B/17/111 NSS Formal Board Meeting – Friday, 1 September 2017

Local Intelligence Support Team (LIST) Expansion

Purpose To provide the NSS Board with an update on LIST expansion covering implementation, initiatives, staffing and engagement. This note supports the papers attached. Recommendation It is recommended that the Board note the very positive progress in the development of LIST since its inception and the plans for its development in the year ahead, in particular the potential for it to align with the emerging regional structures. Timing There are no timing issues with this issue. Background LIST continues to successfully engage and support health and social care partnerships. However, at the start of 2017/18 it commenced expansion into primary care in support of the emerging GP clusters and their focus on improvement through the recently published national framework Improving Together. The attached papers outline the plan for expansion, building upon the existing staff management and technical infrastructure. The aim by March 2018 is to grow to around 65 (whole time equivalent) staff (including NSS funded staff) with expected further growth throughout 2018/19. The multi disciplinary team will consist of a variety of professionals, who have specialist knowledge and training, with different areas of expertise. This will include, for example, data scientists, health care professional’s (nurse etc), social work, practice managers etc. The funding of this expanding service is a combination of funds from Scottish Government, NHS NSS and augmented by other local commissions. The increasingly multi-disciplinary nature of the team with its connection to the national level resources in ISD and the ability to link to local data is what drives benefit through actionable intelligence. The continued roll out and development of SPIRE and Source will further enhance the capability of LIST. The major decision for LIST in the year ahead will be in articulating its role in supporting the emerging regional structures; there is potential for it to play a significant role in connecting the regional level to both the local and national levels. Engagement LIST is inherently engaged with a broad range of external stakeholders, in particular working closely with Health Care Improvement Scotland and Health Scotland. Phil Couser Director, Public Health and Intelligence Ext 6849 Phillip.Couser@nhs.net

Enclosures:

1. 1. LIST Milestone Chart (programme plan) 2. 2. LIST August 17 – monthly update 3. 3. LIST GP Cluster Engagement (map) 4. 4. LIST Expansion – Hub modelling 5. 5. LIST Workforce Projections 6. 6. LIST LDPs & KPI 7. 7. LIST Benefits

LIST Expansion Project (Primary Care)

Produced by:

Jessica Parish, PgMs

4. Recruitment

and Workforce

Development

(DB)

1. Governance

(DB)

2. Implementation

(DB)

Key: Milestone Completed Milestone Milestone Delayed Critical Milestone Meeting

3. Stakeholder

Engagement &

Communications

(JB)

May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2017 Jan 2018 Feb2018

5. Collaborative

Working (with

partners)

(MAh)

Mar 2018

Date: 3 August 2017

Page: 1 of 1

03/08 Proj Bd

26/05 LIST Expansion discussed with National Teams

19/05 Meet with key contacts on site (Phase 1)

19/05 Key areas for action & site work plans agreed

19/05 SLA agreed (Phase 1)

13/10 Meet with key contacts on site (Phase 2)

13/10 Key areas for action & site workplans agreed

13/10 SLA agreed (Phase 2)

02/10 Phase 2 commences

31/05 Monthly Review Meeting (Phase 1)

18/07 Phase 2 Engagement Framework completed

03/08 31/07 07/06 20/04 Comms Action Plan Agreed

02/05 Interviews held

17/05 01/06 6 of 11 Resources in post 18/08 Agree next round of recruitment

10/08 5 Resources in post

03/08 Risk Mgt Strategy approved

04/05 Practice Managers Conference

17/05 Scottish National Users Group Day

20/06 NHS Scotland Event

26/09 SNUG / SCIMP Annual Conference

30/06 Single Mechanism for GP cluster access established

30/05 03/05 LDP Target trajectories agreed

30/05 28/04 Joint ISD / Health Scotland / HIS / IS session and agree approach

30/05 03/05 Review of LDPs (monthly)

29/09 Showcase – LIST Stories/Case Studies

22/06 One Team – PC Dev Co-ord

27/07 One Team – PC Dev Co-ord

24/08 One Team – PC Dev Co-ord

28/09 One Team – PC Dev Co-ord

01/06 RAFs raised

16/07 Candidates shortlisted

21/07 Interviews held

30/03 Support CPP’s improve approach to

sharing real time data &intelligence - local level

07/09 Learn & Review Event (Phase 1)

29/09 Update CPT ToR

26/10 Updated CPT ToR approved

26/10 Proj Bd 07/12 Proj Bd 15/02 Proj Bd

TBC Agree next round of recruitment

TBC Agree next round of recruitment

TBC Agree next round of recruitment

31/10 Review resources in post

07/09 Review of LDPs

TBC Review of LDPs

TBC Review of LDPs

TBC Review of LDPs

TBC Review of LDPs

TBC Review of LDPs

29/09 People outposted from LIST understand the One Team offering

29/12 PHI understand how to articulate the One Team offering

30/03 Joining CeAD to support

understanding on the rest of NSS

operates 10/08 Meeting with CEO

15/08 31/07 07/06 28/04 Stakeholder & Comms Strategy approved

10/11Comms Action Plan Reviewed

Local National

Intelligence

Support Services

Team Scotland

Supporting Primary Care and GP Cluster information needs across Scotland

August 2017 Update Since April 2017 the Local Intelligence Support

Team (LIST) has expanded its service into Primary

Care to support Cluster Quality working, in

particular intelligence led influence and decision

making. The expanding service has built upon the

existing team skills and technical infrastructure that

have already been supporting health and social

care integration across Scotland. The future

aspiration is an intelligence led service which is

joined up across health and social care including

GP Practices and GP Clusters. Over the last 4 months the LIST team has been

engaging with Cluster Quality Leads and other key

Primary Care stakeholders to better understand

their information needs and how the team can

support this. We have taken a multi team approach

with regards to our engagement. Staff from other

teams in ISD, such as SPIRE and SOURCE have

also been part of our Cluster site visits. This multi

team approach to engagement has ensured we

maximise our Cluster site visits by helping to

describe the data landscape as well as the types of

support the team can provide, which includes

complimenting the switch on and use of SPIRE. Our engagement process has also allowed us to

identify ‘Early Adopter’ sites. Early adopter sites

are identified in two ways: • Those sites that have stated they require

support from LIST and are in the process of identifying their information needs / areas for support.

• Those sites that have stated they require

support from LIST with areas for support identified and a work plan established (or in the process of being established).

• Met with 82 of the 143 Clusters to date (57%) • 21 Clusters signed up as “Early Adopter” sites (9

Partnership areas) • 35 Clusters currently agreeing support

required (additional 6 Partnership areas) • 20 Clusters – Planned visit (additional 6

Partnership areas). LIST will present support available and how this can improve local delivery.

• 26 Clusters - Engaged, require follow-up

(additional 2 Partnership areas). Types of support have been presented but follow-up visit required.

• 41 Clusters - Still to engage during September 2017 to March 2018 (additional 9 Partnership areas)

During the Cluster visits, some areas of interest

identified by the Cluster Quality Leads have

included: • Diabetes and prevalence / number of foot

screening for diabetics • Home Visits • Demand and Capacity (housing developments) • ACPs, Frailty and Risk prediction • Chronic Pain Management • Appointments, Impact of Pharmacy,

Benchmarking and Variation

The team will continue to engage with Cluster

Quality Leads with our intention of extending our

reach to all 143 Clusters by March 2018. Our aim

continues to be as responsive to your local needs

as possible, to ultimately make a difference in the

health and wellbeing of the people in your area.

The LIST team is working across all the Integration

Authorities. The main topics & themes for work that

LIST staff have undertaken in 2017 for Health &

Social Care Partnerships include: • High Health Gain • Delayed Discharges • Emergency Admissions • Unscheduled Care • Children’s Services • Homelessness • Third Sector working • Test of Change - Inverclyde New Ways Home

Visits project looking at telephone triage of patients requesting a home visit

• Analysis of appointments for an East Lothian

GP practice. Key areas of interest included most popular type of appointments, time trends and frequent attenders

Heath & Social Care Partnerships: There is a

wide range of work undertaken some of this is

focussed on unscheduled care and emergency

admissions, both current and projections for the

future, to assist planning. Local Authorities: Project undertaken on

improving accuracy of data held on local citizens to

ensure appropriate information is received by them.

Looking at different data sets of housing

information ensuring it is accurate. Supporting

work to move services to greater online provision

and where possible targeting certain groups

encouraging use of this option. LIST collaboration with HIS, HS & The

Improvement Service: • Collaboration with HIS & SG to produce paper

on, “An approach to understanding resource usage data to inform strategic commissioning”

• LIST has regular collaborative meetings to

share work plans; knowledge; developing themes and working together with HIS (and other organisations) to assist in the interpretation of data

• Working alongside HS to compliment the roll

out of Community Link workers

Work is under way across a number of CPPs to

look at ways to: • Raise awareness of, and access to, data and

support already available using the Community Planning Support Portal to signpost

• Continue to develop the Community Planning

support portal to share details of all resources and support available to CPPs

Third Sector: LIST presenting to H&SC

ALLIANCE’s Strategic Commissioning Forum in

August to showcase progress on homelessness

and the developing Source platform. Customer Feedback “Highly pleased with LIST support to date. Felt that

input from LIST PIA had been ‘invaluable’” Head of Planning, H&SCP Very positive about a report produced on “Diabetes

Foot Screening” Clinician, GP Cluster

If you think that our Local Intelligence Support Team might be able to help you please contact: Manira Ahmad David Baird Philip Johnston

Head of Local Intelligence Service Manager Service Manager email: manira.ahmad@nhs.net email: dbaird@nhs.net email: philip.johnston@nhs.net

Email: nss.list@nhs.net Website: www.isdscotland.org/localintelligencesupport

Local Intelligence Support Team

H&SCP Cluster Name

East Dunbartonshire Bishopbriggs/Auchinairn

Edinburgh City Leith Cluster

Fife Fife West 2

Fife Fife West 3

Fife Fife West 4

Fife Glenrothes

Fife Levenmouth

Fife North East Fife

Glasgow City NE - Baillieston / Shettleston

Highland Caithness

Highland East Sutherland

Highland Lochaber

Highland Mid and East Ross District

Highland Skye and Lochalsh

Highland West Sutherland

Highland Wester Ross

Highland (Argyll & Bute) Highland Subset 1

Highland (Argyll & Bute) Highland Subset 2

Highland (Argyll & Bute) Highland Subset 3

Highland (Argyll & Bute) Highland Subset 4

Highland (Argyll & Bute) Highland Subset 5

Highland (Argyll & Bute) Highland Subset 6

Moray Moray

North Lanarkshire Wishaw Houldsworth

Perth & Kinross Kinross/Errol/Bridge of Earn/Invergowrie Cluster

Perth & Kinross NW Perthshire

Perth & Kinross Perth City Cluster

Perth & Kinross Strathearn Cluster

Perth & Kinross Strathmore Cluster

Renfrewshire Paisley 5

Renfrewshire Paisley 6

Renfrewshire West Renfrewshire 1

Renfrewshire West Renfrewshire 2

Renfrewshire West Renfrewshire 3

Renfrewshire West Renfrewshire 4

H&SCP Cluster Name

East Renfrewshire Eastwood 1

East Renfrewshire Eastwood 2

East Renfrewshire Levern Valley

Edinburgh City East Edinburgh

Glasgow City NE - Bridgeton

Glasgow City NE - Dennistoun / Townhead

Glasgow City NE - Easterhouse / Ruchazie

Glasgow City NE - Parkhead / Cranhill

Glasgow City NE - Springburn

Glasgow City NW - A

Glasgow City NW - B

Glasgow City NW - C

Glasgow City NW - D

Glasgow City NW - E

Glasgow City NW - F

Glasgow City NW - G

Glasgow City S - Pink

Glasgow City S - Blue

Glasgow City S - Green

Glasgow City S - Grey

Glasgow City S - Lilac

Glasgow City S - Red

Glasgow City S - Yellow

West Dunbartonshire Alexandria

West Dunbartonshire Clydebank

West Dunbartonshire Dunbarton

H&SCP Cluster Name

Aberdeen City Aberdeen City Central

Aberdeen City Aberdeen City North

Aberdeen City Aberdeen City South

Aberdeen City Aberdeen City West

Dumfries and Galloway Annandale & Eskdale

East Dunbartonshire Bearsden/Milngavie

East Dunbartonshire Kirkintilloch/Lennoxtown

East Lothian East Lothian East

East Lothian East Lothian West

Edinburgh City North Edinburgh

Inverclyde Greenock Cluster

Inverclyde Greenock West Cluster

Inverclyde Kilmacolm Cluster

Inverclyde Port Glasgow Cluster

Midlothian Midlothian

North Lanarkshire Bellshill

North Lanarkshire Coatbridge

South Lanarkshire Bothwell, Uddingston & Viewpark

South Lanarkshire East Kilbride & Strathaven

South Lanarkshire East Kilbride Hunter

South Lanarkshire Larkhall/Stonehouse

LIST GP Cluster Engagement August 17th 2017

Map shows the current status of engagement with GP Clusters that LIST has within the 32 H&SCP areas.

Key:

Agreed SupportThose clusters that have stated they require support from LIST with areas for support identified and a work plan established (or in the process of being established).

Early AdoptersThose clusters that have stated they require support from LIST and are in the process of identifying their information needs / areas for support.

Engaged require follow up

Those clusters where LIST have presented types of support available but follow up visits required.

Planned VisitPlanned cluster visit arranged where LIST staff will present to GP Clusters what support is available and how this can support improved local delivery.

Still to engage Clusters still to be engaged with during September 2018 to March 2019.

GP Cluster H&SCP

Agreed Support 35 24.5% 6 18.75%

Early Adopters 21 14.7% 9 28.1%

Engaged require follow up

26 18.2% 2 6.3%

Planned Visit 20 14.0% 6 18.75%

Still to engage 41 28.7% 9 28.1%

143 32

Contactnss.LIST@nhs.net

H&SCP Cluster Name

Aberdeenshire Banff & Buchan

Aberdeenshire Buchan

Aberdeenshire Formartine

Aberdeenshire Garioch

Aberdeenshire Kincardine & Mearns

Aberdeenshire Marr

Borders Borders Central

Borders Borders East

Borders Borders South

Borders Borders West

Clackmannanshire Clackmannan

Falkirk Bo’ness, Grangemouth

Falkirk Denny & Bonnybridge

Falkirk Falkirk Town

Falkirk Slamannan & The Braes

Falkirk Stenhousemuir & Larbert

Fife Fife West 1 (Cowdenbeath?)

Stirling North West Stirling

Stirling Stirling City

Stirling West Stirling

H&SCP Cluster Name

Angus Angus South East

Angus Angus South West

Angus North East/Angus

Angus North West Angus

Dumfries and Galloway Dumfries & Upper Nithsdale

Dumfries and Galloway Stewarty

Dumfries and Galloway Wigtownshire

Dundee Dundee 1

Dundee Dundee 2

Dundee Dundee 3

Dundee Dundee 4

East Ayrshire Cumnock Cluster

East Ayrshire Doon Valley Cluster

East Ayrshire Irvine, Kilwinning, Dundonald

East Ayrshire Kilmarnock Cluster

Edinburgh City Canal Cluster

Edinburgh City Lothian Cluster A

Edinburgh City Lothian Cluster B

Edinburgh City Pentlands Cluster

Edinburgh City South Edinburgh Cluster

North Ayrshire Garnock Valley Cluster

North Ayrshire Irvine Valley

North Ayrshire North Ayrshire Including Islands Cluster

North Ayrshire Three Towns Cluster

North Lanarkshire Airdrie

North Lanarkshire Cumbernauld Central

North Lanarkshire Cumbernauld North & Kilsyth

North Lanarkshire Motherwell

North Lanarkshire Newmains, Shotts & Harthill

Orkney Orkney

Shetland Shetland

South Ayrshire Ayr & Prestwick Cluster

South Ayrshire Maybole & Girvan Cluster

South Ayrshire Troon Cluster

South Lanarkshire Blantyre

South Lanarkshire Cambuslang & Rutherglen

South Lanarkshire Clydesdale

South Lanarkshire Hamilton

West Lothian West Lothian East

West Lothian West Lothian West

Western Isles Western Isles Cluster

Local Intelligence Support Team (LIST) Supporting Primary Care and GP Cluster

information needs across Scotland LIST Expansion

Business Model To support the expanding service a review of the current LIST business model and staffing structure has been conducted. This is to ensure we not only continue to maintain the current level of service to our current customers but that we also meet the future demands associated with GP cluster quality working.

Figure one below presents the new LIST business model that has been established during 2017.

To inform the staffing levels required within each region / HUB a triangulated approach was adopted. The triangulation approach means that three to four sets of 'indicators' on which to base staffing levels (and structure) are considered.

Figure two below presents the triangulation approach that was adopted to inform LIST staffing level requirements.

As part of the above methodology both skill mix (band) and staff experience (skill set) were also considered. This model will be reviewed at planned time points during 2017/18 to ensure the skill mix and staff placement across each area (region) is sufficient and meets local demands and priorities. The structure and staffing levels are available by each area.

A key feature of the new business model is the introduction of regional HUBS. These virtual HUBS will 'house' a mix of staff with varied skill sets e.g. analysts, project managers etc. Key benefits include:

Ensure resource / skills are shared to manage peaks and troughs in demand.

Ability to pull and push any requests for specific skills.

Flexibility to manage gaps created by vacancies.

Offers flexibility in rotating staff across LIST teams to support knowledge / skills transfer.

Local Intelligence Support Team (LIST) Supporting Primary Care and GP Cluster

information needs across Scotland

LIST Workforce Projections

Workforce

Figure one below shows the projected staffing levels (wte) during April 2017 to March 2018. Also shown are the actual staffing levels (wte) that will be achieved via recruitment during the same period. A projected ‘dotted’ line from September 2017 onwards is also shown. This includes some staff already secured via recruitment and due to join LIST during Sept/Oct, as well as an anticipated wte expected via future recruitment. ISD has moved to a regular cycle of recruitment to further support the LIST expansion, and on-going PHI recruitment challenges.

Current Gaps

Gaps remaining to be filled within the LIST team include:

Area WTE

Lothian – West, East, Mid 1.0

Glasgow City 1.0

Dumfries & Galloway 1.0

East Renfrewshire, Renfrewshire and Inverclyde 0.5

North HUB 0.5

West HUB 1.0

East HUB 1.0

Local Commissions* 2.0

Total 8.0

* Includes: Falkirk and West Lothian

Local Intelligence Support Team (LIST)

LDPs and KPIs

Local Delivery Plan

LIST have 6 LDPs as part of the 2017/18 business year, and include:

LDP 1: Actively working with GP clusters in 60% of Health and Social Partnership areas by March 2018 (LIST).

LDP 2: Contact made with 100% of established GP clusters by March 2018 (LIST).

LDP 3: Single coordinated mechanism for access to GP cluster support established with partners (Healthcare Improvement Scotland and Health Scotland) by end June 2017 (LIST).

LDP 4: Sustained support to 100% of Integrated Authorities (IAs) by March 2018 (LIST).

LDP 5: Tests of change established within 4 CPPs by March 2018 (LIST).

LDP 6: Working on 10 projects involving the third/voluntary sector by March 2018 (LIST).

Progress as at July 2017

LDP Target (July) Actual

Actively working with GP clusters in 60% of Health and Social Partnership areas by March 2018 (LIST).

32% 25%

Contact made with 100% of established GP clusters by March 2018 (LIST).

35% 45%

Single coordinated mechanism for access to GP cluster support established with partners (Healthcare Improvement Scotland and Health Scotland) by end June 2017 (LIST).

100% by June 2017

Achieved

Sustained support to 100% of Integrated Authorities (IAs) by March 2018 (LIST).

100% 100%

Tests of change established within 4 CPPs by March 2018 (LIST).

1 by Aug 2017 0

Working on 10 projects involving the third/voluntary sector by March 2018 (LIST).

5 5

Key Performance Indicator(s)

KPI Target Actual

Use of primary care data and/or analyses agreed as a priority in 30% H&SC Partnerships' work plans by Mar 18.

10% by Sept 17

Will be updated in

Sept 17

Local Intelligence Support Team (LIST) ‘The Benefits’

LIST has continued to help our customers gain deeper insights into data where our advanced analytics allows them to access, blend, explore and analyse the many local and ISD data sources. Supporting Health and Social Care Partnerships, Community Planning Partnerships and Primary Care GP Cluster information needs across Scotland is a top priority for LIST. Key benefits as a direct result of the LIST service have included:

Ability to source, link and interpret data helping our customers to understand service user journeys and project patterns of service demand.

Working with Primary Care Cluster Quality leads to help them better understand the data landscape and information that is available to support cluster quality working and improve data collection.

Co-design and influence our national teams to produce a range of analytical outputs designed to support local decision making and strategic planning, with a ‘do it once for Scotland’ approach.

Build bespoke analytics such as visualisation, demographics, trend analysis, forecasting, profiling and targeting of service user population.

Supporting third sector and other public organisations to better understand how they contribute to the health and wellbeing of individuals informing future commissioning and transformation of these services.

Work Area Benefit

Demand /Capacity Understanding local demand and practice workload by linking health and GP data, with workforce modelling being performed to inform local workforce plans. Work underway for Larkhall cluster.

Workforce (pan Forth Valley)

Supporting the local workforce strategy allowing the HB and HSCPs to better understand the current workforce profile and skill mix. This work will inform next year’s workforce and development plan. Retirement trajectories will also highlight potential areas of challenge / workforce gap(s).

A&E (pan Lanarkshire HSCPs)

Ability to support A&E frequent users with care provided at home. This work has narrowed the focus to a smaller cohort of frequent A&E frequent attendees (77 people). The average ‘whole service’ cost of an individual service user is approx £18k per year (a total of £1.38m), a potential to reinvest this money to improve their journeys across the health and social care settings.

Delayed Discharges (Falkirk)

Local dashboard developed and used operationally to better manage delayed discharges within Falkirk (updated weekly). This shows variation in discharge practice and local care home challenges. Future work includes further analysis on care home admissions mapped against vacancies to better understand capacity with a view to drive improvements in delayed discharges.

GP practice activity ‘audit’ (Inverclyde, Dumfries & Galloway)

A ‘week of care’ audit was carried out across GP practices in Inverclyde with the aim of redirecting appropriate activity away from GPs and onto other professions including Physiotherapists and Advanced Nurse Practitioners. This work is now being reproduced to suit local needs within a GP Cluster in Dumfries and Galloway.

GP Home Visits (Inverclyde)

As a result of LIST analysis and finding, the associated GP triage system is being rolled out to other health care professionals e.g. ANP & paramedics. Triage system resulted in a 20% reduction in GP home visits during the 2 week period (approx 25 hrs).

Third Sector

Perth and Kinross; a linked health and social care data set was used to understand service-user journeys and how third sector services can be used to improve outcomes. Third sector services also used this intelligence to help demonstrate the value their service(s) provide. This is being used to inform local commissioning decisions. ALLIANCE (Dementia project); analytical skills used to support the high profile dementia carers project which evaluated data collected by the third sector and how this could inform the national dementia strategy.

Homelessness (North Lanarkshire)

Analysis from the linked health and homelessness data used by local Health and Wellbeing group to draw up an action plan to tackle issues experienced by this group. Aim of the action plan is to reduce the admission rates associated with this group and re-direct to a more appropriate care setting. If a 10% reduction in costs were to be achieved for this cohort, this would release £280k per year.

Ministerial Strategic Group (SG / all IAs)

LIST is supporting IAs in their requirement to forecast future demand and re-design services. This is an essential contribution to local/national planning, reporting into the MSG and linked to the national H&SC Delivery Plan. The work includes novel techniques and is providing sound evidence for local decision making. This is one example of a ‘once for Scotland’ common approach.

Releasing Time to Care (FV HSCP)

District nurses were spending considerable time on administrative task. Via LIST working with local contacts to revise the data collection and processing, 64 hours per week of DN time has been saved, equating to 1.7 wte per year, with an annual resource transfer of £49k.

18 August 2018