NHSScotland Local Delivery Plan Guidance 2015-16

2. Improvement Priorities

2.1 Six Strategic Priorities

NHS Scotland is recognised as a global leader in the application of improvement science to improve outcomes for people. As outlined above, Local Delivery Plans should focus on improvement activity around six key strategic priorities:

NHS Scotland Improvement Priorities 2015/16

• Health Inequalities and Prevention
• Antenatal and Early Years
• Person-centred care
• Safe care
• Primary Care
• Integration

2.2 Health Inequalities and Prevention

The Scottish Government is committed to enabling those more at risk of health inequalities to make better choices and positive steps toward better health and wellbeing. Four areas have been identified for specific NHS action:

• NHS procurement policies should support employment and income for people and communities with fewer economic levers;
• actions relating to employment policies that support people to gain employment or ensure fair terms and conditions for all staff;
• actions to support staff to support the most vulnerable people and communities have been identified as specific areas for NHS action; and
• health improvement actions to promote healthy living and should include, preventing obesity, promoting a healthy diet, tobacco related health inequalities, uptake of smoking amongst young people, protecting children from second-hand smoke, supporting smokers to quit, targeting alcohol brief interventions on harder to reach communities including those in deprived areas, access to alcohol and drug misuse, and promoting physical activity. This activity should be focussed through workforce and the Health Promoting, Health Service as well as the wider community.

The LDP should set out local priorities for addressing health inequalities and improving prevention work based on the needs of the local population. Plans should focus on those communities where deprivation is greatest. The plan should outline how these will be achieved setting out improvement aims, levels of activity, and demonstrating how the activity is embedded in to routine practice. The plan will also include information about how the NHS Board and its partners prioritise action and monitor progress.

2.3 Antenatal and Early Years

It has long been recognised that there are significant benefits to children's wellbeing - not least their health - as well as to the vibrancy of communities and the sustainability of services from a systematic approach to early intervention and primary prevention. The focus on primary prevention and early intervention has also increased the importance of antenatal and early years support. Early antenatal access will help ensure a foundation for the future health of the baby and mother, and health boards should continue improving antenatal access to strengthen that foundation. Early years care will be substantially affected by the new duties to be placed on health boards through the Children and Young People (Scotland) Act 2014. Specifically, under the Act, health boards will be responsible for providing a Named Person service for every child up to 5 and a single statutory Child's Plan for every under-5 who requires one. The LDP should set out the local actions to be taken to ensure that the relevant parts of the workforce will have the capacity, training and relevant protocols to carry out these duties under the Act by 1 August 2016.

2.4 Person centred care

In person-centred care, health and social care professionals work collaboratively with people who use services. Person-centred care supports people to develop the knowledge, skills and confidence they need to more effectively manage and make informed decisions about their own health and health care. It is coordinated and tailored to the needs of the individual. And, crucially, it ensures that people are always treated with dignity, compassion and respect. The NHS in Scotland is committed to developing a culture of openness and transparency in NHS Scotland that actively welcomes feedback as a tool for continuous improvement. The LDP should set out how services will support a positive care experience delivered in accordance with the "five must do's with me". It should also outline the key local action being taken to transform the culture to support staff and the public to be open and confident in giving and receiving feedback; widely publicise the information people need to give feedback and make complaints, and the support available for them to do so; and with a focus on learning from feedback, implementing the changes, and telling people what improvements were made as a result of their feedback. The plan will include information on how progress will be measured locally.

2.5 Safe care

NHS Boards have made significant progress in providing safe care within their hospitals. Along with a range of Hospital Associated Infection (HAI) improvement activity, the Scottish Patient Safety (SPS) Programme continues to drive improvement in clinical care and has been extended beyond the acute programme into primary care, maternity, neonates and paediatrics and mental health services. The LDP should set out the priority actions the NHS Board is taking across these programmes of work, the plans for spread and sustainability and the impact they are having on patient care and should include an example from each SPS programme of how safety of care has improved in the last 12 months. This should include plans to ensure that governance and leadership across managerial and clinical staff is in place for each programme and that robust data collection methods are in place to demonstrate improvement. Boards will work towards implementing the recommendations set out in the Vale of Leven Inquiry Report.

2.6 Primary Care

Successful primary care is integral to the 2020 vision and integrated health and social care. The overwhelming majority of healthcare interactions are at primary care level, both in-hours and out-of-hours. In the context of an aging population with more people living with two or more long term conditions the number of interactions will increase as they are supported to manage their own conditions and live at home. Last year NHS Boards developed strategic assessments of primary care. These identified four key themes: leadership & workforce, planning & interfaces, technology & data, contracts & resources. The LDP should set out the prioritised local actions that are being pursued to increase capacity in primary care and the resources identified to achieve this. The plan should also identify where national action would help local delivery.

2.7 Integration

The Scottish Government has set out nine national health and wellbeing outcomes in secondary legislation supporting the Public Bodies (Joint Working) (Scotland) Act 2014. In the planning and delivery of health and social care services, the new integrated partnerships for health and social care are aiming to ensure successful delivery of these outcomes. A suite of integration indicators, to underpin the national health and wellbeing outcomes has also been developed to demonstrate progress. Integrated partnerships will be required to report on the national health and wellbeing outcomes and the underpinning indicators annually. Quality and safety for people who use our services must remain at the forefront during 2015-16 while the system transitions towards integration.

It is through the strategic commissioning process that the national health and well-being outcomes will be delivered and the required shift in the balance of care achieved. Integrated partnerships will be responsible for strategic planning, in partnership with the hospital sector, of those hospital services most commonly associated with the emergency care pathway, alongside primary and community health care and social care. The role of clinicians and care professionals, along with the full involvement of the third and independent sectors, service users and carers, will be embedded as a mandatory feature of the commissioning and planning process through the clinical and care governance framework now agreed, and through locality arrangements. Integrated partnerships will be required to establish a strategic planning group to prepare the strategic plan - this group will include representation of these key stakeholders.

The LDP should set out the key local actions that are being pursued to ensure effective involvement of clinical and care professionals in the strategic planning group. The LDP should also set out the redesign priorities emerging for the integrated care pathways delivered in the community.