Achieving Excellence - southlanarkshire.gov.uk€¦ · “Achieving Excellence” summarises our...

Achieving ExcellenceA plan for person-centred, innovative healthcare to help Lanarkshire flourish

NH

S Lanarkshire

Ach

ieving

Excellence

March 20

17

MARCH 2017

1Contents

Contents

Foreword 2

1 THECASEFORCHANGEANDLANARKSHIREQUALITY APPROACH 3

2 THECHANGINGHEALTHANDSOCIALCARENEEDSOF THEPEOPLEOFLANARKSHIRE 9

3 THEROLEOFHEALTHANDSOCIALCAREPARTNERSHIPS 17

4 WORKSTREAMSUMMARIES 23

Introduction 24 PrimaryCare 24 LongTermConditions 32 OlderPeople’sServices 35 MentalHealthandLearningDisability 38 AlcoholandDrugs 42 Maternity,EarlyYears,ChildrenandYoungPeople 45 PlannedandUnscheduledAcuteCare 49 OrthopaedicServices 55 CancerServices 64 StrokeServices 68 PalliativeCare 72

5 CROSSCUTTINGSERVICES 75

Pharmacy 76 Property 80 eHealthandDigitalTechnologies 84 Transport 88

6 THEWORKFORCEOFTHEFUTURE 92

7 PLANSFORSERVICECHANGE 99

8 FINANCIALRESOURCES 104

9 LISTENINGTOYOURVIEWS 107

GlossaryofAbbreviations 111

2 Achieving Excellence: Healthcare Strategy

Foreword

ItisfiveyearssinceNHSLanarkshirepublished“AHealthierFuture–AFrameworkforStrategicHealthPlanning”whichsetoutaroutemaptoimprovethequalityoftheservicesweprovide,whilealsosettingoutourplansformeetingthefuturehealthneedsoftheLanarkshirepopulation.

Inthattime,wehaveseenimportantchangesinthewayinwhichhealthandsocialcareisplannedanddelivered.Theneedsofthepopulation,andthewayinwhichclinicalservicesareprovided,havealsomovedon.So,in2016NHSLanarkshirerevisedandrefreshedtheHealthcareStrategy,lookingtothefuturehealthcareneedsofthepopulation.Ourvisionistoensuretheseservicesaresafe,effective,person-centredandsustainable.

OuraiminLanarkshireistodevelopahealthcaresystemthatsupportsthedevelopmentofanintegratedhealthandsocialcaresystemwhichhasafocusonprevention,anticipationandsupportedself-management.Withtheappropriateuseofhealthandcareservices,wecanensurethatpatientsareabletostayhealthyathome,orinacommunitysetting,aslongaspossible,withhospitaladmissiononlyoccurringwhereappropriate.

During2015and2016,LanarkshireNHSBoardcollaboratedwithpatients,carers,staffanditspartnerstorefreshthevisionastohowservicesshouldandcouldchangeoverthenexttenyears.Werecogniseandacknowledgethevaluableroleplayedbycarersandthisisreflectedinourambitionsforthefuture.

Wecarriedoutathree-monthconsultationonthecontentofthedraftHealthcareStrategy.Thereweresomestrongthemeswhichcamefromtheconsultation,forexamplewithrespecttosupportingcarersandimprovingtransportlinks,andtheseledtochangestothestrategy.Asummaryofthatconsultationanditsconclusionsisdescribedinsection9,andisreflectedinsignificantrevisionstothestrategydocumentitself.

“AchievingExcellence”summarisesourfutureplans,whichwillplayanimportantroleinimprovinghealthandsocialcarealongside-andintegratedwith-thetwoStrategicCommissioningPlansforHealthandSocialCareNorthLanarkshireandSouthLanarkshireHealthandSocialCarePartnership.OtherkeyinfluencesonthisworkarebothTheNationalClinicalStrategyforScotland,andtheHealthandSocialCareDeliveryPlan,bothpublishedbytheScottishGovernmentin2016.Thekeystagestoimplementingtheseplansaredescribedinsection7.

OurforemostambitionistoensurewearesuccessfulinturningthisstrategyintopositivechangesforthecommunitiesofLanarkshire.

Finallywewouldliketothankthosewhohavehelpedshapethestrategy,thepeoplewhorespondedtotheconsultation,andthemanystaffinvolvedindevelopingtheworkstreams.

Mrs Neena Mahal, Chair of Lanarkshire NHS Board

Councillor Harry McGuigan, Chair of North Lanarkshire Joint Integration Board

Councillor Jackie Burns, Chair of South Lanarkshire Integration Joint Board

3Foreword

TheCaseforChange

1


THECASEFORCHANGE

IntroductionInScotland,justasintherestofthedevelopedworld,healthandsocialcareservicesarefacingarisingtideofdemandwhichisdrivenbydemographicchanges,advancingmedicalscienceandnewtechnologies,atatimeofconstrainedresources.Aspeoplelivelonger,healthylifeexpectancyisnotadvancingatthesamepace.Thismeansthatwewillhavemorepeople,manyofwhomareolder,livingwithmultiplelong-termconditionsandoftencomplexneeds,whowillbereliantonsupportandinterventionfromhealthandsocialcareservices.Ifwedonotchangeourapproachbyshiftingthebalanceofcareawayfromacutehospital-focusedcaretoonewherethereisagreateremphasisonpreventionandcommunity-basedintervention,thenNHSLanarkshirewouldneedanadditional500acutehospitalbedsby2025–equivalenttoafourthdistrictgeneralhospitalinthecounty.Thisisnotachievable,affordableordesirablegiventhatthepeopleofLanarkshirehaveclearlystatedthat1,whereitissafetodoso,theywouldliketoreceivetheircareathome.

Thesecircumstancesmeanthatallpublicsectorservicesneedtoadaptandinnovateinordertoensurethatthehigheststandardsoftreatmentandcarecontinuetobedelivered.ScottishGovernmenthascommissionedanumberofstrategicreviews,includingtheChristieCommission2;theHealthcareQualityStrategyforScotland3;EveryoneMatters:2020WorkforceVision4,theNationalClinicalStrategyforScotland(2016)5;theHealthandSocialCareDeliveryPlan6andtheCarers(Scotland)Acttoprovidearoadmaptosupportfuturepublicservicereformsthatensuresafe,effective,person-centredandsustainableservicesaredeliveredthroughaworkforcethathastherightskillsandcompetenciesandisabletoachievethebestpossibleoutcomesforourpatients.

AimOuraiminLanarkshireistodevelopahealthcarestrategythatsupportsthedevelopmentofanintegratedhealthandsocialcaresystemwhichhasafocusonprevention, anticipation and supported self-management. With the appropriate use of health and care services we can ensure that patients are able to stay healthy at home, or in a community setting, as long as possible, with hospital admission only occurring where appropriate.

Thishealthcarestrategyisonepartofatrilogyofplans,withessentialco-dependenciesbetweenthisandtheJointStrategicCommissioningPlansproducedbytheNorthandSouthLanarkshireHealthandSocialCarePartnerships(HSCPs).TheChiefOfficersoftheHSCPsandNHSLanarkshireareco-authorsofthisstrategy(seesection3formoreinformation).

Theplansarebasedontheassessedneedsofourcommunitiesandaredesignedtoensurethattherightmixandvolumeofservicesaredeliveredtobestmeetthechangingneedsofourpopulation.Atthesametimeasfocusingonlocalpriorities,theLanarkshirehealthcarestrategywilltakefullaccountoftheNationalClinicalStrategyandtheHealthandSocialCareDeliveryplanwhichsetouttheprinciplesthatwillunderpinclinicalservicechangesacrossScotland.Futureservices,locallyandnationally,willhave:

1

5The Case for Change

• system-widedriveforimprovementacrossdiseaseprevention,earlyprofessionalintervention,supportedself-careandimprovedrehabilitation

• primarycarewithamoreprominentrole,treatingmorepeoplewithouttheneedtorefertohospital

• secondarycareorganisedin‘centresofexcellence’andnetworksofhospitalsprovidingspecificclinicalservices(asopposedtoallclinicalservicesasatpresent)thusmakingbestuseofskilledstaffandspecialisedfacilitiesandequipmenttoproduceexcellentoutcomes

• anewclinicalparadigmwhichwillensurethatpatientvalueisenhancedbyproceedingwithminimallydisruptive,realisticmedicine.

LanarkshireQualityApproachNHSLanarkshireiscommittedtodeliveringworld-leading,high-quality,innovativehealthandsocialcarethatisperson-centred.Ourambitionistobeaquality-drivenorganisationthatcaresaboutpeople(patients,theirrelativesandcarers,andourstaff)andisfocusedonachievingahealthierlifeforall.ThroughourcommitmenttoacultureofqualityweaimtodeliverthehighestqualityhealthandcareservicesforthepeopleofLanarkshire.

Ourfocusonqualityisnotnew,butsometimesithasmeantdifferentthingstodifferentpeople.WehavethereforedevelopedaStrategicFrameworkcalledtheLanarkshireQualityApproach.Itwillunderpinalloftheworkthattheorganisationdoes.Itwillensurethatthedecisionstheorganisationtakes,theservicesweprovideandthewayinwhichinwhichwedoso,alignwiththevaluesatitscore.Thismeansthatwhenweplanandredesignourservices,theorganisation’skeyprincipleswillinformanychangeswemake.ItprovidesthestructureandvaluestodrivehealthcareimprovementssuchasthosedescribedinthisStrategy.

PeopleattheHeartofourApproachTheLanarkshireQualityApproachsetsoutcorevaluesandprinciplesandwillensurethesereflectouraimtoprovideassurancetothepublic,theBoardandMinistersthatasaqualityorganisationwedemonstrate:

• Acaringandperson-centredethosthatembedshighquality,safeandeffectivecare

• Thatwecontinuallystrivetodothebestindividuallyandcollectively• Thatweacceptindividualaccountabilityfordeliveringaservicetothebest

ofourability• Thatweareresponsivetochangingculture,expectationsandneeds

QualityDrivenAimsWehaveidentifiedfourstrategicaimstoachieveourvision,whichhaveaspre-requisitecriteriatheNHSScotlandQualityStrategyambitionsofbeingperson-centred,safeandeffectivealongwiththerequirementtoimproveefficiencyandtoachievefinancialsustainabilitybydoingtherightthing,ontimeandwithinbudget.Thesestrategicaimsare:

• toreducehealthinequalitiesandimprovehealthandhealthylifeexpectancy• tosupportpeopletoliveindependentlyathomethroughintegratedhealth

andsocialcareworking


• forhospitaldaycasetreatmenttobethenorm,avoidingadmissionswherepossible

• toimprovepalliativecareandsupportendoflifeservices

Ourunderpinningqualityambitionsaretodeliverperson-centred,safeandeffectivecare.Forusthismeans:

• person-centred–mutuallybeneficialpartnershipsbetweenpatients,theirfamilies,carersandthosedeliveringhealthcareserviceswhichrespectindividualneedsandvaluesandwhichdemonstratecompassion,continuity,clearcommunicationandshareddecisionmaking;

• safe–therewillbenoavoidableinjuryorharmtopeoplefromthehealthcaretheyreceiveandanappropriatecleanandsafeenvironmentwillbeprovidedforthedeliveryofhealthcareservicesatalltimes;

• effective–themostappropriatetreatments,interventions,supportandserviceswillbeprovidedattherighttimetoeveryonewhowillbenefitandwastefulorharmfulvariationswillbeeradicated

Webelievethatoursharedpursuitofthesethreequalityambitionswillmakesignificantandpositiveimpactsonefficiencyandproductivityandthroughthiswewillsecurebothimprovedoutcomesforthepeopleweserveandfinancialsustainabilityfortheorganisation.

OurValuesItisnotonlywhatwedothatisimportant;thewaywedothingsalsomattersenormously.TheNHSLanarkshirevaluesofFairness,Respect,WorkingTogetherandQualityunderpinourpurpose,providinglocalfocusandcontextfortheimprovementofourservicesandguidingourindividualandteambehaviours.Forusthismeans:

• Fairness:Ensuringclearandconsideratedecisionmakingatalllevels• Respect:Valuingeveryindividualandtheircontribution• Quality:Settingandmaintainingstandardsineverythingwedo• Working Together:Thinking,growing,deliveringasateam

Howwillwegetthere?Wearecommittedtoestablishingaconnectedinfrastructurethatsupportstheorganisationtodeliveronitsambitionofputtingqualityattheheartoftheorganisation.Thecomponentsofthisinfrastructureinclude:

• Leadership and Behaviours–Tobringtheculturetolifethequalityambitionsmustbedemonstratedindaytodaybehaviours“fromboardroomtothepatient”.Wewillensurethatleadersatalllevelsintheorganisationareempoweredtoworkinthisway

• Improvement and innovation–Wewilluseaconsistentapproachtoimprovementthroughouttheorganisationthatreflectallstagesoftheimprovementjourneyandapplytocontinuousdailyimprovementaswellaslarge-scaletransformationalchange

• Communications and Engagement–Tosupportourapproachwewillimplementacomprehensivecommunicationandengagementplaninordertopromoteourorganisationalpurposeandqualityambitionsanddevelopevenfurtherourpartnershipwithpatients,thepublic,staff,professional

7The Case for Change

advisorycommittees,localauthorities,generalpractitioners,generaldentalpractitioners,thirdandindependentsector,carerorganisationsandelectedrepresentatives

• Information–Wecollectarangeofdataontheservicesweprovide.ThisinformationcansupportustomeasurehowtheStrategicFrameworkisbeingappliedtogivetheBoardconfidencethattheorganisationisplanninganddeliveringwithintheaspirationsoftheFramework

• Knowledge and skills–Wewantourstafftobethemostcaring,knowledgeableandskilledworkforceinScotland.Wearecommittedtoensuringstaffareprovidedwiththeappropriateknowledge,skillsandconfidencetodeliverhighqualityservicesonadaytodaybasisandatthesametimecontinuouslyimprovethoseservices.

Thesethemesareintendedtoillustrateareasofactionthatwillenableustoachievetheculturalchangesneededtosustaintheorganisationwithqualityatitsheart.

Insummary,theLanarkshireQualityApproachprovidesaclearoutlineofthevision,mission,valuesandobjectivesofourorganisation.Itisimportantthatweareclearwithourselvesandothersaboutourvisionandthekeyvaluesandobjectiveswebelievewillenableustodelivergoodquality,person-centredcare.InordertoprovidethisclaritywehavedevelopedavisualisationoftheLanarkshireQualityApproachasshownbelow.

TheLanarkshireStrategicFramework


References1 NHSLanarkshireOnlinesurvey,20162 CommissionontheFutureDeliveryofPublicServices.Edinburgh:Scottish

Government,2011.3 TheHealthcareQualityStrategyforScotland.Edinburgh:Scottish

Government,2010.4 EveryoneMatters:2020WorkforceVision.Edinburgh:ScottishGovernment,

2013.5 ANationalClinicalStrategyforScotland.Edinburgh:ScottishGovernment,

20166 HealthandSocialCareDeliveryPlan.Edinburgh:ScottishGovernment,

2016

9The Changing Health & Social Care Needs of the People of Lanarkshire

TheChangingHealth&SocialCareNeedsofthePeopleofLanarkshire

2


THECHANGINGHEALTH&SOCIALCARENEEDSOFTHEPEOPLEOFLANARKSHIRE

PopulationProfile

ThepopulationofLanarkshireis654,490with338,260peoplelivinginNorthLanarkshireand316,230inSouthLanarkshire.

Figure1outlinesthepopulationbyagegroupandbyhealth&socialcarepartnershiparea.Therearemorepeopleagedlessthan65yearslivinginNorthLanarkshirewhencomparedtoSouthLanarkshire,whereasmorepeopleaged65yearsandoverliveinSouthLanarkshirewhencomparedtoNorthLanarkshire.

Figure 1:PopulationofNHSLbyagegroupandhealthandsocialcarepartnershipareas

Thetotalpopulationisexpectedtoincreasebyonly1%by2025.

Using2014dataasabaseline,figure2overleafillustratesthattherewillbefallingnumbersofpeopleagedunder65yearsandmorepeopleaged65andoverinfutureyears.

2.1

2

5599,,332222

113300,,114411

9933,,669955

3311,,554433 2233,,224499

5511,,227755

111144,,332244 9922,,115533

3322,,009999 2255,,550099 0

50,000

100,000

150,000

200,000

250,000

300,000

0 to 14 15 to 44 45 to 64 65 to 74 over 75

More North

More North

More North

More South More South

North H&SCP Population = 337,950South H&SCP Population = 315,360

Total Population = 653,310


Figure 2:Predictedcumulativepopulationchangefrom2014to2020and2025byagegroup

BirthandDeathRatesandLifeExpectancyinLanarkshire

BirthsTherewere6,901babiesborninLanarkshirein2015.Thisnumberwillfalloverthecomingdecade.TheoverallbirthrateinLanarkshirewas56.5birthsper1,000womencomparedtotheScottishbirthrateof53.9.

DeathsTherewere7,121deathsrecordedinNHSLanarkshireresidentsin2015.ThereisconsiderablevariationindeathratesacrossthedifferentlocalitiesinLanarkshire,whichlargelyreflectsdifferencesindeprivationlevels.

Deathsratesfromtheso-called‘bigkiller’diseasesofcancer,coronaryheartdisease(CHD)andstrokecontinuetofallbutstillcausedalmosthalfofalldeathsin2015.

Individually,cancer,CHDandstrokewereresponsiblefor29%,12%and7%respectivelyofalldeathsinLanarkshire.Respiratorydiseasewasalsoasignificantcauseofdeathin2015,beingresponsiblefor14%ofalldeaths.

Whilethereissomeevidenceofimprovementindeathratesforcancer,CHDandstroke,thedeathratesforrespiratorydiseaseinLanarkshireremainssignificantlyhigherthanthatforScotland.Itisestimatedthattherewillbeanincreaseintheincidenceofallcancersby33.5%by2027,mainlyasaresultofthepopulationgrowingolder.

2.2

574

-12,598

3,064 6,349 8,165

5,554

-1,498

-15,179

-4,399

11,009

18,646

8,579

-20,000

-15,000

-10,000

-5,000

0

5,000

10,000

15,000

20,000

25,000

0 to 14 15 to 44 45 to 64 65 to 74 over 75 Total

2020 change 2025 change

Cumulative Change from a 2014 Baseline

REDUCING

INCREASING


2.3

LifeexpectancyAsisthecaseacrossScotland,lifeexpectancycontinuestoincreaseinLanarkshire.AmaleinfantborninLanarkshirein2012couldexpecttoliveto75.8yearsofage,whileafemaleinfantcouldreasonablybeexpectedtolivetobe80.0yearsold.Thisrepresentsanincreaseacrossa10-yearperiodof2.9yearsformalesand2.1yearsforfemalesinLanarkshire.However,lifeexpectancyisstillbelownationallevels;bothmalesandfemalesinLanarkshireliveonaverageayearlessthanothersinScotland.

Therearesignificantinequalitiesinlifeexpectancyforthoselivinginsomeofourmostdeprivedareaswhencomparedtoourleastdeprivedareas.Forexample,lifeexpectancyforamanlivinginoneofourmostdeprivedcommunitiesis68.2yearscomparedwithalifeexpectancyof81.1yearsformenlivinginoneofourmostaffluentcommunities.

Key Points

• TheNHSLanarkshiretotalpopulationisexpectedtoincreasebyonly1%by2025

• Therewillbefewerchildreninthefuturepopulation• Therewillbefewerpeopleofworkingageinthefuture• Theelderlypopulationwillbegrowingatthefastestrateinthefuture–

whilegreatlywelcomed,thispopulationwillproportionatelyneedmosthealthcareresources

• Theover75spopulationisexpectedtogrowby11%by2020and29%by2025

• ThegrowthratefortheelderlypopulationishigherinLanarkshirewhencomparedtoScotlandasawhole

• LifeexpectancyisincreasinginLanarkshire• ThelifeexpectancygapbetweenLanarkshireandScotlandisnotclosing• Therearestarkdifferencesinthelifeexpectancyofthoselivinginourmost

deprivedareascomparedwiththeleastdeprived

InequalitiesandSocialIssues

TheLanarkshirepopulationprofileispoorerthanthenationalaverageformanyindicators.Forexample,NHSLanarkshireissignificantlyworsethantheaveragefor:

• smokingattributabledeaths• deathsfromalcoholconditions• childrenlivinginpoverty

Thereareexceptions,however,suchasthenumberofpeoplewithhighlevelsofneedbeingcaredforathome,childdentalhealthinprimaryschoolandimmunisationuptakefor‘5in1’vaccinationat24monthsinwhichNHSLanarkshireisbetterthanthenationalaverage.

Thelinkbetweeninequalitiesandpovertytopoorhealthhasbeenfirmlyestablished.Inequalitiesleadtopoorerhealthandincreaseddemandsuponclinicalservices.


Lanarkshirehasmanychallengestoface.Forexample,20%ofpeopleinLanarkshireliveinoneofScotland’smostdepriveddatazones;thereare1,440looked-afterchildreninLanarkshire.

Inequalitiesgobeyondsocio-economicdeprivationissues.Thereare,forexample,particulargroupsinourcommunitiessuchashomelessandtravellingpeoplewhoexperiencepoorerhealthoutcomes.

TheworkoftheHealthandSocialCarePartnerships(HSCPs),theCommunityPlanningPartnershipsandofpeopleintheircommunitiesisvitalinaddressinginequalitiesandisinextricablylinkedtothesuccessofthisstrategy.DetailedanalysisofthisworkcanbefoundinbothNorthandSouthLanarkshireHSCPs’respectiveStrategicCommissioningPlans.

Key Points

• ThehealthconsequencesofpovertyarewelldocumentedandNHSLanarkshirefacesmajorchallengestodeliverhealthcareduetolevelsofpovertyandinequalitieswithinitscommunities

• NHSLanarkshireanditspartnerswillstrivetodeliverservicesthatareresponsivetoneedsandthatcontributetothereductionininequalitiesinhealth.

TheAgeingPopulation

Asdescribed,wewillseemorepeoplesurvivingintooldage,oftencontinuingtocontributetoourcommunitiesascarers.Itwillbetheroleofourhealthandsocialcareservicestosupportpeopleastheygrowoldertohelppeopletomaintainanactiveandenjoyableoldage.However,thiswillmeanwewillhavetoadapttheseservices.Diseasessuchasdementia,hipfractures,Parkinson’s,strokeandfrailtygenerallyhaveastrongagecorrelation.Inaddition,multi-morbidities(thepossessionofmorethanonechronicdisease)areincreasinglycommonamongstolderadultsleadingtoincreasedvulnerabilitytoacuteillnessaswellasariskofdependenceordisability.

Forthecaresector,impairedhealthresultingindisabilitycanleadtoincreaseddemandsoncareathomeoradmissionstolongtermcare.

Sustainingservicestopromotehealthyageing,activesocialinvolvement,managementofacuteillness,rehabilitationandultimatelypalliationmustbedonewiththepatientandcareratthecentreandwiththeaimofmaximisingahealthy,engagedandindependentoldage.

Figure3providesanindicationofthedistributionofthoseadultslivingwithlongtermconditions(LTC)byagegroup.

2.4


2.5

Figure 3:Relationshipbetweenaperson’sageandnumberoflong-termconditions

Key Points • ThepeopleofLanarkshirewilllivelonger,buttheburdenofdiseasein

laterlifewillincreasetheproportionofpeoplewithlong-termhealthconditions.

• Theageingofthepopulationpresentspotentiallythesinglebiggestchallengetothehealthandcaresectorinthefirsthalfofthe21stCentury.

SignificantRiskFactorsandIssues

Therisktoindividualsofdevelopingthemajorlife-threateningillnesses(cancer,coronaryheartdiseaseandrespiratoryillness)canbereducedbynotsmoking;beingahealthyweight;beingphysicallyactive;drinkingwithinrecommendedlevelsofalcohol;andmaintainingahealthydietandgoodmentalhealth.

TobaccoTobaccosmokingremainsthemostsignificantpreventablecauseofillhealthinLanarkshire,accountableforapproximatelyonequarterofalldeaths.

SmokingprevalenceinLanarkshireis21.3%comparedtothenationalaverageof20.2%withmalesandallagegroupsnotsignificantlydifferentfromtheirrespectiveScottishaverages.

ObesityApproximately65%ofadultsinLanarkshireareoverweight(includingobese).Theproportionofadultswhowillbeoverweight(includingobese)willbe87.5%by2050.

Distribution of LTCs in Lanarkshire by age band in 2013/14

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0–4

5+ LTCs

4 LTCs

3 LTCs

2 LTCs

1 LTC

0 LTCs

85+75–8465–7445–6425–4415–245–14


ThepercentageoftotalNHSspendingonobesityrelatedconditionssuchasType2diabetes,heartdiseaseandstrokewas9%in2015andisexpectedtoriseto12%by2050.

Significanteffortsarerequiredtocreateenvironmentsthatsupportgoodhealthbypromotinghealthiereatingandincreasinglevelsofphysicalactivitytoreducenumbersofoverweightandobesepeople.

AlcoholandSubstanceMisuseLevelsofalcoholconsumptioninLanarkshire,asintherestofScotland,arefalling.Fewerpeopleareexceedingweeklydrinkingguidelinesandtheaveragenumberofmeanunitsconsumedisfalling,bothformenandwomen.Whilethisisawelcometrend,itdoesmaskagreatertendencyinLanarkshirethanintherestofScotlandtoexceeddailydrinkingguidelines.

Therateofdeathsdirectlyattributabletoalcohol-relatedcausessuchasliverdiseasecontinuestobehigherinLanarkshirethaninScotlandoverall,andisofparticularconcerninNorthLanarkshire.Theoutcomesforhealthissuesrelatedtoalcoholanddrugusearealsoworseindeprivedareas.Similarly,themajorityofdrug-relateddeathsoccurinareaswiththegreatestlevelsofmultipledeprivation.

MentalHealthandLearningDisabilitiesThereisnohealthwithoutmentalhealth:everypartofthehealthandsocialcaresystemisrequiredtoplayamoreactivepartinimprovingthementalhealthandwell-beingofthepeopleofLanarkshire.

Oneinfiveadultswillhavementalhealthcareneedsatsomepointintheirlife.Itisestimatedthatthereare10,000peoplewithdementialivinginLanarkshireandthatapproximately17,000peoplemayhavealearningdisability.Thenumberofpeoplewithlearningdisabilitiesislikelytogrowby14%by2021:advancesinmedicalscienceandcaremeanthatmanymorepeoplewithlearningdisabilitiesarelivinglonger,morefulfilledlivesthanhaseverbeenthecasebefore.

ImprovementsarebeingmadeinLanarkshirewithfewerpeopleself-reportingcommonmentalhealthproblemsandmoreself-reportingimprovedlevelsofwellbeingandlifesatisfaction.Themodernisationprogrammeinmentalhealth,whichinvestedacrossthevarioustiersofserviceprovision,hasresultedinthedeliveryofmorepreventionandearlyinterventionprogrammes,improvedaccesstoself-help,socialprescribing,groupbasedandtelephonesupportandenhancedaccesstocommunitybasedmentalhealthandpsychologicaltherapyservice.


Key Points • Smokingisreducing,butremainsamajorcauseoflife-threateningillness• Increasingobesitywillimpactonbothhealthandsocialcare• Alcoholandsubstancemisusepresentsmajorchallengesforthedeliveryof

healthcare• Significanteffortisrequiredtopromotegoodmentalhealthandwell-

beingandprovidesupportstopeoplewithmentalillhealthoralearningdisability

WhatWillSuccessLookLike?

LifeexpectancyformenandwomentobesimilartothatoftheScottishpopulation,withthegreatestimprovementamongthoselivinginourmostdeprivedareas

SmokingprevalencetocontinuetoreduceandachievethesamelevelastherestofScotland

ToworkwithCommunityPlanningPartnerstoreducethenumberofchildrenlivinginpovertyto,atleast,theScottishaverage,withspecificfocusonthosewhoaremostdeprived

ToachievetheScottishaveragefortheprescriptionofdrugsforanxiety,depressionandpsychosis

ToimprovethemeanmentalwellbeingscoreasmeasuredbytheScottishHealthSurveytothatofthenationalaverage

ToworkwithScottishGovernmentandCommunityPlanningPartnerstoreducethepredictedrateofincreaseinthepopulationwhoareeitherobeseoroverweight

Toenablethosewithlongtermconditionstomanagetheirconditionsinthecommunityandreducetheirrelianceonacuteservices.

17TThe Role of Health and Social Care Partnerships

TheRoleofHealthandSocialCarePartnerships

3


3 THEROLEOFHEALTHANDSOCIALCAREPARTNERSHIPS

IntegrationofhealthandsocialcareistheScottishGovernment’sprogrammeofreformtoimproveservicesforpeoplewhouseadulthealthandsocialcareservices.ThePublicBodies(JointWorking)(Scotland)Actwasgrantedroyalassenton1April2014.Thatmeanschangestothelawwhichrequirehealthboardsandlocalauthoritiestointegratetheseservices.TheActisalandmarkadulthealthandsocialcarereformforScotlandandisthemostsubstantialreformtothecountry’snationalhealthservicesandsocialcareservicesinageneration.

OneofthemainaspectsofthePublicBodies(JointWorking)(Scotland)ActistocreatestatutoryIntegratedJointBoardsineachlocalauthorityareareplacingCommunityHealthPartnerships(CHPs).1April2015markedtheconclusionofahighlysuccessfulerainthedeliveryofcommunityhealthservicesinLanarkshire.Astheintegrationofhealthandsocialcarecameintoeffect,therespectiveNorthandSouthLanarkshireIntegratedJointBoardssupersededLanarkshire’sNorthandSouthCommunityHealthPartnerships(CHPs).

Thereareninenationaloutcomesthatprovideaframeworkformeasuringtheimpactofintegratedhealthandsocialcareonthehealthandwellbeingofindividuals:

1 Peopleareabletolookafterandimprovetheirownhealthandwellbeingandliveingoodhealthforlonger

2 People,includingthosewithdisabilitiesorlongtermconditionsorwhoarefrail,areabletolive,asfarasreasonablypracticable,independentlyandathomeorinahomelysettingintheircommunity

3 Peoplewhousehealthandsocialcareserviceshavepositiveexperiencesofthoseservices,andhavetheirdignityrespected

4 Healthandsocialcareservicesarecentredonhelpingtomaintainorimprovethequalityoflifeofpeoplewhousethoseservices

5 Healthandsocialcareservicescontributetoreducinghealthinequalities6 Peoplewhoprovideunpaidcarearesupportedtolookaftertheirown

healthandwellbeing,includingtoreduceanynegativeimpactoftheircaringroleontheirownhealthandwellbeing

7 Peoplewhousehealthandsocialcareservicesaresafefromharm

TheScottishGovernmentVisionforHealthandSocialCareIntegration:‘Ensuring better care and support for people where users of health and social care services can expect to be listened to, to be involved in deciding upon the care they receive and to be an active participant in how it is delivered. This will result in better outcomes for people, enabling them to enjoy better health and wellbeing within their homes and communities.’


8 Peoplewhoworkinhealthandsocialcareservicesfeelengagedwiththeworktheydoandaresupportedtocontinuouslyimprovetheinformation,support,careandtreatmenttheyprovide

9 Resourcesareusedeffectivelyandefficientlyintheprovisionofhealthandsocialcareservices

TheIntegratedJointBoardsarethebodiesthatareresponsibleforplanningandhaveoperationaloversightofintegratedcare.Theywilldecidewhichintegratedserviceswillbeprovided,howtheywillbefundedandwhattheyshouldlooklikeandwilldirecttheNHSBoardandlocalauthoritytodeliverthoseservices.Theywillreportannuallyagainstprogresstowardstheninenationaloutcomes.

ThetablebelowdescribeswhichLanarkshireserviceswillbedeliveredorcommissionedbytheHSCPs.

Figure 4:ResponsibilitiesofthetwoHSCPsinLanarkshire

Communitybasedhealthservices

Hospitalbasedhealthservices

Communitybasedsocialworkservices

•AlliedHealthProfessionals(inanoutpatientdepartment,clinicoroutwithahospital)

•CareHomeLiaisonservice•CommunityAddictionservices•CommunitybasedGeriatricMedicine•CommunitybasedPaediatrics•CommunitybasedPalliativecare•CommunityChildren’sHealthservices•CommunityLearningDisability

services•Continenceservice•Diabetesservice•Dietetics•DistrictNursing•GPoutofhours•HealthandHomelessness•HealthVisiting•MentalHealthandLearningDisability•Ophthalmicservices•Pharmaceuticalservices•PrimaryCareAdministration•PrimaryCareoutofhours•PrimaryMedicalservices•PrisonerHealthcare•Psychology•PublicHealth–HealthImprovement•Public,GeneralandCommunity

Dentalservices•Sexual&ReproductiveHealthand

BloodBorneViruses•TraumaticBrainInjury

•Accident&Emergency(A&E)

•GeneralMedicine•GPInpatientservices•Hospitalbased

Addiction/Dependenceservices

•HospitalbasedGeriatricMedicine

•HospitalbasedMentalHealthservices(includinglowsecureforensics)

•HospitalbasedPaediatrics

•HospitalbasedPalliativeCare

•OccupationalHealth•Physiotherapy•Podiatry•Psychiatryof

LearningDisability•Rehabilitation

Medicine•RespiratoryMedicine•Speechand

LanguageTherapy

•Addictionservices•AdultProtection•AdultswithDisability

andLongTermConditions

•CareHome•CarersService•CommunityCare

AssessmentandPlanning

•ContractedSupportservices

•Dayopportunitiesanddayservices

•EquipmentsandAdaptations,Technology,EquipmentandTelecare

•HealthandWellbeingimprovement

•Homecareservices•Housingsupport

(someaspects)•IntermediateCare

service•MentalHealth

services•Occupational

Therapy


Coretotheethosofintegrationisamovetowardslocality-basedplanning,providinglocalitieswiththeautonomytoidentifyprioritiesandshiftresourceswithinacoherentstrategiccontextandwithdueregardtoclinicalandprofessionalgovernance.LocalityprofileshavebeendevelopedaspartoftheJointStrategicNeedsAssessment,providinganassessmentofactivity,demandandresourcewithineachofthetenrecognisedlocalities,sixinNorth(Airdrie,Bellshill,Coatbridge,Motherwell,North-Cumbernauld,KilsythandtheNorthernCorridor-andWishaw),fourinSouth(Clydesdale,HamiltonEastKilbrideandCambuslang/Rutherglen),supportingtheidentificationofkeyactionstoenablethedeliveryofbetteroutcomesforthepeopleofLanarkshire.

ThevisioninLanarkshireistodevelopanintegratedmodelthatwillputthepersonatthecentreofdecisionsabouttheirtreatmentandcare,withgreaterunderstandingandconfidencetomanagetheirowncondition,takingcontroloftheirlifeandhavingtheirvoiceheard.Thiswillbesupportedbyeducationandgroupprogrammes,harnessingtherangeofthirdsectorandcommunityassets,anticipatorycareplanningandgreateruseoftechnology,preventingordelayingtheneedtousemoreintensiveservices.Wewillpromotetheuseofanticipatorycareplanswhichenableindividualstodeveloparecordofwhattheywouldlikecareproviderstodofollowingaclinicaldeteriorationintheirconditionoracrisisintheircareorsupport.Thisproactiveapproachaimstopreventtheneedforformalservicesarising,buildingresilienceinbothindividualsandcommunities.

Whereformalservicesarerequired,thesewillbeintegratedinlocalities,removinghand-offsandservicebarriers.Theintegratedmodelwillsupportpeopletomaintaintheirhealthandwellbeinginthecommunityortheirownhome,withhospitalservicesonlyrequiredforrealaccidentsandemergenciesandsomeelementsofspecialistcare.Componentsofacutecarewillalsobedeliveredinthecommunity,co-designedandembeddedwithintheintegratedcommunityinfrastructure.

TheobjectivesandprioritiessetoutinthisHealthcareStrategyareonepartoftheoverallprogrammetoimprovethehealthandsocialcareforthepeopleofLanarkshire.TheStrategicCommissioningPlans(SCP)developedbytheHealthandSocialCarepartnerships(workingwiththewidercommunityplanningpartners)formthetwootherkeycomponentsofthisworkanddescribetheactionsthatthePartnershipswillundertakewithinthenearfuturetoimprovehealthandtacklehealthinequalitiestoformtheStrategicCommissioningPlans.

TheSouthLanarkshireIntegrationJointBoard,hasagreedavisionwhichcommitsthepartnershipto“working together to improve health and wellbeing in the community – with the community”.

ThroughthestrategicdirectionoftheIntegrationJointBoard(IJB)therewillbeaconsciousmovetowardscommissioningbasedupontheachievementofbetterpatientandclientoutcomes.


TenemergingprioritiesarereflectedintheSouthLanarkshireSCP:1 Statutoryandcorework2 Earlyintervention,preventionandhealthimprovement3 Carerssupport4 Modelsofself-careandself-managementincludingtelehealthandtelecare5 Sevendayservices6 Intermediatecaretoreducerelianceonhospitalandresidentialcare7 Suitableandsustainablehousing8 Singlepointsofcontact9 Mentalhealthandwell-being

10 Enablerstosupportbetterintegratedworking

Theimplementationplanwillensureallcommissioningintentionsarelinkedtothe9nationaloutcomesandthe10HSCPpriorities.

HealthandSocialCareNorthLanarkshirehasidentifiedthecoreaimofenabling“safer, healthier, independent lives”throughlocality-basedengagementaseriesofcommissioningprioritieswhichwillformthebasisoftheNorthLanarkshireStrategy:

1 Developmentofintegratedlocalityteams;2 Strengtheningrehabilitationwithinthecommunity;3 ReconfiguringSupportatHome;4 BedModeling;5 SelfDirectedSupport;6 UniversalHealthVisitingPathway;7 FamilyNursePartnership;8 Campaignsandmessagingforthepublic;9 Organisationaldevelopmentforstaff;

10 Technicalsolutionsanddatasharingmechanismstoimprovecaredelivery;11 ImplementationoftheCarers(Scotland)Act2016.12 Communitytransport;13 Telehealthandtelecareservicesandsolutionsforpeoplerequiringsupport;14 Communitycapacitybuildingandcarersupport;15 SupportingtheredevelopmentofMonklands.

YoucanfindoutmoreabouttheseplansforNorthLanarkshireathttps://mars.northlanarkshire.gov.uk/egenda/images/att85465.pdf

https://mars.northlanarkshire.gov.uk/egenda/images/att85465.pdf



Preventavoidableadmissionstohospital

Improvetimelydischargefromhospital

Supportmorepeopletoremainathome

Shiftresourcesfromahospitaltoacommunitysetting

23Workstream Summaries

WorkstreamSummaries

4


WORKSTREAMSUMMARIES

Introduction

During2015and2016,LanarkshireNHSBoardaskedserviceleaderstoengagewiththeirpatients,carers,staffandpartnerstosetoutarefreshedvisionofhowtheirservicesshouldandcouldchangeoverthenexttenyears.

ThissectionoftheHealthcareStrategysummarisesthatwork.ThereisparticularemphasisonwhatourprioritiesforimprovementaretoensureweimprovehealthcareoutcomesforthepeopleofLanarkshire.ThisprogrammeforimprovementhasbeendevelopedalongsidetheplanssetoutintheStrategicCommissioningPlansforNorthandSouthLanarkshireHealth&SocialCarePartnerships(HSCPs).

PrimaryCare:ATransformationProgramme

VisionThe future model of primary care in Lanarkshire will help all clinicians to spend more time with their patients, less time on unwarranted bureaucracy and have each professional individually and collectively working to their full potential. It will promote the aims at the core of Scotland’s Quality Strategy. Safe, effective and person-centred care will be delivered within a more collaborative health and social care system, and increasingly shaped at a community level.

Stronger primary care services are essential to: managing future demand; ensuring the success of community-based integrated working; and reducing the healthcare system’s reliance on hospital beds. Multidisciplinary teams in health and social care will work together to meet the assessed needs of patients and it is this multidisciplinary team work which will deliver improved care for the future.

However,thefuturevisionwillonlymeettheneedsofthepopulationandtheserviceifcontinuinginvestmentismadeincommunitybasedservicesandtheentirehealthandcaresystemisbettercoordinated.Wealsowanttopreventillhealthandreducetheburdenofexistingillhealth.Thisrequiresamajorchangeinthesizeandskillsofourworkforce,aswellasmajorchangesinthewaythatpeopleaccessprimarycareservices.

TheimplementationofthisvisionwillbestrengthenedbythecommitmentofScottishGovernmenttospendanadditional£500monprimarycareservicesby20213.

CurrentServicesPrimaryhealthcareprovidesthefirstpointofcontactinthehealthcaresystem.Thismaybewithageneralpracticedoctor(GP),nurse,communitypharmacist,optometrist,generaldentalpractitioner,podiatrist,healthvisitororotherallied

4.1

4.2

4


healthprofessional.Assuch,primarycareisthelargestpartofthehealthcaresystem.

Theaimistoprovideaneasilyaccessibleroutetocare,whateverthepatient’sneeds.Primaryhealthcareisbasedoncaringforpeopleratherthanspecificdiseases.Thismeansthatmanyprofessionalsworkinginprimarycarearegeneralists,dealingwithabroadrangeofphysical,psychologicalandsocialproblems,ratherthanspecialistsinanyparticulardiseasearea.However,therearemanyspecificservicesprovidedinprimarycaresuchasoptometryorcontinenceservices.TheGPisoftenseenastheultimatelyresponsibleprofessional.

AnimportantroleoftheGPisactingasthepatient’sadvocateandco-ordinatingthecareofthemanypeoplewhohavemultiplehealthproblems.Sinceprimarycarepractitionersoftencareforpeopleoverextendedperiodsoftime,therelationshipbetweenpatientandpractitionerisparticularlyimportant.Primaryhealthcareinvolvesprovidingtreatmentforcommonillnesses,themanagementoflongtermillnessessuchasdiabetesandheartdiseaseandthepreventionoffutureill-healththroughadvice,immunisationandscreeningprogrammes.Throughthevarietyofdisciplines,italsoprovidesinputtorareillnessesandcomplexinterventionstopatients,carersorotherhealthprofessionals.

Primarycarealsoactsasaconduittotheopportunitiesforcareprovidedbyspecialisthospital-basedservices,anditistheseinterconnectionswhicharefundamentaltotheeffectivenessoftheentirehealthsystem.TheGPisoftenseenastheroutetomorespecialisedcare.

TheNeedforChangeDemandsongeneralpracticeandprimarycarehaveneverbeengreaterwithprimarycareprofessionalsseeingmorepatientsthaneverwithcomplexhealthissues.Risingpatientexpectationsandpersistenthealthinequalitiesillustratethechallengesfacingprimarycare.Descriptionsofthechallengesatapopulationlevelhavebeenprovidedintheearlysectionsofthestrategy,andwithoutchangethesechallengescannotbeaddressed.Thereiscurrentlyasignificantandincreasingdifficultywithworkforceandresourcecapacitywithintheprimarycaresectorandwithoutchangethecurrentarrangementswillnotdeliverontherequirementsofthepopulationorthesystem.Thisishappeningnowandisevidencedbyshortagesofcliniciansinanumberofareasandadeterioratingperformanceonaccesstoprimarycare.

Atpresent,generalpracticeandinparticulartheGPisexpectedtoprovideservicestoallthosewhoareorbelievethemselvestobeunwell.Thisisunsustainable.

Thechallengesdescribedwithin‘RealisticMedicine’1needtobeaddressed.ThisreportresonateswiththeNationalClinicalStrategywhichcallsforanewclinicalparadigmthatadoptstheleastinvasiveordisruptiveprocessesasafirststep.Thisisbothachangeofmind-setandachangeofserviceprovision.Thiswilloftenmoreappropriatelyincludelifestyleinterventionsbeforedrugsandoperations


aswellasabetterunderstandingofthelimitationsofanyintervention.Wewantpatientstoremainincontroloftheirownillnesses.

Weneedtoavoidunwarrantedvariationinstandardsofcareandavoidwastefulinvestigationsandtreatmentsthatdonotaddvalueforpatients.Qualityimprovementisoneofthekeystounlocktheproductivityofprimarycare.

TheScottishGovernmenthassetoutanambitiousvisionforhealthandsocialcaretoenableeveryonetolivelonger,healthierlivesathomeorinahomelysettingby2020.Primarycareisattheheartofthisvisionandismostpeople’sexperienceoftheNHSmostofthetime.Tomeetthisambitionatatimeofincreasingdemand,weneedtochangethewaythatprimarycareoperatesbycreatingteamsofhealthandcareprofessionalsworkinginpartnership.

Whilstlifeexpectancyisrising,healthylifeexpectancyisnotrisingsorapidlyandsotheneedforillhealthcareincreases.Sustainabilityforthesystemcanonlybedeliveredwhenthehealthylifeexpectancyincreasesandwhenthepopulationareempoweredtotakeamuchmoreactivepartintheirowncarewhentheydobecomeunwell.Thisrequiresresourcemuchearlierinthehealth/illhealthcontinuum.

WhatWillChangeThepresumptionthattheGPaloneisresponsibleforallhealthcareoutsidehospitalwillchange.Thewaythiswillchangeislikelytobemadeclearerinthe2018andthe2020GPcontractreviews.ThesechangeswillbemanagedbytheHealthandSocialCarePartnerships(HSCPs)inNorthandSouthLanarkshire.

Self-managementwillincreasinglybeseenasasensibleoption.Thisistrueforlongtermconditionsandshorterdurationillness.Self-managementshouldnotbeconsideredaninferioroption:itisadesirablehighqualityinterventionwithanevidence.Itdoesrequireadequateresourcing,andisacost-savingoption.

Also,theassumptionthatallcomplexcarehastobedeliveredinahospitalwillcontinuetochange:therewillbeincreasedintheclinicalskillsacrossawidevarietyofhealthcareprofessionalsinprimaryandcommunitycare.Thisideaismentionedalotin“AchievingExcellence”,butisdeliveredinprimarycare.Thestrategicdirectionsoutlinedacrossotherpartsofthisdocumentare


fundamentallydependentonthechangesinprimarycarebeingeffective.

Hospitalcareremainsasanimportantelementoftotalhealthcare.Thechangeaswemoveforwardisthatonlythosewhoneedtobeinhospitalwillbeinhospital.Theservicesprovidedinhospitalwillbebetterabletodeliverontheserequirements(seesection4.8).

Asaresultofthis,ourapproachtoprimarycarewillsupportGPsandotherhealthprofessionalstoworktogethertoenablethesustainabledeliveryofhighquality,safeandeffectivepatientcarethatisintegratedwherenecessarywithaccesstohospitalbasedserviceswhenrequired.Thiswillinevitablyincludeagreaterfocusonself-care,supportedself-managementandjoined-upcareforpeoplewithmultipleconditionsandcomplexneeds.ItalsorequirescontinueddevelopmentofITsystems,laboratoryandinvestigationaccess.Assuch,wearedependentonnationalaswellaslocalchanges.

Asresponsestothe2016consultationemphasised,peoplewanttobeathome;theyalsogetonbetterathome.Therefore,thereneedstobeamechanismbywhichtheproportionofhealthandsocialcarespendingonprimaryandcommunitycareisincreasedinrealterms.

Transportisanimportantconsideration.Transportationofpatientstoroutineappointmentsviathepatienttransportservicehastraditionallybeenonlytoplacesdesignatedashospitals.Formoreinformationonhowwewilldothisseesection5.4.

“AchievingExcellence”dealswiththehealthandsocialcarecontributiontothelivesofourpeople.Itwouldbewrongtoignorethevastcontributionmadebyunpaidcarers,thevoluntarysectorandthepaidcarerstohealthcare.Furtherdevelopmenttoallowtheseservicestocontributetoaneverincreasingextentandinapersoncentredwayisessentialtomakesenseoftherestofprimarycare.

Prescribinginprimarycarewillbedevelopedtoensuremaximumbenefitsforpatientoutcomes,whileavoidingwastage.Wastageincludesunused,unwanted,ineffectiveandunnecessarymedications(seemoreinsection5.1).

Localityteams,includingGPs,willbeconfiguredtoco-ordinateandmanagecomplexclinicalconditions;thiswillspeedupaccessandimproveoutcomes.

Threeadditionalthemeswillformpartofourchanges:healthimprovementmodelswillbeimplementedtodelivertheninenationalhealthandwellbeingoutcomes;therewillbegreateruseofdigitaltechnologiestoimprovesafety,efficiencyandeffectivenessofclinicaldecisionmaking;wewillsupportleadershipforchange,qualityandefficiency.

Recentimprovementsinthequalityofurgentout-of-hoursprimarycarewillbesustained,withclearlinkagesbetweentheseservicesandotheremergencycareservices(hospitalemergencydepartments,NHS24,ScottishAmbulanceService).TheHSCPswillcommissionUrgentCareServices(out-of-hours)thatdeliversafe,effectiveandsustainableservicesinaccordancewiththeIndependent


ReviewofUrgentPrimaryCareServices2.Thenewmodelwillbedevelopedandimplementedtosignificantlyimproveaccesstoarangeofin-hoursservicesandtoprovideimprovedcollaborativeworkingtoprovideurgentcareinthecommunitythatrequiresaresponsebeforethenextroutinecareserviceisavailable.

There are multiple initiatives being employed to implement some of these changes, many of which are collected together as the Primary Care and Mental Health Transformation Programme. Some of these are described below.

HouseofCare(HoC)TheHouseofCareProgramme(HoC)describesaframeworktoenhancethequalityoflifeforpeoplewithlong-termconditions(LTCs),nomatterwhattheirconditions.ItisbeingintroducedcurrentlywithinLanarkshireacrossanumberofpracticesandteams.BylisteningtotheexperiencesandfeedbackfrompeoplecopingwithLTCs,itisevidentthattheindividualneedstobeatthecentreofhowcareisdesignedandimplemented.(Seesection4.3).

Personalisedcarewhichunderstandsandsupportstheindividualisvital.Thereisnomagicbulletwhichwillsupportthedeliveryofpersonalisedcarebutthereisevidencethatthinkingsystematicallyabouttheessentialcomponentsdoes.

TheapproachprovidesthebuildingblocksthatneedtobeinplacetoenablecareandsupportplanningtotakeplaceasthenewnormalcareforeveryonewithoneormoreLTCs.TheHoCprovidestheplanningtoolforbothacommunity-widesteeringgroupandforapracticebasedteamtouseastheyredesigntheirservicesandisalreadybeginningtotransformthinkingacrossthewholehealthsystem.Strategically,HouseofCareisoneexampleofanimportanttransformativewayofworkingandcanbeseenasamodelofchangeacrossmanypartsofthesystem.Itcoordinatesdeliveryofcare,concentratesonwhatisimportanttothepatient,encouragesself-careandmakeslinkstothewidernetworksofsupport.Itmaybecomeastrategicleaderinoursystem.Allofthisis


consistentwiththeotherpartsof“AchievingExcellence”andwiththeHealthandSocialCareDeliveryPlan3,whichcommittedanadditional£23mtosupportthesenewmodelsofcareacrossScotland.

PharmacistsinPracticesPharmacistsareexpertsinmedicationandintroducingpharmacistsintopracticesettingsshouldassistinqualityimprovementandreleasetimeforotherprofessionalstodeliverontheirspecialistareas.Pharmacistsbegantobeintroducedandtheirimpactassessedin2016.Thelearningfromtheearlyphaseswillbeusedtoextendthisin2017andbeyond.

MentalHealthTransformationScottishGovernmenthasfundedourmentalhealthtransformationplanwhichwilllinkupandsupportthecaredeliveryinmanywaysclosetopracticesandatanearlystageinthepatientjourney.Wewillmeetthementalhealthneedsofpeoplewithotherill-healthproblems.Fromapatient’spointofview,thiswillimproveboththedeliveryofcomplexmentalhealthinterventionsandtheabilitytoreducethedurationofimpactofproblemswithinamentalhealthfield.

WebGP/eConsultThisinitiativeusesinnovativeprocessesalreadyusedinEngland,andisbeingtriedinLanarkshiretoencouragepatientsaccessingtheirpracticetoaccessservicesofallkindsviaadigitalroute.Thiswillincludeemailbasedconsultations.Thishasthepotentialtobringpartsofprimarycareintotheheartofthedigitalage.Itwillbeimplementedfrom2016-2018whereappropriateforindividualpatientsandtheirmedicalcondition.

Therearealsoinitiativesinleadership,useofIThardwareandsoftware,recruitmentandretentionofGPs,andnewdeliveryofpsychologyserviceseachofwhichareofsignificantimpact,butwhenappliedtogetherhavethepotentialtocreatesignificantchange.

Takentogether,thesechangesarerequiredtoprovidebetteraccesstoappropriatecliniciansandothersandenablemanymorepeopletoself-manage(withgoodsupport).Thewholesystemimpactofthisapproachwillreducethepressureonhospitalswhilstexpandingtherangeofcareavailableincommunityandprimarycare.

WhenWillItChange?Asdescribed,somestrategicchangesarealreadyhappeningaspartofthetransformationprogramme.Additionally,thissectionwithintheHealthcareStrategyrepresentsasummaryofworkstartedin2015andcontinuedinto2016.Wewillcontinuetousethislargerbodyofworkfrommanystakeholderstodriveourimprovementsoverthecomingyears.Theprogrammeforimprovementtimescaleissupportedbychangesin2018tothecontractualarrangementsforgeneralpracticebeingledbytheScottishGovernmentandkeystakeholders,andontheworktobesetoutintheStrategicCommissioningPlansoftheHSCPs.


Thelikelymilestoneswillbe:

Phase 1:2016–2018Testsofchangeinpreparationfor2017contract:EmbeddingthestructuresandopportunitiesfromintegrationofHealthandSocialCarePartnerships.Developmentofnewrolesforhealthandcareprofessionalstoenablethemtodeliverawiderrangeoftreatmentsandinterventions.

Phase 2:2018–2020/2021ImplementationofsubstantialchangesrequiredbynewGPcontract.Thisworkwillleadtowidespreaduseofnewroleswithmoreintegratedworking.Wewillimplementworkforceplanstoprovidestaffwhohavetherightskillsandcompetencestomeetchangingpatientandcarerneeds.

Phase 3:2020–2025Consolidationandcompletionofspreadofsuccessesof2018contractandnewservicemodelsusingtheevidencefromthetest-of-changetodemonstrateimprovedaccess,betteroutcomesandenhancedpatientandcarerexperience.

ThestrategicchangeswillcontinuetobeledbythestrategiccommissioningplansoftheHSCPs,theirimplementationplansandtheoutputsfromthetransformationprogramme.

ThetimetabledescribedhereisinrelationtochangesdrivenonaScotland-widebasis.Thereisalsoaneedtodeliverbefore2018substantialchangetoprimarycare.Thecontractualchangescannotlimittheimmediatelyrequiredchangesacrossthewholesectorwhicharealreadydevelopingatpace.


References1 ChiefMedicalOfficer’sAnnualReport2014–15;ScottishGovernment,2016.2 Pullingtogether:transformingurgentcareforthepeopleofScotland;

ScottishGovernment,20153 HealthandSocialCareDeliveryPlan;ScottishGovernment,2016


Betterclinicaloutcomesforpatients

Speedieraccesstoacareprofessionalwiththerightskillstomeetthepatientneed

Designofcarebuiltaroundneedsandaspirationsofpatientsandcarers

Patientsgoingtohospitalonlywhenthatisthebestplacetomeettheirneedsasmorecarewillbedeliveredat(orcloserto)homewithbetterpatientandcarerexperienceofourservices

Improvedlinkagestostreamlinethepatientjourneyacrosscareboundaries,includingprogressonasingleelectronicpatientrecordtosupportclinicaldecisionmakingwhereverthepatientreceivestheirtreatment

AsustainablelongtermfutureforgeneralpracticebuiltaroundthenewGPcontract,withasmallerGPworkforceworkingaspartoflargermultidisciplinaryteams

Asustainablelong-termfutureforcommunitybasedservicesbuiltaroundavarietyofprofessionalsworkinginthemultidisciplinaryteamswithwiderskills

Greaterself-managementbasedonbetterinformationforpatientsandtheircarersenablingmorechoiceandoptionsforcare

Saferandmorecost-effectiveprescribinganduseofnewertechnologiestosupportallofthesesuccessmeasures.

Reducedneedtoaccesshealthcarebutwhenneededaccessinallitsformsincludingtransportsupportisimproved


LongTermConditions

Vision We will provide integrated care – care that brings general practice and community services closer and crosses the boundaries between primary and community, hospital and social care. We will provide a full range of services for people with long-term conditions (LTCs) in the form of high quality, comprehensive community health care and, when necessary, hospital care. Active and early interventions to prevent the onset of worsening conditions, coupled with more effective management of people living with LTCs, will be pivotal to improving health and wellbeing outcomes for the population.

CurrentServicesServicesforpeoplewithlong-termconditionstendtofocusonasingleconditionmanagementapproachanddonotalwaysconsidertheperson’smultipleconditionsorthepersonasawhole.Existingservicesareprovidedacrossacuteandprimarycareservicesanddonotalwaysmeettheneedsofpeopletoallowthemtoliveasindependentalifeastheywouldwish.

TheNeedforChangeServicesinthefuturewillneedtochangebecauseof:

• AnincreaseinthenumberofpeoplelivingwithLTCs(someofwhichcanbedelayedorprevented)

• advancesinhealthtechniquesandtreatmentsmeanthatpeoplearelivinglongerliveswithlongtermconditions

• increasesinthenumberofpeoplelivingwithcomplexcareneeds(morethan3or4LTCs)

• thehealthneedsoftheLanarkshirepopulationisgreaterthanthenationalaverageformanyindicatorsofhealthinequalities

• patientshavingagreaterexpectationofhealthcare• challengesinavailableworkforcecreatingplanning,retentionand

recruitmentchallenges

WhatWillChange?Theproposedapproachhasbeendesignedasamodelofcarewhichtakesaccountoftheimportanceofmaintainingpeople’swellbeingandprovidingcare,supportandtreatmenttopreventanydeteriorationorexacerbationoftheircondition.Thisintegratedmodelofcarewillbesupportedbythedevelopmentofpathwaysofcarewhichcontainclearthresholdstoassistinstrengtheningawhole-personapproachtothemanagementofthecomplexcareneedsofpeoplewithseveralchronicandlong-termconditions.

• Peoplewillhaveaccesstoarangeofhighqualityservicestomeetphysicalandpsychologicalhealthneeds,aswellaswelfareservicestoprovideawellinformedandsupportiveadvice,support,careandtreatmentservicewithsign-postingtoalternativeorganisationstoensuresupportisavailable.

4.3


• ThefuturemodelwilldemonstratethatwehavelistenedtopatientswhouniversallysaythattheywishtobetreatedasawholepersonandfortheNHSandsocialcaretoactasoneteam,supportingpeopletoremainintheircommunitieswiththeappropriateinfrastructureofsupport.

• Futurecaremodelswillfurtherimproveservicesforthosepeoplewhohavemorethanonecondition,particularlyadultsandolderpeople,whomayhavepreviouslyfacedanincreasinglyfragmentedresponse.

• Theneedsofpeoplewithlong-termconditionsgobeyondtheorganisationalboundariesofsocialcare,GPs,primarycareandhospitalcare.Thefuturemodelofcarewillreplacethecurrentsystemwhichfeelsdisjointedforindividualpatients,islackingcontinuityandthatevidencesuggestsoftenleadstopooreroutcomesandincreasedhospitaladmission.

Key Point

Amodelforcommunitypractitionershasbeendevelopedtomeettheneedsofthefuturecommunityhealthservicesmodel.Thiswillrequirethecurrentnursesandalliedhealthprofessionalstoworkinnewwaysanddeveloparangeofskillstomeetthechangingneedsoftheirpatients,creatinganenhancedrangeofaccessibleserviceoptionsforpeopletoimprovetheopportunitiestodelivercarewithincommunities.Thefuturemodelwillbefacilitatedbyrobustinformationsystemstosupportthesenewmodelsofcaredelivery.

Wewillprovidesupportatarangeofpoints:1 Asolidfoundationofpopulation-wideprevention,healthpromotionand

targetedhealthimprovementactivity,throughactiontopreventdisease,raiseawarenessofriskstohealthandsupporthealthylifestylechoices.ThiswillinvolveeducationacrosstheagespectrumtobothpreventandreducetheimpactoflongtermconditionsonthepeopleofLanarkshire.Thisisessentialgiventhehighprevalenceoflongtermconditionswhicharepreventable,andthehealthinequalitiesassociatedwithlivingwithlong-termconditions;

2 Self-careandsupportedmanagement,wherepeoplewithlongtermconditionsaregiventheinformationandotherpracticalsupporttheyrequiretomanagetheirownconditionsinawaythathelpsthemusethisinformationtotheirownbenefitwithconfidenceintheirknowledgeoftheirconditionandwhatsupportisavailable;

3 Conditionmanagementinwhichagreaterlevelofprofessionalsupportisrequiredtohelpmanagetheircondition(s)andavoidcomplicationsorslowtheprogressionofdisease;and

4 Forthosewithparticularlycomplexcareneedswhorequiremorefrequentandanintensivelevelofcare,oftenreferredtoascaremanagement,aproactiveandco-ordinatedapproachtoimprovetheirhealthcircumstances,helppreventdeteriorationwherepossibleandmanageexacerbationsandcomplicationsoftheircondition(s).

Throughprovidingthissupport,thehealthandsocialcaresystemwillplaceanexplicitexpectationonusersofourservicestoincreaseself-managementand


intimemakethisthenorm.Primary,communityandsecondarycareserviceswillbeprovidedwhennecessary,thatiswhereotheralternativesandself-managementoflongtermconditionshaveprovedinsufficient.Thiswillsupporthealthservicesbeingmoreaccessibletoallwhennecessary.

NextSteps2 Generalpractice,communityhealthandsocialcareserviceswillwork

togethertodesignanddeveloptherangeofcommunitybasedservicestosupportthepopulationtolivehealthierandhappierlives.

2 Aswemovetoimplementchangewewillmoderniseourworkforcetomeetfuturerequirementswiththecapacityandcapabilitytomeettheneedsofthepopulation.

2 Wewillbuildonareasofgoodpracticeinintegratedcommunityteamsandaddresstheservicepressurestodeliverthecurrentdemandinoutpatientsaswellasthenumberofpatientswhocurrentlyattendandareadmittedtoacuteservices.


Peoplewithlongtermconditions(LTC)willbesupportedtoliveasindependentlivesaspossible

Careacrosscommunityserviceswillbeintegratedtomeettheneedsofthelocalpopulations

WorseningofaLTCwillbeidentifiedearly,throughselfmonitoringorenhancedcommunitymonitoringandtreatedappropriately

oCommunitybasedstaffwillbeskilledandequippedtosupportmorecomplexillnessincaringforpeoplewithLTCthereforepromotingselfcareandbettermanagementofhealthconditions

Transitionsofcareacrossthesystemwillbeseamless,supportedbyrobustinformationsystemsaroundepisodesofcare,creatingcarecontinuums

TailoredcarepathwayswillbedevelopedforpeoplewithLTCstosupportchangesincareneedsandtheabilitytoreturntoahomeortoacommunitysettingasquicklyaspossible

Peoplewillbeinvolvedindevelopingtheircareconsideringalloftheircareneedsandnotdesignedwithasinglediseaseprocessapproach

PeoplewithLTCswillnotrequirehospitaladmissionunlessinthemostacutecircumstances

Asaresultofamoreintegratedcommunityhealthservicepeoplewilllivelongerinanindependentenvironment


OlderPeople’sServices

VisionWe will promote independent, active and engaged citizenship; ensure clear recognition of crises through shared information between agencies; support active early specialist management of acute illness; facilitate rapid recovery and independence at home or close to home and provide patient-centred, dignified, supportive care to those who require support at the end of life.

CurrentServicesAswedescribedinsection2,peopleinLanarkshirearelivinglonger,moreactivelivesandthistrendwillcontinueintotheforeseeablefuture.ThepartnerorganisationsinLanarkshirehavedevelopedastrongtrackrecordofdevelopingnewandinnovativeservicemodelswhichcanadapttothechanginghealthandsocialcareneedsofpatients,theircarersandtheirfamilies.

Thishasincluded:• testingofdifferentmodelstopreventpeoplebeingadmittedtohospital

andprovidingmoresupportathomeafterdischarge;• linkinghousingservicestosocialcarepackages;• listeningtowhatclients’andcarers’needsare;• movingtoward24hour/7dayperweekcareinthecommunityand

reducingtheneedtoadmitpeopletoolderpeople’shospitalbeds.

Peopleastheyagearelikelytohaveoneormorechronicdiseases.Inaddition,theprevalenceofimpairmentanddisabilityisalsodirectlylinkedwithage.Thepriorityoftreatmentistopreventdependence,declineandphysicalorcognitiveimpairmentwithamovetoearlierintervention,self-managementandenhancedrecovery.

Whatwillchange?Ouraimistoreducedependenceonacutehospitalorresidentialcarebybuildingadditionalcapacityandcapabilitywithinlocalcommunities.OnekeyelementofthisenhancedprovisionistheIntegratedLocalityTeamswhichbringtogetherdistrictnurses,AlliedHealthProfessionals,socialworkers,mentalhealthclinicians,homesupportworkersandgeneralpractitionerstoensurethatthereisaunifiedfocusonprevention,self-managementandsupportand,whereserviceisrequired,toprovideaseamlessapproachtodelivery.

Weneedtochangethewayinwhichhospitalbedsareusedforthecareofolderpeople,withmorefocusonrehabilitationfollowedbysupportathome:morehospitalbedswillbeusedas‘intermediatecare’whichisdefinedbyHealthcareImprovementScotland1as:

‘Intermediate care services provide a package of focused, intensive, time-limited interventions commonly provided in the home or a community setting.’

4.4


Intermediatecarehospitalbedscanbeusedbothtoavoidadmissiontoacutehospitalservicesandalsoaspartofthedischargeandrehabilitationpathwayfollowingaspellinanacutehospital.

Bybuildingthiscapacityandcapabilityinthecommunity–includingearlyaccesstoservicestraditionallyonlyavailableviasecondarycare,wewilllessendependenceonresidentialcarehomesandhospital-basedcare.Thiswillenableanongoingreviewofhowtheseresourcesaredeployedinwayswhichbettermeettheneedsofpatients,carersandfamilies.

Toreducethelengthofstayinhospital,wewillidentifypatients’acute,rehabilitationandhomecareneedsearlierintherecoveryphase.Thiswillincludetheidentificationandallocationofcommunitysupportandinterventions,i.e.moreintensiveearliercare,theninitiationofcomprehensiveassessment.Thiswillreducetheneedforhospitaladmissionsandtimespentinhospitalforthosepeoplewhodoneedtobeadmitted.

Providingsafealternativestoadmittingfrailpeopletoahospitalwillbethemainobjectiveandwillleadtocarepackagesdeliveredbyajointhealthandsocialcareteam,leadingtoongoingrecoveryandrehabilitationinthecommunity.Jointworkingalsoresultsinbetterdischargeplanningandearlierreturntohomeorcommunitycare.

Themodelofservice,whichisclearlyarticulatedintheNationalClinicalStrategy2,willrecognisethattheacutehospitalisasmallpartofthesupportthatpeopleneedtomaintaintheirhealthandwellbeing;themajorityofadvice,supportandcare(includingsomeurgentandnon-urgentacutecare)canbeprovidedintheperson’shomeortheplaceofordinaryresidencesuchasresidentialornursinghome.


Alllocalitystaffandprimarycareprofessionalswillworkasanintegratedteamandhaveaccesstodiagnosticsandsupportfromacuteclinicaldecisionmakersallowingthemtoprovidesupporttopeopleacrossthespectrumfromprimarypreventionthroughtoacutecareathome.Thelocalityteamwillincludeallhealthandsocialcarestaffincludingconsultants,GPs,thethirdandindependentsectorsandwillbeabletoharnessarangeofthirdsectorandcommunityassetstosupportitswork.

Supportingindependence,givingchoiceandcontrolthroughsignpostingandgivingnonservicebasedoptionswillbeakeyfocusofplanningwithinlocalitiesaswillthefollowing:


Carersandfamilywillbesupportedandenabledtoprovidecarethroughappropriateadviceandsupport

Communitycapacitywillbedevelopedandcommissionedonlocalityneed

Personaloutcomesareattheheartofdecisionmaking

Servicesareprovidedfromafullyintegratedhealthandcareservice.

Olderpeoplewillspendlesstimeinhospitalbeds

Delayeddischargeswillbeeffectivelytackledbyallcareproviders

Greaterleveloftreatmentandcarewillbeprovidedathome

Peoplewillbeenabledtolivelongerathomeorinahomelyenvironment

References1 HealthcareImprovementScotland.CareofOlderPeopleinHospital

Standards,Standard12.2 ANationalClinicalStrategyforScotland;pp65;ScottishGovernment,2016


MentalHealthandLearningDisability

VisionThe Mental Health and Learning Disability (MH&LD) element of the strategy proposes further expansion of our focus on prevention; supporting people to look after their own mental health wherever possible; building stronger, more resilient, better informed communities; and providing consistent advice, information, support and care so that fewer people require specialist mental health services. Those who require mental health or learning disability services will receive the majority of these in their local area. We aim to provide person-centred, clinically effective, safe mental health and learning disability care, where required, which is of the highest quality.

Of paramount importance is the principle that there is no health without good mental health. Every part of the health and social care system is therefore required to play a more active part in improving the mental health and well-being of people with whom they work and by doing so contribute to the well-being of the population through collective action.

TheimplementationofthisvisionwillbegreatlyassistedbytheScottishGovernmenttoinvest£150minimprovingmentalhealthservices1.

CurrentServicesTheMH&LDserviceisaLanarkshire-wideservicehostedwithinHealthandSocialCareNorthLanarkshire.TheMH&LDServiceprovidesinpatientandcommunityservicesforpeoplelivinginLanarkshireaged16toendoflife.Thereareapproximately1,200MH&LDhealthstaffbasedacrosstheservice.

InpatientProvisionTheMH&LDservicecurrentlyprovidesinpatientcareforacuteadmission,rehabilitationandrecovery,forensiclowsecure,intensivepsychiatriccare,learningdisabilityassessmentandtreatmentandcontinuingcare.Thisisprovidedwithin17wardsbasedovereightsitesacrossLanarkshire.Inaddition,urgentassessmentandliaisonservicesareavailable24/7atthethreedistrictgeneralhospitalsbothinemergencydepartmentsprovidingadvice,assessmentandsupportandthroughoutthegeneralacutehospitalwards.Thereisacommitmenttosustainingaccesstospecialistassessmentandinitialtreatmentatallthreehospitalsites.

Hospitalcareremainsavitalaspectofthemodelofcarebutisincreasinglybeingusedfortheshortesttimerequiredforsafetyandclinicaleffectiveness.

CommunityProvisionThecommunityprovisioniscentredonmulti-disciplinarycommunitymentalhealthteamsforadults,olderpeople,andcommunity-basedpsychologicalserviceswithineachofthe10localities.Thesecommunityservicesprovide

4.5


arangeofinterventionsfromlowlevelinputsthroughtohighintensitysupportforpeoplewithcomplexneeds.Localityservicesaremulti-agencyandincludecolleaguesfromNorthandSouthLanarkshireCouncils,thethirdandindependentsectorsandserviceuserandcarerorganisations.AdditionallythereareLanarkshire-widespecialistcommunityserviceswhichincludelearningdisability.Thesecommunityservicesareanessentialpartoftherangeofservicesthatneedtobeavailableforpeoplewithlearningdisabilities.Theyhaveimportantrolestoplayintraining,facilitatingaccesstomainstreamservices,healthpromotion,healthscreeningandtheprovisionofspecialistassessment,interventionsandmonitoring.

NeedforChangeByshiftingthebalanceofcarefromhospitaltocommunitylocality-basedcareandincreasinglydeliveringcarethroughatieredmodel,LanarkshireMH&LDServicehasseenasignificantimprovementinsafe,efficient,person-centredcarewhileatthesametimeimprovingcapacitytomeetincreasingservicedemand.Thissignificantservicechangehasseenareductioninbedswithanincreaseinoccupancywhileatthesametimeareductioninlengthofstayandreadmissions.Theimplementationofthetieredmodelhasseenanincreaseincommunitycapacitywhichhassupportedimprovedaccesstolowertierinterventionsanduseoftechnologyenabledcareandadecreaseinwaitingtimes.

LanarkshireMH&LDservicehasconsistentlyperformedwellagainstnationaltargetsandstandards,beingoneofthebestperformingBoardsinScotland.However,therearestillsomeareaswherematchingcapacitytomeetdemandremainachallenge.Theseinclude:

• postdiagnosticsupportfordementia• clinicalhealthpsychologyincludingneuropsychology• developingasustainableseniorandtraineemedicalstaffingmodel• inpatientnursingstaffacrossmentalhealthandlearningdisabilitywards• servicesforadultswithautism• providingfit-forpurposeclinicalaccommodation• reviewingthebalancebetweenlevelsofsecureforensiccare

Theneedtomeetthesedemandscanbesupportedbycontinuingthemodernisationprocessthathasdeliveredatransformationinqualityofservicesoverthelastdecade.Furthermodernisationwillincludeprogresstowardsthegoalofbringingspecialistadmissionbedsformentalhealthontotwodistrictgeneralhospitalsites(withinNorthandSouthLanarkshire,respectively).Theprovisionofbedsontwositeswillbesupportedbyfurtherdevelopmentofassessmentandinitialtreatmentcapacityonallthreesites.Furtherdetailedstakeholderinvolvementwilltakeplaceaspartoftheprocessofmovingtowardsthisgoal.

In2016wesawtheintegrationoffunctionalassessmentbedsforolderpeople,inCoathillHospitalandAirblesRoadCentre,intomorefit-for-purposeaccommodationinWishawGeneralHospital.Furtherconsiderationwillalsobenowgivento‘bestfit’ofadultandolderpeople’swardsacrosstheestateandtopotentialsolutionsforolderadults’inpatientservicesinSouthLanarkshirethat


willinduecoursemovetoHairmyresHospital.Thesemoveswillhelpensurethatmentalhealthinpatientfacilitiesbestmeetthehighestspecificationswithpatientsafety,dignityandcomfortasprincipleaims.

WhatWillChange?

Community• Afurthershifttowardsaperson-centredapproachthatencourages

selfmanagementandfamily,carerandpeersupport.Prevention,earlyidentificationandinterventionformentalhealthproblemsinprimarycaresettingswillbesupportedthroughincreasedmultiagencyworkingaspartoftheprimarycaretransformationprocess.

• oIntegratecommunitymentalhealthserviceswithwiderhealthandsocialcarefunctionsatlocalitylevelinbothNorthandSouthLanarkshire,usinglocalassetsandresourcestosupportimprovedmentalhealthforall.

• Improvethephysicalhealthofpeoplewithmentalhealthproblemsand/oralearningdisabilityandimprovethementalhealthofpeoplewithco-morbidphysicalillness.ToincludethedevelopmentofaclinicalhealthpsychologyserviceacrossLanarkshirefocusingonco-morbidphysicalhealthandmentalhealthconditions,andmedicallyunexplainedsymptoms.

• Furtherimprovecarepathwayswhichsupportaccesstoandintegrationofserviceswhichincludeprimarycare,acutecare,independentsectorandvoluntaryorganisations.

• Addressspecifichealthinequalitiesofpeoplewithalearningdisabilitythroughhealthimprovement/healthpromotioninitiatives.

• Animprovedresponsetocrisisand/ordistresswillbeprovidedbyamulti-agencyapproachofferingimprovedaccesstobriefinterventions.

Hospital• Pursuestrategicintentforadultandolderpeople’smentalhealthacute

admissionstomovetoatwositemodelondistrictgeneralhospitalsites.• Completeolderpeople’smentalhealthinpatientmodernisationplanfor

acuteadmissions/hospitalbasedcomplexcare.• ReviewofLanarkshireservicemodelforforensicinpatientandcommunity

servicesandinformworkoftheNationalForensicNetworktoassessfutureneedsforhigh/medium/lowsecureprovision

• AllwardswillhaveaQualityImprovementGrouptoallowlocalfocusonsafeandclinicallyeffectivecare

• ReviewofLanarkshireservicemodelforrehabilitationandrecoveryinpatientandcommunityservices

• IncreasecapacityofmentalhealthliaisonserviceinallthreeDGHstoensuregoodmentalhealthserviceprovisionateachsite


We will also:• Strengthenpartnershipworkingbetweenhealth,thecouncils,thethird

sectorandotherkeypartners,buildingonexistingjointandintegratedworking

• Developaninformationsystemwhichworksacrosssectors,providingbothquantitativeandqualitativeinformation,andwhichprovidesabasisforinformationsharingacrossservicesinvolvedinsupportandcare.

• EnsuretheMH&LDinpatientandcommunityestateisfitforpurposetosupportthedeliveryofsafeandeffectivecareintherightsettingtomatchanindividual’slevelofneedatanypoint.

• Resolvemedicalstaffingissuesatseniorandtraineelevels• Provideagoodfitforfluctuatingdemandforthethreelevelsofsecurecare.


Increasedfocusonpreventionandearlyintervention

Morepeopleabletolookaftertheirownmentalhealth

Betterinformed,moreresilientcommunities

Morepeopleabletolivewithmentalillhealthoralearningdisabilityunaffectedbystigma

Provisionofeasilyavailableandconsistentaccessibleinformation;advice;support;highquality,safe,locallybasedcarewhenrequired

Fewerpeoplerequiringspecialistcommunityorhospitalbasedserviceswitheaseofaccessandflowthroughforthosethatdo

Narrowingoftheinequalitiesgap

Provisionofservicesthatrecognisethediverse/complexhealthneedsofpeoplewithlearningdisabilities

References1 HealthandSocialCareDeliveryPlan;ScottishGovernment,2016


AlcoholandDrugs

Vision We will continue to develop a recovery orientated system of care which has at its heart the needs of individuals, their children and other family members affected by alcohol and drug problems.

Thenationalalcoholstrategy,Changing Scotland’s Relationship with Alcohol: A Framework for Action1 2009,andthenationaldrugstrategy,The Road to Recovery: A New Approach to Tackling Scotland’s Drug Problem2 2008,willcontinuetoprovidetheframeworkfordeliveringalcoholanddrugprevention,treatmentandsupportservicesinLanarkshire.TheLanarkshireAlcoholandDrugPartnership(ADP)isresponsibleforimplementingthesenationalalcoholanddrugstrategieswithineachofourlocalauthorityareas.

CurrentServicesAllofouralcoholanddrugservicesrecognisethatrecoveryisnotsimplyabouttacklingthesymptomsandcausesofdependence,butaboutenablingpeopletosuccessfullyreintegratebackintotheirfamilyandlocalcommunities.Itisalsoaboutensuringthattheyhavesomewheretolive,somethingtodoandtheabilitytoformpositiverelationshipswithothers.ThisincludesensuringthatthereisafullrangeofserviceswithineverylocalityinLanarkshire.Theseservicesinclude:identifiablecommunityrehabilitationserviceswhichhavepeoplewithlivedexperiencewithintheirstaffingcomplements;accesstodetoxificationandresidentialrehabilitation;accesstoafullrangeofpsychologicalandpsychiatricservicesandproactiveengagementwithemployabilityandaccommodationproviders.

Gotowww.lanarkshireadp.orgforfurtherdetailsoftheservicesavailableacrossLanarkshire.OurDeliveryPlanalsoprovidesthisinformation.

TheNeedforChangeThelifecourseperspectivereferstoanapproachwhichrecognisesthestructural,social,andculturalcontextsinwhichweliveandwork.Indoingso,itreflectstheimportanceofourearlyyearsandhowthisimpactsonarangeofotherhealthandsocialindices.Additionallytherefore,wewillstrivetopromotehealthandwell-beingwithinourwidercommunitiesbytacklingtheunderlyingrootcausesofalcoholanddrugproblemsincludingtrauma,socio-economicdeprivation,familybreakdown,poverty,mentalill-healthandcrime.

Moreover,theissuesassociatedwithsocialexclusionandhealthinequalitiesforpatientsonlongtermopiatereplacementtherapy(ORT)aredeepening.ThedemographiccharacteristicsofthoseusingsubstancesthatmightbenefitfromORThavechangedinrecentyears.Theaverageageofthegrouphasmarkedlyincreasedsuggestingthatthedegreeofbothphysiologicalandpsychologicaldifficulty,alreadyhigh,islikelytoincreasefurther.Equally,ashealthinequalitiescontinuetoincreasesotheeffectsonthisalreadydeprivedandmarginalisedgroupwillbecomemoreextreme.Thesefactorsfurthercompoundedbythe

4.6

www.lanarkshireadp.org


effectsofstigma,willproduceapictureofincreasinglycomplexsocialandmedicaldifficultywhichwillrequireamorecoordinatedapproachfromallprovidersofsocialandmedicalcarethaniscurrentlythecase.

IndevelopingtheLanarkshire Alcohol and Drug Partnership Strategy3,wehavethereforeincludedtheviewsofserviceusers,theirfamilymembers,carers,staffworkingwithinourtreatmentandcareservices,membersofourthirdsectorandcommunitygroupsaswellasotherkeycommunityplanningpartners(housing,mentalhealth,criminaljustice,education,socialworkandpolice).Wehavealsoreviewedanumberoflocalplansandnationalstrategiestoensurethatwearereflectingthekeyprioritiesofourcommunityplanningpartners.

ContinuinginvestmentbytheScottishGovernmentalsoprovidesanopportunityforourADPtomakeconsiderableprogresstowardsachievingthenationaloutcomesandministerialprioritiesassetoutinthenationalstrategies

WhatWillChange?ThecommunityplansandsingleoutcomeagreementsforbothNorthandSouthLanarkshireCouncilsoutlinetheprioritiesforLanarkshire’scitizensandcommunitiesinthefuture.Thesearetheoverarchingstrategydocumentswhichlinktothepriorityoutcomeswehopetoachieve.Wehavereflectedtheseprioritieswithinourstrategyandwillworkwithourcommunityplanningpartnersoverthenextthreeyearstoreportonourprogress.FurtherinformationonhowthiswillbeachievedisincludedinourdeliveryplansforNorthandSouthLanarkshire(2015–2018).

ThereisalsoasuiteofnationalrecoveryindicatorswhichformpartofthenationalDrugandAlcoholInformationSystem(DAISy)databasewhichwillbeusedfrom2016.Wewillthereforeworkinpartnershipwithourlocalstatutoryandthirdsectorproviderstoensurethattheseareincludedwithinourservicelevelandpartnershipagreementsinorderthatwecanmeasuretherecoveryoutcomesforallclientswithinourtreatmentandcareservices.


Recoveryorientatedsystemofcarearedevelopedwithinourcommunities

Adults,includingparentsandolderpeoplewithalcoholand/ordrugrelatedproblemsaresupportedtoreceivetherightkindofservice,intherightplaceattherighttime

Theinterestsofchildren,youngpeopleandyoungcarersaffectedbysubstancemisusearesafeguardedandpromoted

Speedyaccesstowiderhealthcareservices(suchasprimarycare,sexualandreproductivehealth)


References1 ChangingScotland’sRelationshipwithAlcohol:AFrameworkforAction.

Edinburgh:ScottishGovernment,20092 TheRoadtoRecovery:ANewApproachtoTacklingScotland’sDrug

Problem.Edinburgh:ScottishGovernment,20083 LanarkshireAlcoholandDrugPartnershipStrategy:

www.nhslanarkshire.org.uk/boards/2015-board-papers/Documents/August/15-ADP-Strategy-2015-18--August-2015-Board.pdf

www.nhslanarkshire.org.uk/boards/2015-board-papers/Documents/August/15-ADP-Strategy-2015-18--August-2015-Board.pdf


Maternity(IncludingNeonatal),EarlyYears,ChildrenandYoungPeople

Vision All children and young people will have the best possible start in life and reach their full potential – regardless of their starting point. We will improve health and wellbeing outcomes by delivering targeted early intervention and prevention from services which are designed and delivered to reduce inequalities and best meet the changing needs of women, children and their families achieving generational changes by 2025.

CurrentServicesUniversal and Additional Service Provision: NHSLanarkshiretogetherwiththeirpartnersinNorth&SouthLanarkshireareintheprocessofadoptingtheUniversalPathwayforchildrenandyoungpeoplesetoutinGettingItRightForEveryChild(GIRFEC)1nationalguidancewhichspanstheearlyantenatalperioduntilthechild’s18thbirthday.InadditiontherearenationalandtargetedinitiativessuchasFamilyNursePartnership,EarlyYearsCollaborative2andFirstStepswhichprovideafocusofintensivesupportforparticularcohortsofthepopulationfromtheantenatalperiodintothepostnatalperiodandbeyond.

Maternity and Neonatal Services withinNHSLanarkshirearedeliveredfromawiderangeofcommunitysettingsincludingthewoman’sownhomeandWishawGeneralHospital.TheNeonatalIntensiveCareUnitiscapableofcaringforthesmallestandsickestofnew-bornbabiesdeliveredbothwithinWishawGeneralHospitalandthosetransferredinfromotherMaternityUnitsacrossScotland.

Community and Primary Care: Mostoftheactivityrelatedtochildreniscarriedoutinthecommunity.Generalpracticeactivityislargelyconcernedwithchildrenpresentingwithacuteillness.InadditiontothishoweversomechronicconditionswhichwerepreviouslymanagedinanacutesettingarenowalmostentirelymanagedinaGPsetting,e.g.asthma,teenageacneandchildhoodeczema.NursesandAlliedHealthProfessionalssupportGPpracticestoofferbothspecialisedclinicsandone-to-oneconsultations.

Hospital Care: forchildrenisconcentratedonasinglesiteatWishawGeneralHospital.GPsreferchildrentoWishawHospitalforemergencytreatmentorcanaccessspecialistpaediatricadvicefromthePaediatricUnit.OutpatientconsultantclinicsareheldonallthreeacutehospitalsitesandalsoinhealthcentresacrossLanarkshire.Clinicswhicharemorespecialistaregenerallyfocussedonthethreeacutesites.ThosechildrenwhocannotbetreatedlocallyarereferredtotheRoyalHospitalforChildreninGlasgow.

Thereareintotalapproximately30,000attendancesperannumatthethreeEmergencyDepartments(EDs)withinLanarkshireforpatientsagedunder16,ofwhicharound80%areclassedasminorinjuryandillness.

4.7


TheNeedforChangeItisessentialthattheservicesweprovidetochildren,youngpeopleandtheirfamiliesaretimely,ofhighquality,efficientandcontinuallyimproving.WeneedtodemonstratethroughtheservicesweprovidethatweunderstandthehealthneedsofLanarkshire’schildrenandyoungpeopleandthatweareresponsivetothem.

• Mostoftheactivityrelatedtochildreniscarriedoutinthecommunity,notinhospitals,andsodevelopingcommunityteamsmustbeourpriority.

• Maternalobesitylevelsareexpectedtorisefromthecurrentlevelof20%toaconservativelyestimated30%by2030.Thiswillincreasethecaesareansectionrates,whicharecurrentlyathirdofalldeliveries.Therefore,hospitalmaternityserviceswillneedtoadapt.

• Thereisanissueofcotspacingwithintheneonatalunitwhichwillneedtoberesolved.

• WecanexpectthepopulationofchildreninLanarkshiretofall,andsoourpaediatricmodelsofcarewillhavetoadapt.

• Thereareapproximately30,000attendancesperannumatEmergencyDepartments(EDs)forpatientsagedunder16,ofwhicharound80%areclassedasminorinjuryandillness.Dataanalysissuggeststhatalargeproportionofthesechildrencouldbemanagedbetterinprimarycare,withspeedieraccessandbetteroutcomes.

• Generally,healthandlifeoutcomesforthosechildrenbornintopovertyarepoorerwhencomparedtochildrenwhoarebornintomoreaffluentlifecircumstances.LikewisethehealthandlifeoutcomesforLookedAfterChildrenaregenerallymuchpoorerthanthosewhoarenot.

• TheChildrenandYoungPeople(Scotland)Act2014requiresustostrengthenthefocusontherightsandwellbeingofindividualchildrentoenablethemtoachievetheirfullpotential.

WhatWillChange• Improvedhealthandwellbeingoutcomesforthisparticularpopulation

willonlybeachievedthroughdeliveringtargetedearlyinterventionandpreventionfromserviceswhicharedesignedanddeliveredtoreduceinequalitiesandbestmeetthechangingneedsofthewomenandchildrentoachievegenerationalchange.InlinewiththeChildrenandYoungPeople(Scotland)Act2014childrenandfamilieswillbenefitfromenhancedsupportfromuniversal(midwiferyandhealthvisiting)andAHPservicesenablingearlieridentificationofneedandsubsequentappropriateintervention.AllchildrenandyoungpeopleinLanarkshirewillhaveaNamedPersonwhowillberesponsibleforpromoting,supportingandsafeguardingtheirwellbeing.

• SupportwillbegiventotheCommunityPlanningeffortstoaddressthewiderissueofobesity.Specificfocuswillbeplacedonintensivesupporttowomenbefore,duringandafterpregnancy.Lengthofstayforobesepregnantwomenrequiringplannedcaesareansectionwillreduceasaresultofanenhancedrecoveryservice

• Wewillimplementtherecommendationsoftherecentlypublishedreport“TheBestStart:AFive-YearForwardPlanforMaternityandNeonatalCareinScotland”3


• Neonatalserviceswillberedesignedtoensureappropriatecapacityandimprovedcotspacing.

• AsopposedtoattendingA&Eunnecessarily,pathwayswillberedesignedtoensurethatchildrenandyoungpeoplearetreatedinthecommunitywhenclinicallyappropriate.

• WewillredesignourservicestosupportourmostvulnerablechildrenandyoungpeoplesuchasChildrenwithLearningDisabilities,thosewithComplexCareNeedsandLooked-AfterChildrentoimprovetheirhealth,wellbeingandlifechancesastheytransitionintoadultservices.

• Datasystemswillbereviewedtoensureidentificationofneedandrisksinvulnerablepopulations.


Overall,wewillfocusonthedeliveryofthekeyoutcomessetoutintheChildrenandYoungPeople’sHealthPlantoensure:• Thehealthandwellbeingofchildrenandyoungpeopleisimproved

andthestretchaimsoftheEarlyYearsCollaborativeareachievedandexceeded

Deliveryoftargetedearlyinterventions• Reducingtherateofincreaseinmaternalobesitylevels• Reducingfoetalalcoholspectrumdisorderlevels• Enhancingsupportforperinatalmentalhealth• Enhancingthemultiprofessional/agencyinterface

Deliveryofincreasinglypersoncentredmaternityandneonatalservices• Enhancingearlypregnancyassessment• Enhancingthemodelofparenthoodeducation• Reducinginappropriateinterventions• ReducingneedtotransferbeyondLanarkshire

DeliveryoftheStretchAimsoftheEarlyYearsCollaborative• Womenexperiencepositivepregnanciesandtheratesofstillbirth

decreaseby15%• 85%ofallchildrenreachalltheirexpecteddevelopmentaloutcomesat

thetimeoftheir27–30monthchildhealthreview• 90%reachtheirexpecteddevelopmentaloutcomesatthetimethechild

startsprimaryschool• 90%ofchildrenachievetheirdevelopmentalandlearningoutcomesby

theendofprimary4

Deliveryofincreasinglypersoncentredpaediatric,childandadolescentmentalhealthservices(CAMHS)• Enhancingoutofhoursservicesforchildren• EnhancingaccesstoCAMHSupto18yrs• ReducingminorEDAttendances• Reducingno-showratesatcommunityandhospitalclinics• Childrenandyoungpeopleexperiencesmoothandefficienttransitions

References1 Gettingitrightforeverychild(GIRFEC);ScottishGovernment,20042 www.gov.scot/Topics/People/Young-People/early-years/early-years-

collaborative3 TheBestStart:AFive-YearForwardPlanforMaternityandNeonatalCarein

Scotland;ScottishGovernment,2017


Deliveryofmorewithless• Buildingcommunitycapacitytoreduceinequalities• E-enablingtheworkforce• Remodellingclinicprovision• Strengtheningoutcomefocusedapproachtoinformcontinuous

improvement

www.gov.scot/Topics/People/Young-People/early-years/early-years-collaborative


PlannedandUnscheduledAcuteCare

Vision Our Health and Social Care Partnerships (HSCPs) will commission services that support people in the community and avoid hospital admission. Both Partnerships will aim to ensure that social work and community health support and services for people who are admitted to hospital are better aligned so that our discharge processes from hospital are as smooth as possible.

Acute hospital teams will work with our partner agencies and clinical teams in community and primary care settings to ensure the demand for planned and unscheduled services is delivered by the most appropriate healthcare professional, in the most appropriate location, through the development of clinical and service models designed to meet the assessed needs of the population.

CurrentServicesEachofourthreeacutehospitalsWishaw,HairmyresandMonklandshasthefollowingcoreservices:

• anemergencydepartment(ED),• acutemedicalandsurgicalservices• diagnosticsandimaging• operatingtheatresandcriticalcare• outpatientservices

Clinicalservicesoneachhospitalsitearerelevanttoeachhospital’sbedconfigurationsandservicemodelsarearrangedaroundour‘CentresofExcellence’2inLanarkshirewhereindividualspecialtyservicesdelivercareforthewholeoftheLanarkshirepopulationwithconsistentlyhighlevelsofclinicalqualityandpatientsatisfaction.Thesearearrangedasfollows:

MonklandsDGH HairmyresHospital WishawGeneralHospital• ENTsurgery• Haematology(cancer)• Histopathology• Infectiousdisease

medicine• LanarkshireBeatson

(radiotherapy)• Renalmedicine• Urologysurgery

• Interventionalradiology

• Ophthalmologysurgery

• Optimalcardiacreperfusion

• Vascularsurgery

• Bariatricsurgery• IntensivePsychiatric

Care• Maternity&neonatal• Paediatricservices• SpecialistLabservices

TheseservicesareunderpinnedbyclearpatientpathwayssupportedbytheScottishAmbulanceService,NHS24andPrimaryCareOutofHoursServices.

4.8


TheNeedforChange

Key Points

• In2016Lanarkshireresidentsusedtheequivalentof1,750acutehospitalbeds;mostlyinLanarkshire,butalsointheGlasgowandLothianacutehospitals

• Ifwedonotchangeourmodelsofcare,thepopulationneedsassessmentshowsthatthiswillrisetoover2,200by2025:nearlya30%increasewhichwouldrequireover500morehospitalbeds,theequivalenttoanotherDistrictGeneralHospital

• Tostandstill,admissionsand/orhospitallengthsofstaymustreduceby25%inthenext10years.

• Theserviceredesignworkbothinhospitalsandinthecommunityoverthelast10yearshasalreadydelivereda29%reductioninlengthsofstayinhospital.

ChangestoSpecificClinicalSpecialties

a Gastroenterology and Upper Gastrointestinal (GI) CareDuringthelast15yearstherehasbeenasignificantchangeinthenumberofgastroenterologyandupperGItreatmentswhichcannowbedeliveredbykeyholesurgeryorusingendoscopes,whichmeansthatmanypatientshaveashorterlengthofstayinhospital.Thereiscurrentlyadifferentmodelofcareinplaceoneachsite.Animprovedclinicalmodel,asingleCentreofExcellencewithinLanarkshire,couldbecreatedtodealwithpatientswithseveregastricbleeding.Forpatients,thiswouldensurebetterclinicaloutcomesandabetterpatientexperience,basedonamulti-disciplinaryapproachformanagementbetweenendoscopictechniques,interventionalradiologyandsurgery.Wewillexplorethisideafurtherin2017andbeyond.

b TraumaHealthcareservicesmustconstantlyadapttotheevolvingneedsofthepopulation.TheAcademyofMedicalRoyalCollegesandFacultiesinScotlandevidencedtheneedtoreconfigureorthopaedicservicestoprovidetheconsolidatedclinicalteamswhoworktogethertoimprovethequalityofourservices,theclinicaloutcomesandexperienceofourpatientsandoptimisetheuseofourresources.

TheNHSLanarkshireBoardhasacceptedthatthefirstchangethatNHSLanarkshiremustmaketoacuteservicesisintheprovisionoforthopaedicsurgery.InkeepingwiththeNationalReportonTraumaServices,andtheNationalClinicalStrategy2,themosteffectiveandefficientwaytomeettheneedsofpeoplewithseveretraumaticinjuriesmustbeprovided.TheAcademyofMedicalRoyalCollegesandFacultieshasspecificallyaskedNHSLanarkshiretoconsidercreatingatraumaservicewithinpatient


servicesbasedatasinglehospitalsite.Thiswillbeamajorchangeintheconfigurationofseveralkeyacutespecialties(includingcriticalcare,generalsurgery,orthopaedicsandrehabilitation).Thisworkwillrequiretimetoplanandimplement.IntheinterimsteptowardsthisinNovember2016wereconfiguredorthopaedicinpatientservicestobesharedbetweenHairmyresandWishaw(seealsosection4.9).

WishawGeneralHospitalwillbeatraumaunitaspartoftheWestofScotlandTraumaNetworkcentredattheQueenElizabethUniversityHospital’snewMajorTraumaCentreinGlasgow.Thiswillseethedevelopmentofimprovedpatientpathwaysforthosewhosuffermajortraumaticinjury,andtheaugmentationofthehealthcareworkforcetodeliver24/7integratedcareacrossarangeofclinicalspecialtiesparticularlyemergencymedicine,criticalcare,generalandemergencysurgery,orthopaedics,paediatricsandimaging.Shoulditprovepossibletoresourceasingletraumasiteinfuturewithoutsubstantialdisruptiontootherkeyservices,thiswouldbelocatedatWishawGeneralHospital.

c Impact of Glasgow changes in hospital servicesThechangestoGlasgow’shospitalservicesin2015sawastep-changeincreaseintheunscheduledcareactivityatHairmyresHospitalandacorrespondingincreaseinthecapacityofthehospital’semergencycareteams.ThepatternofpatientflowsacrossEastRenfrewshire,SouthGlasgow,RutherglenandCambuslangwillcontinuetobecloselymonitoredbutincreasedregionalworkingislikelytobeagrowingfeatureofhealthcaredeliveryinthefuturewithlessemphasisonwhichNHSBoardpeoplelivein.ThisisexpectedtohaveasignificantimpactonthefuturedevelopmentofbothgeneralandspecialistregionalservicesatHairmyresHospital.

d Other areas of possible changeThecontinuedcapacityforophthalmologyprocedures,e.g.cataracts,tobeprovidedatHairmyresHospitalwillbereviewedin2017inconjunctionwithregionalplansforcapacityattheGoldenJubileeNationalHospital.

Theprovisionofvascularsurgeryandinterventionalradiologyserviceswillalsobereviewedinconjunctionwithregionalplansbasedonavailabilityofspecialistexpertiseacrossanumberofhealthboards.

Wewillseektogetthebestclinicaloutcomesthroughensuringspecialistsurgery(eitherinvolvingovernightstaysorasadaycase)isprovidedsafelyandeffectivelyaspartoftheCentresofExcellenceconcept.

TheScottishGovernmentwillcreateaseriesofdiagnosticandelectivetreatmentcentreswhichwillaffecthowplannedorthopaediccareisdelivered(seesection4.9).


WhatWillChange?

a On all three hospital sites

Key Point

EachDGHwillcontinuetohavestaffingandinfrastructuretodeliveremergencycarethatincludes:• Anemergencydepartment(ED)• Acutemedicalandsurgicalservices• Diagnosticsandimaging• Operatingtheatresandcriticalcare• Outpatientclinics

Weplantocontinuetoprovideacomprehensiveprogrammeofplannedcareacrossthethreeacutehospitalsites,butreducetheproportionofcarewedeliverwhichisunscheduledinnatureandonlyuseemergencyinpatienthospitalservicesasalastresort.Thiswill,inturn,allowustoshiftresourcesanduseagreaterproportiontodelivermoreplannedcareinhospitalandinthecommunity.Thiswouldreducetheneedforinpatientstaysinhospital.

Inthemain,patientswouldhavetheirclinics,pre-admissionassessmentandrehabilitationlocallyattheirDGH,butwithspecialistsurgeryprovidedincentresofexcellencecoveringthewholeLanarkshirepopulation(asisthecaseatpresentformanytypesofsurgery–seetableabove).Thismayinvolvefurtherconcentrationofdaysurgeryprocedures,and/orshiftingsomeclinicalproceduresfromoperatingtheatrestooutpatientclinictreatmentrooms.

WeplantodeliverRealisticMedicine1eliminatingprocedureswithlowclinicaleffectiveness,improvingouruseofmedicinesandreducingvariationinclinicalpractice2.

Thesethemeswereexploredfurtherthroughtheconsultationprocessandwerebroadlysupported.Membersofthepublicconsideredthatmoreemphasisneededtobegiventoprevention,self-managementandrealisticmedicineapproachesincludingimportantconversationsaroundmedicalinterventionsandlikelyoutcomes.

Peoplealsowantedtounderstandwhatrealisticmedicinewouldmeaninpractice,forexample,inthedeliveryofcancercare.Ourclinicalstaffgavestrongsupportforrealisticmedicine,recognisingthatwithoutthiskindofapproachthestrategywouldnotworkandacknowledgingtheworkalreadybeingprogressedacrosstheBoardtoprogressguidelinesandimportantareasofworksuchasanticipatorycareplans.LikewisetheRoyalCollegeofNursingreiteratedtheirpositionofsupportingtreatmentwhichisminimallydisruptiveandbasedonrealisticoutcomes.Wheremedicationswerediscussed,peoplewerecomfortablewitharealisticmedicineapproach,usingthecheapestavailableifqualityisassuredandmaximisingtheuseofcheapergenericdrugswhereverpossible.


b Monklands

Key Point

NHSLanarkshireisnowpreparingabusinesscaseforamajornewdevelopmenttoreplacetheexistingMonklandsHospital,creatingamoderninfrastructurethatwillhelptosupporttheredesignofservicemodelsforbothhospitalandcommunitycare.Thiswasstronglysupportedduringourconsultationprocess.

Theplanningprocesswillcontinueinto2018andsubsequentbuildingworkwilltakeseveralyears.ThiswillprovideauniqueopportunitytoensureourspecialistacuteservicesandCentresofExcellencecanbedevelopedfurtherandfullyintegratedintocommunity-basedservices.

Intheshort-termweplantoenhanceourexistingfrontdoorfacilitiesandemergencydepartmentontheMonklandssiteandcreateimprovedfacilitiesfordaysurgeryandasame-dayadmissionsunit.

Wewillprepareplanstocreateasinglecentreofexcellenceforthegastrointestinal(GI)bleedingservice.

WeplantoconsolidatecancerservicesinacentreofexcellenceatMonklands.WhilecancercareforLanarkshireresidentswillcontinuetobeprovidedatHairmyres,Wishaw,theBeatsonCancerCentreandelsewhere,theplanningassumptionwillbethatwherecancerservicesaredevelopedinthefuture,anyexpandedcapacitywouldbeco-locatedwiththeexistingcancerservicesatMonklandsHospital(seealsosection4.10).

Longer-term,plannedorthopaedicsurgeryisproposedtobeconcentratedonasinglesitewhichislikelytobeeitherHairmyresorMonklands(seesection4.9).

c HairmyresHairmyresHospitalbecamethesecondinpatientunitinLanarkshire,alongsideWishawGeneralHospitalinaninterimreconfigurationoforthopaedicservicesin2016.Asstatedabove,longer-term,itisproposedthatelectiveorthopaedicswouldbeconcentratedonasinglesitewhichislikelytobeeitherHairmyresorMonklands(seesection4.9).Hairmyreswillalsoseenewfacilitiescreatedforophthalmology.

d WishawIntheshortterm,weplantoenhanceourexistingfrontdoorfacilitiesandEmergencyDepartmentatWishaw.


InthelongertermNHSLanarkshireproposetocreateasingletraumasiteatWishawalongsideasecondelectivesite.ThissitewouldserveastheBoard’straumaunitwithintheWestofScotlandregionaltraumanetwork.


SeamlesscareprovidedthroughcollaborativeworkingacrossLanarkshireinpartnershipwiththepatient,providingabetterpatientexperience

Specialistcareathomeespeciallyfortheelderly,minimalhospitalstayswithfollowupinthecommunity

Reducetheneedforadmissiontohospitalandinparticularexpandtherangeofpreventativeand/oracuteinterventionsprovidedinorclosetopeople’shomes

Emergencyservicesaccessedasalastresortensuringonlypeoplewhorequirespecialisthospitalcareareadmittedintoageneralhospital

Morepatientstreatedwithinplannedcare(urgent)servicesthroughimprovedaccesstodiagnostics,outpatientsanddaysurgeryprocedures

Rapidaccesstotreatmentsupportingimprovedclinicaloutcomesandminimumlengthofstayinhospitalfollowingsurgery

Centresofexcellencedeliveringthehighestpossiblestandardsofsafetyandclinicalcare

Furtherimprovingqualityofcareandclinicaleffectivenessbyreducingvariationinclinicalpractice

Enhanceourresearchanddevelopmentworktosupportimprovementsinclinicalpractice

Improvethetrainingsupportandenvironmentforhealthcareprofessionals

Wewillenhanceourabilitytorecruitandretainhighlyskilledspecialistclinicians

References

1 RealisticMedicine–AnnualReportbytheChiefMedicalOfficer;ScottishGovernment,2016

2 ANationalClinicalStrategyforScotland,ScottishGovernment,February2016.


OrthopaedicServices

Vision Orthopaedic services will be provided to a high standard comparable to any other UK service. Patients will enjoy a seamless treatment pathway from referral through to rehabilitation, and will spend the right amount of time in hospital. The service will be fully integrated with other health and social care providers in primary, community and acute. Our workforce model will be sustainable into the future as the needs of the population change.

CurrentServiceOrthopaedicservicesarethesecondlargestsurgicalspecialty,andarecurrentlyprovidedfromoutpatientclinicsinthethreeDistrictGeneralHospitals,withsurgerybeingperformedatHairmyresandWishaw.Over26,000peopleareseeninorthopaedicclinicseachyear.10,000peopleareadmittedtohospitalfororthopaedictreatmentaseitheremergencies(generallyreferredtoas“trauma”e.g.afracturedleg)orforplannedsurgicalprocedures(“elective”e.g.ahipreplacement).

NotallorthopaedicspecialistservicesareprovidedoneachofthethreeDGHs:theserviceissplitintosub-specialties(e.g.footandanklesurgery,paediatricsurgery)andtheseservicesareprovidedinsinglespecialistunitsatonelocationforallofLanarkshire.Also,nearly1000LanarkshirepatientsaretreatedattheGoldenJubileeNationalHospitaleachyearforelectivesurgery(mainlyhipandkneereplacements).

TheNeedforChangeAformalreviewoftraumaandorthopaedicserviceinLanarkshirebeganin2014followingthepublicationofthe“RapidReviewofSafetyandQualityofCareforAcuteAdultsinLanarkshire”carriedoutbyHealthcareImprovementScotland1.

Theconclusionsfromthatreview,andthecaseforchange,wereconsideredbytheNHSLanarkshireBoardinJuly2016.FurtherinformationisavailablethroughtheconsultationwebsiteandtheNHSBoardpapers:www.nhslanarkshire.org.uk/boards/2016-board-papers/Pages/July.aspx.

TheNHSBoardconsideredthecaseforchangefororthopaedicservicestoensure:

• improvedpatientoutcomes,• asustainablemedicalworkforce;and• futurepathwaysofcarethatmeetthechangingneedsoftheLanarkshire

population.

4.9

www.nhslanarkshire.org.uk/boards/2016-board-papers/Pages/July.aspx


TheviewofNHSLanarkshire,whichhasbeenconfirmedbythe2016reportfromtheAcademyofMedicalRoyalCollegesandFacultiesinScotland4,isthatmaintainingthestatusquowasneitherasustainableoption,norwoulditaddressthesafetyandqualityissuesraisedinthe2013HISRapidReviewreport.TheAcademyalsonotedthattherewasconsensusonthisopinionacrossEmergencyDepartments,Trauma&OrthopaedicsandCareoftheElderlyteamsacrossNHSLanarkshire.

WhilstinitialworkwithinNHSLanarkshire’sorthopaedicreviewfocussedonimmediatechangesnecessarywithintheserviceandhowtheycouldbedelivered,furtherconsultationwithcliniciansledtowideacceptancethatthestrategicdirectionistomovetoTraumaandElectiveworkonseparatesites.TheseconclusionshavebeenreinforcedbytherecentpublicationoftheNationalClinicalStrategyforScotland2.

TheNHSLanarkshirereviewofOrthopaedicservicesfocussedon4possibleoptionsforreconfigurationofservices.

MaintainTraumaandElectiveAcrossTwoSites

TraumaandElectiveonSeparateSites

• 50/50SplitbetweenWishawandHairmyres

• 50/50SplitbetweenWishawandMonklands

• WishawTraumaOnly

• HairmyresElectiveOnly

• WishawTraumaOnly

• MonklandsElectiveOnly

Furtherinformationandanalysisisavailablethroughwww.nhslanarkshire.org.uk/INVOLVED/CONSULTATION/ORTHO/Pages/Traumaorthopaedicchanges.aspx.

AlloptionsreviewedincludedWishawGeneralduetoitsproposeddesignationasatraumaunitwithinNHSLanarkshire.WiththeproposalstocreateamajortraumanetworkacrossScotland,onemajortraumacentrewillbecreatedattheQueenElizabethUniversityHospitalinGlasgow.NHSLanarkshire’sproposalforinclusioninthenetworkisthecreationofadesignatedmajortraumaunitatWishawGeneralHospital.Wishawisbestplacedforthisdevelopmentduetoitscentreofexcellenceforpaediatriccareandgeographiclocationwithacatchmentcoveringsouth/centralScotland.

ThescaleofchangethatisrequiredtoachievethiswithinLanarkshireischallenginganditisimpossiblethatasingletraumaunitcanbeachievedwithinthecurrentbedcomplementandEmergencyDepartmentfootprintatWishawwithoutcausingsignificantdisruptiontootherservices.Thepragmaticapproachisthereforetomovetowardsthisstrategicobjectiveinaphasedmannerbymovinginitiallytotwocombinedtraumaandelectiveunits.TheNHSBoardagreedtomakeimmediatechangestoorthopaedicinpatientservicesonthegroundsofclinicalsafetyandservicesustainabilityinJuly2016,andthiswasimplementedinNovember2016.

www.nhslanarkshire.org.uk/INVOLVED/CONSULTATION/ORTHO/Pages/Traumaorthopaedicchanges.aspx


AnotherfactoristhecommitmentbytheScottishGovernment(2016SNPmanifesto)toinvestinaseriesofdiagnosticandelectivetreatmentcentrestoprovideconcentratedelectivesurgeryforarangeofprocedures,includinghipandkneereplacements.Theservicemodelforthesecentresisnotyetagreed,butwhatevertheirconfigurationthiswillchangethefutureserviceconfigurationforelectiveorthopaedicsurgeryforLanarkshire.

SustainingthemedicalworkforceAkeyissuenotedinthe2013HealthcareImprovementScotland(HIS)reportwastheneedforafundamentalreviewofthedistributionoforthopaedicservicesacrossNHSLanarkshiretosupporttheprovisionofsafe,person-centredandeffectivecare.Thereportnotedsignificantandpersistentissues,thesolutionsforwhichrequiredmodelsofcarebuiltaroundpatientsbutwhichtakeaccountoftheavailableworkforce.Onerousandstretchedoutofhoursandon-callrotasforconsultantsimpactingonrecruitmentandretentionwasidentifiedasachallengeofthecurrentclinicalmodelwhichhaselectiveandtraumaservicesprovidedacrossthreesites.

SinceMarch2014,theservicehasbeensubjecttoenhancedmonitoringbyNHSEducationforScotland(NES)onbehalfoftheGeneralMedicalCouncil(GMC)toensurethatthenecessaryqualityoftrainingandenvironmentofsafepatientcareinwhichtrainingisprovidedcanbeassured.Withoutthiscontinuedassurance,whichiscurrentlyatrisk,trainingrecognitionwillberemovedandtheservicewillnotbesustainablewithinNHSLanarkshire.

The2016interimmovetotwoin-patientunitshasassistedwithmanagingsomeofthemoreacutepressuresontheservice,butitisthecommitmenttolongertermsustainablechangeaspartofthemajortraumanetworkthathashelpedtoprovideassurancetotheregulatoryagenciesofcontinuedprogresstoacentreofexcellenceforbothtraumaservicesandelectiveoperating.

ThechangingneedsofthepopulationPlanningthefutureserviceprovisionwillrequireaccounttobetakenofanumberofsignificantchangeswhichwillimpactuponthedemandfortheserviceoverthenexttwentyyears.Thelargestfactoristheincreaseinover75s,recognisingthatpatientsarelivinglongerandtheaddedcomplexityofeachindividual’sclinicalpresentationduetoanumberofagerelatedfactors(seealsosection2).Orthopaedicactivityisexpectedtoincreaseby12.9%by2020andafurther11.7%by2025.Activityfor2015isshownbelowasabaselineforfuturedevelopmentaswellasthepredictedactivitylevelsfor2020and2025.


PatientCategory 2016 2020estimate

2025estimate

DayCases 2,147ElectiveIn-Patients 1,578GJNHPatients 960ElectiveTotal 4,685Emergency/TraumaPatients 4,631OverallTotal 9,316 10,760 12,019

Theproposedmodelforchangecannotbeasinglestepprocess.Thecomplexityofchange,staffingandresourceimplications,impactonotherservices,physicalcapacityandnewmodelsofcareallpointtotheneedtomanageserviceredesignwithinasteppedprogrammeofchange.

TheagreeddevelopmentofacaseforanewhospitalatMonklandspresentsopportunitiesandflexibilitywithintheprogrammeinordertoensureappropriatecapacityisavailabletolocateserviceswhilstachievingtheintendedgoalofasinglesiteTraumamodel.LanarkshirewillsetoutthecaseforthedevelopmentofatraumaunitatWishawGeneralHospital,aspartofaLanarkshireemergencycareservicebasedonthreeEmergencyDepartments,andaWestofScotlandmajortraumanetwork.Thenationalcaseforthemajortraumanetworkidentifieshowthiswillsavelivesandreducesignificantdisabilities.

ThemovetothefinalconfigurationwillseealltraumasurgeryatWishaw,withallelectivesurgeryonanothersite.Thelocationofelectivesurgerywillbeshapedby:

• Thefinalservicemodelforthe5NationalElectiveTreatmentCentres(SNPmanifesto2016);

• ThefinalservicemodelfortheWestofScotlandmajortraumanetwork• Thecapacityforsurgery,diagnosticsetc.tobeprovidedbythe

developmentofMonklandsHospital(earliest7yearsinthefuture)whichwouldenablechangestobeds,theatresandcliniccapacityacrossLanarkshire.Thiswillalsoembedsufficientcapacitytomeetthefutureneedsofthepopulationforsurgery

• Theviewsofpatients,publicandotherstakeholdersthroughtheconsultationprocess.

Newservicemodelswillbeunderpinnedbyagreedpatientpathwaysandworkforceplanstooptimiseclinicalexpertise.

Outpatientcontactsaccountforgreaterthan85%ofallorthopaedicappointmentsandadmissions.Theservicewillremainlocalwiththevastmajorityofpatientsaccessingtheserviceattheirlocalhospital.TheinterimstepwascompletedinNovember2016,withorthopaedicoutpatientcareandcarewithinemergencydepartmentsprovidedacrossall3sites.OnlyinpatientanddaycasesurgerycurrentlyprovidedatMonklandswasaffected.


WherespecificinpatientcareisrequiredpathwayswereimplementedtoensurepatientsaretransferreddirectlytothenearestinpatientsiteandwheretheservicesofaMajorTraumacentreisrequiredforspecialistcareappropriatepathwayswereimplementedwithQueenElizabethUniversityHospital(QEUH)andtheScottishAmbulanceService(SAS).

Thisprovidesacomprehensivepackageacrossallof3acutesitesinNHSLanarkshireensuringpatientscanaccessthemajorityoftheircareasclosetohomeaspossiblewhilstconcentratingspecialistcaretoappropriatesitesinordertoimproveoutcomes.Evenwiththeeventualconsolidationoftraumaonto1site,orthopaedicswillretainapresenceacrossall3sites.

Thereareanumberofkeyprinciples/issueswhichwereaddressedintheplanningprocess:

• AnEmergencyDepartmentpathwayforpatientswithorthopaedicinjurytobeimplementedatanysitewithoutinpatientorthopaedicactivity.

• ScottishAmbulanceService(SAS)pathwaysforpatientsandprehospitalmanagementoftrauma&orthopaedicpatients.

• Workforceplanningforallclinical,non-clinicalandcommunitybasedstaffaffectedbychangestothecurrentservicemodels.

• Adetailedprotocol/pathwaywhichsetsouthowtheCareoftheElderly(COE)teamnowengageorthopaedicpatientsaspartoftheirworkloadandtotakeoverthecareofappropriatepatientsatamuchearlierpointintheprocess.

• AJointClinicalPathwayModelfororthopaedic,olderpeople’scareandlocalityservices.

• Managementoftheimpactonotherpriorityserviceswhichwereimpactedonbyimplementationofaservicereconfiguratione.g.theatres/anaesthetics,wardstaffing,traumaandout-patientclinics,localitybasedservices.

• Fullstaffengagementwithaffectedstaffandotherstakeholdersontheproposedservicemodelsthroughout.

ItwasalsorecognisedthatakeydriverinthischangeprocessisthedevelopmentandearlyimplementationofanewclinicalandsocialcarepathwaywhichdeliversimprovedaccesstoCareoftheElderly(COE)servicesandcommunitybasedservices.InparticularservicessuchasHospitalatHomeandcommunitybasedCareatHomewillimproveourabilitytosupportpatientswithinthecommunityandwillfacilitatethe‘HomeFirst’approachthatwillbeapplied.Thisfocussesonpatientsbeingtransferredhomewithappropriatesupporttomanagetheirongoingmedicalandrehabilitationneedsandimprovetheiroutcomes.Implementationofthisapproachwillensurethatthecareofelderlypatientsisnotdisruptedandalsothatthosepatientsthatdorequirealongerstayinhospitalaremanagedinthemostappropriatelocationunderthecareofthemostappropriateclinician.

Thisimprovementwilldeliverasignificantbenefitthroughimprovedpatientoutcomesaswemovecarefromhospitaltohome.Thereduceddependencyoninpatientbedswillfacilitatetheabilitytoaccommodateorthopaedicbedswithintheexistingbedallocationacrossthetwosites.


StakeholderEngagementThroughouttheorthopaedicreviewprocessNHSLanarkshirehasbeencommittedtoensurethatitinforms,engagesandconsultswithstakeholdersandanorthopaedicplanninggroupwasestablishedtotakeforwardthisreviewprocess.Thisgroupincludedclinical,managerial,patientandstaffrepresentation.AspartoftheNHSLanarkshireReviewprocesstwokeystakeholdereventswereheldtoconsiderandunderstandthechallengesofthecurrentconfigurationoforthopaedicservicesandtoidentifyandappraiseoptionsforarevisedservicemodelwhichwouldaddressthereview’skeyobjectives.TheeventswereheldinDecember2014andinMarch2015witheachattendedbyapproximately60delegatesincludingpatients,patientrepresentatives,carers,clinicians,managers,andstaffrepresentatives.ScottishHealthCouncilrepresentativeswerealsoinattendance.

TheshortlistofservicereconfigurationoptionsfromtheDecemberworkshopwasdefinedindetailpriortothenextstageofformaloptionappraisal,whichtookplaceattheMarch2015workshop.Thedetailedprocessincludedidentificationandimpactassessmentofanychangesrequiredatindividualhospitalleveltofacilitateimplementationofanyoftheoptions.Italsotookaccountofworkingpractices,capacity,demand,bedrequirements,theatreavailabilityanddemographicchanges.

TheanalysisoffinaloutcomesconcludedthatoutpatientservicesshouldcontinuetobeprovidedacrossthreesitesandthatsurgeryshouldbelocatedatWishawGeneralHospitalandoneothersite.

AttheirmeetinginJuly2016theNHSBoardconsideredallevidencefromthereview,includingtheAcademyreport,furtherpeerreviewvisitsandfurtherreportsonthesafetyandsustainabilityofmedicalstaffingfromNES.Theyconcludedthatamovetoaninterimservicemodel(the50-50splitbetweenelectiveandtrauma)shouldbeputintoplaceimmediately,andthatMonklandsDGHcouldnotprovidesufficientcapacity(theatresandwards)toprovideinpatientservicesaspartofthischange.

InJuly2016athird(external)stakeholdereventtookplaceinadvanceoftheconsultationprocesswhichallowedpatient,carerandvoluntaryorganisationrepresentativestounderstandthecontinuingworkoftheorthopaedicsreview,thedecisionsmadebytheNHSBoardinJuly2016,andtheproposalsforthelongertermconfigurationofsingletraumaandelectiveorthopaediccentres.

WhatWillChange?

Interim Changes to Inpatient ServicesTheNationalClinicalStrategy2andtheNationalTraumaNetworkReport3setouthowconcentratingtraumaandelectivesurgeryonseparatesitescandeliverarangeofbenefits,bothintermsofclinicaloutcomesandtheeffectiveuseofhighlyskilledstaff.


Intermsofdeliveringserviceimprovementakeychangewillbethroughrecognisingthatalargeelementofthecareforthe65+agegroup,thelargestpatientgroupreceivingorthopaediccare,doesnotnecessarilyneedtobedeliveredinanorthopaedicsetting,andwillbemoreeffectivelydeliveredinrehabilitation/sharedcareenvironment.

Thenewmodelofcaresetsoutsignificantchanges:• improvedpatientpathwayfortheelderlypatients,leadingto• improvedclinicaloutcome,and• reductioninlengthofinpatientstay.

Theyoungerandtheelderlypatientgroupshavedifferentneedswhicharebestmetbydevelopingpatientpathwaysspecifictoeachgroup.

ThescaleofchangethatisrequiredtoachievethiswithinLanarkshireisverychallenging:asingletraumaunitcannotbeachievedatWishawGeneralHospitalwithinthecurrentbedcomplementatthatsitewithoutcausingsignificantdisruptiontootherhospitalandcommunityservices.TheNHSLanarkshireBoardagreedon14thJuly2016tomovetowardsthisstrategicobjectiveinaphasedmannerbyfirstmovingtotwocombinedtraumaandelectiveunits,whichwasachievedwithoutmajordisruptiontootherhospitalservices.Thiswillenablethedevelopmentandimplementationofaclinicalmodelwhichimprovesservicesforpatients,resultsinimprovementstothelengthofstayinhospital(LOS)andimprovesthesustainabilityofthehighlyskilledworkforce.

Thishadnoimpactonoutpatientclinics,fractureclinicsandfracturestreatedinthethreelocalEmergencyDepartments.


Longer Term ChangesThetraumaworkoftheorthopaedicservicewillbecomepartoftheWestofScotlandmajortraumanetwork,focussedatWishawforLanarkshirepatients.Thiswassupportedbythosewhorespondedtotheconsultation.Thetimescaleforthisisdependentontheconclusionofnationalandregionalplanningforthenewmajortraumanetworks,andtheplanningofnew/refurbishedMonklandsHospital(whichwouldallowchangestoacuteservicestobemadebeyondthelimitationsofthecurrentbuildings).

Similarly,thefutureconfigurationofelectivesurgerymaybeaffectedbytheScottishGovernment’splansfordiagnosticandelectivetreatmentcentres.However,electiveorthopaedicsurgerywillcontinueinsomeforminLanarkshireandthiswouldbeconcentratedononesite,eitherMonklandsorHairmyres.

Therewasnoclearviewfromtheconsultationaloneastowhichhospitalthisshouldbe,andfurtherappraisalworkandstakeholderengagementwilltakeplacebeforeadecisiononthiscanbemade

Bothofthesenationalandregionaldevelopmentswillhaveabearingonthefuturelevelofservicesweprovidefororthopaedicsurgery,whichwhencombinedbytheincreaseintheneedsoftheageingpopulation-andanyopportunitiesfordevelopingsurgicalservicespresentedbythereplacement/refurbishmentofMonklandsDGH-meanthattheconfigurationofthesesurgicalservicesisnotyetfinalised.Impact at Monklands DGH

Key Point

TheNHSLanarkshireBoardhasmadeitclearthatMonklandswillcontinuetoprovidefullA&Eservicesthroughoutthecurrentandfuturechangestoorthopaedicservicesdescribedabove(seealsosection4.8).

TheMonklandsemergencydepartmentteamwillcontinuetotreatthemajorityoffractures(almost3,000eachyear),andreferthosepatientstothelocalfractureclinic–asatpresent.TheScottishAmbulanceServicenowtakesthesmallnumberofemergencycaseswithmajorfracturestothenearestappropriatehospital(Wishaw,Hairmyres,orintoGlasgow–asatpresent).Patientswhoself-referatMonklands(i.e.notsentbyaGPorbytheambulanceservice)andwhorequireimmediatesurgeryarestabilised,transferredandadmittedtoeitherHairmyresorWishaw.

Intotalthishasseenachangetothecurrentpathwayforemergencytreatmentforthreeorfourpatientseachday.

ThetotalreductioninactivityatMonklandsEDwillbearoundthreepercent,andsowillnotaffectthesustainabilityofthedepartment.

ThisisnowthesameprocesswhichallowspatientswhopresentataLanarkshirehospitalsitewiththeneedforothertypesofspecialistsurgerytobesafelymanaged–asatpresent.Forexample,specialistvascularsurgerycasesare


onlyoperatedonatHairmyres,urologyandENTsurgeryonlyatMonklands,paediatricsatWishaw,seriousburnsattheRoyalInfirmary,andseriousheadandspinalinjuriesattheQueenElizabethUniversityHospital.This’CentresofExcellence’modelhasshowntoprovidemuchbetterclinicaloutcomesandfasterrecoverythanprovidingallproceduresineveryDGH2.


Improvedqualityofcareandoutcomesforpatients

Shorterhospitalstaysforpatientswithenhancedrehabilitationandhomesupport

Introductionofconsistentpracticewithinorthopaedicservices

Improvedsustainabilityofthehighly-skilledworkforce

Shorterwaitingtimesforpatientspriortosurgery

Buildingcapacitytomeetthefuturepopulationneedsfororthopaedicsurgery

References1 RapidReviewoftheSafetyandQualityofCareforAcuteAdultPatientsin

NHSLanarkshire;HealthcareImprovementScotland,20132 ANationalClinicalStrategyforScotland;pp67;ScottishGovernment,20163 SustainabilityandSevenDayServicesTaskforceInterimReport:

www.gov.scot/Publications/2015/03/7764/84 TraumaandOrthopaedicServicesinLanarkshire;AcademyofMedicalRoyal

CollegesandFacultiesinScotland,2016

www.gov.scot/Publications/2015/03/7764/8


CancerServices

Vision To ensure high-quality diagnosis, treatment and care for patients, the work of clinical teams should ensure that care is provided consistently i.e. with less variation. This will take account of the patients’ views, preferences and circumstances when considering the clinical team’s advice on the care that is most appropriate for the patients’ conditions. There should also be clear communication pathways to include patient, GP and wider community teams, with documented evidence to reflect the discussions and outcome.

CurrentServicesThenumberofpeoplediagnosedwithcancerisrising,reflectingtheincreaseinScotland’sageingpopulationaswellasimprovementsindiagnostics.Astreatmentsimprove,morepeoplewilllivewithcancerforlonger(seesection2).

TheambitionsoftheNationalCancerStrategy1are:• Tomakeearlydetectionofcancerthenorm• Tohaveswiftdiagnosisandresultsforcliniciansandindividuals• Toenhancetheroleofprimarycareinbeatingcancer

Largermulti-disciplinaryclinicalteamsworkingacrosstheWestofScotlandwillbefurtherenhancedwhichwillimproveaccessto,andoutcomesfor,cancertreatment.

NHSLanarkshirehasaCancerStrategy2andthisissupplementedbyservicedevelopmentplanswhichcoverall9maintumourgroups:

• CancerPreventionandScreening• GeneticandMolecularTesting• ReferralandDiagnosis• Treatment• LivingwithandBeyondCancer

TheCancerStrategyImplementationSteeringGrouphasbroadrepresentationfromacrossLanarkshireanditspartnerorganisations.IthastakenforwardawiderangeofinitiativestoembedprimaryandsecondarycancerpreventionmessagesintheclinicalcommunityaswellaswithinthewidercommunityandhasactivelysupportedthenationalDetectingCancerEarlycampaignwork.

OneofthemostpressingkeyclinicaldriversforchangeacrosstheWestofScotlandhasbeenthesignificantincreaseinSystemicAntiCancerTherapy(SACT).SACTiscommonlyreferredtoaschemotherapy.In2015NHSLanarkshiresawa24percentincreaseandtheSACTRegionalExecutiveCommitteeprojectanincreaseofatleasteightpercentperannumtocontinue.

CurrentlyNHSLanarkshireprovidesalmost1,000SACTpatienttreatmentepisodespermonth.Theserviceisdeliveredinover60treatmentspaces

4.10


distributedbetweenWishaw,HairmyresandMonklandsHospitals,witheachspaceprovidingtwoorthreepatienttreatmentslotsperday.

ThechangesinthecurrentdeliveryofSACT,inrelationtothefrequencyofchemotherapyepisodesandcomplexityofregimenshaveresultedinanincreasedchairtimefromthreehourstofivehoursforsometreatments.Inaddition,patientsarealsobeingtreatedlonger,forexample,theintensityanddurationoftreatmentshassignificantlyincreasedthereforetheimpactonavailablecapacityhasbeenverydifficulttomanage.Onaweeklybasisthereisaneedtoscheduleandreschedulepatientstoensureallpatientscanhavetheirchemotherapysafelyaspernationalguidancewhichinvolvesdailycarefulco-ordination,includingpatientsrequiringsupportivecare(forexamplebloodtransfusion).

DetailedanalysisshowsthatcurrentlycapacityacrossthethreesitesforSACTisadequatebutitisnotusedefficiently.Patientscanreceivetheirtreatmentsfrommorethanonehospital.Patientsfindthisconfusingandlessthanacceptablewhenfeelingunwell.

NeedforChangeNHSLanarkshirehasastrongtrackrecordoverseveralyearsofdeliveringcareinaccordancewiththenationalcancerdiagnosisandtreatmentwaitingtimestandards.WeareamongsttheverybestintheUK.Thishascontributedtomorepeoplesurvivingaftercancer.However,thegrowinglevelofdemandaspeoplelivelongermeansweneedtocontinuouslylookforthemeanstoprovideeffectiveandsafecare.

OnethirdofSACTtreatmentsarehaematologycancers,onethirdbreastcancer,andtheremainingthirdfromothercancers.Thegreatestincreaseby42percentwasseenincolorectalcancer,withanincreaseinactivityacrossallspecialtiesasillustratedinFigure10.

Figure 10: PatientTreatmentEpisodesperMonth

Year Averagemonthlytreatmentepisodes

Increasefrompreviousyear

2012/2013 674 N/A2013/2014 745 10.5%2014/2015 925 24.2%

WhatWillChange?ThefutureservicemodelforSACTtreatmentwillneedtomeettheclinicalneedsofthepeopleofLanarkshire.Thestandardsofclinicalcarewillbeworld-classtoensurethatwecontinuetoreducethemortalityratesforcancerwithinthepopulation.

Thereareindicatorswhichsuggestthataclinicalmodelwithclinicsandday-unitSACTtreatmenttypesconcentratedononesiteinacentreofexcellencewouldleadtobetterclinicaloutcomesandgreatlyimprovepatientandcarer


experience.Thisoptionwouldrequireonlyonesiteasafocusforoncologyassessmentandtreatmentdelivery.MonklandsHospitalwouldbethespecialistsitetositalongsideclinicalhaematology,thenewLanarkshireBeatsonradiotherapyunit,LanarkshireMaggie’sCentreandthepotentialnewpharmacyasepticfacility(below).

Patientoutcomeswillbeimprovedfromthischangetocurrentservicesthrough:• SACTchairspacesandsomebedspacesusedmoreefficientlyandare

sufficienttomeetallfuturedemand• Dedicatedoutpatientanddiagnosticfacilitiestoensuretimelyandeffective

diagnosis• Multi-disciplinaryteamworkingimprovedthroughfulluseofexisting

(teleconference)andanynewtechnology• EffectiveandtimelyasepticpharmacyprovisiontoSACTUnits

Therewillbeaphasedapproachtoplanningandimplementingchangestothecurrentandfutureservicewhichenablesatransitionovertimetowardsthesinglesite,butwhichwillensurecontinuityofservicestopatients.

Furtherengagementwithpatients,carersandstaffwilltakeplacetoallowfuturechangestotheservicetoensuretheissuesofservicequality,patientaccessandstaffingrolesarefullyexploredbeforeanychangesareagreed.

InitialplanningworkbeganinFebruary2016withfurthercapacitymodellingleadingonfromareviewofSACTprovisionacrosstheWestofScotlandcancernetwork.Asthemajorcapacityissuesarewithincolorectaloncology,thefocuswasaroundthisspecialtyinthefirstinstance.Activityanddemandmodellinghasprovidedfurtherunderstandingofthecurrentpositionandthechallengesfacedbyservicesandidentifiedareaswhereimprovementanddevelopmentsarerequired.Smalltestsofchangeareunderwaywiththeaimofimprovingtheflowandcapacityofpatientsundergoingcolorectalchemotherapytreatmentsandforthosewaitingtocommence.Theoutputfromthelearningwillbeadoptedandimplementedwithinotheroncologyclinicstoimproveserviceefficiencyandpatientexperience.

Thereisalsoanopportunitytoconsiderasupportingpharmacyfacilitytothisproposal.Thenationalshared-servicereviewofpharmacyasepticserviceshasrecommendedthatasingleLanarkshireasepticfacilityshouldbebuilt,preferablyinthesitethatminimiseslinesofdistribution.ThiswouldprovidecomprehensiveSACTservicesforpatientswithinthesamebuildingcomplexandserveasanewCentreofExcellence.

Thiswillbeusedtoevidenceadirectbenefittopatientsandclinicalcareincluding:

• Consistencyofclinicaltreatment• Reductionindelays• Improvedpatienteducation• Improvedexperienceandpromptnessofchemotherapydelivery• Improvedskillsdevelopmentofstaff.


Thisworkwillunderpinthefurtherredesignofservicesandenablemoredetailedmodellingworktobeundertakentoidentifyandquantifyfutureresourcerequirements.


Aserviceco-designedwithpatients,carersandfamiliestoensurebetteraccesstoservicesandtreatment

Sustainablehighqualitydiagnosis,treatmentandcareforpatientsdiagnosedwithcancer

Improvedcommunicationpathwayswithinthewiderhealthcareprofessionalteamstoreflectdecisionmaking,caremanagementandfollowuprequirements

Animprovementintreatmentoptionstoincludepalliativecare,whenconsideringthequalitycareaspectsofpeoplediagnosedwithcancerandtheirfamilies

Aradicalimprovementintheefficiencyofflowandchaircapacityforchemotherapydelivery

AsinglesiteofferingacentreofexcellencewithinNHSLanarkshireforchemotherapydelivery

Aperson-centredapproachtochemotherapydeliverythroughtheintroductionofoutreachmodelsthatincludetreatinginthecommunityorwithinanindividual’shome

Improvedskillsdevelopmentofstaff

Improvedpharmacyasepticservicessupportingcentreofexcellence

Continuetoworkinpartnershiptosupportandrecognisecarers’needstoenablethemtocontinueintheircaringrole

UtilisevoluntarydriverservicesandcontinuetolinkwiththeTravelandTransportworkprogrammeandimprovetransportforcancerservices

References1 BeatingCancer:AmbitionandAction.Edinburgh:ScottishGovernment,

20162 CancerStrategy–AFrameworkforLanarkshire,NHSLanarkshire,2013


StrokeServices

Vision We will continue to provide excellent stroke care that improves the speed of access to the most appropriate clinical treatment and care resulting in improved outcomes for patients. This includes access to both acute stroke care in a dedicated stroke unit and effective rehabilitation to reduce the risk of longer-term disability. Wherever possible rehabilitation treatment and support will be delivered in a community setting.

Through improvement work, the Stroke Service will continue to deliver world-leading stroke care which is consistently person-centred, evidence-based and safe. We will consult and liaise with other clinical specialties, patient and carer groups and the voluntary sector. Communication with all service partners is key in being able to continue to deliver improvements.

CurrentServiceWhenmeasuredagainstotherpartsofScotland,NHSLanarkshirehasaconsistenttrackrecordofprovidingverysafeandeffectivecareforpeoplewhohavesufferedastroke.StrokeisthemostcommoncauseofsevereadultdisabilityandthesecondmostcommoncauseofdeathinEurope.Strokeincidencehasbeenrelativelystableoverrecentyearsandthisisnotexpectedtochangesignificantlydespitethechangingdemographicprofile.NHSScotlandspendsfivepercentofitsbudgetonstrokecare.Lanarkshirehasparticularchallenges,withayoungerstrokepopulationthantherestofScotland,resultinginagreaterneedforservicestobedeliveredtomeetthehealthandsocialchallengesthispresents.NHSLanarkshirecurrentlyhasthreeintegrated,comprehensivestrokeunits,oneoneachofthethreeacutehospitalsitesprovidingstrokecaretothelocalpopulation.In2015,995inpatientswereadmittedtotheLanarkshireStrokeService.

Rapidaccesstotime-criticalstrokecareisimportant.Thefocusofstrokeimprovementhasmovedtowardsmeasuringthequalityofstrokecarethroughdefinedaspectsofcareknownasthestrokecarebundle,i.e.agroupofspecificinterventions/processesofcarethatsignificantlyimprovepatientoutcomesifdonetogether.Insteadofmeasuringhowanindividualfaresagainstanyonestrokestandard,thebundlemeasureshowthatindividualfaresagainstallrelevantScottishStrokeCareStandards.Theseclinicallyevidencedinterventionsaimtoensurethatallpatientsreceiveallaspectsofhigh-qualitycarethatareproventoimprovetheoutcomeforpatients,reducingdeathanddisability.

Key Point

“Achievingacarebundleforischaemicstrokeisassociatedwithreducedmortalityat30daysand6monthsandincreasedlikelihoodofdischargetousualresidenceatsixmonths.”1

4.11


NHSLanarkshirehasmadecontinuousimprovementyearonyearinthedeliveryofthestrokecarebundle.Overthepastfiveyears,acontinuousimprovementinperformancehasresultedinNHSLanarkshireimprovingcompliancewiththestrokebundlefrom46percentin2010to83percentin2015.Throughthecooperativeworkingofstrokeclinicians,strokeunitstaffandtheStrokeManagedClinicalNetwork,thestrokeservicemodelhasdevelopedintoaneffectiveandefficientservicewithlengthofstayatleastfivedaysshorterthantheScottishaverageinallthreeunits.Weseektobuildonthisexcellentstandardofcareinthefuture.

TheNeedforChangeWithongoingchangestotheevidencebaseandstandardsbecomingmorechallenging,areshapeofelementsofthestrokeservicesisinevitableinordertorespondandcontinuouslyimproveoutcomesforpatients.

Alternativemodelsofdeliveringhospitalstrokecarewerereviewedin2015,includingconsiderationoftheconcentrationofacutestrokecareatonehospitalsiteinLanarkshire.Evidencesupportedthecurrentservicemodel(withthreestrokeunits)tobethemosteffectivemodelofstrokecareforNHSLanarkshire,withothermodelslikelytoleadtopooreroutcomesforpatientsincludinglongerinpatientlengthsofstayandincreasedmortality.Therefore,Lanarkshirewillcontinuetoprovidecomprehensivestrokeservicesateachdistrictgeneralhospital.

Howeverwedoneedtoconsiderourongoingchallengesacrossthepathway:• Interventionalradiologyforclotretrieval• Neurovascularclinicsandoutpatientcarepackages,includingsameday

treatmentanduseofnewdrugstreatingatrialfibrillation• StrokespasticitypatientscurrentlytreatedbyGlasgowservices• Strokeeducation• Carotidsurgery

WhatWillChange?By2020moreadvanced‘clot-busting’treatmentsinvolvingspecialistinputfromneuro-radiologyservicesarelikelytodevelop.Thebestmodelstodeliverthisinterventionnationallyarenotyetclear,andworkisongoingacrosstheUKtoexplorethis.ItispossiblethatsomepatientswillneedtobetransferredtoGlasgoworEdinburghforthesetreatments.Alternatively,telemedicine/technologyadvancementsmaymakemorelocaltreatmentfeasible.

Inneurovascularclinics,anoutpatientcarepackageincludingimaging,secondaryprevention,medicationsandlifestyleadviceisplannedfor2020.By2025,patientswillbetreatedonthedayoftheireventtofacilitatebetterpatientoutcomesandmoreefficientuseofhospitalbeds.Useofnewdrugswillallowspeediertreatmentofoutpatientswithatrialfibrillation(AF)andreducedstrokerisk.Itisexpectedthatby2020,allpatientswithnewlydiagnosedAFwillhavetheoptionofreceivingoneoftheseneweragents.Strokerateswillbereduced.

Inthedevelopmentofstrokespasticitytreatment,patientswillnolongerbereferredtoGlasgowservices.By2020,aservicemodelcomprisingofacentral


Lanarkshireclinicwithhospitalin-reachisplanned.Thiswillbeacollaborativeventurewithcolleaguesinthetraumaticbraininjuryteamthroughreorganisingcurrentstaffingandotherresources.

Strokeeducationwillcontinuetoplayanimportantrole,witheducationinitiativesfortheScottishAmbulanceService,emergencydepartmentsandcommunityteamshelpingtoensureeffectiveknowledge,skills,attitudesandconfidenceinstrokecareprovision.

Evidencesuggeststhatthemostbenefitforastrokepopulationcomesifcarotidsurgeryisperformedearly.Thereisanationalstandardthat80percentofpatientsshouldundergosurgerywithinthistimeframeandNHSLanarkshire,incommonwiththerestofScotland,currentlymissesthisstandard.By2020,throughcollaborationwithradiologyandvascularcolleaguesandwithserviceredesignandpathwayoptimisationNHSLanarkshirewillconsistentlymeetthistarget.


Deliveringmoreutilisingcurrentresources:BydeliveringaserviceacrossLanarkshirecomprisinghigh-qualitycareforpatientsandcontinuingtorespondtomorechallengingevidence-basedstandards.

ImprovethecapacityandcapabilityofcommunityteamstodelivercomprehensivestrokerehabilitationinacommunitysettingsupportedbyaSpecialistStrokePractitionerwhosemainroleissupportingVocationalRehabilitation(includingworkingwithOccupationalHealthServices)anddeliveringself-managementtopatientsacrossLanarkshire.

Bydeliveringmoreintensiverehabilitationforcomplexcasessupportedbyspecialistpractitionersworkingwithgenericcommunityteamstobuildcapacityandcapabilityintotheseservicesthroughmentoring,practicalsupportandongoingeducation.

BydeliveringefficientsecondarypreventionclinicsinlinewiththeNationalStrokeStandardswhichfacilitatetheprovisionofcuttingedgeservices.Thesewillbeledbyhighlytrainedspecialists,acrossNHSLanarkshire.

Deliveringtargetedearlyintervention:byprovidingspeedyaccesstothelatestclot-bustingtreatments,eitherlocallyorregionally,inlinewithemergingnationalstandards.

Consistentlyprovidecarotidinterventiontoallappropriatepatientswithintwoweeksofsymptomsinlinewiththenationalstandard.


References1 ImplementingaSimpleCareBundleisAssociatedWithImprovedOutcomes

inaNationalCohortofPatientswithIschaemicStroke.Turner,M.etal,ScottishStrokeCareAudit,2015

Deliveringamoreresponsiveneurovascularclinic:providingpatientswithspeedieraccesstoimagingandappropriatesecondaryintervention,thusreducingstrokerates.

Deliveringalocaltonemanagementservice:providingalocalserviceforpatients,improvingtheoutcomeforpatientswithspasticityfollowingstroke.


PalliativeCare

Vision NHS Lanarkshire and its partners will meet palliative care needs and provide services in the setting of patient/carer choice, wherever possible. For the majority of people this will be in their own homes or their care home of residence. Admission to an inpatient bed will only happen where absolutely necessary, with discharge facilitated as quickly as possible. There will be an increased range of suitable alternatives to hospital admission, involving partner organisations (NHS Lanarkshire, North and South Lanarkshire Councils, health and social care partnerships, hospices, voluntary and independent sectors and other West of Scotland NHS Boards).

CurrentServicesPalliativecareisanapproachtoimprovethequalityoflifeofpeoplefacinglife-limitingillness.Itisnolongerprovidedjustattheendoflife,ratherneedsareidentifiedfromdiagnosisonwardsbasedontheentiretyofaperson’scircumstances.Palliativecareisnotjustconcernedwithphysicalsymptoms,itextendsbeyondthepatienttotheirfamiliesaswell.

Themajorityofpalliativecareneedsaremetbygeneralists(e.g.carers,communitynurses,GPs)supportedbyasmallteamofpalliativecarespecialists.Canceriscoveredinsection4.10,butotherpeopletransitionintopalliativecarewiththeirowncondition-specificteams(e.g.respiratory,heartfailure,renal).Additionaladvice/inputisavailablefrompalliativecarespecialists,mostlytowardstheendoflife,andsupportedbythenationalpalliativecareguidelinespublishedin2014.

Thescopeofpalliativecareserviceshasgrowninrecentyears,inlinewithour2013strategy1.Thefocushasbeenongreateravailabilityofarangeofsupportsfordyingpeopleandtheircarers,includingexpansionofthecommunityMacmillanservicetoseven-dayworking,IntegratedCommunitySupportTeamsinSouthLanarkshire,LocalityModelling/ResponseTeamsinNorthLanarkshireandanticipatoryprescribingvia‘JustinCase’boxes.

TheNeedforChangeThereareanumberoffactorswhichmeantheservicemustcontinuetoimprove:

• People’swishes:around70percentofpeoplesaytheywanttodieathome(DyingMatters2),yetonlyaquarterdidsoinLanarkshirein2011

• Changingpersonalcircumstances:smallerfamiliesprovidingsupport,ornofamilylivinglocally(5percentofpeopleagedover85livedalonein2012)andtheageingLanarkshirepopulation(seesection2)

• Publicationofthenational‘StrategicFrameworkforAction’3and‘RealisticMedicine’:thePalliativeCareManagedClinicalNetworkisexploringhowthesecanhelptofurtherdevelopthequalityofourservices,withafocusonendoflifeinterventionsandgreaterpublicdiscussionofbereavement,

4.12


deathanddying.RealisticMedicine4involvesinformationandchoice,andnotprovidinginterventionswhichdonotaddvalueforpatients.

• TransferofresponsibilityforhealthcareprovisionfromNHSGreaterGlasgow&ClydetoNHSLanarkshire:thereisaneedtoassessthepreferredplaceofcareforpeoplefromRutherglen/CambuslangandtheNorthernCorridor

WhatWillChange?• Moresupportisneededtoenablethosepeoplewhowishtodieathome.

Thismayincludearapidresponsetoavoidbreakdownofcareathome,helpforelderlycarerswhocannotcurrentlycopewithpalliativecareathomeanddedicatedpalliativecarehospitaldischargesupport

• InlinewiththeshiftofcaretoincreasesupportforcareathomeorinahomelysettingtheHSCPscommissioningstrategiesmaychangetheconfigurationofpalliativecareinpatient(hospice)beds

• Newsupportsarebeingintroducedtoinformdecision-makingtowardstheendoflifetoensureoptimalcareandtreatmentchoicese.g.HospitalAnticipatoryCarePlanning5,RecordofEndofLifeCare.Agoodexperienceofhospitalpalliativecarecanprovidetheassurancesthatfacilitatedischargeandmaintaincareathome

• Lanarkshirehasbeendeliveringastructuredconversationtoenablepeopletobemorecomfortabletalkingaboutdeath,dyingandbereavement.ThiswillberolledoutfurthertosupportStrategicFrameworkforActionimplementation

• Earlydiscussionshavetakenplacearoundthepotentialimpactoftelehealthinpalliativecare.Initiallythismayinvolvesimpletextmessagingtoallowpalliativecarespecialistnursestomaintaincontactwithsomepatientsremotely,thusincreasingserviceefficiency.Therangeofothertelecaresupportforpeopleathomeprovidedthroughcarepackagescontinuestoevolveandimproveinqualityandsophistication.


Peopleareroutinelyaskedwhatmatterstothemandthisformsthebasisofallpalliativecareplanningi.e.peopleareatthecentreoftheircareplan

Peopleaccessthepalliativecareservicesthatmeettheirneedsinallcaresettings,includingfuturedevelopmentssuchastelehealth

Peopledieintheirownhomes,iftheywishthis,withthelevelandrangeofsupportstheyrequire,includingsupportfortheircarers

Peopleapproachingtheendoftheirlivesundergoonlythoseinterventionsthatareeffective,thusoptimisingtheirqualityoflife

Allstaffarecomfortabletalkingaboutdeath,dyingandbereavement


References:1 NHSLanarkshire(2013)PalliativeCareStrategywww.nhslanarkshire.org.

uk/Services/PalliativeCare/Documents/Palliative%20Care%20Strategy%20Aug%2013.pdf[accessed29.6.16]

2 DyingMatters[accessed9.12.15]www.dyingmatters.org/page/frequently-asked-questions

3 TheStrategicFrameworkforActiononPalliativeandEndofLifeCare.Edinburgh:ScottishGovernment,2015

4 ChiefMedicalOfficer(2016)RealisticMedicine:CMOAnnualReport2014-15.www.gov.scot/Resource/0049/00492520.pdf[accessed29.6.16]

5 Taylor,DR(2014)COPD,endoflifeandCeilingofTreatment.Thorax0:1-3.doi1136/thoraxjnl-2013-204943

www.nhslanarkshire.org.uk/Services/PalliativeCare/Documents/Palliative%20Care%20Strategy%20Aug%2013.pdf

www.dyingmatters.org/page/frequently-asked-questions

http://www.gov.scot/Resource/0049/00492520.pdf


CrossCuttingServices

5


CROSSCUTTINGSERVICES

Pharmacy

VisionAll patients, regardless of their age and setting of care, will be supported to ensure they get the best possible outcomes from their medicines while avoiding waste and harm. This will be delivered through pharmacy working in collaborative partnerships with patients, carers, medical and nursing colleagues and the other relevant health, social care, third and independent sector professionals.

Pharmacy Services will support NHS Lanarkshire, North and South Health and Social Care Partnerships to deliver the most appropriate and cost effective, evidence-based treatments, interventions and services to meet the needs of patients. Clear procedural and governance systems which quality assure how services are developed and resourced will be part of the routine practice.

CurrentServicesTreatmentwithmedicinesisthemostcommonhealthcareinterventionintheNHS.WithinNHSLanarkshireover11millionprescriptionsaredispensedeachyearatacostofover£150million.Thisindicatesthatthevastmajorityofpeoplewhoseekhealthcareadviceandtreatmentwillaccesspharmacyservicesatsomepointduringtheircarejourney.

Teamsofpharmacistsandsupportstaffwithineachofthe143communitypharmacieslocatedacrossNHSLanarkshiredispensethesemedicinestopatientsandprovideadviceandhelptoprescribers,patientsandtheircarersabouthowtousetheirmedicinessafelyandtothebesteffect.Thecommunitypharmacyserviceisgovernedbyaseriesofnationalandlocalcontractswhichsetoutthestandardsfortheseservices.Inadditiontodispensingmedicinescommunitypharmacistsalsoprovidecompletepackagesofcarewithouttheneedforreferraltoothers,thisincludessmokingcessation,emergencycontraceptionandthesupplyofmedicinestotreatself-limitingminorailments.Manypharmacistsarenowalsocontractedtoworkasindependentprescribersacrossabroadrangeofareassuchasaddictionservicesandpolypharmacyreviews.

Thesethemesarereplicatedwithinhospitalpharmacypracticewhereteamsofpharmacists,techniciansandsupportstaffprovidearangeofservicesincludingmedicineprocurementandsupplyandspecialistdispensingservicessuchasasepticandcancerchemotherapydispensing.Thisissupportedbywellestablishedclinicalpharmacyandmedicinesinformationservicesinwhichclinicalpharmacistsarefullyintegratedintothespecialitymedicalandnursingteamstoprovidecareforpatientsthatisfocussedonachievingthebestoutcomesfrommedicines.Asincommunitypracticemanyofourhospitalpharmacistsarequalifiedindependentprescribers.

5.1

5

77Cross Cutting Services

ThePrescribingManagementTeamworkswithinprimarycaretoprovideanalysis,adviceandsupporttomanagementteams,generalpractitionersandotherhealthcareprofessionalsinordertopromotehighqualityandcosteffectiveprescribing.ThePrescribingManagementTeamisparticipatinginthePrimaryCareTransformationProgrammewhichwillseetheintroductionofgeneralpracticeclinicalpharmacistindependentprescribersintoasubstantialnumberofGPpracticesacrossNHSLanarkshire{seesection4.1).

TheNeedforChangeAcrosstheNHStheuseofmedicineshascontinuallyincreasedoverrecentyears.Whilemedicineshaveasignificantimpactonimprovingpatientoutcomestherearerisksandthepotentialoveruseofmedicinesisacauseforconcern.Takingmoremedicinesthanrequiredmaybeharmfulinthatitcanincreasetheriskofdruginteractionsandadversedrugreactions,togetherwithimpairingmedicationadherenceandqualityoflifeforpatients.Unlessthedrugsprescribedtopatientsarereviewedregularlybyclinicianswithup-to-dateknowledgethereisariskthattreatmentmaybeineffectiveatbestandharmfulatworst.IndeedeachyearinScotlanditisestimatedthat61,000non-electiveadmissionsareduetoamedicine-relatedissue1.Tosupportthecontinuedsafe,effectiveandefficientuseofmedicinesrequiresthattherearerobustmedicinegovernancesystemsinplacesothatallprescribersinLanarkshirehaveaccesstoinformationandsupportnecessary.

FiguresrecentlyreleasedbyHISsuggestthat20percentoftheScottishpopulationistakingfiveormoreprescribedmedicinesonaregularbasis1.


LanarkshirehasanunenviableandconsistentpositionofseeingahighervolumeofprescribingperheadofpopulationthananyotherNHSboardarea.

TherearedriversatbothUKandScottishGovernmentlevelswhichwilldirectchangesinpracticeanditisessentialthatwetakethisopportunitytoimprovetheusemedicinesforthebenefitofourpatients.RecentdocumentspublishedbytheScottishGovernmentsuchas‘PrescriptionforExcellence’2and‘RealisticMedicine’3makethisclear.Inparticularitisrealisedthatthereisscopeforpharmacistsandotherhealthcareprofessionalstoworktogethertobetterutilisetheirconsiderabletrainingandexpertiseandcontributemoretohowourhealthcaresystemandpatientsusemedicinestobesteffect.TheMedicinesAct1968isthebasisformuchcurrentpracticeandthisisreservedtotheUKGovernment.In2013theUKGovernmentestablishedtheRebalancingMedicinesLegislationandPharmacyRegulationProgrammeBoard4.Thisisduetoreportinlate2016withrecommendationstoremovesomeofthebarriersthatexistwithincurrentlegislation.

WhatWillChange?WithinNHSLanarkshirewewillembracetheopportunitiesprovidedandwilladoptthemtoourlocalenvironment.Forexample:

• Thepharmacyworkforcewillbesupportedanddevelopedtoensurethatitsuniqueskill-setisabletobeutilisedtodeliversafeandeffectivepatientcareandserviceefficientlyacrossallhealthandsocialcaresettings.

• Wewillcontinuetodevelopandbuilduponourfoundationoflocallynegotiatedcontractswithcommunitypharmacists,particularlyintheareasofminimisingharmsfrommedicinesandprovidingsupportforvulnerablepatientsintheirownhomes.IncreasinglythisworkwillbecoordinatedwithHealthandSocialCarePartnershipssothatthecontributionofthepharmacistsaugmentsthecontributionofallothermembersofthehealthandsocialcareteams.

• Wewilldevelopservicesandsupportmaterialstohelppatientsandtheircarersunderstandthebenefitsandrisksofmedicationandsopavethewaytoempowerpatientstomakefullyinformeddecisionsabouttheirmedicationtreatments.

• WewillbekeypartnersinthePrimaryCareTransformationprogrammeanddeliverserviceswhichwillseepharmacistsandsupportstaffcontributemoretothesafeandeffectivetreatmentofpatients,andwhichwillalsoempowerotherhealthcareprofessionalssuchasnursingstaff,physiotherapistsandoptometriststodolikewisewhentheyaccessandusemedicinestocarefortheirpatients.

• ThenewPrescribingQualityandEfficiencyProgrammewillrefreshthegovernanceandfinancialmanagementsystemsformedicineswithinNHSLanarkshiretoensuretheyremainfitforpurposeforthenewopportunitiesandchallengeswhichchanginglegislation,structuresandtheavailabilityofnewmedicineswillbring.

References1 www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/Medicines/

SPSP%20Medicines%20Infographic.pdf2 PrescriptionforExcellence;ScottishGovernment,20133 RealisticMedicine–AnnualReportbytheChiefMedicalOfficer;Scottish

Government,20164 www.gov.uk/government/groups/pharmacy-regulation-programme-board



Everypersonisabletogetthebesthealthoutcomethattheycanfromtheirmedicines

Patientsareabletomakeinformeddecisionsabouttheirmedicinesanddiscussthemwithanyoneinvolvedintheircare

Patientsareabletoaskforhelpiftheyhaveaquestionoradifficultywiththeirmedicines

Harmfrommedicinesisreduced

Treatmentsoflittlevaluearenotused

Medicinesnolongerrequiredarestopped

Lanarkshireachievesgreatervaluetheformoneyinvestedinmedicines

www.scottishpatientsafetyprogramme.scot.nhs.uk/Media/Docs/Medicines/SPSP%20Medicines%20Infographic.pdf

www.gov.uk/government/groups/pharmacy-regulation-programme-board


Property

VisionAll facilities will be designed to meet the clinical and care needs of the population we serve. We are investing in primary care facilities that support the drive towards delivering care closer to home, without affecting longer term changes being considered for acute and elderly care service models. There will be continuing investment in existing buildings that will improve the quality of health and social care provision and patients’ experience.

NHSLanarkshire’sExistingEstate1

NHSLanarkshirehasarelativelylargeexistingestatecomprisingageographicallyandfunctionallydiversepropertyportfolioprovidingover296,000m2ofaccommodation.

Primaryhealthcareisprovidedinthecommunityfromhealthcentres/clinics,communityhealthcentres/dayhospitals,aswellasfrompremiseshousinggeneralpractitioners(GPs),dentists,pharmacists,optometrists,healthvisitorsandawiderangeofalliedhealthprofessionals.Someoftheserepresenthighqualityestatethatisdesignedformodernhealthcarewhileothersdonot.Overall,NHSLanarkshireservicesareprovidedfrom59locationswithatotalof174buildingsonthesesitesranginginsizefrom15m2to65,000m2.However,themajorityofthesebuildingsarerelativelysmall,with112buildingslessthan1,000m2valuedatcirca£155million.InadditionwedeliverhealthcarefrompropertieswhicharenotownedbytheNHSBoardthroughPrivatePublicPartnership(PPP)/PrivateFinanceInitiative(PFI)agreementsandcommercialleases.

AnanalysisoftheexistingpropertyownershipshowsthatthePPP/PFIhospitalsatWishaw,HairmyresandStonehouseaccountforoveronethirdofthegrossinternalarea(GIA)occupiedbytheBoard.ThisisoneofthehighestproportionsforanyNHSBoardinScotlandandsotheproactiveperformancemanagementofPFIContractsisakeyfeatureoftheworkofPropertyandSupportServices.Figure11showsthatnon-hospitalspaceisapproximatelyathirdoftheestate,reflectingatrendofmovingservicesintothecommunity.However,itmustberecognisedthatNHSLanarkshirewillcontinuetohaveahigherratioofhospitalareastoprimarycareareasthanthosecomparableNHSBoardswhichhaveonlyoneortwodistrictgeneral1hospitals.

5.2


Figure 11:Ananalysisoftheexistingestatebybuildingtype2014/15

Area(GIA)sq.m

%ofTotalArea

Hospitals–Acute(3) 171,093 58%Hospitals–Community(12) 35,438 12%CorporateSites* 19,134 6.5%NorthLanarkshire:HealthCentres,ClinicsandOffices 39,660 13%SouthLanarkshire:HealthCentres,ClinicsandOffices 31,089 10.5%Total 296,414 100%

28thApril2016,Source:EstateManagementSystem

*CorporatePremises:KirklandsHQ,LawHouse,BeckfordStreet,WestLaundry

MonklandsDGHhasgreatlyexceededitsdesignlifewhichposesmanyoperationalandfinancialchallenges.By2018amajor£20mprojectwillbecompletedwhichwillseetherefurbishmentofMonkland’soperatingtheatresandIntensiveCareUnit(ICU).However,thereremaintensofmillionsofpoundsofupgradingwhichwouldbenecessaryinordertobringallareasofMonklandsaccommodationandservicesupto21stcenturystandards.

WhatWillChange?

Key Point

InJanuary2017NHSLanarkshireapprovedthefirststageinthebusinesscasetoreplacethecurrentfacilitiesatMonklandsDistrictGeneralHospitalwithnewhospitalaccommodation–eitheronthecurrentsiteoronanewlocationinNorthLanarkshire.

WiththeapprovaloftheScottishGovernment,thiswillprovideafacilitywhichwillservethepeopleofthewholeofLanarkshireforthenext40years,andwilllikelyseeover£400minvestedintheLanarkshirehealthcaresystem.Theplanningandapprovalprocesshasbegunonthisexcitingnewproject,withexpectationthenewfacilitieswillbeopenedinsevenyears’time.

AcrossLanarkshire,wewilldevelopafit-for-purposeestatethatsupportsashiftinthebalanceofcarefromacute/residentialfacilitiestocommunity/primarycaresettings.

Withthecontinuousdevelopmentofdigitaltechnologiestherewillbeanincreaseinthenumberofclinicalcontactswhichdonotneeddedicatedspecialistfacilities.Atthesametimetherewillbeareducedneedforstaffofficeaccommodationandclinical(paper)recordsstorage.


Maintainingourexistingestatetoensureasafepatientenvironmentisakeypriorityincluding:

• Investinginbacklogmaintenanceandstatutorycompliancetocontinuethetrendtowardsreducingtheassociatedpropertyrelatedrisks

• Rationalisingtheexistingbuildingportfoliotoensurethemosteffectiveandefficientuseofbuildingstosupportservicedelivery

• Incorporatingallassetsintotheinvestmentprioritisationanddecisionmakingprocesssothatresourcescanbefocussedongreatestneedandbenefit

• ContinuedinvestmentinimprovingfacilitiestofurtherreducebacklogmaintenanceandstatutorycompliancerisksatMonklandsHospital,withknowledgeoftheintenttoreplacethiskeyfacilityinduecourse

• Continueddeliveryofariskbasedapproachtoimprovementstootherexistingfacilitieswithoutstandingbacklogmaintenanceandstatutorycompliancechallenges.

Thelimitationsoncapitalfunding(seesection8)willhaveanongoingimpactontheabilityofNHSLanarkshiretoprovidenewhealthcarepremises.Neverthelesssomeprioritieswillbeprogressedwhichwillinclude:

• PlanningthepermanentreplacementofMonklandsDGH;• ConsolidationofSouthLanarkshireinpatientmentalhealthatHairmyres

Hospital;• PrimaryandcommunitycarepremisesimprovementsintheNorthern

Corridor(Stepps,MuirheadandMoodiesburn);• Improvedophthalmology,dermatologyandneonatalfacilitiesinourDGHs;• Regional/sharedasepticpharmacyproduction;• Changestoaccommodationwhichhelptoimprovepatientflowinour

DGHs.

Inthisrapidlychangingenvironmentofhealthandsocialcare,revisedgovernancearrangementswillbeusedtoensurethecorrectallocationofspacetoservicesarebeingrefreshedandastandardisedandconsistentapproachshallbeappliedtoensurethecorrectallocationofspacetoclinicalneed.Thiswillreflectnationalhealthcarestandardsandtheactualneedsofserviceswhichalignforeffectivedeliveryofthehealthcarestrategy.


Therehavebeenmajorchangesinthehealthcareestateinthelastdecade,especiallyacrosstheprimarycare,administrationandmentalhealthfunctions.Withrecognitionthatapproximatelyone-thirdoftheBoard’sexpenditureisstillonpropertyandassociatedmaintenance,thereisidentifiedscopetomakebestuseoftheestate.Buildinguponinformationwhichwillbecollatedinthepropertygazetteerrelatingtohowspaceiscurrentlyallocated,arollingprogrammeofspaceutilisationsurveysshallbeundertaken.Thiswillidentifyanypotentialoverorunderallocationofspace,withaviewtoreallocatingthisspacetoclinicalprioritiesor,whereapplicable,considerationofdeclaringsomespacesurplusfordisposal,withassociatedsavings.Thisworkwillbeundertakeninpartnershipwiththecommunityplanningpartners.


Monklandswillbereplacedbyafacilitydesignedtobeanintegralpartofdelivering21stcenturyhealthandsocialcare

Primaryandcommunitycarewillbeprovidedfromfit-for-purposebuildingsabletomeetthefutureneedsofthepopulation

Allofourpropertieswillbefullyefficientlyusedwithlittleunderutilisationorovercrowding

NHSLanarkshirewillmeetorexceedourcarbon-reductiontargetsintermsofheating,lightandpower

Optimiseopportunitiesforsharedaccommodationwithotherpublicandthirdsectorpartners

References1 NHSLanarkshireProperty&AssetManagementStrategy2013–2017


eHealthandDigitalTechnologies

VisionMeeting the 2020 Vision for Scotland and the ambitions set out in the National Clinical Strategy for Scotland1 requires a well-trained and highly motivated workforce that is supported with modern, adaptive and sustainable eHealth and digital technologies. We need to strengthen our ambition to use technology to enable safer, more efficient delivery of services and provide the ability to collect and analyse data to guide service planning and treatment decisions.

eHealth and digital technologies will support the transformation of patient care enabling further self-care /management supporting patients and their carers.

NHS Lanarkshire recognises the growing impact that eHealth and Digital Technologies (eHealth) is bringing to the delivery of healthcare around the world today. eHealth and Digital Technologies are making healthcare systems more efficient and more responsive to changing healthcare needs and expectations.

CurrentServiceNHSLanarkshirehassuccessfullyimplementedarangeofeHealthanddigitaltechnologiestosupporttheprovisionofcare.eHealthsystemsareoperationalacrossprimaryandsecondarycare.Ratherthaninventinglocalsolutions,wherepossiblenationalITsystemshavebeenadopted.

TheNeedforChangeOurlongtermvisionistoprovideasingleelectronichealthrecordforourpatients,however,moreworkisrequiredtodigitisepaperrecordsandcasenotes,sharesummaryinformationbetweenservicesandpartners,andmanageworkflowacrossboundaries.

Thecurrentlimiteduseofelectronichospitalprescribingandadministrationsystemsneedstobeextendedtoreplaceexistingpaperbasedsystemstoensurepatientsafety;andworkisinhandtodoso.Electronicreconciliationofmedicationrecordsisrequiredbetweenhospitals,GPsystems,andcommunitypharmaciststoensurethatacommonuptodateelectronicmedicationviewisavailable.

Improvedelectronicinformationsharingisrequiredbetweenhealthandsocialcareprovidersandtheirthirdsectorpartnerstoensurethatthepatientreceivestherightlevelofcarebasedonalltheinformationavailable.Electronicsystemswillincreasinglyneedtosupportcrossboundaryworkingasweconcentrateandintegrateresourcestodeliverthebestavailablecare,andsupportmobileaccesstomeetpatientandclinicians’needs.

5.3


WhatWillChange?Modernclinicalinformationsystemscanhelptocontributetoimprovementinpatientcare,efficiencyandclinicaleffectiveness.Adoptionofdigitaltechnologiespresentstheopportunitytoredesignandstandardisehealthcareprocessestomeethealthcarepractitionerandpatientneeds.WhenappliedintherightsettingsITsystemscandeliverefficienciesandfreeupmuchneededresourcestosupportfrontlineservices.

Telehealthcanhelpsupportpatientslivelongerlivesathomeorinahomelysetting.MoreadvanceddigitalservicesincludingeConsultation,andhomemonitoringandvideoconferencingcouldsupportGPsandenhancecapacitywithincommunityservicesovertimebutwillrequirewholesystemschange.Theworldofwearabletechnologyincorporatingmedicaldevicesrepresentsenormouspotentialtorevolutionisecurrentmodelsofcare.Overthenext5years,therewillbeaseismicshifttowardsproactivehealthcaremonitoringandmanagement.Thiswillbedriveninpartbytheconsumerisationofthemarketplaceprovidingadvancedcapabilityatlowcost.Thistechnologywillbedisruptive;itwillbegintotrulyempowerpatientswithmedicalgradeinformation.TheNHSwillneedtoharnessthiscapabilityandadaptmodelsofcareaccordingly.

ClinicalportaldevelopmenthasfacilitatedelectronicinformationsharingacrosstheWestofScotlandprovidingstaffwitheasyaccesstoessentialpatientinformationandhistory,andisincreasinglybeingmadeaccessibletoGPsandstaffinthecommunity.ClinicalPortalisacriticaltoolinprovidingaccesstopatientrecordsaspatientscrossboundariesforcaretoGlasgow,theNationalWaitingTimesCentreandbeyond.

Theopportunitytoincludedigitised“live”healthrecordswithintheClinicalPortalwillprovideasingleviewofthepatient’srecord,accessiblereal-time24/7


andwilleradicatemanyoftheproblemsexperiencedwiththetraditionalpaperrecord.

Theintroductionofahospitalelectronichospitalprescribingandadministrationsystem(HEPMA)willprovideclinicaldecisionsupportimprovingpatientsafety;thesystemwillreducedrugerrors,speedupthemedicationreconciliationandimprovethenotificationofallergies,druginteractionsandduplicatetreatments.

Wewillstarttocaptureclinicalinformationelectronicallyatthepointofcare.Thiswillreducetheneedforhandwrittenpatientrecords.Significantbenefitswillbedeliveredincluding;legiblerecords,increasedavailability,easiertoshare,easiertosecure,manageandmonitor.

Primarycarerepresentsanareawherethereareconsiderableopportunitiestoimprovepatientcare,efficiencyandclinicaleffectivenessthroughtheintroductionofmodernITsystems.ModernsystemsprovidefullintegrationbetweenGeneralPracticeandthewidercommunitysetting.TheneedtoadoptacommerciallyviablecommunityITsolutionwillenabletheshiftinthebalanceofcareandsupportthe2020VisionandimplementationoftheHealthcareStrategy.Improvedelectronicinformationsharingisrequiredbetweenhealthandsocialcareandtheirthirdsectorpartnerstoensurethatthepatientreceivestherightlevelofcarebasedonalltheinformationavailable.Electronicsystemswillincreasinglyneedtosupportcrossboundaryworkingasweconcentrateandintegrateresourcestodeliverthebestavailablecare,andsupportmobileaccesstomeetpatients’andclinicians’needs.

PatientonlineaccesstotheirpersonalhealthrecordisstillonlypossibleinLanarkshireinverylimitedcircumstances.Forexamplesomediabetespatientscanaccesstheirrecordson-line.Theneedtoextendaccesstopatientrecordsisakeystrategicobjective.

PlansareinplacetosignificantlyimprovethesituationwithpatientaccessinScotlandwithinthenextfewyearsthroughthecreationofapatientportal.Thiswillgiveaccesstoasummaryelectronicpatientrecord,personalisedhealthinformationanddigitalservicesforeverycitizeninScotland.

ThereisagreatopportunitytoensureITsystemsareinplacethatwillmaketheNHSsafer,moreefficientindeliveryofservices,moreeasilyaccessibleandprovidetheabilitytocollectandanalysedatatoguideserviceplanningandtreatmentdecisions.

Theintroductionofrealtimebusinessintelligencedashboardshasmadeperformancemanagementmuchmoreeffective.Thisapproachshouldbeextendedtocovercriticalareasforexampleimprovingpatientflowandprovidingkeyperformanceinformation.

Weaimtodeliverasingleelectronicpatientrecordthatisaccessiblebyallappropriateclinicalstaff,operatinginmultipleclinicalsettings,tosupportthedeliveryoftimely,consistentandhighqualitypatientcare.


TheNHSLanarkshireeHealthStrategyisaboutbalancingprioritiestodeliverimprovedserviceoutcomesaroundthesevenaimsintheScottishGovernmenteHealthStrategy2014–20172.

Thisisparticularlyimportantaswereshapeservicestomeetthechangingneedsofourpatientsandstaff:increasingdemand;providing24/7services;morecareawayfromthelargerhospitals;andpatientshavingaccesstokeyinformationtohelpthembettermanagetheirowncare.Resourceswillcontinuetobeusedtoensuretheserviceandthepatientcanmakethebestuseoftechnologyaroundsafety,quality,efficiencyandeffectiveness.

Anelementofthepopulationis‘digitallyexcluded’becausetheylackinternetaccessorhavelowlevelsofdigitalliteracy.Digitalexclusionisakeybarriertoprogressbecausethepeoplewiththegreatesthealthcareneedsareoftenlesslikelytohavethetechnologyandskillstoengagewithandbenefitfromdigitalservices.

NHSLanarkshirewillaimtoensurethatourpatientsarenotdisadvantagediftheyaredigitallyexcluded.Thismeans,forexample,thatwewillnotassumeallpatients,relativesandcarershaveaccessto(orcanmakefulluseof)internetserviceswhendevelopingdigitalservices.


Safer,andmoredependablehealthandsocialcareservices

Personcentredinformationacrosssectorsandboundariesofcarewhichspeedsupcare

Digitalpatientinformationwithminimaluseofpaper,andmoreefficientclinicalservices

Ultimately,asingledigitalhealthandsocialcarerecordwiththemanybenefitstopatientcarethiswillbring

Increaseuseofstructureddigitaldatatoenableclinicaldecisionsupport,leadingtobettercareandtreatment

Increasedhomemonitoringallowingearlierclinicalinterventionsandsupportingcareathome

References:1 ScottishGovernment.ANationalClinicalStrategyforScotland.Edinburgh:

ScottishGovernment,20162 ScottishGovernment.eHealthStrategy2014–2017.Edinburgh:Scottish

Government,2015


Transport

VisionNHS Lanarkshire is committed to supporting patients, carers, visitors and staff to access our facilities in a manner which is as straight forward and cost effective as possible. We will work with our partner organisations and a wide range of stakeholders to develop and implement a sustainable transport and travel policy.

CurrentSituationAverylargeproportionoftheresponsestothe2016consultationontheHealthcareStrategyfocussedontransporttoorbetweenoursites.

Patients,carers,visitorsandstafftraveltohealthcaresitesbyanumberofdifferentmodesoftransport.Surveyinformation,initiallyundertakenbyStrathclydePartnershipforTransport(SPT)thenfollowedupinahospitalsurveyin2016,indicatedthefollowing:

Modeoftransport Patients/Visitors/Carers StaffPrivatecar–asdriver 71.53% 81.82%Privatecar–aspassenger 10.57% 3.38%Privatecar–carshare 0.00% 0.78%Bus 5.70% 4.68%Train 0.80% 4.16%Taxi 5.70% 0.78%Walk 5.70% 3.12%Cycle 0.00% 0.78%Other 0.00% 0.50%

Theabovetableindicatespreferredmodeoftravelforpatients,carersandvisitorsandalsoforstaff.Theresultsforthevariousgroupsareverysimilarandsetoutthecontextwithinwhichasustainabletransportandtravelpolicyrequirestobedevelopedandimplemented.Thesurveydataconfirmsthat82%ofpatients,carersandvisitorsand85%ofstafftraveltooursitesbyprivatecar.

TheNeedforChangeAs“AchievingExcellence”isimplemented,theworktoestablishfurthercentresofexcellence(seesection4.7)needstobeunderpinnedbycontinuedimprovementinaccesstopublictransportandimprovedmanagementofcarparkingatoursites.Thiswillmakeiteasiertomovebetweenourhospitalsitesandassistpatients,carers,visitorsandstafftoaccessthesesites.ThisreflectstheScottishGovernmentstrategicintentiontoreducerelianceoncaruseandtoimproveourcarbonfootprintbyimprovingsustainabletransport.

Thereisalsorecognitionthatsupportingpeopletousetheirownpreferredchoiceoftransportisakeyelementofensuringpatientchoice.Withinthis

5.4


processthereisaneedtoimproveaccesstopatienttransportwhichmaybeprovidedbyanumberofagencies,includingtheScottishAmbulanceService.TheScottishAmbulanceServicewillcontinuetoprovidetransportforpatientswhohaveaclinicalrequirement,andwillworkcollaborativelywithhealthcarepartnersandtransportproviderstoformulateacohesivetransportstrategy.Ourformalengagementwitharangeofstakeholdershasidentifiedthattheprimaryareasofconcernforpatients,carers,visitorsandstaffareaccesstocarparkingandavailabilityofpublictransport.Themajorityofpeopleaccessingoursitesdosobyprivatecarandtheirspecificconcernsrelatetoavailabilityofparkingandcongestionwithinoursites.

WhatWillChange?Ourimplementationprogrammewillfocusinitiallyonthefollowingfourareasofworkastheseareseenaskeyelementswhichwilldeliveranimprovementforstakeholders:

1 Parking at our SitesItisourintentiontodevelopinconjunctionwithallrelevantstakeholdersadefinitiveparkingpolicyduring2017/18,asameanstoresolveanumberofissueswhichhavebeenraisedbypeopleasbarrierstothemaccessingclinicalservices.Inparticularthepolicywillconsiderandsetoutmechanismstoprovide(whereappropriate):• Designatedpatientparking,• Designatedstaffparking,• Arrangementstopreventinappropriateparkinge.g.railcommuters,• Protectedparkingforspecificpatientgroupse.g.renaldialysis,cancer,• Protectedparkingforparticularstaffgroupse.g.on-callclinicians,• Parkingforcarsharevehicles,• Parkingfordesignatedpoolvehicles.

Itisproposedthatthefinalagreedpolicywillbeimplementedaftercompletinganappropriateapprovalsprocesswitheffectfrom1stApril2018.

2 Public TransportWewillcontinuetoworkwithkeystakeholderssuchasStrathclydePartnershipforTransport(SPT)toensurethateachofoursitesissupportedbyappropriatepublictransportslinks,andthatdetailsofallavailablepublictransportarewidelypublicisedviaappropriatemedia.Thereareclearservicecriteriaregardingthelevelandtypeofpublictransportavailableanditisourintentiontoensurethatthesecriteriaaremetforeachofoursites.

Akeyelementofthisprocessistoensurethatcommunicationfortransportandtravelinformationisdeliveredaseffectivelyaspossible,anditisourintentiontodevelopandimproveexistinglinkstoensurethatserviceproviderandtimetableinformationisavailablequicklyandeasily.ThiswilltaketheformofimprovedaccesstoTravelineScotland’slivetimetableandtravelplanninginformationwithspecificplanstoensurethatthisisreadily


availableonanumberofplatforms.Thiswillinclude:• NHSLanarkshirepublicwebsite,• TravelineScotlandwebsite• TravelineScotlandsmartphoneapps,• Accesstoliveinformationonpublictransportservicesatkeyhospital

locations.

3 Scottish Ambulance ServicePatienttransportprovidedbyScottishAmbulanceServiceisakeyelementinthedeliveryofclinicalservicestothewiderpatientpopulation.Whilstthenumberofpatientswhorequirethisserviceislow,(recentsurveydatasuggests2%)thisisacriticalserviceforthosepatientswhorequiremedical/clinicalsupportduringtheirjourneyto,orfrom,healthcarefacilitiesfortreatment.

ScottishAmbulanceServicehaveacommitmenttoprovideappropriatetransportforpatientswhomeettheireligibilitycriteria,andwewillensurethatthereisappropriateparkinganddropofffacilitiesatoursitestoenableScottishAmbulanceServicetocontinuethiscriticalwork.WewillalsoworkcloselywiththeScottishAmbulanceServicetoensurethatoptionsareavailableforthepatientswhocontacttheambulanceservicefortransportbutdonotmeettheireligibilitycriteria.

Wewillalsoimproveourappointingsystemstotakecognisanceofpatients’geographicallocationwhenmakingappointmentsfirstthinginthemorningorlateintheafternoonasthiscanbeaffectedbyavailabilityofpublictransport.

4 Integrated Transport HubTherecurringthemefromstakeholdersthroughtheconsultationhasbeenaconcernthatthewiderprovisionoftransportfromallserviceprovidersisnotwellintegratedandthataccesstoinformationonserviceprovisioncanbechallengingtoaccessquicklyandeasily.Third-sectorandvoluntarytransportprovidersprovideimportantservicestopatientsandrelatives,butplanningforthisisnotintegratedwithambulanceandpublictransportoptions.Therearealsoconcernsthatpatientswhohaveverylimitedaccesstopublictransport,areunabletoaccesspublictransportorthosewholiveinremoteorrurallocationsanddonotmeettheScottishAmbulanceServiceeligibilitycriteria,havenoaccesstosupporttotraveltohealthcarefacilities.

Ourvisionistoestablishanintegratedtransporthubwhichwillachievethefollowing:• Improvethetransportexperienceforusersoftransportservices• Improvethecoordinationandefficiencyoftransportforhealthand

socialcarewithinLanarkshire(NHS,thirdsector,commercialandlocalauthority)

• Providetransportbaseduponneed• Reduceinappropriatejourneys• Demonstratevalueformoney


Withinthisstrategicintentionandrecognisingthatmostpatientstraveltohospitalbycar,itiskeythat:• PatientswhorequiretransportviaScottishAmbulanceServiceareableto

accessthis• Patientswhorequirepublictransportareabletoaccessthiseasilyand

quickly• PatientswhodonotmeettheScottishAmbulanceServiceeligibility

criteriabutdorequiresomesupportareprovidedwithanoptionwhichiseffectiveandaccessible(e.g.thirdsector)

Intentionthereforebecomesthedevelopmentofahubwhichwillactasasinglepointofcontactforbooking,schedulingandplanningallofNHSLanarkshirepatienttransport.Wewilldevelopthisproposalduring2017–18.Thiswill:• Increasecapacitythroughmoreappropriateuseofallpatienttransport• Improvepublictransportinformationtopatients,relativesandstaffand

prioritiseSASresourcestoensurethatthemostappropriatepatientsareabletoaccessthem

WewilldevelopthisserviceinconjunctionwithSPTandotherpartnersastheyhavesignificantexpertiseandknowledgeofoperatingcontactcentreservices.ItisanticipatedthatthecontactcentrewillbephysicallylocatedwithintheexistingSPTcontactcentreinGlasgowandwilloperateinparallelwiththeScottishAmbulanceServicecontactcentre.Theintentionistopromoteauniquecontactcentretelephonenumberforpatients,relatives,carersandstaffinorderthattheycancallthecontactcentreiftheyhaveahealthrelatedtransportrequirement.Contactcentrestaffwill:• Provideuptodateaccurateinformationonpublictransportavailabilityto

thecaller,• TransferthecallertoSAScontactcentreifappropriate,• Identifyandarrangealternativetransportprovisione.g.community

transport,volunteerdriver,localauthoritycapacity


Clearandunderstandableparkingpolicyatoursites

Improvedpublictransportlinkstoourfacilities

Improvedpatientandcareraccesstoaccurateandup-to-datetravelinformation

Improvedjoint-planningwithambulanceservice

DevelopmentofanIntegratedTransportHubprovidingasinglepointofcontactforpatients,carers,visitorsandstaff


TheWorkforceoftheFuture

6

93The Workforce of the Future

THEWORKFORCEOFTHEFUTURE

VisionThe NHS in Scotland has one of the most skilled workforces in the world, and a proud tradition of education and training. Overall the numbers of doctors, dentists and nurses have increased but we know that in many specialties there are challenges in employing the numbers of highly skilled staff we need to meet ever changing levels of demand.A National Clinical Strategy for Scotland, Scottish Government 2016

NHSLanarkshire’sworkforcewillbeinstrumentalinthesuccessfuldeliveryoftheLanarkshireHealthcareStrategythroughmakingbestuseoftheskillsandcapabilitiesofitsstaff.Theworkforce,inallprofessionsandatalllevels,willhaveaparttoplayandstaffwillbesupportedanddevelopedtoensuretheycanfullyengageandcommittotherevisedservicedeliverymodels.Thefutureworkforcewillbebasedonteamsofstaffratherthanindividualpractitionerstodevelopeffectivemulti-disciplinaryteamsworkingwiththeappropriateknowledgeandskills.Itwillintegratemorecloselytheworkofhospitalbasedspecialtiesalongsidecommunitybasedteams,withaclearunderstandingandvalueofeachother’srolesandaculturewhichsupportspeoplewithlongtermconditionsandtheircarerstobetheleadpartnersindecisionsabouttheirhealthandwellbeing.

Theroutemaptothe2020VisionforHealthandSocialCareoutlinestheScottishGovernment’svisionforimprovingqualityandmakingmeasurableprogresstowardshighquality,sustainablehealthandsocialcareservicesinScotland.IndevelopingtheHealthcareStrategywewillcontinueouractionstosupportthefiveprioritiesoutlinedwithinEveryone Matters1.

Figure 12:Everyone Matters5Priorities

6

2020 Workforce Vision

Our 20 20 V

ision for Health and S

ocial Care

Capable workforce

Effective leadership and management

Integrated workforce

Healthy organisational culture

Sustainable workforce


Thefuturemodelfortheworkforcewillberealisticandconsidertheworkforceavailability,adaptabilityandaffordabilitytodelivertherevisedclinicalmodelinthespecifiedtimeframe.Ineffect,theworkforcemodelrequires:

• Earlyprojectionandpreparationofstafftomeetthefuturedemandifdifferentskillssetsarerequired

• Adequateopportunityforstafftobedevelopedtomeettheserequirements• Allthistobeframedwithinafinanciallyviableworkforcemodel

StaffGovernanceNHSScotland’scommitmenttostaffgovernancewasreinforcedbythelegislativeunderpinningwithintheNHSReform(Scotland)Act2004.TheStaffGovernanceStandardFrameworkisthekeypolicydocumenttosupportthelegislationwhichaimstoimprovehowNHSScotland’sworkforceistreatedatwork.ThefourtheditionwasdevelopedtotakeintoaccountdevelopmentswithinNHSScotland,toreflecttheimplementationoftheHealthcareQualityStrategyforScotland,thethreeQualityAmbitionsandQualityOutcomesandtheStrategicNarrativesettingoutour20:20Visionforhealthcare.TheStaffGovernanceStandardsare:

• wellinformed;• appropriatelytrainedanddeveloped;• involvedindecisions;• treatedfairlyandconsistently,withdignityandrespect,inanenvironment

wherediversityisvalued;and• providedwithacontinuouslyimprovingandsafeworkingenvironment,

promotingthehealthandwellbeingofstaff,patientsandthewidercommunity.

TheStaffGovernanceStandardsprovidethefoundationforengagementwithourstaffinshapingthefutureWorkforcetodelivertheHealthcareStrategy.TheFairWorkvisionisthat,by2025,peopleinScotlandwillhaveaworld-leadingworkinglifewherefairworkdrivessuccess,wellbeingandprosperityforindividuals,businesses,organisationsandsociety.TheFairWorkFrameworkreinforcestheNHSStaffGovernancestandardsasitdescribesthesignificanceofprovidinganeffectivevoice,opportunity,security,fulfilmentandrespect;thatbalancestherightsandresponsibilitiesofemployersandworkersandthatcangeneratebenefitsforindividuals,organisationsandsociety.

WorkforceAvailabilityMedical StaffingCurrently,thereareongoingissueswithmedicalstaffingavailabilityinLanarkshireandacrossScotland.Thisisparticularlyacuteingeneralpractice(seesection4.2).Withanincreasingolderpopulationandsubsequentincreaseinhealthcareneeds,thecontinuationofclinicalservicesdeliverybasedonthecurrentworkforcemodel,withthesamelevelofrelianceonmedicalstaffing,isunsustainable.MostoftheworkstreamsintheLanarkshireHealthcareStrategyrecognisethisandplantoadoptaworkforcemodelwherebythereishigherrelianceonarangeofAdvancePractitionerroles.Theseroleswilldevelopfrom


severalprofessionalbackgrounds(nursing,alliedhealthprofessionals,pharmacyandphysicianassociates),willbetrainedtotakeontraditionalmedicalroles/tasksandwillbecomeasignificantcomponentofthefutureNHSLanarkshireworkforce.

Ageing Population Theageingpopulationwillnotonlychangetheservicedemands,itwillalsobereflectedintheavailabilityoftheNHSLanarkshireworkforce.Ineffect,wewillhaveanolderworkforcein2025andahighervolumeofretirementsyearonyear.Withthis,NHSLanarkshireisconsideringapproachestosupportolderstafftoremaininemployment(e.g.lessphysicallydemandingroles,reducedhours,etc.)whilerecognisingandsuccessionplanningforpotentiallossofskillsandknowledge.AWorkingLongerinNHSLanarkshirewebpagewillbelaunchedinSpring2017.

Service DeliveryToprovidesafe,effectiveandperson-centredcare,theworkforceof2025shouldmatchtheworkloaddemandsinthecarecontext,locationandhoursofservice.Thiswillseeashiftinstaffingintothecommunityworkforceandwillrequireachangefromtheexistingpatternsofworktowards24x7dayworking.

Recruitment & RetentionNHSLrecognisestheimportanceofbeinganEmployerofchoicewhichattractsandretainsstaff,supportedby,recruitment,selections,induction,performancemanagement,strongleadershipandstaffdevelopmentprocesses.

Tomaximiseworkforceavailabilityandreduceagency/locumspend,NHSLshouldpromoteLanarkshireasaplacetoworkandwherepossiblereviewworkforcestrategiesandpoliciestoreflectandsupportthisbothforsubstantiveandbankstaff.

WorkforceAdaptabilityCommissioning New Roles NHSLanarkshirewillundertakedetailedmulti-professionalworkloadandworkforceplanning.Effectiveuseofexistingresourceswillbeessentialaswillgaininganunderstandingofcurrentutilisationoftheworkforceandthelikelyimplicationsforretentionoftheexistingworkforce,manyofwhomwillremainpartoftheworkforceforthenext5-10years.Thiswillprovideessentialbaselinedataforfutureremodellingwork.Theidentificationofskillsandcompetencygapswillbeequallyimportantinensuringappropriatetraininganddevelopmentisongoingtoensuretheworkforceisappropriatelypreparedandsupportedforthefuture.Itcantake18-24monthstotrainaqualifiedhealthcareprofessionaltoadvancedpracticelevelandthereforeitiscriticalthatthisisinitiatedasearlyaspossible.

Asimilarapproachwillberequiredtodefinethegenericsupportworkerrole.Itmaynotbepossibletodeterminetheexactnumbersofeachrolerequiredandsoaninitialestimateofneedshouldbeagreedandusedforthepurposesof


development.Todothis,itisessentialthatprofessionsareabletodefinetheiruniqueprofessionalcontributionandidentifytaskswhichcanbeprescribedandcarriedouteffectivelybysupportworkers,thusbuildingsafeandeffectivecapacity.

Influencing Undergraduate ProgrammesOngoingworkisrequiredwithRegulators,ScottishGovernmentandHigherEducationalInstitutions(HEIs)toensurethatthedevelopmentofundergraduateprogrammesisdesignedinlinewiththefuturehealthcareneed,withsufficientfocusoncommunitycare.

Development of existing staff skillsItisenvisagedthatadvancedpracticeroleswillbeanintegralpartofbuildingcapacityandcapabilitywithinthecommunity.Thedevelopmentsforextendedroles,suchasintravenoustherapy,advancedpractice,nonmedicalprescribingandextensionofhealthcaresupportworkerrolestosupportthefuturecommunitycarewillrequireengagementwithHEIsinconjunctionwithNHSLanarkshire’sPracticeDevelopmentTeamandGPpractices.NHSLanarkshireisfullyengagedinthenationalagendatodeveloptherolesofcommunitypractitionerswithaviewtoensuringitmeetstheneedsofpeopleusingourservices.TheframeworkbelowhasbeendevelopedbyNHSEducationforScotlandforcommunitynursingandoutlinestheelementsrequiredforsafe,effectiveandpersoncenteredcareandsupportinthecommunity.Whileitfocusesonnursinginthecommunity,itreflectsthedirectionoftravelinourapproachacrossallprofessions.

FRAMEWORK FOR MODERNISING NURSING IN THE COMMUNITY

Safe, effective & person-centred care

CHILDREN,YOUNG PEOPLE

& FAMILIES

WORK & WELLBEING

ADULTS & OLDER PEOPLE

Using care pathways

Promoting health

& addressing inequality

Building workforce capacity

& capability

Achieving an outcome-focused

approach

Strengthening leadership

& team working

Utilising Telecare & Telehealth

Improving quality

& efficiency

Enabling & supporting

self care

Anticipating health needs & responding

earlier

Working with other agencies & disciplines as

partners

Providing choice

& care in the right setting

Working with clients, carers

& patients as partners

INFORMINGPRACTICE

WITH POLICY,RESEARCH AND

EVIDENCE

DEVELOPINGSKILLS AND KNOWLEDGE

THROUGH EDUCATION

Figure 13:FrameworkforModernisingNursingintheCommunity


WorkforceAffordabilityImprove efficiencyTomaximisetheefficiencyofservicedelivery,severalworkforceredesignfactorsarebeingconsidered:

• Avoid duplication–opportunitiestointegrateandstreamlinepatientpathwayswillbeconsideredandwherepossiblegenericsupportworkersintroducedbothacrosshealthandhealth/socialcare(AHP,nursing,socialcare).Thisalsohastheaddedbenefitofprovidingagreatercareerstructureforthestaffinvolved.

• Work to “top of licence”(registeredandsupportstaff)–rolesrequiretobereviewedwithstaffsupportedanddevelopedtoworktothe“topoftheirlicence”.Thisoffersthepotentialtoincreasestaffnumbersandredistributetheworkloadtolowerbandedbutappropriatelytrainedstaff,thusavoidinganincreaseincost.

• Extended scope –tostreamlinethepatientjourneyandminimise“hand-offs”,certainroleswillrequiretoextendtheirscopetoprovidesomeadditionalaspectsofcareandavoidreferringontoadifferenthealthcareproviderorintoacuteservicese.g.communitynursesdevelopingIntravenous(IV)therapyskillstoallowpatientstobecaredforinthecommunity;extendingpsychologicalcareapproaches,growingtheresilienceofpeopleusingservicestoeffectivelyself-careandsupportingconcordancewithagreedpersonalisedtreatmentplansreducingdemandsonunscheduledcare.

• Roles appropriate to skill–toensureefficiency,appropriatelyskilledstaffshouldundertakerolese.g.adminstaffundertakingadminroles,notclinicians.Staffdevelopedtoconductproactiveengagementwithpatients,theirfamiliesandcarersaboutwhatmatterstothemandhowtheyfeelbettersupportedtoaccessservicesandtoself-carewhentheyareable;staffempoweredtopromotehealthylifestylesandprovidesupporttopatientsandcarerstomeetsocialchallengessuchasfinancialsecurityandemployment.

Inaddition,thereareotheropportunitiesforefficiencywhichwouldsupporttheworkforce:

• Improvementsintechnologysuchaselectronicpatientrecords,mobiletechnology(tabletcomputers),etc.wouldsupportgreaterworkforceefficiency

• Innovativepracticeusingexistingtechnologybasedplatforms(e.g.NHSInformMATS)anddevelopingotherweb-basedaccesstoservicesforearlyadviceandself-management,influencingacultureofself-efficacywhichdeflectsdemandawayfromhealthcareservicesandintoupstreamservicese.g.leisure,voluntaryandthirdsectorservices.

• NHSLanarkshire,NorthandSouthLanarkshireHealthandSocialCarePartnershipswillcontinuetoworkwiththirdsectorcolleaguestofocusonsupportingandtestingoutnewapproachesforthedeliveryofcommunity-basedsupportforpeoplewithcomplexandmultipleconditions.Thiswillincludedeliveringanintegratedapproachthatcomplementsmainstreamservicesbyotheragencies,isfullylinkedintolocalityplanningarrangements,continuingtofocusonbuildingcommunitycapacityandlocalinfrastructuretosupportthedeliveryoflocalservicesand


furtherdevelopsthecommitmenttocarersupportthroughastructuredprogrammeofassessmentandsupport

• Integratemorecloselyallcontractordisciplinessuchascommunitypharmacists,dentists,optometristsandcareproviderstoenablepatientstobetteraccessappropriatecareandadvice

• IntroducepharmacistsinGPpracticeswithadvancedclinicalassessmentskillstosupportthecareofpatientswithlongtermconditionsandbettermanagetheirmedications

TheworkforcetosupporttheLanarkshireHealthcareStrategywillnotbe“moreofthesame”.TheworkforcewillbeolderandhaveagreaterrelianceonAdvancedPractitionersandroleswithextendedscope.Allstaffgroupswillworktothe“topoftheirlicence”withworkalignedtotheirskills.Theworkforcemayrequiretoberedistributedtomatchtheincreasedworkloaddemandinthecommunity.

Itisdifficultatthisstagetoindicatetheexactnumbersanddevelopmentrequirementsforeachroleuntilmoredetailedworkloadandplanninghasbeenundertaken.TheworkstreamswithinthisstrategyhaveidentifiedkeyareasofrolerequirementsthathavealreadybeendevelopedinotherareaswithinNHSLanarkshireandtheapproachcanbeusedtosupportthedevelopmentandextendtherolesofourexistingstaff.Inaddition,leadershipandteamdevelopmentapproachesarewellembeddedwithinNHSLanarkshireandcanbeutilisedtofurtherdeveloptheknowledgeandskillsrequiredtoachievetherequiredoutcomes.

References1 ScottishGovernment.EveryoneMatters:2020WorkforceVision.Edinburgh:

ScottishGovernment,2013.


PlansforServiceChange

7


PLANSFORSERVICECHANGE

IntroductionInreviewingthefuturehealthcareneedsoftheLanarkshirepopulation,thereisarangeofchangestothescopeanddispositionofclinicalservicesnecessarytoachievetheobjectivesofthestrategy,ensuringallofourservicesareperson-centred,safeandeffective.

Someofthesechangesrepresentanimmediatechallengetotheseobjectivesandwillbeimplementedsoon,butotherswilltaketimetoplananddevelopbeforeimplementationispossible.NHSLanarkshire,inconjunctionwithHealthandSocialCareNorthLanarkshireandSouthLanarkshireHealthandSocialCarePartnership,willdevelopaphasedplanforservicechangeoveranumberofyears,beginningin2017.

ThissectionoftheStrategydescribesthepossibletimescalesforthesignificantchangestoserviceswhicharedescribedearlierinthedocument.However,manyofthesechangesareatanearlystageofdevelopmentandfurtherengagementanddiscussionmaybenecessary,alongsideclarityoftheresourcingandfinancialimpactofsomeofthesedevelopments.

4.1 Primary Care Transformation Programme• Carryouttests-of-change2017–18• ImplementchangesrequiredbynewGPcontract2018–21• Implementmulti-professionalworkforcedevelopmentplans2018–21• ImplementaprogrammetospreadchangesacrossLanarkshire2021–26

4.2 Long Term Conditions• Newmodelsofcarefinalised2017–18• Implementworkforceplanstobuildcommunitycapacity2017–20• SpreadgoodpracticeacrossLanarkshire2017onwards

4.3 Older Peoples Services• EnhancedLocalityteamsestablishedby2019• Intermediatecareservicesdefined2017onwards• CommunitysupportandinterventionsspreadacrossLanarkshire2017

onwards

4.4 Mental Health and Learning Disability• Developintegratedcommunitymentalhealthservices2017onwards• DevelopandimplementaCrisisandDistressInterventionsservicemodel

2017onwards• Developtwo-sitemodelforacuteadmissionsfor2020• Completeinpatientmodernisationplanforolderpeople’spsychiatry2017• Reviewofforensicservices2017onwards

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101Plans for Service Change

• AllwardswillestablishaQualityImprovementGroupin2017• Reviewofrehabilitationandrecoveryservicemodel2017onwards• EnhancementalhealthliaisoninDGHsby2019

4.6 Alcohol and Drugs• ImplementationofagreedstrategiesaspartoftheSingleOutcome

Agreements2017onwards• MonitorandreportLanarkshire’sprogressinaccordancewiththenational

recoveryindicators2018onwards

4.7 Maternity, Early Years, Children and Young People• Developingtherolesandcapacityofcommunitypaediatricteams2017

onwards• Changingservicemodelformaternityandpaediatricstoreflectchanging

demographicsofthepopulation2017onwards• Ensuretheneonatalunitaccommodationisenhancedin2017• Developanewservicemodelforpaediatricemergencycareby2019

4.8 Planned and Unscheduled Care• Developplanswhichshiftclinicalcarefromunscheduledtoplanned(but

urgent)modelsofcare2017onwards• Prepareabusinesscaseforthereplacementorredevelopmentof

MonklandsDGH2017–24• EnhanceemergencydepartmentcapacityatMonklandsin2017• Developaproposalforagastrointestinalbleedscentreofexcellence2017

onwards• FurtherdevelopthecancercentreservicemodelatMonklands2017

onwards• EnhanceemergencydepartmentcapabilityatWishawin2017• DeveloptheservicemodelformajortraumaservicesintheWestof

Scotland2017onwards

4.9 Orthopaedic Services• Consolidatetheinterimchangestoinpatientservicesduring2017• Inconjunctionwithnationalandregionalstrategies,in2017/18prepare

aproposalfortheestablishmentofamajortraumacentreatWishawGeneralHospital

• Developaservicemodelforelectiveorthopaedicswhichwillformpartoftheemergingproposalsfordiagnosticandelectivecentresofexcellencethrough2017/18


4.10 Cancer Services• ReviewtheservicemodelforSACTtoimproveaccessandqualityofcare

by2017• Prepareaproposalin2017fortheestablishmentofaSACTcentreof

excellenceatMonklands• Implementtheconclusionsofthenationalsharedservicesreviewof

asepticdrugproductionby2020

4.11 Stroke Services• Developaservicemodelforadvancedclot-bustingtreatmentsby2020• Implementanoutpatientserviceforneurovascularconditionsby2019• Developaservicemodelforlocalstrokespasticitytreatmentby2019• Enhanceprofessionaleducationforstrokecare2017onwards• Developaservicemodelforearlycarotidsurgeryby2020

4.12 Palliative care • Developarapidresponseserviceforsupportathomeby2020• Agreeacommissioningstrategyforhospiceinpatientservicesby2018• Improvesupportforhospitalstafftoassistpatients’decisionmakingby

2020• Deliverastructuredconversationpackageby2019• Developtheuseoftelehealthtosupportpatientsandfamiliesby2019

5.1 Pharmacy• Enhancetheskillsandcapabilityofthepharmacyworkforce2017onwards• Maximisetherolesofcommunitypharmaciststhroughrevised

contracting2017onward• Developimprovedinformationforpatientsandcarers2017onwards• Developprofessionalrolesfurtheraspartoftheextendedprimarycare

teams2017-20• Refreshthegovernanceandfinancialmanagementofmedicines

prescribinginprimarycareandhospitalsfrom2017onwards

5.2 Property• Supporthealthandsocialcareteamstodevelopthefuture

accommodationneedsforMonklandsDGH2017to2024• Developtoolsandtechniquestoimprovetheefficientuseandallocation

ofspaceinourpremises2017onwards• Deliverasafeandefficientbacklogmaintenanceprogrammeacrossall

areas2017onwards• Supportservicedevelopmentsinprimarycare,hospitalservicesand

supportservices2017onwardstosupportrealignmentofservices

103Plans for Service Change

5.3 eHealth and Digital Technologies• Provideasingleelectronicpatientrecordwhichcanoperateinallclinical

settingsby2020• DevelopideasandproposalsfortheuseofeConsultation2017onwards• Adaptmodelsofcaretoenablepatientstopersonalisetheirhealth

informationby2020• Enhancetheclinicalportalsystemfrom2017onwards• Introducethehospitalprescribingandadministrationsystemby2020• Developtheuseofpoint-of-careinformationsystemsby2020• ProvideafullyintegratedprimarycareandcommunityITsolutionby

2020• Providerwiderelectronicaccessforpatientstotheirownhealthcare

recordsthroughthenewpatientportalby2020• Developreal-timebusinessintelligencethroughonlinedashboards2017

onwards

5.4 Transport• Improveaccesstoparkingforpatientsandvisitorsathospitalsitesby

2019• Providebetterinformationonpublictransporttothosewhouseour

facilities2017onwards• Furtherdevelopeffectiveuseoftheambulanceservice2017onwards• SupportthedevelopmentofanIntegratedTransportHubin2017/18


FinancialResources

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105Financial Resources

FINANCIALRESOURCES

NationalPositionTheScottishbudgetsetsouttheoverallScottishGovernmentfundingfor2016/17until2019/20.Overthatperiodthetotalrevenuebudgetissettoincreasefrom£26.098billionto£26.468billion,whichaveragesoutat0.47%perannum.Healthbudgetshavesofaronlybeenannouncedfor2016/17,witha3–5yearbudgetexpectedlaterintheyear.Meanwhile,NHSBoardshavebeenadvisedtouseahigherplanningpercentageof1.8%perannumwhensubmittingtheirfutureyearplans.

NHSLanarkshireFutureResourcingNHSLanarkshirereceivesacoreallocationatthestartoftheyear(£1105min2016),followedbyaseriesofin-yearfundingadjustmentsforspecificpurposes.Thedetailsofthespecificfundingfor2016/17havenotyetbeenconfirmed.

HealthbudgetshavetraditionallybeengivenadegreeofprotectionandinrecentyearsBoardshavebeenadvisedtoplanonreceivinganupliftequivalenttoaneconomicindicatorknownastheGDP(GrossDomesticProduct)deflator.IfcostswithinthehealthservicewererisingatthesamepaceasGDPdeflator,thiswouldallowthehealthservicetocontinuetoprovidethesamelevelofserviceinfutureyears.Anyefficiencyorproductivitygainscouldthenbeusedtoprovideadditionalserviceontopofthatallowedbyanynewin-yearallocations.

In2016/17healthcostswillrisefasterthantheGDPdeflatorof1.7%.Thepaybill,whichmakesupjustunder50%ofthetotalcostsisforecasttoriseby3.4%throughthecombinedimpactofnationalinsuranceincreases,abasicpayriseof1%andagreementstoassistthelowerpaid.

Around20%ofthebudgetisnowspentondrugs.Expenditureondrugsprescribedroseby22.8%inhospitalsduring15/16andGPprescribingby4.9%(seesection5.1).

Otherfactorsdrivinganaboveinflationarycostriseincludeanationalshortageofdoctors,causinganincreasedrelianceonhighercostlocumsandincreasedexpenditureneededtomaintainwaitingtimes.Evenwiththegeneralallocationupliftedby1.7%NHSLanarkshirewillneedtosave£43min2016/17inordertostaywithinbudget.Apartfromthoseareasthatreceivedspecificadditionalfunding(e.g.primarycare)anyclinicalservicechangewouldneedtobeachievedwithintheexistingbudgets.

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Atpresent,theestimateofwhattheNHSBoard’sunderlyingfinancialpositioncouldbeovertheperiodto2019/20isasshownbelow.

2016/17(£m)

2017/18(£m)

2018/19(£m)

2019/20(£m)

Allocationupliftat1.8% 19.3 19.7 20.1Paybillincrease 8.7 6.4 6.5Othergeneralsuppliesincreases 6.7 6.8 6.9Increaseindrugsexpenditure(lowestimate)

10.3 11.2 12.1

Minimumgaptobemetfromefficiencysavings

-43.0 -6.3 -4.7 -5.4

Therearestillmultipleuncertaintiesaboutthisprojection.

Thekeyvariablesare:• TheextenttowhichNHSLanarkshirecangenerate£43mofrecurring

savingsin2016/17.AsofJune2016therewasstillagapof£19mrecurringly.• WhethertheScottishGovernmentwouldbeabletogiveabudgetrise

of1.8%totheexistinghealthservicesgivenitsownbudgetpositionandcompetingdemands.

• Whethertheriseinhospitaldrugcostswillreducefromitsrateof22.8%in15/16.Thefinancialplanaboveassumesonly10.6%from2016/17onwards.A22.8%risewouldbeover£7.7mmoreeachyear.

Giventhecontextofcontinuedconstraintonpublicsectorfundingatanationallevelandthehistoricriseindrugscosts,theaboveforecastrepresentsthemoreoptimisticendoftherangeofrealisticforecasts.Evenstill,itindicatesthatcontinuedefficiencygainswillbeneededandeachareaofservicedeliverywillhavetomaximiseproductivityandtheuseofexistingresources.

CapitalInvestmentVariousservicechangesmayneedcapitalorothertransitionalfundingtosupportaservicereconfiguration.AreplacementforMonklandsHospitalwillbebyfarthemostsignificantelementofthecapitalrequirementbutintheshortertermtherewillbearangeofsmallerscalerequirements.NHSLanarkshire’s2016/17corecapitalallocationof£12.9m,evenoncesupplementedbyanadditional£3mofcentralsupport,isalreadyovercommitted.ThefuturecapitalrequirementsoftheHealthcareStrategywillbemappedoutindetailanddiscussedwiththeScottishGovernment.Inparticular,abusinesscasetosecure£400mininvestmentinMonklandswillbeprepared.

107Listening to Your Views

LetUsKnowWhatYouThink

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LISTENINGTOYOURVIEWS

EarlyDevelopmentWorkNHSLanarkshirehasbeeninvolvingpublic,patientandcarerrepresentatives,aswellasclinicalstaff,indevelopingitshealthcarestrategysincetheoutsetofthedevelopmentprocess.

InrecognisingtheneedforthedevelopmentofahealthcarestrategyforLanarkshire,astrategygroupwassetupin2015totakethisworkforward.IndividualworkstreamsweredevelopedtoreviewservicesledbyNHScliniciansandmanagers,withinvolvementfrompatientrepresentatives,specialinterestgroupsandthethirdsector.

Capturingthepatientexperienceofserviceshasbeenattheheartofthereviewprocesstoensurethatanyserviceproposalsareaimedatprovidingbetteroutcomesforpatients.NHSLanarkshireisgratefultothosewhotookpartinthisearlydevelopmentworkandfortheirinvestmentandcommitmenttotakingthisworkforward.

Aspartoftheprocess,NHSLanarkshirespoketopatients,families,carersandstafftoexplorehowwellcurrentservicesmeettheirneedsandidentifywayswecandothingsdifferentlytobettermeettheseneedsinthefuture.

Throughouttheearlydevelopmentworkengagementtookplacewithintheindividualworkstreams,inlocalitiesandonaLanarkshire-widebasis.TwomajorstakeholdereventstookplaceinAugust2015andNovember2015toshareanddiscusstheearlyemergingviewsonfutureserviceneeds.

Inaddition,aHealthcareStrategyEngagementGroup-whichincludedpatient,carerandthirdsectorrepresentatives-andaClinicalReferenceGroup–madeupofleadcliniciansfromallprofessions-wereestablishedtoreviewtheoutputsfromtheclinicalworkstreamsandoverseethedevelopmentofthisdocument.AnonlinequestionnaireonSurveyMonkeywascarriedoutinFebruaryandMarch2016toinformthedevelopmentofthedraftstrategy.

Throughthiscollaborativeapproach,thedrafthealthcarestrategy‘AchievingExcellence’wasproducedinsummer2016.

TheConsultationProcessAformalthree-monthconsultationprocessonthedraftstrategyranfrom2Augustto1November2016involvingawiderangeofstakeholders.NHSLanarkshire’soverarchingaimfortheconsultationprocesswastoconsultonthedrafthealthcarestrategyinordertoreceivemeaningfulfeedbackfromstakeholderstoshapethefinalstrategy.

NHSLanarkshireworkedcloselywiththeScottishHealthCounciltoensuretheapproachtakenwasinlinewithCEL4(2010)‘Informing,EngagingandConsultingPeopleinDevelopingHealthandCommunityCareServices’setsouttheprocesstobefollowedbyNHSorganisationsintheplanningandimplementationofservicechanges.

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TheScottishHealthCouncilcarriedoutqualityassuranceoftheconsultationprocesswhichincludesseekingtheviewsofstakeholdersontheprocessitself.NHSLanarkshirehasreceivedareportoftheconsultationprocessfromtheScottishHealthCouncilconfirmingthatitwassatisfiedthattheconsultationprocessmettherequirementsofCEL4(2010).

NHSLanarkshiresetouttoconsultwidelytoensureawiderangeofstakeholdersfromacrossLanarkshirehadanopportunitytobeinformedoftheconsultationandcommentontheproposals.

TheconsultationexerciseaimedtoprovidetheopportunityforthepeopleofLanarkshire,ourpartners,staffandpoliticalrepresentativestounderstandthecontextinwhichourserviceswilldevelopinthenextdecade.

Theintentionwastoinitiateaconversationonwhatthiswouldlooklikeintermsofchangingthewaysinwhichtheseservicesmayneedtochangeasaresult.Theexercisethereforesetouttogatherawiderangeofideasandopinionsthatwouldbeinvaluableincompletingawell-roundedstrategicvisionandimplementationplan.

Theconsultationplanincludedabroadrangeofcommunicationandfeedbackmethodstoensurepeoplehadarangeofopportunitiestobeinformedandprovidetheircommentsonthecontentsofthestrategy.

Thisincluded:• Consultationdocumentsinarangeofformats.• ConsultationquestionsonlineasaSurveyMonkeyquestionnaire–435

responses.• E-Newsletter–Threeissuesemailedto464stakeholdersduringthe

consultation.• Mediareleases.• Advertisementsforthepublicmeetingsinlocalnewspapers.• NHSLanarkshirepublicwebsiteAchievingExcellencewebpages.• DigitalpostersonNHSLanarkshireelectronicdisplayscreensinthethree

acutehospitals.• Printedposterswithpublicmeetingdetailsdisplayedinhospitals,health

centresandlibraries.• Awarenessraisingroadshowsattheentrancesandrestaurantsofthethree

acutehospitalsreachingapproximately200people.• Fivepublicmeetingswereheld(Wishaw,EastKilbride,Cumbernauld,

LanarkandAirdrie).• 10localityeventswereheldbytheSouthLanarkshireHealthandSocialCare

PartnershipandHealthandSocialCareNorthLanarkshire.• 27additionalmeetingsfeaturedtheconsultation.• Arangeofstaffcommunications.

YourFeedbackThroughthisactivityfeedbackwasreceivedfromawiderangeofstakeholdersincludingpublic,patients,staff,electedrepresentativesandorganisationsduring


theconsultationprocess.Throughouttheconsultation,strongsupportwasexpressedforthedirectionoftravelandvisioninthehealthcarestrategy.Therewasalsoagreatdealofusefulandconstructivecommentsabouthowbesttoachievethese(seelinkbelow).Theseviewstheninformedthepreparationofthefinalversionofthisstrategy.

NHSLanarkshirewouldliketothankeveryonewhotookthetimeparticipateintheconsultationprocessforthethoughtandefforttheyputintoprovidingawealthofvaluableandconstructivefeedback.

ThefullconsultationresponsesweremadeavailabletomembersoftheLanarkshireNHSBoard.Inaddition,allthespecificanddetailedcommentsmadeonthevisionsandplansforindividualworkstreamsandcrosscuttingissuespresentedinthehealthcarestrategyweresharedwiththeworkstreamleadstoinformandshapethisfinalversionofthestrategyalongwiththeimplementationplansandprocesses.

Inadditiontotheconsultationresponsesreceived,theAcademyofMedicalRoyalCollegesandFacultiesinScotlandwasaskedtoundertakeareviewofAchievingExcellence.TheacademyoutlinedthatthestrategywasconsistentwiththeNationalClinicalStrategyforScotlandandrealisticmedicine.

ThefullNHSLanarkshireconsultationreport,whichwasendorsedbytheNHSLanarkshireBoardon30November2016,canbefoundat:www.nhslanarkshire.org.uk/boards/2016-board-papers/Pages/November.aspx

We’llbepublishingregularbulletinsonhowtheimplementationoftheambitionssetoutin“AchievingExcellence”arebeingtakenforward;pleasecheckourwebsitewww.nhslanarkshire.org.ukforfurtherupdates.

Ifyou’dliketocontactuswithanyquestionspleasewriteto:

HCS ViewsPlanning&DevelopmentDepartmentNHSLanarkshireHeadquartersFallsideRoadBothwellG718BB

[email protected]

www.nhslanarkshire.org.uk/boards/2016-board-papers/Pages/November.aspx

www.nhslanarkshire.org.uk


GlossaryofAbbreviations

A&E AccidentandEmergencyDepartment(nowknownasED)ADP AlcoholandDrugPartnershipAF AtrialFibrillationAHP AlliedHealthProfessionalCAHMS ChildandAdolescentMentalHealthServicesCHD CoronaryHeartDiseaseCHPs CommunityHealthPartnershipsCS CaesareanSectionDAISy DrugandAlcoholInformationSystemDGH DistrictGeneralHospitalED EmergencyDepartmentENT EarNose&ThroatERAS EnhancedRecoveryAfterSurgeryGDP GrossDomesticProductGI GastrointestinalGIA GrossInternalAreaGIRFEC GettingitRightForEveryChildGP GeneralPractitionerHEI HigherEducationalInstitutionHIS HealthcareImprovementScotlandHoC HouseofCareHSCP Health&SocialCarePartnershipICU IntensiveCareUnitIJB IntegrationJointBoardIV IntravenousLENS LanarkshireEye-healthNetworkServiceLOS LengthofStay(inhospital)LTC LongTermConditionMCN ManagedClinicalNetworkMH MentalHealthMH&LD MentalHealthandLearningDisabilityNHSL NHSLanarkshirePFI PrivateFinanceInitiativePPP PrivatePublicPartnershipQEUH QueenElizabethUniversityHospitalSACT SystemicAntiCancerTherapySCP SocialCarePartnershipSPT StrathclydePartnershipforTransportSVD SpontaneousVaginalDeliveryTEC TechnologyEnabledCare

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