NHSScotland Chief Executive's Annual Report 2014/15

Chapter 1: High Quality Health and Care for Scotland

Dr Alex Connan, Portobello Surgery

To see Dr Connan’s story see the online report at: www.nhsscotannualreport.scot

Our focus on quality has secured for Scotland an internationally-strong record in health outcomes and patient safety improvements.

Improving the health and wellbeing of the people of Scotland is one of the Scottish Government’s five strategic objectives.^[1] Helping people, especially those in disadvantaged communities, to sustain and improve their health and ensure better and faster access to healthcare locally is a key priority and gives strategic direction to both the policy and delivery landscape for health and social care in Scotland.

We have articulated through our 2020 Vision for Health and Social Care (2020 Vision) what we want care to look like by the year 2020.

Our 2020 Vision for Health and Social Care

Our vision is that by 2020 everyone is able to live longer, healthier lives at home, or in a homely setting.

The healthcare system will have integrated health and social care and a focus on prevention, anticipation and supported self-management. When hospital treatment is required, and cannot be provided in a community setting, day-case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Quality continues to be at the heart of all we do in pursuing our 2020 Vision and is our key operating principle for developing new policy. Quality drives our approach to improving the health of the population and developing new models of compassionate, safe, person-centred and effective health and social care provision.

This approach, described in our Healthcare Quality Strategy for Scotland,^[2] continues to underpin improvements in the care people receive. Our Quality Ambitions for person-centred, safe and effective care remain the guiding light for work undertaken at national and local levels, transforming care and improving performance against the Triple Aim of:

• improving the quality of the care we provide;
• improving the health and wellbeing of the population; and
• securing the value and financial sustainability in the health and care services we provide.

Our focus on quality has secured for Scotland an internationally-strong record in health outcomes and patient safety improvements. We nevertheless face unprecedented longer-term challenges, including:

• poor patterns of health and health inequalities across the population;
• changing demography, including a rapidly ageing population;
• high levels of preventable diseases and other conditions among those growing older; and
• continuing tight finances, despite our record £12 billion of health resource spending in 2015/16.

We will start to address these challenges as we move toward 2020, but we also need to look to a longer horizon, over 10 to 15 years, to develop new ways of improving the health and wellbeing of the population and deliver high quality, efficient, appropriately integrated and locally-delivered health and social care services.

NHSScotland cannot, of course, address the challenges or develop new approaches to the future on its own. Effective partnership working with people, staff and partners across the public, third and private sectors and industry will continue to be the hallmark of our approach.

To this end, at the beginning of April 2014, the Scottish Parliament unanimously passed the Public Bodies (Joint Working) (Scotland) Act 2014.^[3] The Act, which came into effect from April 2015, will transform the way health and social care services are provided in Scotland and drive real change that improves people’s lives. It puts in place a framework to make sure that health and social care services are planned, resourced and delivered together by NHS Boards and Local Authorities to improve outcomes for people using services, their carers and families.

Under the new arrangements, newly-formed Integrated Health and Social Care Partnerships – involving NHS Boards and Local Authorities – will be responsible for delivering national outcomes for health and wellbeing. Through its emphasis on effective strategic commissioning, underpinned by a shared understanding of the population’s needs, services will be planned and delivered in a co-ordinated way; listening to what people tell us matters most to them in their lives as we build support around achieving the outcomes that are important to them. There will also be a strong role for the third and private sector, clinicians, social workers, other professionals and local service users and communities.

Our health and social care workforce will play a vital role in ensuring the successful achievement of the 2020 Vision, working across boundaries and delivering services in new ways with the creation of new roles and models of care. We are committed to all staff being empowered to influence the way they work, leaders who show by example and managers who have the skills to manage well, with all being held to account for what they do and how they do it. We want to see all staff being fairly treated and supported to do the best job they can, as evidence shows staff who are motivated and valued deliver better quality care for patients.

Our 2020 Workforce Vision is: We will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations. We will continue to modernise the way we work and embrace technology. We will do this in a way that lives up to our core values. Together we will create a great place to work and deliver a high quality healthcare service which is among the best in the world.

Our shared values, developed through extensive engagement with staff and stakeholders and described in Everyone Matters: 2020 Workforce Vision^[4] are: care and compassion; dignity and respect; openness, honesty and responsibility; and quality and teamwork. We expect everyone in NHSScotland to live by these shared values.

We will continue to ensure people are at the centre of decisions about the care they receive and the shape of our health and social care services in the future. While Integrated Health and Social Care Partnerships are now engaging with their communities about what matters to them locally, in August 2015 the Cabinet Secretary for Health, Wellbeing and Sport launched a forward-looking national conversation – Creating a Healthier Scotland – to gather views on how we might improve the health of the population and on how health and social care services should evolve over the next 10 to 15 years.^[5]

The conversation is wide-ranging and will help us define an ambitious programme of work to:

• create a culture in which healthy behaviours are the norm, founded in the early years and supported by changes in institutional, social and physical environments;
• ensure that users and providers of services are jointly responsible for a healthier population, with high quality services matched by individuals promoting their own health and wellbeing;
• develop new models of compassionate care appropriately tailored to individuals’ needs, with success measured by improved patient outcomes;
• further support the integration of health and social care, with more care and support provided at home or close to home where possible and blurring of the boundaries between Primary and Secondary Care and mental and physical support;
• redesign Primary Care services in a collaborative and inclusive way, transforming and invigorating the workforce, creating new roles and supporting communities to innovate so that services are available where people need them; and
• develop new ways of delivering care across the Primary/Secondary Care boundary, including multi-disciplinary teams being sited in local community hubs (physical or virtual), with centres of expertise for some acute services and regional centres to provide greater capacity for planned surgery and procedures – all, of course, focused on high quality care and improved health outcomes.

The conversation will run until the early part of next year. We will produce a report on the key themes emerging from the conversation, and our responses to them, by next spring. We will use the Our Voice framework (see Chapter 3) beyond then to continue to engage with the people of Scotland on any future service change and on continued service improvement.