NHSScotland Efficiency and Productivity: Framework for SR10

3 Supporting and Enabling Delivery

3.1 Supporting the Workforce: SR10, the next 5 years

Supporting the workforce is essential to ensure that the drive for quality and efficiency is owned and achieved. The NHS leadership strategy, NHS Education for Scotland ( NES) and local organisational development functions will have key roles in ensuring that the workforce is equipped with the strong leadership skills and change management capabilities needed for the coming years. Ongoing access to improvement expertise through local and national improvement teams, the Quality Improvement Hub and through nationally commissioned activities, including the Releasing Time to Care/Productive Series, will empower staff to make improvement within their clinical settings.

Given that many NHS staff will have entered the service during a period of sustained growth, there will need to be sufficient skills in rostering, scheduling and Improvement training that is rigorous at capturing efficiency savings and measurement of benefits realisation. QEST will work with NHS Boards and national programmes to ensure that these are hardwired into all activities. Enablers to support this work will include: workforce benchmarking, review of skill mix and considering carefully the staff demographic profile.

3.1.1 Partnership Working

The efficiency and productivity agenda will affect all staff regardless of grade or profession. Locally, NHS Boards will be discussing the potential changes to services within existing partnership forums. Nationally, trade unions will continue to provide staff representation on the EPSOG.

3.2 Identifying, Spreading and Sustaining Good Practice

There are a number of enablers within this theme that will support NHS Boards to identify good practice, test or pilot innovative ideas on behalf of others and accelerate the spread of good practice.

3.2.1 Benchmarking

The NHS Benchmarking Programme will be further developed in 2010/11 to provide an enhanced level of information. This will be set out in a revised benchmarking strategy during Spring 2011.

3.2.2 Data Development

Continued co-production between Information Services Division ( ISD) and NHS Boards to produce data that is fit for purpose will be essential to foster ownership. It is necessary that Boards have access to user-friendly toolkits to identify areas for improvement, redesign and to highlight productive opportunities within their services.

One example of this is the Patient Journey Analyser, which can be populated with NHS Board information and will be developed as a valuable tool to be used locally to identify variation and improve services. Lessons learned from the development of information systems to enable real-time monitoring of services and dashboards will also be promoted.

The Efficiency and Productivity Information Development Group ( EPID) will focus on further improvements in the range of information that drives up quality and efficiency. While quality and cost data will underpin the monitoring of the savings, more work is required to ensure that there is easy access to quality cost data for the health service.

3.2.3 NHS Boards and Lean

To date, the Efficiency and Productivity Programme has supported the use of lean methodology across a number of projects. Moving forward, NHS Boards can and should align this work with other improvement programmes (eg patient safety) to provide a spectrum of approaches to improvement under one local improvement hub or team. Nationally, the ongoing deployment and sharing of lean methodology across Scotland will be sustained, building on the good practice already identified as a result of the strategic lean programme and network.

3.2.4 The Quality Improvement Hub

NHS Health Improvement Scotland, NES, ISD and IST have collaborated in the establishment of a Quality Improvement Hub of high-level improvement expertise. The Hub will provide valuable expertise to NHS Boards on national improvement priorities, and the QEST portfolio office will commission advice or improvement activities from the Hub where the requirements are beyond the capacity or capability of NHS Boards.

3.2.5 Improvement Support Team / Quality and Efficiency Support Team

Recognising the developing capacity and capability for continuous improvement that has resulted from the national IST collaboratives and Scottish Patient Safety Programme ( SPSP), and to avoid duplication with the Quality Improvement Hub, IST will re-focus its activities to support quality and efficiency and re-brand itself to underline this shift in emphasis.

The result will be a much smaller team of specialists, with particular experience in the priority workstreams, working in partnership across the SGHD to:

• act as portfolio office to coordinate the delivery of the NHS Efficiency and Productivity Framework
• coordinate support to NHS Boards, including benchmarking, data development and its associated toolkits
• focus on high-volume, high-cost services and key priority areas
• identify and test innovations which could lead to improved levels of performance
• work closely to assess the impact of redesign on the workforce and the impact of workforce changes on service redesign, and
• support NHS Boards who need additional help to identify and release efficiencies.

3.3 Enabling Technology

It is important not to underestimate the potential savings and improvements that can be made by using technology effectively. The following highlight the potential of existing NHSScotland programmes and organisations.

3.3.1 NHS 24 Capability and Capacity

NHS 24 is using its technology and telephony platform as a base for the provision of a wide and developing range of national telehealth and online services. Recognising that citizens interact with many services (eg banks, holiday companies, supermarkets) through channels such as the telephone, the internet, and face-to-face, NHS 24 is delivering and developing national telehealth services which also use these channels and support the hands-on delivery of NHS services by healthcare professionals on the ground.

Opportunities are being identified through partnership working which will improve the quality of care while reducing cost and duplication. National telehealth services can also contribute to the self help/care agenda, tackling health inequalities and meeting the needs of people in remote and rural areas.

NHS 24 has a range of additional national clinical services using telephone and/or website channels, including: Breathing Space (a mental health listening service originally established as part of the national suicide prevention strategy); Living Life (cognitive behavioural therapy); Taking Measures (brief interventions on alcohol); and Life Begins at 40 (health checks).

Having taken responsibility for the Scottish Centre for Telehealth in April 2010, NHS 24 is supporting national clinical videoconferencing services in the clinical areas of paediatrics, stroke, chronic obstructive pulmonary disease ( COPD) and mental health, as well as creating a national videoconferencing infrastructure. Box 2 provides an example of recent work.

3.3.2 eHealth

eHealth is defined as the use of information, computers and telecommunications to meet the needs of patients and improve the health of citizens. The eHealth Strategy 2008-2011 targets its effort on using technology effectively to ensure patients get the right care, at the right time, with the right outcomes. It is therefore a key enabler of this Framework as it focusses on transforming traditional processes in a way that continues to shift the balance of care while delivering all-round benefits.

The strategy seeks to integrate and build on existing systems and information stores to enable change and support the growing application of telehealthcare to change the way services are delivered while achieving efficiencies and improvements.

The capabilities of the existing tools and of some of the newer ones within NHSScotland's infrastructure have still to be brought fully into play. For example, the new Patient Management System being installed in five Boards over the next year and the introduction of clinical portals will move NHS Boards towards 'paper lite' operations with clear efficiency gains. Investment in eHealth will continue, albeit at a reduced level, with a concentration on completing current initiatives and building on investments to deliver efficiencies and improve the quality of patient care. eHealth has made £5m available for NHS Boards to pilot potential efficiency information and communication technology-related projects. EPSOG will keep a close overview of progress and the potential opportunities for redesign that could be delivered.

Box 2: The NHS 24 Living Life Service

This service was launched in August 2008 as a pilot service to deliver brief cognitive behavioural therapy ( CBT) for depression and anxiety by telephone. The service began accepting referrals from GPs in 42 practices across five NHS Boards. In order to improve access, in February 2010 the service also launched self-referral access within these same Boards. The outcomes are favourable and provide an alternative option for patients while ensuring competitive costs for psychological therapies.