Highland NHS Board
2 October 2007
Item 6.4

DELIVERING CARE, ENABLING HEALTH: A REVIEW OF PROGRESS BY NHS HIGHLAND AGAINST THE NATIONAL NURSING, MIDWIFERY AND AHP STRATEGY

Report by Heidi May, Board Nurse Director

The Board is asked to:

  • Note the current progress against the National Strategy.

1Introduction

In November 2006 the Chief Nursing Officer and the Chief Health Professions Officer published the national Nursing, Midwifery and AHP (NMAHP) Strategy – Delivering Care, Enabling Health. The Strategy responds to the policy direction set out at the time in Delivering for Health (SEHD 2005a), reflecting the principles of the Kerr Report (2005). It builds upon the vision described in Caring for Scotland (SEHD 2001a), the strategy for nursing and midwifery, and Building on Success (SEHD, 2002), the strategy for AHPs reflecting the populations changing profile and health needs.

The Strategy presents actions around 3 key themes:

  • Culture and Context – setting Delivering for Health as the new policy for health care in Scotland and defining the underlining principles of NMAHP practice
  • Capability – describing the NMAHP contribution to meeting the needs of Scotland’s population
  • Capacity – considering the extent and competency requirements of the NMAHP workforce necessary to meet the challenges of the future.

2Progress Report

The first progress report against the Strategy has been submitted by NHS Highland to the Chief Nursing Officer. The report was informed by the lead AHP, midwives and nurses of NHSHighland using examples of local initiatives and good practice. The report demonstrates clearly the significant contribution that midwives, AHPs and nurses in Highland make to the delivery of patient focused, quality care. Highland has a green rating for all the objectives marked this time for a progress report by the Chief Nursing Officer. Progress pan-Scotland against the Strategy will be benchmarked and published towards the end of the year. The Chief Nursing Officer has advised that 6 monthly reviews will be requested from the Boards.

3The Future

NHS Highland is now completing the development of its own local NMAHP Strategy, reflecting the content of the National Strategy but delivering a locally-focused document, reflecting the objectives of our Clinical Framework and the Local Delivery Plans. It is anticipated that this will be ready for presentation and agreement at the November 2007 Board.

Working with you to make Highland the healthy place to be

4Contribution to Board Objectives

This progress report demonstrates the contribution made by nurses, midwives and AHPs to all of the Board Objectives.

5Governance Implications

This report provides an opportunity for the lead midwives, AHPs and nurses to highlight local successes for staff in order that they may see the benefits of their hard work. In addition to this, the report provides a tool for staff to share good practice across the Board, and for Board Nurse Directors to share good practice pan-Scotland.

It is important to note that the achievements detailed in this report have been achieved within the context of multidisciplinary and multi-agency teams.

6Impact Assessment

Where new policies are developed impact assessment is undertaken as per Board policy.

Heidi May

Board Nurse Director

21 September 2007

1

APPENDIX 1

Delivering care, enabling health
Harnessing the nursing, midwifery and allied health professions’ contribution to implementing Delivering for Health in Scotland
NHS Board nurse directors DELIVERY ACTION PLAN REPORTING TEMPLATE
DECEMBER 2006 – JUNE 2007
Name of Organisation / Contact Person / Email Address / Date completed
NHS HIGHLAND / Heidi May,
Board Nurse Director /
(PA) / 27.08.07

Monitoring of Delivery Action Plan Implementation

Implementation of the actions from Delivering Care, Enabling Health will be monitored by the Scottish Executive Health Department NMAHP Directorate via NHS Board Nurse Directors, NHS Board Lead AHPs, HEIs, NES and other NHS organisations and individuals working within the NMAHP area. Reporting bodies will be required to submit reports on progress to the NMAHP Directorate twice yearly (covering the periods to end June and end December). It is anticipated that as the delivery plan is implemented these progress reports will help identify actions needing review, further development or amendment. The detailed annual report will contribute to a comprehensive report to the Chief Nursing Officer on national implementation, progress and impact in January of each year.

The key below should be used to report on progress and will give a visual indicator of the progress and achievements within local organisations whilst highlighting more challenging areas or areas that require more support. Only report on progress of the recommendations that your organisation is responsible for delivering on.

Implementation
RED / Little or No Progress, Will Miss Timescale
AMBER / Ongoing, But May Miss Timescales
GREEN / Task On Course and Due to Meet Timescales
Task Completed

monitoring report

Action / NHS Board Nurse
Directors
Working with / Timescale / Current Status
1. / Caring is the essence of nursing and midwifery practice, and enabling is at the heart of allied health professionals’ practice.
Caring and enabling must be valued equally with technical competence within NHS Boards.
  • Job profiles for nursing and midwifery posts reflect caring and technical competence requirements.
/ NHS Board Human Resources departments / End 2007 / GREEN
  • Patient satisfaction with caring and enabling elements of NMAHP services consistently demonstrated through formal and informal surveys.
/ NHS Board Human Resources departments / End 2007 / GREEN
Report of Progress / achievements / challenges / proposed plans
  • Governance arrangements are in place to monitor patient satisfaction on an ongoing basis, managed through the Clinical Governance Department. Reports are regularly submitted to the Board and also the Professional Forums feeding back with regards to patient complaints, identifying trends in order that specific action plans can be put into place to address these.
  • Patient satisfaction surveys are well established in NHS Highland. Examples include recent surveys of patient satisfaction in the Respiratory Nursing Service in Oban, a Case Management Survey in the Argyll and Bute CHP and Diabetes Services. All showed a high level of satisfaction and results are available in the evaluation reports. Other recent surveys include the NHS Highland Stroke Unit and the Community Rehabilitation Services
  • The Podiatry Service in NHS Highland is currently developing a Patient Satisfaction Survey, which once piloted and if successful will be rolled out across AHP services. This is being monitored through the Area AHP Committee.
  • Another recent initiative includes the auditing of thank you letters and gifts to staff to reinforce high standards of care delivery. Patient comment cards are also in use across NHS Highland. These ensure timely feedback from patients to specific areas where local action plans can be put into place to improve the patient experience
  • Patient and public involvement is given the highest priority in NHS Highland to ensure that the patient, public and carers are provided with appropriate forums to be involved in the delivery and shaping of services. Governance arrangements are in place in Highland to ensure patients carers and the public’s voice can be heard in service planning and delivery systematically. Two examples of this are the Maternity Services Liaison Committee and the newly established Steering Group for the review of Neurology Services. Through supporting patient, public and carer leadership in NHS Highland, a culture of services being responsive to patient need is becoming well established.
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  • Through the Agenda for Change process job profiles for AHPs, midwives and nurses now reflect the caring and enabling and technical competencies required of posts. These are reinforced, assessed and monitored through the KSF / PDP process
  • All qualified AHPs are registered with the HPC and adhere to their ethical framework in addition to professional standards that are also relevant to support workers. Job profiles reflect this.
  • NHS Highland works jointly with the Universities of Sterling and Paisleyto reinforce and explore the caring aspects of nursing and midwifery both in the classroom and during practice placements. A high standard of mentorship is required from Highland staff ensuring that students learn through example and role modelling the importance of caring and enabling. The patient experience is central to the pre-registration nursing and midwifery curriculum and how students can contribute to this is again explored fully in both the classroom and on practice placements. The NHS Highland Practice Education Facilitators (PEFs) play a pivotal part in ensuring appropriate and robust practice placements for students, focusing on the caring and enabling aspects of both care delivery and the management of students. The PEFs have recently developed a set of local NHS Highland Practice Placement Standards which we expect all Team Leaders and Charge Nurses to comply with, again ensuring that all aspects of excellent care delivery are addressed.
  • NHS Highland runs the NiCHEand SVQ training programmes for Support Worker staff. Key to these programmes, and embedded in their curriculum is an emphasis on the caring and enabling aspects of care delivery. NHS Highland has an excellent track record in the development of highly competent and caring Support Worker staff which arguably is reflected in the constant number of these staff who go on to undertake their nurse training.

Action / NHS Board Nurse
Directors
Working with / Timescale / Current Status
2. / The core values of nursing, midwifery and allied health problems must underpin the practice of every NMAHP and should drive models of care that promote positive and equitable engagement with patients, families and carers as the central focus for practice.
A values-based approach must be central to the delivery of nursing, midwifery and AHP services. / GREEN
  • NHS Board strategies for service delivery and workforce development reflect a values-based approach.
/ NHS Boards
Local education providers / End 2008 / GREEN
Patient satisfaction with values-based elements of nursing, midwifery and AHP services consistently demonstrated through formal and informal surveys. / Line managers and professional leads / 2006 ongoing / GREEN
Report of Progress / achievements / challenges / proposed plans
Please also see examples of achievement given in No.1.
  • A values based approach to the delivery of care underpins all care delivery in NHS Highland, and is reflected in the NHSH NMAHP Strategy. A high quality Leadership Development Programme is in place (recently acknowledged as an example of excellent practice by the RCN in 2007) ensuring that the clinical leaders of the organisation role model the approach to care delivery, patient involvement and patient focus required by staff in NHS Highland. For our AHP leaders we have also recently accessed the National Change Weavers Leadership course which has been evaluated very positively. Through this development the use of appraisal to recognise, encourage and document values based activity is promoted.
  • Dignity and respect are core values held by NHS Highland staff. With the recent amalgamation with Argyll and Bute the opportunity has arisen to review local Privacy, Dignity and Respect policies and combine these into a Pan Highland Policy for all staff. The staff currently undertaking the Leadership Development Programme have been given this piece of work to undertake, to both reinforce the importance of a values based approach to care and also to facilitate learning around influencing and Pan Board clinical governance. This piece of work is identified in the NHSH Nursing Midwifery and AHP Clinical Governance Plan, in place to support the Highland Clinical Governance Plan and focusing on the professional caring and values based approach to care delivery.
  • Care Aims is well established in NHSH and training has been provided across all AHP services. Care Aims provides a model of intervention that puts the patient at the centre of all decision making and respects the patients wishes whilst empowering them to take responsibility for their own care. Care Aims is currently being piloted in nursing services.
  • An AHP led project has led to the development of a website with information on both AHP and nursing services that outlines our values based approach to care as well as giving information on how and why services are delivered.
  • The Hospital Chaplaincy and Spiritual Support Service is led by the Associate Nurse Director. This service supports the delivery of care to patients, carers and significant others, helping to meet their spiritual and emotional needs. The Chaplaincy staff are ever present in the organisation providing invaluable one to one support to patients and carers and to staff too. The team have been pivotal in the development of the Liverpool Care Pathway model adopted by NHS Highland for end of life care, and are currently undertaking a specific piece of work looking at a values based approach to care in specific services.
  • NHS Highland values highly the role that carers have to play in the delivery and shaping of care and an inclusive approach is promoted within the organisation. NHSH works closely with Voluntary organisations such as the MS Society to ensure that carers voices and needs are heard. A recent example of this is the provision of paid physiotherapy support to a local Voluntary Services Led patient and carer support group in the North of Scotland.
  • Speech and Language therapists have set up communication groups across Highland to support families and carers, partners and volunteers in their work with patients. Similarly patients, carers and the public have been closely involved in the redesign of SLT services to ensure a patient focused approach to care.
  • Argyll and Bute has a Carers Networking Board in place. A training programme for carers has been developed collaboratively between AHPs, nurses, carers and volunteers. Training resources have been identified and prepared for each topic to be covered, and the first pilot was run between May and July this year in Lochgilphead, delivered by a range of social and health services staff from the locality. In addition to this a training day is being organised for professionals aimed at raising awareness of the needs of carers across all organisations.
  • The nurse led Partners in Change project in Argyll and Bute has focused on delivering improvements in care and involvement for individuals with Multiple Sclerosis. Supported by the MS Society and the specialist services at the Southern General Hospital, education programmes for individuals, families and professionals have been delivered and models for practitioners with specialist interest in MS have been developed (The role of Nurse with Specialist Interest is currently being reviewed in Highland and a standard profile developed to ensure consistency and equity pan Highland but also to ensure maximum potential benefit is derived for patients and carers through these roles. This work is being monitored through the Area Nursing and Midwifery Committee.
  • Through our governance arrangements all policies, including AHP, Midwifery and Nursing policies are assessed for equality and diversity. In addition to this all Board papers are required to address the impact of any given proposal/update on equality and diversity. NHSH has an Equality and Diversity Policy in place and actively promotes equality in service provision and seeks to address any gaps in equity of service. Two examples of this are nurse led initiatives to address the needs of the homeless and also our gypsy populations. The success of both pieces of work have been locally and nationally acknowledged.
  • Patients expect to be cared for by professionals, whose practice is competent, safe and effective, and who care about them and who enable their recovery and self care skills; NHS Highland has a very strong and effective working relationship with its local Higher Education Providers (HEP). NHSH and the University of Sterling have recently had their Annual Review of Pre-registration Training and had positive feedback about our performance with the Chief Nursing Officer indicating a favourable report. As well as an excellent standard of pre-registration training NHS Highland provides a comprehensive Continuing Professional Development Programme, including mandatory training and post graduate education and development with our Higher Education Providers. This is in turn supported by a comprehensive PDP process, and if necessary performance management policies and procedures to safeguard the public against poor practice. Monitoring of Professional Registration is undertaken both centrally by the organisation and locally by Lead Nurses, Midwives and AHPs. NHSH has a Local Supervising Authority Midwifery Officer (LSAMO) in place supported by a comprehensive network of Supervisors of Midwives in place to ensure public protection and involvement in service design and delivery. Highland is soon to move towards the delivery of a North of Scotland LSAMO model with interviews taking place at the beginning of September.
  • The provision of accurate information to help patients reach informed, confident and safe decisions is taken seriously by NHS Highland. A Policy regarding consent is in place supported by a centrally managed patient information support service to ensure consistent and accurate standards of written patient and carer information is achieved and available. Written information is provided in different languages to promote equity of service and in turn patients are supported by translation services when these are required. A recent example of patient information developed by the organisation is a leaflet about how to help to reduce the risk of infection when coming into hospital. An example of partnership working with staff and patients to ensure as safe a stay in hospital as possible.
  • Evidence has demonstrated that often people diagnosed with cancer do not know where or how to access further help and support when initially diagnosed. To address information inequalities a Highland wide leaflet was produced by the Cancer Patient Information Group, targeted at newly diagnosed patients to ensure they are signposted to external agencies such as Cancer Backup, CAB, Macmillan, local and national websites and other voluntary organisations. The patient is given the leaflet by the Health Care Professional co-ordinating their care at the time of diagnosis.
  • NHSH has a small but well established multidisciplinary Research and Development Group. The Highland Nurse Consultants are currently undertaking a piece of work to raise the profile of AHP, Midwifery and Nursing research, and attract more research to underpin evidence based practice in Highland, particularly around remote and rural aspects of care. The Board Nurse Director has recently approached Nora Kearney for help and support with the development of a comprehensive NMAHP research strategy for Highland, building on the excellent work already achieved and under way.