‘Changing to Deliver’ News/Docs... · 2.2 Data and Intelligence Improvement and transformation will be built on robust data and intelligence supported by a workforce skilled in

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‘Changing to Deliver’

National Board Discussion

Document 2018-23

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Contents Strategic Positioning ........................................................................................ 1

1 Collaborative Principles ................................................................................... 3

2 Improvement, Transformation and Evaluation ............................................... 4

2.1 Improvement and Transformational Change Support ............................. 5

2.2 Data and Intelligence .................................................................................. 7

2.3 Research and Evaluation Support ............................................................. 8

2.4 Public Health Reform .................................................................................. 9

2.5 Transforming National Planning .............................................................. 11

3 Digitally Enabled Service Redesign .............................................................. 12

3.1 Digital First Service Redesign .................................................................. 13

3.2 Elective Care and Outpatient Services .................................................... 14

3.3 Primary and Unscheduled Care ............................................................... 16

3.4 Mental Health ............................................................................................. 17

3.5 Older People .............................................................................................. 18

3.6 Radiology ................................................................................................... 19

3.7 National Business Systems ..................................................................... 21

3.8 A Digitally Enabled Workforce ................................................................. 22

4 A Sustainable Workforce ................................................................................ 23

4.1 Workforce Planning .................................................................................. 24

4.2 Staff Rostering .......................................................................................... 25

4.3 Health and Care Careers .......................................................................... 26

4.4 Youth Employment ................................................................................... 27

4.5 Education and Training ............................................................................ 28

4.6 Digital Learning Management .................................................................. 29

4.7 Leadership and Talent Management ....................................................... 30

4.8 Flexible Employment Models ................................................................... 32

5 Financial Sustainability and Investment Case.............................................. 33

5.1 National Shared Services ......................................................................... 33

5.2 Transformation Investment Case ............................................................ 34

5.3 Financial Framework ................................................................................ 34

6 Our Collaborative Discussion Document ..................................................... 36

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Strategic Positioning The NHSScotland national boards provide services where improved quality, value

and efficiency is best achieved through a national approach. We share a common

purpose, enabling improvements in the health and wellbeing of the people of

Scotland. Working more closely together, and with our key partners in the Scottish

Government, territorial boards, regions and integration joint boards (IJBs) will enable

the transformational change required to improve services, strengthen leadership

across public services to protect and improve Scotland’s health and reduce demand

on services.

In producing this discussion document, we recognise the need to support health and

social care integration working with key partners such as the Scottish Social

Services Council, the Care Inspectorate and the Improvement Service, as well as the

third and independent sectors. We acknowledge the need for a constructive

relationship with the Convention of Scottish Local Authorities (COSLA), recognising

local government’s political investment in, and accountability for, integration and

improving health and wellbeing.

This collaborative National Board Discussion Document focuses on the service

priorities identified by our partners with an emphasis on three areas: (1)

improvement, transformation and evaluation; (2) digitally enabled service redesign;

and (3) a sustainable workforce. We will take on difficult issues in partnership to

identify where national support can help deliver real sustainable change to address

priority areas such as waiting times and mental health and drive integration across

health and social care. To do this we will reprioritise our work and deploy our existing

capacity and capability based on service need, not history or organisational

boundaries.

Jill Young, Chief Executive, Golden Jubilee Foundation

Robbie Pearson, Chief Executive, Healthcare Improvement Scotland

Caroline Lamb, Chief Executive, NHS Education for Scotland

Gerry McLaughlin, Chief Executive, NHS Health Scotland

Colin Sinclair, Chief Executive, NHS National Services Scotland

Angiolina Foster, Chief Executive, NHS 24

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Pauline Howie, Chief Executive, Scottish Ambulance Service

James Crichton, Chief Executive, NHS State

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1 Collaborative Principles We will support the Health and Social Care Delivery Plan, providing national services

that meet changing national, regional and local needs. This discussion document will

be closely aligned with regional plans and Scottish Government policy including the

National Clinical Strategy, Realistic Medicine, the Waiting Times Improvement Plan

and the Everyone Matters: 2020 Workforce Vision. We will bring together

collaborative teams to help address the challenges of health inequality, an

increasingly elderly population and finite budgets. This will enable us to deploy our

resources to help reduce waiting times, improve access to services and support the

development of sustainable models of integrated health and social care. We have

identified national support around the following three areas:

These are the areas where we can help our key partners redesign services to meet

technological, demographic and societal changes. Underpinning this discussion

document are the following principles, we will:

use existing capacity and capability wherever possible

focus on the potential benefits

focus on where we can achieve most by working differently together

be ambitious

work in partnership across health and social care

involve the public and staff in defining and implementing change

Improvement, Transformation and Evaluation

Digitally Enabled Service

Redesign

Sustainable Workforce

National Board

Discussion Document

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These three key areas are underpinned by financial sustainability, efficiency and

collaborative planning. In the following sections we will provide a summary of the

high-level outcomes, benefits, scalability and targets for each initiative.

2 Improvement, Transformation and Evaluation The first of these three key areas is the key role national boards play in improving

and transforming health and social care in Scotland. Waiting times for services, the

increasing complexity of care and resource pressures present significant challenges

while maintaining day-to-day services and delivering improvement and

transformational change. The national boards have an opportunity to build on

existing good practice, collaborating to scale up change, prevent ill health, shift the

balance of care from hospital to communities, reduce waiting times and provide

better care at less cost. While doing this we will ensure there is a visible link between

investment and the impact of that investment, and we will involve the people of

Scotland and health and care staff in designing and implementing change.

This section focuses on improvement, transformation and evaluation support for all

aspects of the Health and Social Care Delivery Plan, underpinned by new national

planning arrangements. This will help to integrate the delivery of care and strengthen

support for improvement and transformational change through a collaborative model,

supported by data and intelligence and evaluation expertise.

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2.1 Improvement and Transformational Change Support Addressing waiting times, improving mental health and driving integration across

health and social care have a key role to play in improving the health and wellbeing

of people in Scotland. These priority areas will require improvement and

transformation that is locally delivered and supported by national infrastructure. For

the national boards this will involve transforming our own services as well as building

partnerships with local, regional and national initiatives which bring together

expertise in: evidence; data and intelligence; digital; workforce planning; co-design

and co-production; strategic planning; service redesign; outcomes-based

commissioning; learning systems; quality improvement; change management;

programme delivery; and evaluation.

Outcome – A consistent approach to supporting improvement and transformational

change, which brings together expertise and knowledge across organisations, to

provide better co-ordinated and more timely support for initiatives that are prioritised

collaboratively with a focus on value and impact.

Statement of Intent – We will provide improvement and transformation support for

the prioritisation and delivery of initiatives, developing collaborative networks at a

national, regional and local level. We will have a strong focus on knowledge transfer

to build capacity and capability within national boards and to ensure that expertise is

developed to support continuous improvement as transformed services become

business as usual. Our support will cover areas such as: quality improvement (QI);

service and system redesign; change management and; programme delivery.

This will involve developing collaboratives focused on the areas of greatest positive

impact in terms of reducing waiting times, improving health and wellbeing, care

experience, value and staff experience, and the creation of a connected system that

enables local redesign, learning at scale and the development of national resources.

In addition, we will provide customised support for individual initiatives, coordinating

the contribution from different organisations. We will also clarify the range and focus

of national improvement and transformation support to help declutter the landscape,

identify key gaps and develop a better understanding of respective roles.

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We will help spread and scale up tried and tested approaches to reducing waste and

unwarranted variation and delivering transformational change at pace. We will

promote a stronger understanding of evidence and best practice in complex health

and care innovations to capture and increase learning. We will also continue to

develop our portfolio of national QI training programmes and we will support a

consistent and co-ordinated approach to Quality Management.

Impact (Benefits Statement):

a clearer and more integrated national approach to supporting improvement

and transformational change

more easily accessible improvement and transformation support focused on

key priorities and evidence of where impact is best delivered

better public and staff engagement in improving and transforming services,

including the involvement of traditionally unheard voices

more consistent models of improvement and transformational change built on

where evidence is emerging about what works

the right balance of national support and better local capacity and capability

focused on impact and value

national development of implementation and training resources and improved

knowledge transfer

a more balanced and systematic approach to Quality Management

Scalability - This will be a national system that enables local redesign, learning at

scale and the development of national resources for health and social care.

Outline Targets

Year 1 Year 2 Years 3-5

Scope and agree the collaborative model with key partners while supporting existing initiatives and developing best practice in public and staff engagement.

Implement the collaborative model in identified priority areas for improvement and transformational change.

Evaluate and review the model and identify and support new initiatives collaboratively.

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2.2 Data and Intelligence Improvement and transformation will be built on robust data and intelligence

supported by a workforce skilled in data modelling and analysis. We need to make

data access, collection and analysis more easily available through self-service

models which help to improve how we understand and predict need, model service

demand and inform planning. The national boards will provide data and intelligence

to help different parts of the system consider the factors required to achieve

transformational change. This will be supported by scenario modelling and reporting

and analysis to achieve a better understanding of how the health and care system

works, predict changes in demand and activity, assess the impact of policy decisions

and address unwarranted variation.

Outcome - High quality data and modelling tools supported by analysis and

reporting capability which achieves better access to self-service data and intelligence

for planning, quality improvement and transformational change. This will include a

virtual laboratory for scenario testing and access to the latest information,

intelligence and evidence, underpinned by the sharing of data.

Statement of Intent - We will provide easy access to real-time quality assured data

and intelligence to support better planning, modelling and service demand

projections. This will involve opening access to the latest benchmarking and

performance data and developing a virtual laboratory to allow scenarios to be tested.

These services will support better policy setting and financial decision-making and

help address unwarranted variation. We will draw upon existing evidence about what

works, systematised approaches to understanding population need, an

understanding of the policy and legal mechanisms for innovation, all supported by

expertise in health economics, workforce planning, public health intelligence and

improvement. We will build an approach, consistent with our commitment to sharing

data, which ensures better access to data and intelligence.


a better understanding of the medium to long term impacts of policy

better identification of unwarranted variation to drive quality improvement

better service planning and decision-making over a longer timescale

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better data and intelligence about future demand to help meet need

improved user experience and better collaboration

better access to a single source of evidence, data and analytics

standard data collection and information sharing arrangements

more time for analysing data rather than collecting and processing it

Scalability - This is a national development which will build on established support

and bring consistency; it can be developed and scaled up incrementally.

Outline Targets


Scope and agree the collaborative model and commence an early adopter initiative with key partners.

Develop and implement new data and analytical tools supported by development of the skills to use them.

Fully implement a collaborative service model, establish core funding and evaluate and review the service.

2.3 Research and Evaluation Support We recognise the value of high quality research evidence and evaluation to assess

the impact of improvement and transformational change initiatives. Theory-based

evaluation supports short, medium and longer-term outcomes planning and

measurement, improving the monitoring of initiatives for ongoing learning and

modification. The national boards have expertise which can provide objective, multi-

disciplinary evaluation and impact assessment of the complex change happening

across health and social care. Research evidence; together with experiential

knowledge from practice; can inform the potential benefits of initiatives, an indication

of the anticipated outcomes and the likely barriers and facilitators to change.

Outcome - Better alignment of evidence review and synthesis and evaluation

expertise to support system-wide prevention of ill health. This will provide analysis of

improvement and transformational change initiatives and their benefits and will

support the review and spread of transferable learning.

Statement of Intent - We will co-ordinate and develop support to promote a stronger

understanding of the evidence base and best practice in prevention, health and care

innovation and for evaluating the impact of improvement and transformational

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change. This will involve enabling easier access to synthesis of evidence and

evaluation expertise. We will map national support for the evaluation of

improvement, redesign and transformational change to identify gaps and

opportunities for streamlining, feedback loops and better co-ordination. To do this we

will develop our understanding of best practice in other industries as well as ways of

capturing and spreading the learning on what works.


a better understanding and use of best practice and evidence in improvement

and transformation

improved intelligence about where to invest in service redesign

greater clarity on the transferable learning from good practice and more

effective mechanisms for spreading learning

an improved user experience and better collaboration

better access to research expertise and information

better evidence for planning decisions

Scalability - This is a national resource starting with territorial boards and regions

and then scaled up to health and social care partnerships.

Outline Targets


Scope and agree the collaborative model with key partners and the priority areas for action.

Develop early adopter initiatives and scope new approaches to research and evaluation support.

Fully implement and review the collaborative model to support agreed improvement and transformation initiatives.

2.4 Public Health Reform The Health and Social Care Delivery Plan recognises the need to prevent people

becoming ill, to improve public health and create the conditions for good health. This

discussion document will maintain a strong focus on reducing health inequalities and

improving health, supported by data and intelligence to inform planning and best

practice. This discussion document promotes working in partnership across the

public sector and beyond to transform services so that they support the needs of

those that are most vulnerable.

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Outcome - National boards will work with key partners during the transition to a

modern and sustainable public health system supporting local, regional and national

organisations in areas such as prevention, health protection and health and social

care commissioning. The new national public health organisation will ensure capacity

and capability is applied to public health priorities underpinned by health protection

services, public health advice and data and modelling tools.

Statement of Intent - We will work with key partners to help develop sustainable

options for a transformed public health system in Scotland, ensuring that the theme

of ‘national supports local’ endures in the work of public health organisations. We will

develop options for sustainable health protection out of hours services as well as

public health advice and support for health and care commissioning and delivery. We

will ensure public health data and intelligence is easily available to help identify

priorities, applying knowledge to health improvement and helping to tackle the wider

social determinants of health inequality. As these changes are implemented we will

promote equitable access to services, removing barriers and helping people to

manage their own health and wellbeing.


improved support for strategic commissioning and service delivery

resilient and sustainable health protection systems

improved access to public health data and intelligence

more cost effective public health services

a clearer focus on national public health priority areas

a joined-up approach to public health at a national, regional and local level

a sustainable approach to improving key public health areas

diverse and participatory public engagement

Scalability - This is a national initiative which, as it moves into a second phase, will

develop options for public health services and a long-term vision for the future.

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Outline Targets


Develop options for health protection out of hours services and public health advice and support. Scope and agree a solution for public health data and intelligence and help identify national priority areas.

Test health protection, advice and support and data and intelligence solutions and support the transition to a new public health body.

Fully implement health protection, advice and support and data and intelligence solutions and help develop and implement a long-term vision for the public health system.

2.5 Transforming National Planning There is widespread agreement on the need to transform national planning given the

challenges across health and social care and the new regional planning and delivery

arrangements being put in place. We will establish a new national planning board to

provide planning oversight, governance and decision making for NHSScotland and a

national planning team to lead on priority areas.

Outcome - A National Planning Board (NPB) to provide oversight, governance and

decision-making in national planning and set the strategic direction for the medium to

long-term. The NPB will work with Scottish Government to contribute to the

development of national policy and ensure it is implemented. The NPB will facilitate

the successful planning and delivery of services as locally as possible focused on

what is best for the people of Scotland and aligned to local and regional plans.

Statement of Intent – We will support the NPB through a team who will establish

portfolio groups to develop a forward view and identify planning requirements at

national, regional and local level. Where national planning is required the team will

commission short-life working groups and provide the expertise to develop delivery

plans. This planning infrastructure will gather evidence to understand the needs of

the population and develop plans for new models of care; with public patient and

professional input; underpinned by a financial framework, workforce and digital

requirements, a focus on prevention and evaluation of the impact of new technology.


improved and explicit leadership of national planning within NHSScotland

proactive and early planning to inform transformational change

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better co-ordination of planning with gaps and overlaps more easily identified

improved alignment between local, regional and national boards planning

improved processes and clarity for inter-regional and national level planning

better support for policy development and implementation

Scalability - This is a national planning development for NHSScotland.

Outline Targets


Agree new national planning infrastructure and processes. Streamline existing groups and develop forward views, priority areas and planning briefs. Promote public engagement.

Fully implement new national planning model.

Review and adjust infrastructure and processes based on learning from implementation.

3 Digitally Enabled Service Redesign The second of our three areas is digitally enabled service redesign. The national

boards will support the Scottish Government’s Digital Health and Care Strategy to

develop a single national digital platform which will create the conditions for people

to use Digital First services and where staff are confident delivering digitally enabled

services and using data to improve them. We will work with Scottish Government,

territorial boards, regions and health and social care partnerships to help build

digitally enabled services, ensuring that we improve data sharing and place users at

the heart of those services. This section covers: a Digital First approach to service

redesign; elective care and outpatient services; primary and unscheduled care;

mental health; older people; radiology services; national business systems and; a

digitally enabled workforce.

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3.1 Digital First Service Redesign Developing a Digital First approach to service redesign; supported by improvement,

transformation and evaluation capability; has the potential to radically change how

health and care is delivered, enabling people to better manage their own health and

wellbeing while improving data gathering, sharing, processing and analysis.

Outcome - National board support infrastructure for the Scottish Government’s

Digital Health and Care Strategy which will help quickly scale up digital innovation to

achieve quality and efficiency improvements, better self-management, new models

of care and better use of data and intelligence; all supported by a more enabling

approach to information governance.

Statement of Intent - We will contribute to a collaborative digital leadership group

across health and social care, which will bring together capability and capacity to

implement the Digital Health and Care Strategy for public facing health and care

services. This will include developing consistent digital architecture and inter-

operability standards, helping to put in place a new more enabling approach to

information governance and supporting users and developers to work together to

redesign services using modern digital development methodologies.


simplified and standardised ways of working across the public sector

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better and more simplified data sharing

fast routes to scale up for proven digital initiatives

services that are easier for people to use and don’t waste time and money

common technologies that can be built and procured once

public engagement that creates ownership of digital services and improves

access to them

improved access to digital services to meet the needs of people without IT

access or skills

more transparent information on the costs and performance of public services

better public engagement and quicker responses to feedback

models of care that better meet people’s needs and free up resources

Scalability - This is national work with an initial focus on health and then identifying

opportunities for collaboration across health and care and wider public services.

Outline Targets


Scope and agree the Digital First collaborative model and the priority areas for action and engagement with the public.

Develop early adopter initiatives and help scope new approaches to information governance.

Support the roll-out of priority Digital First national programmes and new model of information governance.

3.2 Elective Care and Outpatient Services Publication of the Waiting Times Improvement Plan along with the Elective Centre

Programme has brought in significant new investment designed to increase capacity,

reduce waiting times and develop new national infrastructure and models of care

which meet the needs of a growing and increasingly elderly population. Supported by

improvement, transformation and evaluation capacity and capability, we will work

with the Elective Board and Access Collaborative, territorial boards and regions to

develop: new elective centres using optimal models of care; Digital First triage; pre-

and post-operative ‘telehealth’ consultation and; self-management services for

people who don’t need a face-to-face outpatient appointment.

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Outcome - Additional capacity and an improved elective and outpatient model which

ensures people are directed to the most appropriate care as part of the wider

programme of transforming elective care, including the outpatient experience.

Statement of Intent - The Waiting Times Improvement Plan and the Elective Centre

Programme will increase capacity through new elective care facilities based on

international best practice. We will work with the Elective Board and Access

Collaborative, to develop digitally enabled in-hours and, where appropriate, extended

hours services for people given a face-to-face outpatient appointment which may not

be necessary. A triage service will identify the requirement for outpatient

appointments based on a series of questions and answers. Post consultation or

procedure support, combined with resources to help people manage their conditions,

will be developed through the Elective Care Pathway Development Programme. In

addition, we will develop a national Patient Reminder System to help reduce ‘do not

attends’ (DNAs).


additional elective capacity with improved models of care which help to

reduce waiting times

reduced outpatient demand through technology enabled services with less

face-to-face consultation

more clinical time to focus on complex cases

people more able to take control of their own health and wellbeing

better self-management of long-term conditions

improved access to digital services considering the needs of those without

digital access or skills

a more cost effective digitally enabled service with less missed appointments

Scalability – New models of care will be designed to be used within any territorial

board or region.

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Outline Targets


Help develop elective care models in trauma, orthopaedics and gastroenterology with Digital First support. Develop national patient reminder, MSK and waiting list management services and expand Attend Anywhere model.

Help develop elective care models in respiratory, general surgery and rheumatology with Digital First support. Deliver a regional digital service for orthopaedics and gastroenterology.

Help deliver a regional Digital First service for respiratory, general surgery and rheumatology.

3.3 Primary and Unscheduled Care The national boards will work with regions, Health and Social Care Partnerships, and

improvement, transformation and evaluation support to develop alternative routes

into services which will help reduce the pressure on primary and unscheduled care

and reduce waiting times. This will require new models of care and advanced clinical

support which ensures the safe and seamless flow of people from one service to

another.

Outcome - Triage and specialist paramedic support which relieves the pressure on

primary and unscheduled care through a collaborative model which protects the

capacity of general practitioners (GP) and improves patient and staff experience.

Statement of Intent - We will work in partnership to improve care for people who

request a same day appointment through the GP In-Hours Triage, Advanced

Paramedics in Primary Care and Ambulance Control Centre Triage and Dispatch

programmes. This will help reduce demand on primary care by enhancing GP

capacity for more complex cases, fully utilising the skills and advanced clinical

support of staff, reducing referrals to acute care and enabling more people to

manage their health conditions at home using tools such as self-help guides.


enhanced capacity in primary care by releasing GP appointments and

enabling more time with complex patients

more accurate and timely information for people on their condition

improved patient experience by reducing the level of calls passed between

national boards

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better management of same day consultations and home visits

a paramedic workforce able to help manage more people at home

more effective deployment of skilled staff focussing on community care

reduced waiting time for GP appointments and fewer referrals to acute care

more capacity for people with more complex needs

reduced waiting times for home visits

Scalability - This is a national initiative that will start with a regional model of care,

with integration joint boards focused on where national boards work closely with

primary care which can then be scaled up across regions and then nationally.

Outline Targets


Evaluate tests of change and deliver a limited regional model which reduces accident and emergency attendance and acute admissions.

Deliver services to East and West regions and many areas of the North region.

Deliver national service with paramedics working in most ‘clusters’ by 2023.

3.4 Mental Health The Mental Health Pathways initiative is part of the Shifting the Balance work stream

which aims to: increase mental health specialists’ capacity; reduce the number of

calls to national boards and the police which require further support and; improve

care and safety for people with mental health issues. We will achieve this through

inequalities sensitive planning and practice which ensures unscheduled care takes

full account of the needs of people with complex needs requiring mental health

support and address the longer waits experienced by them.

Outcome - A tiered approach to the management of mental health conditions

supported by digitally enabled unscheduled mental health services; which

complement local services; to improve access to specialists and provide resources

to support remote monitoring and self-management.

Statement of Intent - We will work with our partners; and improvement,

transformation and evaluation support; to develop digitally enabled mental health

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services which help reduce waiting times and improve access for people with mental

health distress and/or mental health problems. This will also help the National

Unscheduled Care Programme improve hospital capacity and patient flow and

enable more people to be cared for at home or in a homely setting. This initiative will

also better align national board mental health services including NHS Inform,

Breathing Space and Living Life and Distress Brief Interventions through inequalities

sensitive planning and practice.


improved patient care and experience

reduced waiting times for mental health services

improved digital content, monitoring and self-management capability

better access to cognitive behavioural therapy

around the clock easily accessible services

discreet and confidential services which reduce the requirement to travel

better anticipatory and preventative care

Scalability - Small scale change will be implemented within early adopter health

and care partnerships which can then be scaled up to a regional and national level.

Outline Targets


Redesign mental health models of care and implement enhanced capacity and capability.

Implement small scale tests of change within local health and care partnerships.

Embed a national model of care and explore national partnership opportunities, including with the third sector.

3.5 Older People We aim to help prevent falls, improve the patient experience and reduce accident

and emergency and hospital admissions through the Falls and Frailty, Improving

Respiratory Pathways and Dementia Care Pathways initiatives. This work is a key

element of Shifting the Balance and through it we will develop partnerships which

help tackle issues such as loneliness and social isolation and enable older people to

be safely referred to community services where appropriate. This will help prevent

falls and reduce attendance at acute hospitals and the number of bed days.

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Outcome – Support to help address loneliness and social isolation and a new model

for referring older people into community services through alternative care pathways;

including the use of ‘telehealth’ for falls, dementia and respiratory problems.

Statement of Intent - We will help prevent falls by tackling loneliness and social

isolation and providing improvement, transformation and evaluation support to work

with health and social care partnerships to develop alternative options to emergency

care for older people experiencing falls; or conditions such as chronic obstructive

pulmonary disease (COPD) and dementia. This will involve new models of care;

supported by ‘telehealth’; to meet the needs of people with mobility challenges which

open new referral routes into community services.


reduction in falls

less inappropriate attendance or admission to hospital

increased referrals into multi-disciplinary community-based teams

reduced unnecessary bed days in hospital

less repeat callers to emergency services

better more appropriate care and improved self-management

Scalability - This is a national initiative that will be scaled up after initial work with

selected health and social care partnerships.

Outline Targets


Develop a national model of care and guidance for frail and elderly patients.

Test the model and guidance with selected health and social care partners.

Review, adapt and scale-up nationally.

3.6 Radiology The national boards will support the implementation of a sustainable diagnostic

radiology service to improve patient access across Scotland and meet people’s

needs closer to home. This will require a multidisciplinary workforce; supported by

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new technology; and better access to data and intelligence to help discussion

document at a national, regional and local level and reduce unwarranted variation.

Outcome - A digitally enabled national radiology service linked with existing local,

regional and national data which enables better planning and reporting. The service

will be supported by a workforce model and consistent procedures which enable

working across traditional boundaries.

Statement of Intent - We will work with our key partners to develop a digitally

enabled national radiology service designed to meet local requirements while

maintaining a consistent national approach. The new service model will be

underpinned by national clinical governance and quality assurance as well as

consistent management, operational and technical processes, which support working

across boundaries. The new service model will be designed, implemented and

refined with key partners to support better performance reporting and planning and

to help reduce unwarranted variation.


improved performance for priority areas of care such as cancer

reduced image reporting and outsourcing costs

increased productivity through a digitally enabled service

improved strategic planning

better use of the workforce and a more sustainable service

service improvement and reduced unwarranted variation

improved national key performance indicators and benchmarking

Scalability - This is a new national radiology service model with digitally enabled

cross boundary reporting rolled out in a phased approach in parallel with a long-term

vision for the service.

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Outline Targets


Implement data platform and test a national model and clinical decision support. Develop data and performance reporting and a workforce model. Develop the long-term vision for services.

Develop a national improvement process. Scope the wider roll-out of clinical decision support and develop the case for a national delivery model. Progress projects within the transformation programme.

Implement the new national delivery model, embedding national activities in business as usual and continuing with the transformation programme.

3.7 National Business Systems We are committed to implementing the vision of a hybrid digital landscape for

national business systems, founded on a single source of data that is entered once

and can be used by any of the applications within the landscape. We will work to

transform business systems using a core suite of Software as a Service (SaaS)

products for human resources, payroll and finance which can be easily

supplemented with additional business support systems.

Outcome - A hybrid digital landscape with national business systems (SaaS) for

human resources, payroll and finance at its core, providing an improved user

experience closely aligned with best practice. This will enable the adoption of more

effective shared service models, reduce cost and improve data and analytics.

Statement of Intent - We will work with partners to identify the priority areas for

development and with vendors to build confidence in how new technology can

improve functionality. This will involve analysis of the current human resources,

finance and payroll processes to assess the options for change and develop the

commercial and procurement strategy, along with an Initial Agreement. In parallel

we will continue to develop and purchase applications that can be easily added to

the hybrid digital landscape.


increased user confidence in working with the latest digital business systems

released capacity through streamlined processes and best value practices

cost savings in the provision of business systems

improved automation, self-service and collaboration

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better access to a single source of data and analytics

an improved user experience and reduced time spent on administration

Scalability – This initiative will be developed on an Agile basis starting with high

priority and complex areas of business support and then scaled up across health to

replace existing systems. In parallel we will continue to develop and procure

applications that fit with; and will deliver benefit to; the new environment.

Outline Targets


Identify priority areas and build confidence in solutions. Scope work with potential vendors and develop new applications to deliver existing and new business services.

Work on alignment of business processes, new models and procurement.

Complete national implementation of SaaS business systems for human resources, payroll and finance.

3.8 A Digitally Enabled Workforce Digital technology offers real benefits in delivering more efficient and safe person-

centred services. The development of the Digital Health and Care Strategy will

ensure that future digital technology supports integrated services, user centred

approaches and national delivery. Digital leadership and a digitally enabled

workforce will be key to its success and to improving health and wellbeing.

Outcome - A health and social care workforce confident in using digitally enabled

services led by digital champions with the right knowledge, skills and capabilities.

Statement of Intent - We will provide training and support to enable the workforce

across health and care to be confident with digitally enabled services. This will focus

on developing a network of digital champions to lead transformation and best

practice. We will also develop learning resources and identify the best way for them

to be delivered, along with digital standards for employers and employees.


a more digitally ready and better-connected workforce

improved networking, collaboration and sharing of best practice

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a more productive workforce with improved communication

more connected, efficient and safe services

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Scalability - The network of digital champions will start with early adopter territorial

boards and health and social care partnerships and will then be scaled up into a

national network across health and social care. Programmes such as Digital Matters

will be rolled out nationally in a phased way with train the trainer methodology

building internal capacity to ensure sustainability.

Outline Targets


Develop digital leadership requirements and provide training. Identify mechanisms for digital workforce training.

Grow a network of digital champions, implement learning and scope the digital workforce for a future workforce plan.

Implement a sustainable training model, develop digital recruitment and guidance for employers and employees.

4 A Sustainable Workforce The third of our key areas recognises the challenge of having the right workforce,

with the right values and skills, in the right places. Increasingly we will work with

improvement, transformation and evaluation support to reshape the workforce and

improve the data that enables workforce planners to model service demand and

projected workforce supply. We will work with the Scottish Social Services Council,

the Care Inspectorate, territorial boards, health and social care partnerships, regions

and higher and further education to improve recruitment and retention, attraction and

education and training for careers in health and care. In addition, we will promote

workforce health and wellbeing as a key element of developing a sustainable

workforce. This section covers workforce planning, staff rostering, health and care

careers, youth employment, education and training, online learning management,

leadership and talent management and flexible models of employment.

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4.1 Workforce Planning Key to developing a more sustainable workforce is better data analysis and

modelling to support workforce planning. This will require more connected, accurate

and up to date data and intelligence at a national, regional and local level accessed

through a self-service data platform which supports scenario planning.

Outcome - A pipeline approach to workforce planning with a better match between

supply through training and recruitment and demand for services. This will be

underpinned by new workforce planning guidance and a self-service data platform

supported by training and an enabling national approach to information governance.

Statement of Intent - We will develop a data platform bringing together existing

workforce data sources into a ‘data lake’, with visualisation tools accessible by

planners at a local, regional and national level. We will use new technologies to

ensure that the machines do the work of accessing and joining up the data; freeing

up the time of skilled staff to provide analysis and intelligence. This will be supported

by the development of data science skills and training in how to apply national

workforce planning guidance.


improved alignment of workforce, service and financial plans

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better workforce planning over a longer timescale

better use of workforce planning resources

more flexible delivery of services in a changing world

improved user experience and better collaboration

better access to a single source of data and analytics

an upskilled workforce planning community using consistent methodology

service managers better able to link service developments with workforce

improved workforce health and wellbeing.

Scalability - This is a national initiative that will support regions and health and

social care partnerships to improve workforce planning and support the national

processes for setting student intakes to key training programmes.

Outline Targets


Launch the data platform, bringing together data sources and scope the requirement for training. Scope workforce health and wellbeing discussion document.

Identify data gaps and scope the action to resolve them. Develop workforce planning training and a workforce health and wellbeing discussion document.

Further develop the data platform. Roll out training and develop a national approach to controlled student intake numbers.

4.2 Staff Rostering Managing daily work and leave (rostering) is a core workforce function and is closely

aligned with the national business systems work described in section 3.7. We believe

the employment experience can be improved by enabling staff to better manage their

work-life balance using mobile devices. It is also well evidenced that the introduction

of eRostering; combined with consistent rostering practice; reduces administration,

drives efficiencies in staff deployment and reduces expenditure on agency staff.

Outcome - An improved employment experience and digitally enabled rostering

which enables employees to manage their daily working lives across more than one

organisation. This will reduce expenditure on agency staff, improve quality for

patients and provide important data to feed into workforce planning.

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Statement of Intent - We will work with stakeholders through an assessment

process to determine the best option for an eRostering system. We will also bring

together a team to work with partners on implementation and associated change,

taking full advantage of best practice in roster design.


employees better able to manage their working lives

employees better able to take advantage of shifts in other territorial boards

reduced expenditure on agency staffing

reduced administrative time on rostering and interfacing with other systems

improved data on staff deployment to inform workforce planning

improved ability to manage staffing resources to best match patient activity

Scalability - This programme will start with rostering in individual territorial boards

and will build on existing eRostering implementations to roll out across Scotland.

Outline Targets


Establish programme team, develop a consistent national approach and procure the best eRostering solution. Support at least one territorial board to fully implement.

Roll out to five to seven territorial boards.

Roll out to a further five to seven territorial boards followed by full implementation and evaluation.

4.3 Health and Care Careers Digital technology is key to addressing the recruitment and engagement challenges

outlined in the Health and Social Care Workforce Plans. Developing careers and

employee engagement; along with stronger employer branding and a national

approach to overseas recruitment; will ensure people get the best impression of

working in health and care and provide clearer career choices, job application and

engagement. This will also help fulfil the programme for government recruitment

commitments to support primary care transformation.

Outcome - Improved recruitment and employee engagement through a Careers

Portal, incorporating enhanced employer branding, a national approach to overseas

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recruitment and employee engagement. This will provide easy access to careers

information, recruitment resources and employee engagement tools; building a

reputation for rewarding working lives.

Statement of Intent - We will provide a digitally enabled user journey from the point

of interest to application and build compelling employer branding; strengthening

employee engagement and making health and care a career of choice. To improve

recruitment and retention; and to help fulfil commitments to recruit more community-

based staff; we will develop social media, build a new Careers Portal, (incorporating

a national overseas recruitment) and further develop employee engagement tools.

This will enable interactive and collaborative employee engagement and seamless

job application or register of interest in work opportunities.


improved job application rates in a highly competitive market

better talent management and a wider talent pool to choose from

stronger employer branding to reinforce our values and support retention

increased international recruitment

improved employee feedback and engagement

Scalability - This is a national development that will support regions and health and

social care partnerships to promote roles and career opportunities.

Outline Targets


Define project, develop capacity and undertake Careers Portal design work.

Develop new branding and an implementation discussion document for the Careers Portal.

Roll out the Careers Portal and branding, an evaluation and on-going development discussion document.

4.4 Youth Employment The Scottish Government has set out the vision of a prosperous and fair society

where everyone can contribute and share success. A key element of achieving this

is how we support young people into employment and this will require a

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transformational change in how we equip young people for jobs in health and care so

that; whatever their life experience; they have better access to opportunities.

Outcome - A new national approach to youth employment in health and care to

improve development of the future workforce in support of the Scottish Government's

Youth Employment Strategy, the Health and Social Care Delivery Planand the

National Health and Social Care Workforce Plans (parts 1-3).

Statement of Intent - We will work with further and higher education and Young

Scot to develop the Careers Portal (see 4.3), to connect with employers and support

a national work experience scheme informed by young people's experiences. This

will be underpinned by national principles and guidelines which supports a consistent

approach to the recruitment, employment and development of young people and

enables more flexible movement across employers and sectors.


more young people employed in health and care

less youth unemployment

better awareness of careers in health and social care

improved awareness of work relevant education and experience

better careers advice at an earlier point in education

Scalability - This is a national development to support health and social care

employers deliver youth employment and work experience initiatives.

Outline Targets


Develop partnerships with regional young workforce groups, share best practice and design the Careers Portal and work experience scheme.

Strengthen school/college partnerships and finish development of the work experience scheme, promoting careers to equalities groups.

Roll out the Careers Portal and work experience scheme and implement new attraction and recruitment policies and youth employment guidelines.

4.5 Education and Training The National Health and Social Care Workforce Plan (part 1), highlighted

opportunities for a more consistent approach to education, training and workforce

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development to help develop a sustainable pipeline of staff for the health and care

services of the future.

Outcome - A new national approach to commissioning education, training and

workforce development that is better linked to workforce planning supported by

guiding principles for Recognition of Prior Learning (RPL).

Statement of Intent - Working with the Scottish Credit and Qualifications

Framework Partnership, territorial boards and the higher and further education

sectors, we will develop national collaborative commissioning and Recognition of

Prior Learning (RPL) drawing on the experience of the higher and further education

sectors. This will be underpinned by the development of national guiding principles

and an overarching process.

Impact (Benefits Statement)

better value for money and return on investment in learning

better recognition and transferability of learning for a more flexible workforce

improved access to learning to improve career development

better recruitment and retention from hard to reach groups in society

a secure pipeline of skilled people into services to improve sustainability

ensured fitness for practice and maximised employability of staff

Scalability - This work is being planned at a national level with the initial focus on

territorial boards and regions and a broadening to the care sector thereafter.

Outline Targets


Build engagement to understand current approaches and review their effectiveness.

Develop principles and a high-level process to underpin commissioning and RPL.

Roll out the new process and build engagement with the care sector to achieve consistency.

4.6 Digital Learning Management Underpinning improvement and transformation is a requirement for modern and

easily available learning and knowledge services. The further development and

deployment of a single digital learning platform will support the Scottish

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Government’s Digital Health and Care Strategy by providing digital learning and

decision support resources which can be accessed by all those who need them.

Outcome - A single digital learning platform; as part of the hybrid digital landscape;

founded on there being a single source of resources which can be used by anyone

working in health and social care.

Statement of Intent - We will ensure that health and care staff have consistent

access to digital learning resources from any device, anywhere and at any time. We

will do this by implementing a digital learning platform to enable sharing across

health and social care in areas such as equality and diversity, statutory and

mandatory training and induction; to name but a few examples.


learning more focused on integrated services and national approaches

a more efficient, cost efficient national model for learning management

more automation, self-service and collaboration

better access to a single source of learning and knowledge

an improved user experience and reduced time spent on administration

reduced costs currently associated with multiple providers

Scalability - This work is being planned on a national basis with the initial focus on

the health sector and a broadening to the care sector thereafter.

Outline Targets


Define a roadmap and complete a review of existing content to be hosted on the new platform. Design new equalities learning resources.

Finalise learning programme functionality, user and learning record migration and discussion document the move of existing content along with new equalities resources.

Review and move existing content, user and learning records and fully scale up on a national and cross sector basis.

4.7 Leadership and Talent Management Developing a workforce that is focused on improvement and open to

transformational change is key to the success of the Health and Social Care Delivery

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Plan. The national boards will support key strands of the Scottish Government's

Project Lift aimed at transforming our approach to leadership development, talent

management, performance appraisal and values-based recruitment.

Outcome - Strengthened leadership capability, talent management and performance

appraisal through support for the Scottish Government's Project Lift. Allied to this

there will be a single system of organisational, leadership and workforce

development to work with local systems and national improvement, transformation

and evaluation support to deliver real sustainable change; supported by digitally

enabled resources to engage with and develop talent.

Statement of Intent - We will support the Scottish Government's Project Lift to

improve leadership development, talent management, performance appraisal and

values-based recruitment. We will also develop digitally enabled resources to track

skills, roles and competencies and assemble high-potential employees; resulting in a

pool of talented people which can be drawn upon. This will be supported by a single

national resource for organisational, leadership and workforce development to work

with local systems on improvement and transformational change initiatives.


an enhanced talent pool and improved succession planning

a consistent approach to values-based recruitment and talent management

a pipeline of future leaders with the right ability, ambition, values and insight

improved retention of high potential individuals

reduced waste from investment in development schemes

increased capacity for transforming services

a more efficient national model for organisational development and change

a human rights-based approach to staff and service development

Scalability - The Scottish Government's Project Lift has an initial focus on health

with the national boards already commissioned to support elements of the initiative.

The single system for organisational development will be tested locally and then

rolled out on a national basis with an initial focus on health.

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Outline Targets


Roll out values-based recruitment (VBR) for board appointments and support development of a national model for performance appraisal, talent management and leadership development.

Support VBR roll-out for senior appointments and the wider public sector. Support implementation of national infrastructure for appraisal, talent management and leadership development.

Establish a single system for organisational, leadership and workforce development to support national priorities.

4.8 Flexible Employment Models Scottish Government policy is starting to consider the potential of new more flexible

models of employment in partnership with regions and stakeholder groups. Being an

exemplar employer and ensuring fair and effective staff governance is a key enabler

of change, with new employment models and national policies empowering

employees to work more flexibly across organisations and sectors.

Outcome - New models of employment that respond to the changing aspirations of

employees to work flexibly, supported by consistent policies and digitally enabled

advice and support which ensure effective staff governance and meets legislative

requirements and best employment practice.

Statement of Intent - We will work in partnership to design and implement flexible

employment models which improve regional and cross sector working. This will

include further development of digitally enabled advice and support and

consideration of national employment policies and procedures to support the

application of Partnership Information Network (PIN) national guidelines.


a more versatile workforce that is easier to plan

less bureaucracy making it easier to work in health and care

a better work-life balance for employees

more consistent staff treatment and governance no matter where people work

improved transferability to support regional and national working

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Scalability – This initiative will start with a national lead employer model for doctors

and dentists in training which can then be considered for other staff groups in

partnership, supported by consistent policies and digitally enabled resources.

Outline Targets


Help develop lead employer arrangements for doctors and dentists in training and national employment policies.

Continue implementation of lead employer model and support the development of national employment policies.

Roll out lead employer model, evaluate it, plan for wider application and implement new national employment policies.

5 Financial Sustainability and Investment Case We recognise the continuing financial challenge described within the Scottish

Government’s Medium-Term Health and Social Care Financial Framework. The

framework focuses on reforming how care is delivered to meet growth in demand

over the next five years and it provides a foundation for the national board’s

investment plans. These investment plans will focus on the transformational change

needed to ensure that less care is delivered in hospitals using more digitally enabled

models of care and supported by a workforce shaped with the right values and skills,

in the right places and in the right numbers to meet growing service demand.

To align with the Scottish Government’s financial framework, we are developing a

national board financial framework to support our health and care system through

the benefits that we believe will be derived from the proposals set out in this

discussion document. As well as identifying our investment plans the national boards

financial framework will outline the consolidated financial position over the next five

years and the economic impact of delivering the work in this discussion document.

We will also continue to improve financial sustainability through national shared

service models and consistent best practice.

5.1 National Shared Services The national boards will work with key partners and improvement, transformation

and evaluation support to implement national shared service models in priority areas

to increase consistency, build greater resilience and deliver more cost effective,

sustainable and efficient services.

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The shared service Pharmacy Aseptic Dispensing Programme will deliver a national

pharmacy aseptic dispensing service model, a new configuration of pharmacy

aseptic dispensing units and a national Central Intravenous Additives Service

(CIVAS). In health informatics and technology, we will develop a national approach

for healthcare technology and medical equipment management and in primary care

we will support the implementation of the 2018 GMS contract and primary care

transformation. In procurement we will develop an integrated approach to planning,

governance and measurement underpinned with common processes, technology

and resource allocation. In addition, the Shared Services Laboratories Programme

will develop a distributed model which increases service resilience and sustainability.

Finally, in estates and facilities we achieve better prioritisation of developments

through a new National Infrastructure Board better linked to service planning.

5.2 Transformation Investment Case The overarching aim of this discussion document is to create capacity and capability

to support health and social care to manage the demands on services and

associated workforce challenges. This will require investment to achieve the scale

and pace that is required. The investment case to support this discussion document

includes a detailed financial model and risk assessment for each initiative. These

provide an evaluation of readiness and enable prioritisation based on impact and

value. We have also been rigorous in seeking to identify the benefits that will be

delivered by each of our proposals. This will provide a starting point in assessing our

performance in delivering those proposals that are endorsed. For each workstream

and project within this discussion document there is an assessment of:

the investment required to deliver it; broken down into pay and non-pay

funding from other sources

funding required from the transformational fund

benefits that will be delivered (financial and non-financial)

5.3 Financial Framework To support the Scottish Government’s Medium-Term Health and Social Care

Financial Framework we are developing a national board financial framework which

brings together the collective resources of the eight national boards and starts to

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make sense of these against very different remits, in a way that will support a

deepening of our collaboration and an absolute focus on value for money. The

national board financial framework will:

focus on key activities and their financial value for each national board

modelling revenue and capital gaps if we do nothing

understand what national boards will do to support the Health and Social Care

Delivery Plan around the three priority areas in this discussion document

categorise our current budgets into those which are:

unique to one national board

duplicated across more than one national board, and therefore create

an opportunity to work differently

contribute to one of the three priority areas in this discussion document

do not fall into any of the above and therefore create an opportunity for

re-prioritisation

consider the total scale of the efficiency challenge across all national boards,

and set out high level plans for delivering savings

show a five-year consolidated capital discussion document aligned to a

collective national board Property and Asset Management Strategy

ensure the modelling assumptions are aligned to the Scottish Government’s

financial framework

ensure clarity of governance arrangements for new or re-designed

collaborative services

Financial Framework - Key Messages

Focus on driving forward the 3 key priority areas

with clear plans, benefits and oucomes

Focus on improving efficiency by working

together collaboratively

Focus on the added value of our local spend

Ensure effective investment and

governance aligned to key priority areas

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6 Our Collaborative Discussion Document The national boards have worked closely together to produce this collaborative

discussion document which demonstrates where we will contribute to the Health and

Social Care Delivery Plan through support for national, regional and local plans.

Within this discussion document’s three main areas: improvement, transformation

and evaluation; digitally enabled service redesign; and a sustainable workforce, a

range of priority areas have emerged which will help reduce waiting times, improve

access to services and support integration – these include:

modernising outpatients

primary care sustainability

reducing bed days and accident and emergency presentations

workforce sustainability

public health and prevention

national ‘Once for Scotland’ services

The national boards are confident that we can achieve real benefits across these

priority areas generating positive impact and value by year five of the discussion

document. Some examples of the potential benefits are outlined below:

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We are confident that this collaborative discussion document will provide high quality

and better co-ordinated support for local, regional and national health and care

services. It is comprehensive and high-level and aims to focus on key service priority

areas that are complex and will require real collaboration to address. This discussion

document should be viewed as the first step in a long-term process and through our

leadership commitment, collaborative working and more effective use of resources;

the national boards will collectively build on our past successes to help develop

health and social care services that are fit for the future.

Documents

‘Changing to Deliver’ News/Docs... · 2.2 Data and Intelligence Improvement and transformation will be built on robust data and intelligence supported by a workforce skilled in