NHS Tayside Transformation Support Team: second progress report

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 ^[8] ] 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 ^[9] , Realistic Medicine ^[10] and the Health and Social Care Delivery Plan ^[11] . 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."

NHS Tayside's assessment

"To lead the development of the Integrated Clinical Strategy ( ICS), a Senior Integrated Clinical Leadership Team was established to create the case for change through engaging with key stakeholders and promoting a culture and the conditions for change. The ICS will act as a framework for transformational redesign of services which will deliver financial and service sustainability. The Senior Integrated Clinical Leadership Team, including membership from the three local Integrated Joint Boards, has made significant progress with the development of the ICS, culminating in the publishing and approval of the ICS Staging Report on the 7 December 2017 at the Tayside NHS Board.

This report will enable a realistic conversation with staff, the public and stakeholders on the future shape, safety and nature of clinical services and models for care across health and social care services. It also provides a platform for detailed planning and modelling of sustainable service configuration across NHS Tayside's boundary.

To develop the ICS Staging Report, the Senior Integrated Clinical Leadership Team has:

• Undertaken a comprehensive process of engagement with clinical teams, Health and Social Care Partnerships, educators and patient representatives, numbering 800 in total. This has allowed an open discussion about current challenges including workforce, affordability, sites, sustainability of service and anticipated change intentions
• Completed an analysis of existing strategic documents and consultation with senior stakeholders to inform a view on the future direction for health and social care services and the interdependencies required to achieve this
• Collated baseline activity, workforce and financial information to enable an assessment of the opportunities arising from current and future service change Activity.

We are working in partnership with involve, an organisation which specialises in helping organisations to engage with people and communities in decisions that affect them. Initial sessions with involve took place in November 2017 with the Integrated Clinical Strategy team, Health and Social Care Partnership engagement colleagues and Tayside NHS Board members. A programme of activities with involve and partners will continue during the further development of the ICS.

The emergent ICS seeks to bring together a range of individual service plans with the health and social care delivery plans. Shaping Surgical Services and Mental Health and Learning Disability Service Redesign are key services that have been reviewed during 2017/18 and have been publicly consulted on. The outcome of both public consultations will be presented for decision in January 2018. There is significant further work, including public engagement, to be completed to deliver an ICS. NHS Tayside has recruited an Interim Strategic Planning Director to support this activity.

During 2018 we will continue to build and develop the Integrated Clinical Strategy identifying the case for transformational change, evidencing the plans to achieve viable, clinically safe and effective care aligned with financial and workforce plans taking account of public health imperatives and the North of Scotland Regional Delivery Plan. NHS Tayside recognises the scale of the work that needs to be completed within 2018 to identify and agree transformative plans and proposals in partnership with all our stakeholders and public.

Next steps

Continue to work with involve to inform public and community engagement during the early part of 2018. Establish a Communications and Engagement Reference Group and sessions with partners and third sector to link engagement opportunities and activities. Mental Health and Learning Disabilities and Shaping Surgical Services service redesign programmes to be considered for approval in January 2018."

TST comment

The Staging Report on the ICS, submitted to the Board's December meeting constitutes a key source of evidence for our assessment along with discussions with many of the main participants during the development of the report and observation of the Board's consideration of its contents. The Staging Report clearly sets out the requirement for a 'collective vision of how high quality, efficient and accessible clinical services will be delivered for the people of Tayside' over a 5-10 year timescale. It sets out a clear direction of travel along with a set of guiding principles and delivery objectives which will inform and guide the planning process as it goes forward. The Staging Report also sets out the scale of the work still to be done and identifies the next steps.

Further discussion with NHS Tayside confirms that detailed strategy development plans are being put in place for significant work during 2018. We consider that the Staging Report meets the requirements for the work which this recommendation required to be concluded by the end of December 2017.

The process followed in developing the Staging Report, and in preparing for the next steps has indicated an inclusive approach to this major piece of work and the pace of development in recent weeks has also provided clear evidence of acceleration in the work being done to bring partners on board. Over the last few months, a broad-based team from a variety of backgrounds, working with the ICS Project Manager, have dedicated significant time and resource to undertaking extensive engagement with clinicians, rightly recognising the need to secure clinical buy-in to the change process at the very start. This will be a valuable part of the complex picture going forward.

The remainder of this recommendation sets out expectations of what will feature in the completed ICS. The Staging Report includes references or commitments to each of these including indications of strategic direction which reflect key Scottish Government policies and an initial case for transformational change. The TST also notes the recognition of the need for a whole system approach, focused on improved patient pathways, which acknowledges the critical interdependencies between different aspects of the health and care services and the crucial role to be played in both planning and delivery by the IJBs.

In terms of the priorities for future work, the Board must continue to build on its internal engagement and widen this out to other stakeholders. Given the stage of development of the ICS, public engagement is recognised as being limited. An initial communication and engagement strategy has been developed to take forward this important element of the project work and this now needs to be updated to reflect the results of the recent work with Involve.

It is essential that engagement is meaningful and leads to honest and informed dialogue with the public and other key stakeholders. We have seen evidence of the commitment to establish a Communications and Engagement Reference Group and Non-Executive Champion to progress this. Nonetheless, this next stage in the development of the ICS will require significant preparation and elapsed time to complete.

The work still required to develop and model evidence-based scenarios to support the Strategy as well as the need to incorporate the final outputs of the Regional Planning process are also important considerations to be taken into account in finalising time scales. The Board must ensure adequate time and resource continues to be dedicated to this high priority project to ensure the pace of progress is maintained.

TST rating in September 2017 = Amber
TST rating in January 2018 = Green