NHS Tayside Transformation Support Team: report

3. AAG Recommendation 3 – Integrated Clinical Strategy

"Over the next six months, NHS Tayside should continue to work with its partners to agree the content and a realistic timeline for completion of the Integrated Clinical Strategy, already in progress. We would expect that the completed Integrated Clinical Strategy would set out a comprehensive and evidence based case for transformational change. This would build upon the HSCPs' [Health and Social Care Partnerships] strategic plans for social care, primary healthcare and unscheduled hospital care, taking account of public health imperatives. It should provide a clear strategic direction for acute and community healthcare in Tayside, including the development of Regional Plans. The Integrated Clinical Strategy should take full account of present and future challenges, including those set out in the National Clinical Strategy, Realistic Medicine and the Health and Social Care Delivery Plan. It should provide concrete and detailed options for long term strategic positioning of NHS Tayside's role within a local and regional setting. We would encourage NHS Tayside to accelerate its work together with HSCPs, Local Authorities, the Third Sector, Universities and other partners."

3.1 NHS Tayside's Assessment – Rating = Amber

"To support the major transformation of our health and care services, we have commenced the development of an Integrated Clinical Strategy ( ICS), incorporating a programme of stakeholder engagement; the first of a series of rapid development events; and agreed the programme to produce a strategic framework and consultation and engagement approach to help shape future affordable and sustainable service delivery. There is recognition within Scottish Government, the Assurance and Advisory Group, the Transformation Support Team and NHS Tayside Transformation Executive Group that a critical success factor for the delivery of recommendation 3 is the ability to secure dedicated resource for Strategic Planning and a related infrastructure. Priority resource requirements were escalated by NHS Tayside to Scottish Government in July 2017 and work has continued throughout July, August and September 2017 to identify and secure personnel with the skill, experience and knowledge to support this significant whole system transformation programme.

Whilst significant work has been progressed to support initial phases of the programme, it is fundamental to the ICS programme and outcome to establish the planning and development infrastructure that will ensure stakeholder engagement, activity and improvement with pace and that can inform the strategic direction of the Integrated Clinical Strategy. A road map of staged delivery has been developed to complement the Programme Initiation Document ( PID), setting out the programme and process for the ICS development. The recent two day event was highly successful with around 100 delegates attending on each day and outputs will be used to inform organisation development, the transformation programme and the ICS. We have developed a communication and engagement strategy and plan, including a stakeholder engagement process. We are in the process of commissioning a public engagement resource to facilitate the wider dialogue and consultation with staff and the public.

The next stage through to end of December and beyond will need to deliver a clear and supported strategy that will enable the major service change to progress within an agreed framework. At this stage, with the scale of planning and engagement required, the status of this recommendation is assessed as 'Amber'."

3.2 TST Comment - Rating = Amber

NHS Tayside is clearly making progress in relation to the specific actions it has committed to as part of the development of an Integrated Clinical Strategy ( ICS). The update to the Board in August and the successful 2 day event where the ICS was at the centre of discussions, provide relevant evidence to support this progress. The TST is also encouraged by the range of internal engagement meetings to date with staff groups, and the broadening of the focus and the Leadership Team for the ICS to include greater recognition and emphasis on the role of Integrated Joint Boards and delegated services beyond the acute sector. Nonetheless, as yet there is little in the way of tangible outputs from these processes. The results of engagement meetings have now been written up but have still to be collated and it is unclear what level of detail regarding 'current state' issues or information regarding the scale of the challenges has been made available to inform these discussions. Further work has been done to construct a more comprehensive and road-map to document the whole ICS process including details of plans for external and public engagement although this does not yet go much beyond the December Staging Report. Careful scrutiny will be required over the coming months to ensure adequate resources are available to support the ambitious timeline of work set out in project plans.

The TST acknowledges the considerable challenge arising from the continued lack of a strategic planning function within the Board. We continue to work with NHS Tayside and Scottish Government to identify options to address this gap.

Between now and end December – and particularly for the Board update in October - we would expect to see a comprehensive roadmap and programme of work, which takes into account the key themes and next steps coming out of the 2 day event and the internal engagement to date, and which gives a clear indication of what will be delivered, when and who is responsible. We will also expect to see early action to agree and implement the next phase of the communication and engagement strategy which widens this process out to encompass targeted and pro-active engagement with key external stakeholders.