Five Year Transformation Programme

Five Year Transformation Programme2016-2021

Our Five Year Change Programme | 2016-2021

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Section Item Page

1 Introduction 3

2 Strategic Context 4

What we do in NHS Tayside 4

National, Regional and Local Services 6

National and Local Context 7

Looking ahead - Why do we need to change? 9

Our Five Year Transformation Programme 11

3 Organisational Strategy 12

Strategic Themes and Essential Enablers 13

Clinical Services Strategy 15

Five Year Financial Framework Plan 18

Transformation Programmes 20

Property 21

Medicines Management 23

Workforce and Care Assurance 25

eHealth 27

Programme Governance 28

Communications and Engagement 30

NHS Tayside People Matter Strategy | 2016-2021

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Section 1Introduction

Welcome to NHS Tayside’s Five Year Transformation Programme. This document sets out our strategic transformational plan for the coming five years as we embark on a radical programme of service redesign and reform to improve health and wellbeing for the people and communities of Tayside.

The Five Year Transformation Programme will be supported by an annual operational delivery plan.

The context for making such transformational change is more challenging than ever. The NHS, like other public sector organisations, is facing financial and resource issues and we must be best placed to respond to the new local and national priorities which underpin our service development plans and efficiency programmes.

The newly-launched National Clinical Strategy

sets out the vision and ambition for health and social care services in Scotland for the next 10 to 15 years.

The strategy was developed in partnership with clinicians and staff, as well as the public and many other stakeholders, and all involved acknowledged the need for change and adaptation to improve the sustainability of services and enhance the quality of care. Its aspirations are challenging, but deliverable, and therefore it is with the energy and innovation for which NHS Tayside has become renowned, that we must move forward.

We believe our Five Year Transformation Programme will drive the longer-term service change - and support our staff - to ensure we continue to provide the best and safest care and treatment we can for our patients, their families and carers and the public.

We would welcome your feedback on this Five Year Transformation Programme. You can send us your views by email to [email protected]

Lesley McLayChief Executive

Professor John Connell Chairman


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Section 2Strategic Context

In this section we:• Explain what we do in Tayside and North-

East Fife, what our population challenges are, what we are proud of and where we are going

• Present a summary of NHS Tayside – the organisation and its services

• Review in brief the national and local context – the environment in which we will pursue our programme of change

• Explain what our Five Year Transformation Programme is

NHS Tayside – What we do

NHS Tayside provides primary, community, secondary and specialist care to around 450,000 people in Tayside and North-East Fife from more than 20 major and community hospitals and many more community health centres, GP practices and health and social care hubs. Ninewells Hospital in Dundee, Perth Royal Infirmary and Stracathro Hospital are teaching hospitals. We employ over 14,000 people and have an annual turnover of nearly £900m.

In 2014/15 our activity included the following:• 110,981 A&E attendances• 232,056 new outpatient appointments • 1,022,099 follow-up appointments• 16,682 day case procedures• 84,246 outpatient procedures• 16,916 elective inpatient stays• 44,538 non-elective inpatient stays• 1,069,681 community service contacts


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Our population challenges

In order to plan services that will deliver our vision it is vital that we understand our population challenges and their health needs. This understanding will ensure that our strategic priorities supported by our initiatives, projects and programmes, are focused on where the greatest health gain can be made.

Our population is likely to increase by 14% over the next 25 years as opposed to 8.8% for the rest of Scotland. This means many older people living with complex and multiple conditions. We know that those who are disadvantaged often have poorer health and that is why tackling inequalities is one of our key priorities in Tayside, especially in the early years and with families. We have many successes in this area but we must keep targeting our health improvement programmes towards those most in need.

What we are proud of

NHS Tayside has a strong track record in delivering high-quality, safe and effective care for all our patients.

We have been pioneers in patient safety over the past decade with a relentless focus on improving quality and safety and reducing harm. We have delivered:• 19% reduction in cardiac arrests due to

widespread system of ‘early warning scoring’ (SEWS), which is used to ensure timely recognition, assessment and response for acutely ill patients

• 11 months without a Ventilator Associated Pneumonia (VAP) in Intensive Care

• 50% reduction in stillbirths since introduction of new care pathway for reduced foetal movements

We have also been at the forefront of new models of care:• A new community dementia pathway which

supports individuals and families with multi-disciplinary teams in their own home and their own communities

• The establishment of the Enhanced Community Service which involves health professionals, including GPs, pharmacists, allied health professionals, district nurses and others working together as a single team, in partnership with social care and voluntary sector colleagues, to support individual patients in their own home

• Hepatitis C world leading programme• Birthplace App presents choices to women about

where they can give birth

We have delivered new modern state-of-the-art and improved facilities including:• Acute Medicine Unit and Acute Surgical

Receiving Unit at Ninewells• Young People’s Unit delivering local and regional

Child and Adolescent Mental Health Services at Dudhope, Dundee

• New Murray Royal Hospital and Regional Medium Secure Unit in Perth

• Renal Ward Redesign• Nuclear Medicine at PRI and Ninewells• Assisted Conception Unit at Ninewells• Blairgowrie community ward• Whitfield The Crescent community hub• Arbroath Infirmary upgrade

During 2015/16 we have achieved:• Top performing Board for A&E four-hour waiting

times• 91% patients rated care and treatment as

excellent or good• Teenage pregnancy rate in Tayside dropped

by 49.5% in last seven years with reduction continuing

• 88% of our staff said they would go the extra mile at work

• ISO Accreditation for Blood Sciences labs• Achievement of CAMHS 18 Week Referral To

Treatment


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NHS Tayside National, Regional and Local Services

NHS Tayside Operational Services

1050 8335 WTE£384m budget

National Services and Networks

Regional Services and Networks

Perth & Kinross Health and Social Care Partnership

Dundee Health and Social Care Partnership

Angus Health and Social Care Partnership

1287 WTE £130m budget



• FANS: Familial Arrhythmia Network• Photobiology• Photonet• Porphyria• Advanced Intervention Service• Surgical Lymphoedema Service

• Cytogenetics, Molecular Genetics & Pathology• Cervical Cytology External Quality Assessment• Histopathology External Quality Assessment• NES Genetics Training Scheme• Bowel Screening Service• Hydatidiform Mole Monitoring Service

• CAMHS Regional Network Tier 4 and the Young Person’s Unit

• Plastic Surgery Regional Network• Rohallion Secure Care Clinic

• MOHS Service• East of Scotland Breast Screening• East of Scotland Vascular Network• Scottish Pathology Area Network

Health Services

FHS Prescribing

Independent Contractors

£70m

£25m

£35m

Health Services

FHS Prescribing


£71m

£34m

£43m

Health Services

FHS Prescribing


£50m

£21m

£27m


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National and local context

Scottish Government 2020 Vision1 – and beyond

By 2020 everyone is able to live longer, healthier lives at home, or in a homely setting.This is the Scottish Government’s strategic vision for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland’s public health record, changing demography and the economic environment.

In Tayside it is the role of Tayside NHS Board as the strategic governance body accountable to the Scottish Government and to Scottish Ministers for the functions and performance of NHS Tayside to translate the Scottish Government’s vision into reality. Tayside NHS Board was established by the National Health Services (Scotland) Act 19722. The Functions of Health Boards (Scotland) Order 1991 set out the functions of the Boards and that they are required to make provision for the healthcare of their local population.

Recently the Public Bodies (Joint Working) (Scotland) Act 20143 introduced the single biggest change to health services in Scotland since the creation of the NHS. The Act provides the legislative framework for integration of health and social care services in Scotland. This Legislation to implement health and social care integration came into force on 1 April, 2016. This brings together NHS and local council care services under one partnership arrangement for each council area.

Health and Social Care Integration – Public Bodies (Joint Working) (Scotland) Act 2014

The transfer of services for adults and older people to the new health and social care partnerships took place on April 1 2016 across Scotland. In Tayside, there are three new partnerships in Angus, Dundee and Perth & Kinross. At its heart, health and social care integration is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey. It means all services are focused on person-centred planning and delivery, so that people get the right care, in the right place, at the right time.

The National Conversations – A Healthier Scotland and A Fairer Scotland

The Scottish Government has invited everyone to take part in two conversations: ‘A Healthier Scotland’ is asking people what a healthier Scotland should look like in the next 10 to 15 years and the steps that could be taken to make this vision a reality. It focuses on what matters most to people and what is needed to improve the health of the population and the future of health and social care services in Scotland. ‘A Fairer Scotland’ wants everyone to have their say on what a fairer Scotland should look like in 2030.

2020 Workforce Vision: Everyone Matters

The workforce policy for the NHS in Scotland recognises the role staff play in responding to the challenges that NHSScotland is facing. All Boards are expected to deliver the commitments in Everyone Matters4.

National Clinical Strategy

The new national Clinical Strategy for the NHS in Scotland5 was launched in Dundee in February 2016. It sets out the framework for the development of health services across Scotland for the next 15 years. It is designed to give an evidence-based, high-level perspective of why change is needed and what direction that change should take.

1 2020 Vision2 National Health Services (Scotland) Act 19723 Public Bodies (Joint Working) (Scotland) Act 20144 Everyone Matters: 2020 Workforce Vision5 National Clinical Strategy for Scotland

http://www.gov.scot/Topics/Health/Policy/2020-Vision

http://www.legislation.gov.uk/ukpga/1972/58/schedule/7/enacted

http://www.legislation.gov.uk/asp/2014/9/contents/enacted

http://www.gov.scot/Publications/2013/06/5943

http://www.gov.scot/Resource/0049/00494144.pdf


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Community Empowerment (Scotland) Act 2015

This new law will give communities more powers to take on land and buildings and to have a say on how their services are delivered. It will also mean that NHS Tayside has a statutory duty to consider transferring land and buildings to communities. It will also give community groups the opportunity to be involved in discussions on service development at the earliest stage. NHS Tayside is participating in the consultation on the Community Empowerment (Scotland) Act 2015 draft regulations.

Building on strong local partnerships

We have built strong partnerships with our local partners over the years and we will develop these even further, as well as build a co-production approach with communities, as we recognise they are critical for us to ensure joint planning for future services.

Our partners include:local authorities and other public sectors; our universities colleagues; the Academic Health Science Partnership; third and voluntary sectors; community planning partners; and patients, public and communities.

We have developed an NHS Tayside 2020 Vision which shows the importance of working with all our partners to deliver services in the future.

Health Equity

NHS Tayside is committed to tackling health inequalities as we know that inequalities caused by relative poverty can have a devastating effect on the communities we serve. That effect is the enormous scale of poor mental health and wellbeing, long-term physical ill health and early death in the poorest communities.

We must build targeted community programmes with all our partners to make communities more resilient and support them to take control of their neighbourhoods and the health and care services provided there.


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Over the next 20 years in Tayside, we know that there will be many more older people. At the same time, the number of young people will also increase. What these changes to the make-up of our communities tells us is that the demands for healthcare and the way in which our services will be delivered will need to be very different in future years.

As well as this ageing population profile, our doctors and nurses and other healthcare professionals can see that people’s health needs are changing: people are living longer and more people are living with long term medical conditions such as diabetes and heart disease.

NHS Tayside also has the largest property footprint in the whole of the country. We have many buildings which are old and although the quality of care provided to our patients in them is high, the environment is no longer suitable. This maintenance of old buildings is very costly and it is a drain on the precious resources which we have in NHS Tayside.

In recent years the health sector, whilst receiving the full uplift on its budget from Scottish Government, remains financially challenged. Over the past three years, NHS Tayside has been spending more than the budget it has received and has had to rely on brokerage payments from the Scottish Government to achieve financial balance. This is in part due to the number of premises we have across Tayside and the number of properties we have been unable to sell, but also because we have relied on non-recurring savings to achieve a breakeven position.

Over the next five years NHS Tayside faces a significant financial challenge but has a clear focus on reprofiling the spend pattern in order that it moves in the medium term to a sustainably financially balanced position. Different operational models of care will require to be instigated that does not just redistribute existing spend, but also reduces the level. This will however recognise the demographic changes expected in the population of Tayside in the medium term, the predicted demand on services, whilst also responding to new technologies and the continuing need to provide high quality services.

We want people to be at the heart of every decision. The vast majority of interactions with the health system are with family health practitioners based in the community – GPs, practice nurses, dentists, optometrists, midwives and pharmacists. There are 25 million GP appointments alone in Scotland every year. These practitioners build continuing relationships with people and communities and support a continuity of care and links to the social care and third sectors.

The new Health and Social Care Partnerships in Perth & Kinross, Dundee, Angus and North East Fife will see more services organised around locality “clusters” (groups of practices and services) where patients have those continuing relationships. They have a key role to play in supporting and empowering people to make positive lifestyle choices, supporting our Health Equity strategy.

The National Clinical Strategy launched in Dundee in February 2016 makes proposals for how clinical services need to change in order to provide sustainable health and social care services fit for the future. It sets out a vision that is both ambitious and challenging as a basis for further engagement with clinicians and the public.

For all these reasons, we must start changing the way we deliver healthcare now so NHS Tayside can continue to provide high-quality healthcare in the future. It’s important that we change and modernise our services over the coming years to respond to people’s needs, but we can’t do it on our own. We will always need the help of our patients and our communities to get it right.

Looking ahead - why do we need to change?


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Here in Tayside, the case for change has already been made in the NHS Tayside Clinical Services Strategies. Our clinicians have reviewed the evidence that supports best outcomes for patients in Tayside. They have made a number of recommendations on how we should change our clinical services.

During 2016/17 we will be working with local communities to understand what changes may need to happen as a consequence of the clinical recommendations.

However, every change and every redesign programme will be led by our clinicians to ensure they are person-centred, have patient safety as the overriding consideration and provide high-quality care, clinically-led programmes of change.

This document describes our Five Year Transformation Programme for healthcare across Tayside, along with our understanding of the health challenges facing our local communities and our approach to tackling them.

It also highlights the opportunities ahead and outlines the plans we are making to deliver health and care services for the next five years and beyond.


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Our Five Year Transformation Programme 2016-2021

The Five Year Transformation Programme is our detailed plan setting out the actions we must take to transform our health and care services. It describes the structure, purpose and philosophy of our organisation, along with our understanding of the health challenges facing our local communities, and the strategies for transforming our approach to tackle them, now and over the next five years.

It also sets out the financial plans that underpin the transformation, and our commitment to fully comply with national policy, legislation and the requirements of the Scottish Government.

As a Board we are committed to ensuring that everyone has the best care experience possible. The NHS Tayside Clinical Services Strategy – Reshaping Clinical Services for the Future, sets the direction for the service redesign and transformational change required to reshape clinical services over the next five years and beyond.

Seven transformation workstreams will underpin the clinical services strategies to drive service change. A Transformation Programme Board has been established to oversee and drive forward the transformation of the healthcare system in Tayside and ensure the programme leads are held to account for the delivery of their responsibilities.

Workstreams

• Service Redesign – Ensuring high-quality, seamless, safe and sustainable services and care across the health and care system in Tayside

• Realistic Medicine – Building on realistic medicine in the National Clinical Strategy using international, national and local evidence and benchmarking to inform our service redesign for assessment, diagnosis, testing, referral, treatment, procedures and medication to ensure that we use our resources in the most cost-effective way and make the best choices for patient outcomes

• Right Patients in Tayside/Repatriation – Ensuring Tayside patients are treated or cared for locally, whenever possible and managing inbound patients from other NHS organisations.

• Workforce and Care Assurance – Delivering high-quality, safe and effective patient care using a workforce of the right size with the right skills in the right place

• Better Buying and Procurement – Getting the best value for money for the things we purchase

• Facilities and Estates – Creating smarter working and optimising our working environments

• Property – Reducing the property footprint in Tayside and the backlog maintenance, releasing funds and enhancing the quality of care for patients by providing a more effective and efficient way of caring for them


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Section 3Organisational Strategy

In this section we will describe our:

• Vision and Values• Strategic Themes and Essential

Enablers• NHS Tayside Clinical Services

Strategy • Workforce Plan• Financial Plan• Property• Prescribing• Communications and Engagement

Approach• Transformation Programme

Governance and Performance• Benchmarking

Our Vision and Values

We want everyone to have a positive experience of healthcare. Person-centred, safe and effective care is our priority for communities across Tayside.

Our ambition for everyone is that every day we deliver standards of care that we would want for our own loved ones.

We believe we are judged by how we act and that our reputation is defined by how we deliver against our vision and how we put our core values into practice.

We developed a Vision and Values for NHS Tayside in partnership with our staff, our families and carers and the public and these promises are at the heart of everything we do.

To bring the values alive at the frontline for all members of staff, there are associated behaviours aligned to each of them.

Our Vision

Everyone has the best care experience possible

Our ValuesWe will:

Put patients first

Show compassion, caring and kindness

Treat everyone with dignity and respect

Take the time to have good, open communications and be accountable for our actions

and behaviours

Do the best that we can by working as a team to provide excellent treatment and care


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Strategic Themes

NHS Tayside organisational strategy will be underpinned by four strategic themes which will be essential in delivering the transformational change required. Through the five-year planning process, each of the service groups/directorates are commissioning plans aligned to these strategic themes:

1. Pursuing quality improvement to be the safest, most effective and person-centred organisation in the NHS in Scotland

• For our patients this means receiving care that is centred on their needs, delivers the best possible outcomes that are important to them, in settings that are appropriate for their needs

• For our staff this means working in an ambitious work environment, within high-performing teams in an organisation that is seen as the employer of choice

• We will compare ourselves rigorously with best practice in the NHS and pursue every improvement opportunity to give consistent and reliable care

2. Safely reduce our costs

• For our patients this means removing any elements of their care pathways that do not add value to their experience or outcomes

• For our staff we will ensure we make best use of their skills and ideas as they are best placed to identify duplication, waste and ineffective use of resources

3. Supporting high performance through productivity and efficiency

• For our patients this means being supported by staff who are highly-skilled, caring and compassionate, delivering services which are clean and safe

• For our staff, this means, through their actions, demonstrate the values of accountability and understand the clear link between their personal practice, their team’s goals and those of the wider organisation

• As an organisation, part of our improvement focus will be driven through benchmarking our performance and against best in class

4. Improving care through collaboration and partnership

• For our patients this means they will experience care which is integrated through primary, community, mental health, hospital and social care and feel supported to manage their own conditions with a focus on preventing illness and crises and reducing the need for urgent care

• For our staff and those working in the wider health and social care system being involved in the development in new models of care and ways of working for the benefit of patients, their families and their carers


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Essential Enablers

NHS Tayside has identified seven essential enablers that are critical to achieving our vision and delivering on our strategic themes. These will support the operational and director-led workstream efficiency programmes:

• eHealth NHS Tayside has a highly-developed five year eHealth strategy with a robust IT infrastructure supporting our transformational change.

• Improvement and Business Change NHS Tayside must have the right skills to drive forward the transformational business change required. Directorates and services will be supported by specialist individuals and teams to make change, drive out inefficiencies and, most importantly, improve outcomes and patient experience.

• Capital and Estates A five year property improvement and disposal plan to reduce our ageing estate and allow us to re-align our services within a new footprint across Tayside to allow co-location and effective patient flow, improve patient experience and improve infection prevention and efficiency.

• Strategic Profiling, National and Local Benchmarking In order to plan services that will deliver our vision it is vital that we understand our population challenges and their health needs. This understanding will ensure that our strategic priorities are focused on where the greatest health gain can be made. Independent benchmarking will identify areas of focus for our service redesign, workforce and financial plans in the context of the five year transformation programme.

• Shared Services Infrastructure and Procurement NHS Tayside is committed to the Shared Services Agenda and supports the approach adopted that has sought to achieve efficiencies and improve productivity. We support the ‘Once for Scotland’ to realise opportunities in relation to quality, efficiency and savings.

• Education and Training All of our staff, on every level, have opportunities to further their training and education. We provide training placements for student nurses, doctors, midwives and other healthcare professionals, as well as opportunities for modern apprentices and pre-work placements. The Improvement Academy is a valuable resource which offers a state-of-the-art environment for training and education.

• Research & Development and Innovation Integral to the delivery of high-quality treatment and care for patients is pioneering research and development and opportunities to innovate across all areas. Expertise is critical and the establishment of the Academic Health Science Partnership in Tayside brings together University of Dundee and NHS Tayside to improve the health of the population through advancement of health research, education of healthcare professionals and improved quality and safety.


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NHS Tayside Clinical Services Strategy

Implementing the Clinical Strategy and Transforming Clinical Services

The Cabinet Secretary for Health, Wellbeing and Sport Shona Robison launched the National Clinical Strategy, which sets out the need for transformational change across NHS Scotland, in Tayside in February 2016.

It recognises that in order to bring about change and improved outcomes for patients, clinical services require to be planned and delivered at national, regional and local levels. It identifies the direction for this strategic change that will help the NHS address the challenges ahead and it provides clarity on the priorities to improve the safety and sustainability of services and enhance the quality of care. The report stresses the urgency required to implement the changes and recognises that the pace of change must be accelerated.

The requirement for transformation stems from a recognition that the demand for health services will continue to increase over the next decade, that there are existing difficulties in delivering a safe and sustainable service with the workforce available and that financial constraints will impact on what can be achieved with anticipated future resources. These challenges require to be addressed by focusing on the quality of service, patient safety and clinical effectiveness, maximising patient value from available resources, increasing community care and providing proportionate and realistic care for patients by skilled staff working effectively in multidisciplinary and multi-organisational settings. Enhanced community support and effective working between health and social care organisations will reduce the requirement for hospital beds and the number of patients whose discharge is delayed.

From early 2015, NHS Tayside has been developing a clinical services strategic framework. The framework adheres to a core set of principles agreed by NHS Tayside and has been developed around the clinical community’s understanding of what is best practice. The advice will support the vast majority of care delivered for Tayside patients to be provided locally in Tayside. However, when patients have care requirements that cannot be safely and effectively provided locally, then arrangements will be made to ensure the care is delivered as part of a network with other Scottish health boards in regional or national arrangements. NHS Tayside will facilitate as local a delivery of services as possible in line with its 2020 Vision and will support regional and national service when these provide additional benefit.

Regional and national services tend to benefit patients who have rarer conditions or when highly specialist care is required. In some circumstances there can be a relationship between the minimum number of patients using a service and the quality of care provided. In these situations, the clinical outcome for patients is improved by ensuring the clinicians delivering the care see this minimum number by being clustered in highly specialist centres as part of a multidisciplinary team. All aspects of patient care can then be delivered safely and effectively by ensuring the greater experience of the clinical team with access to specialised facilities and equipment.

NHS Tayside has been developing its own clinical services strategy through 2015 and 2016 with endorsement of an overarching strategic approach supported by individual strategies. This has included specific strategies for older people, maternity services, paediatric services, adult mental health services and primary care that are all aligned with the national clinical strategy. Cancer and medical specialities clinical services strategies have had preliminary NHS Board discussion with full strategies planned for subsequent meetings, and a shaping surgical services strategy will also be delivered. The Chief Officers of the health and social care partnerships are involved in this approach to ensure that associated locality and community perspectives are considered. Where required the clinical strategies will be delivered through clinical boards as evidenced for those of Older People, Children and Young People, and Mental Health and Learning Disabilities. The fundamental aims of these boards are to:

• Provide strategic direction for Tayside through clinical evidence and associated guidance outlined within national policies and strategy;


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• Ensure the clinical, service, workforce and financial models are designed to ensure the continued delivery of good quality, safe and effective sustainable services by mitigating the current risks and challenges of skilled workforce availability;

• To provide the Chief Executive and NHS Tayside Board with assurance that adequate and appropriate arrangements are in place across the organisation to support safe care and treatment;

• Ensure there is an infrastructure in place across the organisation to equip and support staff to fulfil their responsibilities for promoting, supporting and safeguarding the wellbeing of the people we care for safely and effectively;

• Ensure that NHS Tayside works collaboratively with all relevant key stakeholders;

• Ensure professional and clinical standards are operational across the organisation;

• Ensure the development, delivery and monitoring of an annual improvement plan and that governance, monitoring and reporting systems are in place that demonstrate impact and outcome improvement;

• To ensure practice and services are delivered within jointly agreed Governance, Performance and Professional Frameworks.

These endorsed clinical strategies are starting to be implemented in operational service. This means that the benefits from changes in practice that promote greater community working, integration of health and social services and redesigned safer and more sustainable services with patients experiencing reductions in delayed discharge from care settings. Early work has been undertaken and transformational changes are linked to some of the Board endorsed clinical strategies that will be implemented through 2016/17.

Guiding principles for providing services in regional and national arrangements

NHS Tayside decision-making will take account of core principles to guide the provision of regional and national rather than local clinical service. In the situation that the greater concentration of care in a specialist area results in improved outcomes, and where the relationship between higher quality and better outcomes with minimum patient numbers is clear, NHS Tayside will work with regional and national partners to develop service networks over a wider area. These regional and national networks would centre on the requirements of patients and would plan all aspects of the patient journey. Many parts of the patient journey would still be delivered locally, but the more specialist aspects, such as surgery, would be delivered as part of our regional or national networks.

Key issues to consider for regional and national service planning

The issues that Tayside would consider when deciding whether there is a clear benefit to patients and that services should be provided as part of a regional or national network include the following:

1. Where patient outcomes are shown to be improved when a larger population base than Tayside is required to provide minimum numbers and maintain professional skills and provide safe, high quality care

2. Where the sustainability and cost efficiency of maintaining the infrastructure is such that safe contemporary care can be more optimally provided as part of a regional or national network

3. Where the service delivered for patients would be improved with enhanced access to a multidisciplinary specialist team concentrated in one area, thereby improving patient experience

NHS Tayside regional planning partnerships

NHS Tayside is committed to working as part of regional planning networks to provide its regional and national services as a provider and as a partner. The North of Scotland Boards that form the North of Scotland Planning Group include NHS Tayside, NHS Grampian, NHS Highland, NHS Shetland, NHS Orkney and NHS Western Isles. NHS Tayside has close working arrangements with NHS Fife and is a partner in the South East and Tayside regional network that includes NHS Lothian and NHS Borders. Tayside staff will work with clinical and management colleagues in these regional partnership arrangements to agree the best pathways of care for both the Board and the regions’ population. In addition, NHS Tayside has links with all other Scottish boards as part of national networks when this is required for more specialist services, and for very small numbers of patients would offer care in England or internationally where necessary.


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Location of regional and national service provision

NHS Tayside would anticipate providing some of these regional and national services within its own board area, and some would be provided by other boards. The advantages of Tayside hosting a regional and national service include building local multidisciplinary expertise that would promote research activity, academic links and teaching opportunity. The critical mass of services to support integrated care provision would be considered in the decision making.

However, NHS Tayside would have to ensure that it had all of the appropriate facilities including theatre and critical care capacity as well as full multidisciplinary staffing to supply the services sustainably and safely over a wider geographical area. Patients from Tayside may access other board areas for their specialist care as part of agreed regional and national arrangements. This would ensure that Tayside residents could access safe and sustainable services when these cannot be provided locally.

Locally the service strategies will support the emerging integrated joint boards in describing their commissioning plans for their localities as well as helping NHS Tayside decide upon the future configuration of services.

This has included specific strategies for older people, maternity services, mental health and primary care which have all been approved by NHS Tayside Board.


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Five Year Financial Framework Plan NHS Tayside receives resources nationally to provide health services to its catchment population of the residents of Tayside. The principle revenue resource is determined through the National Resource Allocation Formula (NRAC) with Tayside’s current share calculated at 7.73% of all Territorial Boards. The resources received nationally reflect this percentage.

Uplifts for the five year period to 2020/21 have been planned for based on a GDP uplift of 1.7% for 2016/17, which has now been confirmed following the approval of the Scottish Budget, followed by a planned uplift of 1.8% in each of the subsequent years. This is based on planning guidance received from Scottish Government Health & Social Care Department (SGHSCD). The Baseline Revenue Resource anticipated by NHS Tayside over the five years of the plan are set out in the table below:

2016/17 2017/18 2018/19 2019/20 2020/21£m £m £m £m £m

Baseline Resource B/fwd 667.3 698.2 710.7 723.5 736.5

Baseline Uplift 11.4 12.5 12.8 13.0 13.3

Social Care Allocation 19.5

Total Baseline Resource 698.2 710.7 723.5 736.5 749.8

A range of earmark allocations are anticipated each year to provide the total resource envelope that NHS Tayside requires to operate within. The total anticipated resources available are set out in the table below:

Year 1 Year 2 Year 3 Year 4 Year 52016/17 2017/18 2018/19 2019/20 2020/21

£m £m £m £m £mForecast resources availableRevenue Baseline Resource 698.2 710.7 723.5 736.5 749.8

Outcome Framework Allocations 14.0 13.0 13.0 13.0 13.0

Other Anticipated Allocations 24.5 24.5 24.5 24.5 24.5

Alcohol & Drugs Allocation 4.2 4.2 4.2 4.2 4.2

External Contributions -4.8 -4.8 -4.9 -4.9 -5.0

Primary Medical Services 59.0 59.5 60.1 60.7 61.2

Depreciation -17.8 -18.2 -17.4 -16.9 -16.9

Core Revenue Resource Limit 777.3 788.9 803.0 817.1 830.8Non Core Revenue Resource Limit 31.8 37.1 31.7 26.2 28.5

Primary Care Services (Non-discretionary) 42.6 43.1 43.6 44.1 44.6

Total Resources 851.7 869.1 878.3 887.4 903.9

Recognising anticipated changes in relation to pay awards and other pay related issues, medicines growth, and also general price increases over the five years of the plan the table below sets out the total commitments set against the total resources available to identify the level of the efficiency challenge the Board faces in delivering a balanced budget in each year of the plan. The first year also recognises a range of legacy issues.

2016/17 2017/18 2018/19 2019/20 2020/21£m £m £m £m £m

Total Resources 851.7 869.1 878.3 887.4 903.9

Total Commitments 910.1 910.9 910.0 914.9 927.5

Total Overcommitment 58.4 41.8 31.7 27.5 23.6


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The following is assumed within the plan in terms of Savings Delivery Assumptions:

2016/17 2017/18 2018/19 2019/20 2020/21Recurring 40% 50% 50% 60% 60%

Non recurring 60% 50% 50% 40% 40%

Whilst in the early years of the plan it may appear that 40% recurring savings delivery is not ambitious enough, there is a period that the organisation has to demonstrate that it has the willingness to drive through on a range of cost reducing measures and altering the existing pattern of spend. The Transformation Board will have a key role in guiding the organisation through some of these difficult decisions going forward and assisted by clear, concise business cases/papers that facilitate an understanding of all options considered with appropriate officer recommendations. A higher level of delivery of recurring efficiencies each year will lessen the burden in each consequent year.

The total efficiency over the five years is close to 5% of the Board’s Revenue Resource Limit but is front loaded to the early years of the plan with the first year being close to 8%.

NHS Tayside is a Board that has an operating service model that is too expensive. Benchmarking data from a wide variety of sources consistently provide the message that, in comparison with specific Boards or in general across Scotland, our spend patterns are in excess of the level of resource we receive. Different operational models of care will require to be developed that do not just redistribute existing spend commitments, but also reduce the level of spend.

The enormity of the scale of this challenge is recognised, but the Board, through the appropriate guidance of its executive officers, will provide the necessary impetus in order to gain the traction that will see the spend profile of the Board constrained and radically re-profiled in order that it moves to a sustainable financially balanced position in the medium term.

In the context of our Five Year Transformation Programme, the clinically-led service redesign will deliver resource release in the later years of the plan which in part recognises the complexity in ensuring that we have the right capability and capacity in place as well as robust implementation plans and governance arrangements. This transformation programme will also require to understand the demographic changes and the health needs associated with population changes.

The Public bodies (Joint Working) (Scotland) Act 2014 provides a framework for the effective integration of adult health and social care services. Its policy ambition is to:

“…improve the quality and consistency of services for patients, carers, service users and their families: to provide seamless, joined up quality health and social care services in order to care for people in their own homes or a homely setting where it is safe to do so; and to ensure resources are used effectively and efficiently to deliver services that meet the increasing number of people with longer term and often complex needs, many of whom are older”

The arrangements for the establishment of the three Health and Social Care Partnerships were set out within the Integration Schemes established between NHS Tayside and the respective Local Authorities aligned to each partnership. The Integration Schemes for each of the three health and social care partnerships were approved by Scottish Ministers in October 2015.

The creation of the Integration Authorities from 1 April, 2016, sees a reconfiguration and transfer of resources through delegation of functions to each of the new Joint Boards together with the transfer of resources in relation to Hosted Services.

With respect to Capital Resources the table below indicates the estimated capital funding over the five years of the plan.


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Funding Source2016/17 2017/18 2018/19 2019/20 2020/21

£000s £000s £000s £000s £000sFormula capital allocation 9,473 9,473 9,473 9,473 9,473

Project specific 2,445 16,938 11,447 12,013 13,739

Radiotherapy 3,557 0 737 2,554 0

Transfer from RRL to CRL 2,000 2,000 2,000 2,000 2,000

Totals 17,475 28,411 23,657 26,040 25,212

For planning purposes Boards have been advised to assume a flat position on formula capital allocations. No further SGHSCD allocations have been anticipated in 2016/17 over and above the indicative formula capital allocation and the ring-fenced Radiotherapy rolling replacement programme.

Project specific funding includes charitable sources of funding.

It is unclear the level of national support to be provided beyond 2016/17. Boards have been advised to indicate, however, those key projects that would potentially attract support from SGHSCD. The new Scottish Capital Investment Manual (SCIM) currently being piloted, places greater emphasis around service modelling prior to embarking on developing an Initial Agreement. The requirement for capital investment should grow out of good service redesign. Projects need to be set in the broader strategic context of the organisation and Boards have been encouraged to engage with SGHSCD colleagues around the development of business cases as early as possible in the process.

The projects indicated for national support over the five years of the plan include investment in the Ninewells Infrastructure, Critical Care Unit, Neonatal Intensive Care and the re-equipping of the interventional radiology rooms.

Transformation Programmes


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Property

NHS Tayside views Property and Asset Management as a contributor to core business resource planning so as to ensure that the physical asset base is aligned with the organisation’s Strategic Service Planning. Asset management is strongly linked to investment planning to ensure that we can deliver our key primary objectives.

NHS Tayside will utilise its Property and Asset Management Strategy (PAMS) to align asset objectives with Corporate Objectives, Strategic Plans and Clinical Strategy Direction to:• ensure overall efficient and effective use of assets in the medium and long term• provide a platform for structured and rigorous forward thinking• provide a basis for corporate and consultative strategy development• give an explicit description of the direction of the organisation• bring clarity to the way assets are managed within the organisation• provide corporate processes for assets• provide performance measures and targets for assets• ensure robust data management and measurement of estate performance• ensure that service need drives forward the asset strategies

A substantial property asset base worth around £422 million underpins the delivery of NHS Tayside’s wide range of healthcare services. This substantial asset base needs to develop to enable it to better support existing services and to reflect evolving new services. Even modest improvements in performance of these assets have the potential to deliver significant benefits for patients and staff as well as efficiency savings. The Scottish Government’s strategy for increasing efficiency in the public sector gives further impetus to effectively managing property and asset performance. Managing property and assets more efficiently results in NHS Tayside saving money, which it can invest back into services, while property and assets perform better and more sustainably for the benefit of patients and staff.

At a strategic level, the Board of NHS Tayside is regularly faced with significant investment and disinvestment decisions as part of the ongoing modernisation of the asset base to respond to and support the delivery of service reconfiguration across Tayside. The challenge is heightened by funding pressures, which means that the Board must prioritise its investment and disinvestment requirements more rigorously, ensuring affordability and continued development of its Local Delivery Plan to support the transformational change required to deliver the Route Map to the 2020 Vision.

NHS Tayside’s Five Year Property and Asset Management Strategy is based on NHS Tayside’s long-term vision to ensure that planning and investment in our estate is right and matches the timescale for our transformational change programme.

The plan has an important role to play in enabling change, ensuring that our plans accommodate and encourage the changing way services will be delivered tomorrow, taking full account of, improvements in technology, telemedicine and the impact of an ageing population whilst delivering savings, reducing our overall running costs and ensuring that all decisions to invest or disinvest are properly targeted.

Ultimately the plan will ensure NHS Tayside has high quality, fit-for-purpose buildings located in the right place in order to deliver safe, efficient and effective healthcare services to our local populations. Our estate is also often one of the factors which create a lasting impression in our patient’s minds – our reputation depends in part on working from good quality physical environments. Finally there is a strong evidence base to support the therapeutic benefits of a good quality environment.

Over the next five years, we will have reduced our property base by over 29 properties, redesigned our existing property portfolio to ensure fitness for purpose and will have made significant progress in providing alternative models of care within our community settings.

Five Year Capital Plan

To support service improvements and changes in clinical services, we have a robust capital planning process which will allow refurbishment, new developments and enhancements to our property portfolio to ensure we support our new clinical strategies and improvements in patient care and environments. NHS Tayside is currently one of four centres identified to become a Major Trauma Centre, however, there is ongoing national work to establish the most appropriate major trauma system configuration for Scotland. NHS Tayside has also been chosen to host a £40m elective treatment and diagnostic centre on the Ninewells site.


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The table below is an extract from the Five Year Capital Plan, explicitly detailing the proposed capital investment in the NHS Tayside property estate. This investment will deliver an enhanced and resilient estate for the delivery of safe patient care.

2016/17 2017/18 2018/19 2019/20 2020/21£000s £000s £000s £000s £000s

Summary of PropertyState of the EstateEstate Investment - Statutory Compliance & Backlog Maintenance

3,519 2,498 3,318 2,784 3,347

Primary Care Fund Programme 382 205 250 250 250

High Priority Projects

Ninewells Infrastructure Works 350 9,650 4,000 4,000 4,000

Maternity services review, incl theatres 1,300

Neonatal Intensive Care Ninewells 952 2,855

Interventional; radiology rooms - ventilation and rooms G/H/I re-equipping

963 2,946

Critical Care Unit incl SHDU and ICU Ninewells Phase 1

500 2,485

Critical Care Unit incl SHDU and ICU Ninewells Phase 2

6,215 9,000

Children’s Fundraising Project/ARCHIE paediatric theatres

124 4,342 1,466

Theatre compliance 300 300 300 300 300

MacMillan project - Angus 738

MacMillan Haematology & Oncology Unit Ninewells

2,698 5,395 2,698

Other Formula Capital

Laundry Waste Water Heat Recovery 62

Radiation Protection Theatres 3-6 11

Retraction funding 100

6,087 21,395 17,833 18,944 20,895

**Note the table above does not include HUB Projects or those funded through Capital Grants

Summary

NHS Tayside has demonstrated that there are significant opportunities for capital receipts and reduction in maintenance costs, through the redevelopment and disposal of its property portfolio.

This will be achieved through the implementation of its Strategic Change Programme and Clinical Service Strategies to reduce its overall property footprint, provide better patient care facilities and improve the quality and location of our services. Such changes will provide cash savings both in receipts and reduction in maintenance costs.

We will have strong property strategy and delivery plan, governed by our Transformation Board and will work collaboratively with SG and our partners over the next five years in the delivery of this.


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Medicines Management

Medicines are the most frequency and widely used NHS treatment. Audit Scotland reminded us that during 2011/12 there were 91 million prescriptions issued by around 1,000 GP practices in Scotland, costing £974 million, which increased further in 2014/15 to £1.19 billion. Territorial NHS boards spend around 11% of their annual budgets on GP prescriptions. This expenditure is influenced by a multitude of diverse factors including an ageing population with increased requirements for long term condition management, new advances in therapy, the effects of deprivation on ill health, health behaviours and disease prevalence. Additionally implementation of national guidance on best practice and standards of care e.g. SIGN guidelines and HIS standards have had an overall effect of increasing the prescribing of medicines.

Medicines are therefore a significant and increasing area of expenditure for Boards in NHS Scotland. Added to this are the challenges presented by the current economic climate with tightening financial resources available to deliver current services and respond to the increasing demands for healthcare, including medicines. In line with the NHS Scotland Quality Strategy there is therefore a need to ensure that the most effective medicine is provided to everyone who will benefit and that the treatment delivers best value for the NHS.

NHS Tayside currently budgets £80m annually for Family Health Service (FHS) prescribing and £40m for secondary care prescribing. The gap between NHS Tayside and the Scottish average for FHS spending has been growing over recent years, driven by early adoption of new medicines and indications for conditions such as anticoagulation and chronic and neuropathic pain. As a result the spend per weighted patient for FHS prescribing in Tayside is £2.60 more than the Scottish average for the most recent quarter (October to December 2015 - £51.93 per weighted patient in Tayside compared to £49.33 for Scotland). This equates to a variation in spend of £4m per year.

There is national evidence that often there is too much medication prescribed and dispensed and that there may be considerable waste of medicines. The important principles are to ensure that the right patients have the right medicines and at the right time and that they are do not unnecessarily receive medicines or multiple medications that can result in unnecessary harm.

Prescribing expenditure in Primary Care in NHS Tayside has been increasing gradually over the over the last two years, and the gap from the Scottish average is widening. We aim to improve the quality of prescribing by reducing waste, variation and harm in the use of medicines while achieving financial efficiencies in medicines expenditure. Substantial progress has been made to reduce inappropriate prescribing expenditure within NHS Tayside, through a range of activities including cost minimisation initiatives, improved formulary access and optimised stock management and distribution functions.

The aim of this work plan is to continue to embed cost effective prescribing within NHS Tayside in order to enable positive patient outcomes through the following three overarching objectives shown below:

Improved Information Provision and Analysis

We will engage with healthcare professionals through effective communication and information provision to influence prescribing behaviours and will improve Prescribing Information provided to practices on cost-effective prescribing from the Prescribing Support Unit.

Building Capacity and Targeting Resources

We will use available tools and resources to maximise cost effective prescribing opportunities, linking with other initiatives to sustain change and where appropriate building further capacity to improve cost effective prescribing through increased ownership, incentives and collaborative regional/national

Integrated Approach

We will foster an integrated approach to cost effective prescribing across the health and social care systems


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On this basis, efficiency measures have been developed across three aspects:

Centrally Negotiated, Locally Actioned

These interventions include implementation and monitoring of rebate schemes, and centrally directed tariff changes. There is always a level of variation around pricing in any given year; we have therefore included in our planning that a number of other cost increases will be offset against price falls compared to previous years.

Medicines - Managed Interventions

This includes a range of measures that will help reduce core medicine spend across the five year period of the transformation programme. This will include the review of pathways and the application of a programme budgeting approach to ensure that the most appropriate, cost-effective medication is being adopted in for example respiratory, asthma, pain and mental health. We will also address variation in prescribing across primary care with the deployment of a practice review team under our Quality Outcomes Framework Plus (QOF+) programme, supported by flexible deployment of our locality pharmacy teams.

In addition there are areas of work that have been previously identified as opportunities to mitigate increasing spend on medicines where we will deploy strong, clinical and organisational leadership to deliver. These include areas such as Cardiology, Urology and Pain pathway

Non Medicines - Managed Interventions

Non-medicine prescribing accounts for approximately 10% of the overall FHS prescribing cost across Tayside and there remains scope for improvement and cost reduction. Our focus will be on working with General Practices and Integrated Joint Boards (IJBs) to reduce prescribing costs as well as working with the Nursing directorate to work together to improve non medicine prescribing including aspects such as catheters, dressings and oral nutritional supplies.

Improved Governance Framework

In recent years the FHS prescribing budget process has been led through the Operational Unit Medicine Management Group (OUMMG) that met three times in the period leading up to formal budget setting in March of a preceding year.

In light of the introduction of IJBs, and reflecting the NHS Tayside position regarding FHS prescribing costs, the overall Medicine Governance framework has been revised to focus on delivery of the transformation programme within the Realistic medicine workstream.

In addition the prescribing support unit are developing a cluster based report on medicines usage to identify and address areas of high cost, growth and variation across Tayside. The new form of data provision will allow practice clusters to identify areas of prescribing improvements. This supports our direction of travel to provide high quality data and information, to support meaningful improvement dialogue with GP practices.


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Introduction

The role of our workforce is central to successful delivery of NHS Tayside’s Transformation agenda. It is through the people who work within NHS Tayside, their commitment, their effort, and their talent, that our transformation will be delivered. How we deploy our workforce directly influences the ongoing safety, quality and effectiveness of the care and services on which our patients rely.

In a context where staff costs represent our largest revenue spend, NHS Tayside’s approach to workforce deployment must also reflect our duty to ensure the most effective use of public resources. Our local service workforce plans, built to reflect clearly defined clinical strategies, must therefore balance our overriding commitment to maintaining safe and effective services, and help secure the delivery of our Five Year Financial Plan.

The scale of transformational challenge described within NHS Tayside’s Five Year Strategy means financially ‘more of the same’ in relation to our staff cost base is no longer a viable position. Securing an overall reduction in costs will be achieved through the reshaping of the size and grade mix of our workforce, supported by the retraining and redeployment of staff to ensure their alignment with new and transformed models of care.

Transformational Change Programme

Change can only be achieved if it is planned, prioritised and managed effectively using robust project, programme and performance management techniques combined with effective communication and with the involvement of the workforce.

We will strive to ensure we have the culture and capacity to deliver this transformation effectively, and the HR & Development function will prioritise supporting that change to ensure that good people, leadership, and change management practices are consistently followed, so that we enable, empower and support our employees to deal with the challenges and changes we face.

Workforce & Care Assurance

The NHS Tayside Board has approved a Five Year Financial Framework. In so doing, this recognises the need for key strategic and tactical workforce change. It is this change agenda that is central to the Workforce and Care Assurance Transformation Work Stream, which will itself be key in securing our ongoing financial balance.

The detailed action plans which form the core of this workstream will be reviewed and refreshed annually with the Board to ensure they remain appropriately targeted to support the wider transformation of the Board’s services.

These include building on the work already commissioned by the Board, Chief Executive, Director of HR and others, to benchmarking around our workforce - both in terms of cost, numbers, and around policy best practice - to inform our approach to our workforce agenda across all services.

By taking this system-wide approach to key issues, this will help ensure we minimise any detrimental impact on frontline clinical services, and therefore our patients.

As a central part of transformation, the Workforce and Care Assurance Work Stream will target a range of identified, and interrelated, key enablers to support the delivery of the whole system service redesign.

These include:

• Transformational change management through whole-system workforce review to drive movement to ‘best practice’ grade and establishment benchmarks

• Reducing reliance on supplementary staffing through local service redesign and more effective staff deployment• Ensuring effective and efficient rosters across all staff groups• Supporting positive attendance and promoting employee well-being• Reviewing our approach to management and administration support to secure lower costs

Workforce and Care Assurance


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Distribution of Service Delivery

The Board of NHS Tayside is actively progressing Clinical Strategy on the following programmes, including:

• Mental Health Optimisation• Shaping Surgical Services• Primary Care Strategy• Maternity Services• Older People’s Strategy

Three further strategies are in development for cancer, paediatric services and medicine.

These clinical strategies, alongside other local clinical redesign and the Board’s Estates Strategy, will inform the reconfiguration of the workforce. A variation to the locations for delivery of services will impact on the staffing projections required to deliver safe models of care. Redesign will require to be delivered within the financial envelope available.

NHS Tayside has an existing robust system for redeployment in accordance with our Organisational Change Policy. Numbers of staff requiring redeployment have been traditionally low, reflecting the effectiveness of managers in redeploying staff within their own services, thus minimising the numbers declared as displaced through organisational change. A review and redesign of our policy is, however, being undertaken recognising the need to promote a more dynamic, responsive approach to meet the changing needs of the service.

Ensuring Effective Governance

The work of the NHS Tayside Transformation Board plays a key role in oversight of the workforce elements of our wider change agenda.

Alongside this the work plan of Staff Governance Committee - one of the key committees of our Board - has been refreshed to ensure a full and ongoing focus both on the delivery of our strategic plans, and ensuring the delivery of the national and Board commitments to our workforce on delivery of the national Staff Governance Standard.

As part of this delivery agenda, the aboard has recently refreshed its own ‘People Matter’ Five Year Strategic Framework. This framework describes all that we will do to attract, retain, support, develop,and recognise the efforts of those who deliver our service, and how we will make a difference to the day-to-day experience of workforce. This document, and through its monitoring by the Staff Governance Committee, also makes clear how we will deliver NHS Scotland’s commitments under its ‘2020 Workforce Vision - Everyone Matters’.

Securing Engagement

Key to achieving any change is effective staff engagement. A continuous programme of corporate led, orally delivered positive engagement forms a central tenant of our approach to ensuring front line staff understand and are themselves engaged around need for recurring change and become active advocates in our transformation agenda.

This commitment to engagement is critical to ensure every member of our workforce - and each of our key clinical and professional leaders - understands that delivering financial change is a core aspect of their role to help us deliver the safety, quality, and improvement agendas.

Promoting Staff Partnership

NHS Scotland’s partnership approach to employee relations is central to our approach to achieving successful transformation. The role played by our trades union partners is vital in achieving change of the scale sought. By building on the strong history of partnership working that already exist in NHS Tayside, and by mutually strengthening those areas that are still in development, we will ensure all our transformation initiatives are led on a partnership basis to ensure the important influencing voice of our staff is heard.

Through full and early engagement with our trades union representatives at the Board’s Area Partnership Forum, through our Local Directorate Partnership Foras, and at departmental level, we will work together on developing a mutual understanding of the need for change, a joint commitment to securing that change together, and build on our areas of common agreement to help deliver the range of issues that require to be addressed.


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eHealth Strategy

NHS Tayside Board has approved a new Five Year eHealth Strategy which will see the replacement of a number of key systems over the coming years which will deliver modern business-focused eHealth systems to support efficiencies and improvements in patient care.

Our aim of the Five Year eHealth Strategy is to ensure that the health and wellbeing of Tayside residents will be supported by a single, integrated electronic record of care over their lifetime. Our healthcare practitioners will have seamless and appropriate access to personal health information to provide safe, high quality and patient-centred care.

This will support our 20/20 Vision through the deployment of new and emerging technologies, which enable access to Electronic Patient Record information as well as support self-management through the use of home monitoring devices and telemedicine.

We will modernise our information technology infrastructure to ensure a secure and reliable platform to support the use of modern technology devices to access patient records from across Tayside to support our workforce in flexible, mobile working.

Our plan will support the National eHealth Strategy and takes into consideration the national programs of work, such as the CHI Transformation program and the GP IT re-provisioning to ensure alignment across Scotland.


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Programme Governance

Background

The scale of the changes required across NHS Tayside to address the current financial position and deliver the 2020 Vision is significant. Following a series of development sessions for the Directors during the summer period of 2015 a portfolio of workstreams was identified and the leadership allocated to small groups of directors to lead each workstream. On their own the workstreams could address specific issues but not co-ordinate as a whole system response. Clinical Strategy was identified as a requisite for the majority of decisions that needed to be made by the workstreams but no mechanism existed to co-ordinate the divers strategies across the various workstreams.

Many of the activities being put in train raised actual or potential conflicts with business as usual delivery of cost saving initiatives. It was identified that cost saving alone was not going to be the single the answer to financial balance and would not deliver the NHS Tayside Vision. Finally it was recognised that continual cost reduction would not leave NHS Tayside in a sustainable position.

During Q4 2015 it was identified that a coordinated approach was required to address the preceding challenges that were arising and to deliver more than cost savings. A Tayside-wide programme was developed to support the key strategic aims of the board and to enable the workstreams to co-ordinate activities to deliver financial balance, 2020 Vision and a sustainable organisation.

Governance

NHS Tayside Transformation Programme has been set up to deliver against the Five Year Strategic Objectives. The Programme will be overseen by the Transformation Programme Board chaired by NHS Tayside’s Board Chairman. This Programme Board meets on a monthly basis.

The Transformation Programme Board has been established with agreed Terms of Reference. The scope of the Transformation Programme is across NHS Tayside (including the newly established IJBs) and the remit is to support the delivery of changes that will result in the outcomes as follows:

1. Sustainable financial balance2. Improving patient outcomes, quality and safety3. Cost effective service delivery

Programme Structure

This will be through the oversight of the seven Workstreams:

• Service Redesign• Realistic Medicine• Right Patients in Tayside/Repatriation• Workforce and Care Assurance• Better Buying and Procurement• Facilities and Estates• Property

A Transformation Executive Group, chaired by the Chief Executive, reviews the activities of the Strategic Workstreams on a weekly basis, allowing for decision-making and deployment of resources to address issues or risks without delay.

The Executive Group is supported and receive reports from the Transformation Programme Office that will track progress of the workstreams on a day to day basis. This structure is shown in the following diagram.


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Communications and Engagement

The NHS Tayside Corporate Communications and Engagement Strategy – Value Your NHS is a key pillar to delivering NHS Tayside’s strategic objectives and priorities and will significantly contribute to our Five-Year Transformation Programme 2016-21. It recognises the value that good communications and engagement can add by enabling an organisation to achieve its objectives, deliver high-quality services and to continuously improve its performance.

The significance of communications and engagement as a strategic tool has grown exponentially in the NHS over the past 15 years or so. Once upon a time, communications and engagement professionals relied on information giving only, and NHS communications was based on a Public Relations model with media relations and publicity at its core. Today communications and engagement in the NHS has at its core two-way communications and prioritises the value of listening to and learning from our staff, our patients and their families and our communities.

NHS Tayside is also operating in a very different environment from a few years ago facing significant challenges, including• caring for an ageing population with longer life expectancy• an increasing number of people with long-term and multiple conditions• rising costs and growing demand for services• continuing pressures on public finances.

We are committed to delivering safe, high-quality services for all of our patients and their families. The effectiveness of how we deliver our vision here in NHS Tayside is determined to an extent by the quality of our communications and engagement.

The five year strategy outlines the approach we will take to ensure our communications and engagement activity is the best it can be and helps to achieve our vision. It also reflects the importance Tayside NHS Board places on communicating and engaging well and a recognition that effective communications and engagement will ensure that our vision, priorities and outcomes are clearly understood by our patients and their families, carers, our staff, the public, all our partners and other stakeholders.

A Communications and Engagement Workplan and Action Plan will be produced annually to reflect the priorities of the five-year programme.

Value Your NHS – a new approach

Introduction

The Value Your NHS campaign and brand supports a whole organisation effort to achieve the best outcomes for our patients while supporting our ambitious programme of transformation and redesign and a five-year approach to achieve financial stability for NHS Tayside.

The Value Your NHS campaign reflects the importance Tayside NHS Board places on communicating and engaging well and its commitment to doing so in an open, honest and transparent way which is meaningful for our staff, our patients, their families and carers and all our stakeholders.

NHS Tayside staff have tens of thousands of contacts with people and organisations day and every one of them is a reflection of our approach to communications and engagement. Making sure that every patient, relative, carer, staff member, independent contractor, partner organisation, member of the public or journalist experiences high-quality communications is not down to one particular team or department. Everyone must play their part, with clear and consistent standards across the organisation.

Effective communications and engagement is at the heart of our approach to clinical redesign and transformation and our Five Year Transformation Programme 2016-2021.


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This new communications and engagement strategy for Value Your NHS is designed to support NHS Tayside’s Five Year Transformation Programme to achieve its objectives:• Sustainable financial balance• Improved patient outcomes, quality and safety• Cost effective service delivery

Objectives

1. Raise Awareness of Value Your NHS as a whole-organisation drive to inform and engage all stakeholders around the challenges that NHS Tayside faces over the coming years.

2. Create Understanding of what Value Your NHS can do and how stakeholders can be involved. Develop stakeholder buy-in to ensure all our stakeholders feel a sense of ownership and pride towards NHS Tayside.

3. Build Confidence and Reputation by raising the profile of Value Your NHS as a brand and maximising confidence in our Transformation Programme by demonstrating we can all make a difference.

4. Listen to Stakeholders and ensure there are appropriate structures to feed back comments, compliments, concerns. Be responsive and agile.

5. Talk to Stakeholders ensuring they are receiving regular, clear messages letting them know how the Five-Year Transformation Programme is going and how their feedback is playing a part in the programme.

6. Manage Expectations – confirm that things won’t change overnight, although the Five-Year Transformation Programme will bring clinically-led redesign which will benefit patients and staff. Remind stakeholders of the limitations to our resources through Value Your NHS messages.

7. Build Continuous and Meaningful Engagement with all our staff, the public, patients and carers to influence the shaping of services and take ownership of their NHS services.

8. Support staff so they can deliver the best care they can and encourage them to be ambassadors for NHS Tayside’s vision and ambitions.

9. Celebrate our Success and Achievements inside and outside the organisation, inspiring confidence in our Transformation Programme and local NHS services.

It is with this in mind that we are building the Value Your NHS campaign to inform all of our stakeholders around the challenges that the NHS faces over the coming years.

Aims of the campaign:

• raise awareness with our staff and the public about the challenges we face• reassure and remind the public that NHS Tayside is an organisation which provides brilliant care and treatment

every day, delivering safe care and high-quality services to thousands of people across the area• clearly state that we must do things differently if we are to provide sustainable services, explain what these

transformations will be and how we will take these forward• present a call to action to staff that everyone has a role to play in achieving financial stability – and how they can

get involved in our transformation programmes• encourage everyone to ‘Value your NHS’ through short to medium-term campaign

Five Year Transformation Programme

Documents

Transcript of Five Year Transformation Programme