Driving improvement, delivering results: healthcare science national delivery plan 2015–2020

Introduction by the Chief Health Professions Officer

The healthcare science workforce

The healthcare science workforce is the fourth largest clinical group in NHSScotland, with approximately 6000 scientists, practitioners and technologists working across acute and primary care settings. It is hugely diverse, comprising more than 50 disciplines. Collectively, they undertake over 60 million laboratory tests (at a cost of £61 million) and 730 000 clinical physiological measurements per year, and have responsibility for the management of medical equipment with a replacement value in excess of £940 million (Scottish Government, 2014). Their work underpins 80% of all clinical diagnoses.

Among many other services, this workforce provides:

• leading-edge technological services, such as positron emission tomography and magnetic resonance imaging
• advanced laboratory diagnostics
• innovative genomic services that have the potential to change how health care science is delivered in the future
• patient-facing aspects of physiological and physical sciences, including the diagnosis and treatment of hearing disorders, the optimal programming of pacemakers, provision of rehabilitation and assistive technology, and the management of medical equipment in hospitals and community.

It's easy to see, then, that no modern evidence-based healthcare service could operate without the core services healthcare scientists provide.

The challenge, and the opportunity

In common with other developed nations, Scotland is facing challenges on how healthcare is, and will be, delivered. The Scottish Government is committed to ensuring that everyone is able to "live longer, healthier lives at home or in a homely setting", as the Route Map to the 2020 Vision for Health and Social Care (Scottish Government, 2012)^[1] explains. But this aspiration is being delivered against a backdrop of increasing public expectations, changes in lifestyles, an ageing population, new opportunities from developments in technology and a challenging economic climate, each of which places strains on the system.

The model of healthcare is changing, with a greater focus on prevention, anticipatory care and supported self-management. The Report of the Commission on the Future Delivery of Public Services in Scotland (Christie Commission, 2011) suggests that as much as 40% of public service spending goes to interventions that could be avoided by prioritising a preventive approach.

The Scottish Government is driving a preventive approach through its major policy initiatives, including:

• the Healthcare Quality Strategy for NHSScotland (Scottish Government, 2010), with its ambitions of providing safe, effective and person-centred care for all
• the Route Map to the 2020 Vision for Health and Social Care (Scottish Government, 2012), which describes 12 priority action areas for high-quality sustainable health and care services across three domains - quality of care experience, population health and equity, and value and financial sustainability - the "Triple Aim"
• the companion workforce policy Everyone Matters: 2020 Workforce Vision (Scottish Government, 2013), which defines the five key priorities of a healthy organisational culture, a sustainable workforce, a capable workforce, a workforce delivering integrated services, and effective leadership and management.

The healthcare science contribution

Each domain of the "Triple Aim" (shown in Figure 1) has defined priority areas for action that often build on existing work. All require focused attention and acceleration. Healthcare scientists can make a real impact on their implementation, particularly in areas such as service delivery in rural parts of Scotland, working within integrated health and social care settings and delivering seven-day services. As the interim report of the Sustainability and Seven Day Services Taskforce states: "Delivering sustainable services across seven days will require successful diagnostic services to be at the centre of service transformation" (Scottish Government, 2015).

The Delivery Plan's goals and ambitions align with the national shared services agenda being led by National Services Scotland to ensure sustainability of current service provision, keep pace with innovation and enable the ability to work flexibly to achieve cost savings over time.

Figure 1. The "Triple Aim"

This figure reproduced, by permission, from: Mental Health Commission (New Zealand) (2012) Blueprint II: Improving mental health and well being for all New Zealanders - making change happen. Auckland, Mental Health Commission (http://www.hdc.org.nz/media/207639/blueprint%20ii%20making%20change%20happen.pdf).

Originator of "Triple Aim" concept: Institute for Healthcare Improvement (2015) IHI Triple Aim Initiative [website]. Cambridge, MA: Institute for Healthcare Improvement (http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx).

The Mental Health Commission (New Zealand) version of the Triple Aim differs from the IHI original version in that:

• the right side is "improved health and equity for ALL populations"
• the base is "best value from the public system resources".

Radical changes in the demand for health services require healthcare scientists to be bold in visualising the contribution they can make to ensuring NHSScotland meets the needs of the future sustainably and affordably. In discussion with healthcare science leads in Scotland, it has become clear that they share a vision in which "healthcare scientists work with health and care teams and patients across the whole health system, driving proactive and flexible seven-day services that provide diagnostic and service solutions throughout patients' pathways and life-course". They envision healthcare science supporting public health and prevention measures and initiatives to improve patient experience, safety, efficiency and productivity.

This vision confirms that the full engagement of healthcare science staff is key to the proposed transformation of service delivery. They must be enabled and empowered to take responsibility for continuous service improvement.

The Diagnostic Workforce Short-life Working Group reported in 2013 that healthcare scientists should work to "role extension appropriate to task" and that this should be "applied across all diagnostic specialties". Healthcare scientists working to the top of their clinical capability across the whole patient pathway will make a significant difference to the delivery of sustainable services and improvements in patient care.

The ability to broaden the focus of healthcare science-supported technology from secondary to primary and community settings will allow services to provide person-centred, timely and effective treatment. This will facilitate a refocusing on anticipatory care, reductions in inappropriate referrals to secondary care and the prevention of unplanned admissions to hospital or long-term settings. The immediate provision of accurate and reliable test results can improve patient experiences and reduce the number of clinic visits.

A real opportunity now exists for healthcare scientists to play a key role in shaping the evolution of services locally and nationally, leading on national service improvement programmes to transform service delivery, including diagnostic networks. Working collaboratively within a distributed model of leadership and as part of multi-disciplinary teams, they can lead in areas such as the transformation of patient pathways. To do so, they need to be visible and accountable for the services they provide.

The Scottish Government strongly supports this direction of travel and will continue to work with stakeholders such as NHS boards, National Services Scotland (NSS), NHS Education for Scotland (NES) and the diagnostic managed networks to successfully deliver our service improvement programmes. Building on previous work, we will collaborate with these stakeholders to identify national demonstrator sites to take forward the deliverables set out in this Delivery Plan.

The Delivery Plan

The Scottish Government consulted with the workforce and a range of stakeholders in 2014 on the development of this Scottish Healthcare Science National Delivery Plan 2015-2020. Potential proposals over a number of workstreams were presented, with 87% of respondents supporting the proposals.^[2]

The Delivery Plan has therefore been developed with strong support from stakeholders. It presents five improvement programmes with deliverables that describe how healthcare scientists will contribute to the achievement of wider NHSScotland priorities. NHS board healthcare science leads will be pivotal for the implementation of this Delivery Plan.

Conclusion

The healthcare science improvement programmes and deliverables set out in this Delivery Plan are built on a solid basis of success in national improvement initiatives in Scotland, such as the Scottish Patient Safety Programme and the work of the Healthcare Associated Infection Task Force. Healthcare scientists are well equipped to contribute meaningfully to the improvement agenda. The Delivery Plan provides an opportunity to develop a cadre of leaders in NHS boards and at national level who will drive the healthcare sciences beyond the confines of quality assurance to a focus on quality improvement, working in partnership to deliver innovative solutions not only for individuals and groups of patients, but also for the overall system.

Healthcare scientists already make a vital contribution to the delivery of health services in Scotland, but I believe their true potential as agents of change and a force for improvement is as yet largely untapped. The Delivery Plan and the distributed model of professional leadership developed to support its implementation offers a tremendous opportunity to capitalise on their vast array of skills and experience to bring about genuine improvements in service delivery that are effective, sustainable and affordable. I urge NHS boards and healthcare scientists to seize this opportunity and realise their significant potential to deliver results.

Jacqui Lunday Johnstone
Chief Health Professions Officer
Scottish Government