assurance Framework Performance Governance Committee also receives a risk based performance template from each CHP Committee following each of its meetings.
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NHS Board Local Delivery Plan 2010/11 —Contributions to Single Outcome Agreements
Please refer to the Guidance Notes prior to completing the template.
1. / NHS Board: / Grampian
2. / Community Planning Partnership: / AberdeenCity
3. / Summary of critical issue: / Reshaping Care For Older People - the principal policy goal for the Reshaping Care for Older People Programme is to optimise independence and wellbeing of older people at home or in a homely setting. The implications of the current financial situation and the demographic changes make this a challenging task / critical issue, as improved services and or support need to be provided for an increasing number of people using a diminishing level of resources. Therefore transformational change is necessary to achieve and sustain better outcomes for older people. The aim is to work in partnership to shift the focus of care from institutional to community/ home settings while improving quality, value and outcomes through cohesive partnership working across health and social care and between statutory and non-statutory bodies. This will result in older people and their carers feeling safe and valued, receiving timely and responsive care, support leading to improved mental health and wellbeing, a greater ability to self manage and better anticipatory care, leading to better quality of life for older people, a reduction in avoidable emergency admissions and reduction in bed days through more effective acute and community care. ( T6, T12, )
4. / Community Planning Partnership Outputs: / To address the issue the CHP is currently preparing for submission to the Scottish Govt via The Aberdeen City Alliance and the CHP Committee, a Change Plan.
The City CPP Partnership Agreement for Reshaping Care For Older people in Aberdeen (2010 – 2013)
To be included in the SOA and CHP Delivery plan
In response to Towards a Mentally Flourishing Scotland an Aberdeen City Action plan is being progressed.
A Dementia Action Plan is being developed locally in line with Mentally Healthy in Later Life, using the Keep Well model to move things forward in a co-ordinated way
Promoting financial Inclusion – Cash In Your Pocket Partnership - income maximisation advice being made available through Keep Well programme
5. / Local Outcome(s): / Shifting the focus from services, towards supporting people to retain and maximise their independence e.g. establish over 65’s Sports Games – June 11
To see older people as an asset not a burden
To improve the overall health, wellbeing and independence of the people of Aberdeen City through focusing on the factors that are harmful to health and wellbeing and in particular by supporting those most vulnerable. Anticipating any decline before it becomes acute
Increase in proportion of older people living at home
Increases in housing related support
Improved support for unpaid carers
Workforce to become more rehabilitation focused
To provide a range of more integrated community-based services to support older people to live safely in their communities for longer.
6. / National Outcome(s): / We live longer, healthier lives
We have tackled the significant inequalities in Scottish society
Shifting the Balance of Care
7. / Please detail the specific contribution of the NHS Board in tackling this critical issue? / The HealthVillage focusing on wellness rather than illness – community health and care
Supporting the redesign of NHSGrampian Medicine for the Elderly
Shifting the balance of care through the review of long-term conditions
Implementation of self care / anticipatory care initiatives
Primary Care redesign and GP care home alignment
Submission of ‘ Change Fund ‘ template to Scottish Government. Local Implementation Lead appointed.
8. / Please illustrate the ways in which the NHS Board is working in collaboration with Community Planning Partners to tackle the critical issue? / Single Shared Assessment for access to care services – electronic version being piloted in Grampian
Utilisation of Fairer Scotland Fund and HIF fund to support ongoing initiatives
Participation and support for the CPP Strategic Review to agree joint priorities
AberdeenSportsVillage providing Keep Well health checks and ‘well being’ circuits to support life style changes – all ages
Aberdeen Partnership Update News letter - (ACC/CHP)
Jointly funded Programme Development Manger CHP / City Council (Health & Social Care).
Joint Balance of Care Programme- to work on 7 key works streams looking at Shifting the Balance of Care Agenda - (ACC/CHP/NHSG)
Integrated Strategic Management Team - (Chair ACC Dir. Social Care & Wellbeing /CHP/Acute / Mental Health)
Joint Rapid Improvement Workshop – first one held Jan 2011 - involved Supported Discharge Service, Rapid Response Service, and Hospital Discharge and resulted in an agreement to provide a single joint team by Autumn 2011
Mental Health Improvement training for informal cares
Support to establish community based outdoor gyms suitable for older people
9. / Please explain how the NHS Board is performance managing its contribution to tackling this critical issue? / Community Care Outcomes Framework (Quarterly and Annual reporting)
Covalent monitoring of SOA
HEAT Framework and CELs
Health and Care Framework
Local Cross System Performance Reviews
NHSGrampianand sector balanced scorecards
CHP Delivery Plan Performance Review
National Bench Marking
10. / Please explain how the NHS Board will demonstrate continuous improvement in the course of tackling this critical issue? / In line with NHSGrampian’s culture of Continuous Service Improvement a range of CSI methodologies will be applied e.g. A3 Thinking, PSA, Process Mapping to define current state and future desired state
Releasing Time To Care Programme - (productive community model) - to maximise patient/client ‘facing time’. Aberdeen first pilot in Scotland
Data and information collection and evaluation at critical stages
F3391487
NHS Board Local Delivery Plan 2010/11 —Contributions to Single Outcome Agreements
Please refer to the Guidance Notes prior to completing the template.
1. / NHS Board: / Grampian
2. / Community Planning Partnership: / Moray Community Health & Social Care Partnership
3. / Summary of critical issue: / The impact of alcohol and substance misuse in Moray.
Alcohol and drug misuse is a complex issue which severely impacts on the lives of individuals, families and communities. How we reduce the risk of serious preventable ill health is critical to improving the life circumstances and life expectation of those who live in Moray.
Alcohol misuse is a significant problem in Moray in terms of the number of people misusing and the harm caused to death. The number of acute inpatient discharges in Moray largely mirrors the national trend. Moray has seen an 8.9% increase in numbers since 2003/04, with a discharge rate of 625 per 100,000 (2007/08).
In the under 15 year age category, the rate of discharges in Moray (80 per 100,000) was twice that of the national average. Data suggests that there is an increasing trend in the number and rate of alcohol misuse among middle and older age groups, which may be due to the larger population in those age groups.
In Moray a significantly higher proportion of males die due to alcohol related causes. A report published in 2007, comparing all alcohol related deaths from 1998 -2004 placed Moray 14th out of 426 local authority areas in the UK, and 11th in Scotland.
Grampian Police statistics for the period 2005/06 to 2007/08 show on average 58.5% of crimes committed found the accused were either drunk or had been drinking and of the offences committed, serious assault was recorded the highest crime type with 85.5% of the accused found to have been drinking prior to carrying out the assault.
Within Moray there is a wide range of premises operating liquor licences across the area, the majority of which are on-sale. When comparing the proportion of on-sale and off-sale licences in Moray with the national average, Moray has a larger number of licences in force per 10,000 (population aged 18 and over) on both counts.
The 2006 SALSUS report suggested that young people in Moray feel their parents are more accepting of them drinking at home compared with the national average.
Thus, adding to supporting evidence that there are significant cultural and behavioural issues to address in relation to alcohol consumption Moray.
In relation to drug misuse, heroin is the most commonly reported illicit drug reported by around 76% of new clients in Moray and 68% nationally. There has virtually been no change over the last three years. The next most commonly used drugs are diazepam and cannabis, each reported by around 30-35% of new clients. In Moray the proportion of new clients reporting combined usage of diazepam with heroin has increased by 17% between 2005/06 and 2007/08
A proportion of clients are prescribed drugs for the treatment of drug misuse or dependence. In 2005/06 the proportion in Moray was almost half the national average figure, 23% compared with 45%. Over the next two years, an increase in Moray and a reduction nationally have brought these proportions almost in line, at 34% and 39% respectively.
There is an increase in the number of new clients reporting having injected illicit drugs, the proportion of new clients sharing needles and syringes has nearly doubled over the past three years, from 17% to 30%, while the proportion that reports never having shared needles and syringes has reduced from 61% to 47%. Nationally, the situation has reversed.
Data for drug-related deaths is available from two sources, Grampian Police Sudden Death reports and the Scottish Drugs Misuse Database (SDMD), Drug Misuse Statistics Scotland. Grampian Police have recorded 15 drug-related deaths in the last three full fiscal years in Moray, 2 in 2005/06, 8 in 2006/07 and 5 in 2007/08. The majority are the result of heroin overdose.
In addition to the above Moray is currently facing an economic downturn, the UK Government have reviewed the function and configuration of Defence Services and have made initial announcements that will have direct impact on Moray’s two RAF bases. This will in turn present local consequences and implications in relation to the current and future health and wellbeing of the Moray population.
The Scottish Government’s strategic approach to alcohol and drug issues has been set out in two landmark documents: The Road to Recovery published in May 2008; and Changing Scotland’s Relationship with Alcohol: A Framework for Action, published in March 2009. Moray moved quickly, building on the work undertaken by the Moray Drug and Alcohol Action Team, to review and restructure it’s arrangements to form to what is believed to be Scotland’s first Alcohol and Drug Partnership on 1st May 2009. The MADP formally links to Moray’s Community Planning Partnership and this new structure serves to clarify roles, responsibilities, accountability arrangements, priorities and resources between partner organisations.
NHS Grampian is a member of the MADP.
4. / Community Planning Partnership Outputs: / MADP. Finance & Commissioning