Local Delivery Plans &

HEAT

Robert Williams

Health Delivery

Background• Review of NHS Performance Management (summer 2005)

– Too many priorities = no priorities

– Fire and Forget

• Health Delivery Group (summer 2006)– NHS Performance Management

– Spread Delivery Ethos across Health Department (Delivery Proofing)

• National Performance Framework (autumn 2007)– Government’s outcomes

– Public Reporting vs Performance Management

• Single Outcome Agreements (autumn 2007)– NHS Boards working with partners to deliver outcomes

Local Delivery Plans

Include:

1 Supporting the Scottish Government’s Outcomes-based approach

2 LDP Risk Narrative

3 LDP Delivery Trajectories

4 LDP Financial Plans

5 Summary of main workforce issues facing Boards

6 Additional Local Commitments to support SOAs

And “Methods & Sources”

Trajectories still at the heart of LDP – Performance management System

• NHS Boards also provide weekly cancer waiting time prospective reports

Extracted from registered users’ HEAT System

Health ImprovementH2 : 80% of all 3-5 yr old children registered with dentist by 2010/11.

H3 : Deliver child healthy weight intervention programme by 2010/11.

H4 : Deliver alcohol brief interventions (SIGN 74) by 2010/11.

H5 : 50% of key frontline staff trained in suicide prevention by 2010.

H6 : Deliver agreed smoking cessation services (2008/9 – 2010/11).

H7 : 33.3% of babies exclusively breastfed at 6-8 weeks in 2010/11

H8 : Inequalities targeted cardiovascular Health Checks (2009/10)

EfficiencyE4 : Deliver improved efficiencies (basket of 4) by March 2011.

E5 : Operate within agreed revenue resource limit; capital resource limit; meet their cash requirement.

E6 : NHS boards to meet their 2% cash efficiency target

E7 : 90% of new GP referrals managed electronically from Dec 2010

E8 : Reduce Emissions : Reduction in energy consumption (2009/10)

E9 : 97% radiology scans requests with valid CHI (Mar 2010)

E10 : 80% of AfC staff to have had KSF PDP review (Mar 2011)

Access to ServicesA8 : 90% 48hr GP team appointment (2010/11)

90% 48hr GP advance booking (2010/11)

A9 : 62 day RTT for referrals with suspicion of cancer (Dec 2011)

31 day DTTTT for all cancers (Dec 2011)

A10 : 18 weeks RTT (Dec 2011)

12 weeks max wait for all outpatient referrals (March 2010)

12 weeks max wait for inpatient / day case from (March 2010)

A11 : Maximum drug treatment waiting times (definitions & data)

A12 : Maximum CAMHS waiting times (definitions & data)

TreatmentT2 : QIS clinical governance and risk management standards

T3 : Zero growth in anti-depressants by 2009/10 (10% reduction in future)

T4 : 10% reduction in psychiatric readmissions (> 7 days) by Dec 2009

T6 : Agreed reductions in LTC hospital admissions (2006/7 to 2010/11)

T7 : Improvement in the quality of healthcare experience

T8 : Older people with complex care needs (new performance measure)

T9 : Dementia care by March 2011

T10 : Agreed reductions in A&E attendances (2010/11) (formerly A7)

T11 : 30% Reduction in MRSA/MSSA (2010)

30% Reduction in C.diff infections in hospitals (2011)

T12 Older people’s emergency bed days (2010/11)

LDPs & HEAT Continue to Evolve

• Annual HEAT development work – what would you like to see in HEAT?

• HEAT supports Government’s outcomes approach• Increased focus on ‘performance measures’

– E.g. smoking cessation

• Internal NHS Board performance management• LDP focus on SOAs

– what NHS Boards are doing over and above HEAT

• Accountability– Annual Reviews; Annual Report; Scotland Performs

HEAT developed with NHS Boards & other stakeholders

Target Specific includingH : Health Improvement Performance Management groupE : Efficiency and Productivity Steering groupA : 18 weeks RTT Programme Board; NCDWTG; T : Older people multiple emergency admissions

conference; Community Care Outcomes Group

Overall direction– Chief Executives– Chairs– Directors of Planning– Performance Forum

NHS Boards deliver much more than the

HEAT targets

2010-11 HEAT DevelopmentHealth Improvement • Targeted Health Checks• Childsmile• Physical exercise• Mental health improvement

Efficiency • Length of stay• GP referral rates • Prescribing• Carbon

Access • Drug misuse treatment• Alcohol services• CAMHS• Adult Psychological Therapies

Treatment• Palliative care• Psychiatric readmissions• Patient Experience• Long Term Conditions• MRSA

Outcomes – based approach

HIGH LEVEL OUTCOMES

INTERMEDIATEOUTCOMES

SHORT-TERM OUTCOMES

OUTPUTS

Purpose - a more successful country, with opportunities for all Scotland to flourish through increasing and sustainable economic growth

High-level targets

National Outcomes

(National Indicators)

Strategic Objectives

Outcomes related to service delivery

Outputs/interventions

H6 Tobacco

Reduced adult smoking rateSustained quit rate (1 year follow-up)

Improved mental wellbeingReduced inequalities in HLE

Reduced inequalities in CHD mortalityReduced tobacco-related morbidity and mortality

What the NHS has to do to reach smokers and provide effective SC services in key settings

Smoking cessation services

Quit rate at 1 month follow-up

Funding, trained workforce, evidence-based guidance, data to manage and

monitor the delivery of interventions

Smokers who want to quit (key sub-groups)

Inputs

Activities

Outputs

Short-term Outcomes

Reach

Intermediate Outcomes

High level Outcomes

Revised HEAT target

National indicators

Scotland Performs

• NHSScotland will be first part of the wider public sector to report performance through Scotland Performs

• Likely to launch in January 2010

Purpose and High-Level Targets

• Purpose - ‘to focus the Government and public services on creating a more successful country, with opportunities for all Scotland to flourish through increasing and sustainable economic growth’

• 7 High-level National Targets relating to The Purpose are set out in the Economic Strategy (growth, productivity, participation, population, solidarity, cohesion, sustainability)

• Population Target - To match average European (EU-15) population growth over the period from 2007 to 2017, supported by increased healthy life expectancy from birth in Scotland over this period

• Progress towards achieving the Government’s 5 Strategic Objectives will underpin the ambitions set out through the High-level Targets in the Economic Strategy

National Outcomes• We are better educated, more skilled and more successful, renowned for our research and

innovation• We live in a Scotland that is the most attractive place for doing business in Europe• Our young people are successful learners, confident individuals, effective contributors and

responsible citizens• Our children have the best start in life and are ready to succeed• We live our lives safe from crime, disorder and danger• We have improved the life chances for children, young people and families at risk• We live longer, healthier lives• We have strong, resilient and supportive communities where people take responsibility for

their own actions and how they affect others• We have tackled the significant inequalities in Scottish society• We realise our full economic potential with more and better employment opportunities for our

people• We live in well-designed, sustainable places where we are able to access the amenities and

services we need• We value and enjoy our built and natural environment and protect it and enhance it for future

generations• We reduce the local and global environmental impact of our consumption and production• We take pride in a strong, fair and inclusive national identity• Our public services are high quality, continually improving, efficient and responsive to local

people’s needs

HEAT targets 2009/10

We have tackled the significant inequalities in Scottish society

Our children have the best start in life and are ready to succeed AND We have improved the life chances for children, young people and families at risk

We live longer, healthier lives

Our public services are high quality, continually improving, efficient and responsive to local people’s needs

We reduce the local and global environmental impact of our consumption and production

HLE Economic Growth, Productivity, and Participation

Population growth

Cohesion, Solidarity

Sustainability

80% of all 3-5 yr old children registered with dentist by 2010/11.

Deliver child healthy weight intervention programme by 2010/11.

Deliver alcohol brief interventions (SIGN 74) by 2010/11.

50% of key frontline staff trained in suicide prevention by 2010.

Deliver agreed smoking cessation services (2008/9 – 2010/11).

33.3% of babies exclusively breastfed at 6-8 weeks in 2010/11

Inequalities targeted cardiovascular Health Checks during 2009/10

Deliver agreed improved efficiencies (basket of 4) by March 2011.

Operate within agreed revenue resource limit; capital resource limit; meet their cash requirement.

NHS boards to meet their cash efficiency target

90% online handling of new GP outpatient referrals from Dec 2010

Reduce Emissions : 2% reduction in energy consumption (2009/10)

National Outcomes Purpose Targets

Scotland Performs

7 Purpose Targets

15 National Outcomes

45 National Indicators

Scotland Performs : NHS Scotland

NHS Scotland HEAT Performance Targets

NHS Boards’ HEAT Performance Targets

Scottish Government Health Topic pages

Mainly outcome information at a national level

Performance information at Scotland and NHS

Board level

How the proposed new Scotland Performs : NHS Scotland webpages will relate to existing Scotland Performs and Scottish Government Health Topic

Scotland Performs : NHS Scotland sample webpages

Scotland Performs : NHS Scotland These pages provide information about NHS Scotland performance. The 14 NHS Boards in Scotland are committed to deliver the Scottish Government’s HEAT targets. The HEAT targets identify some of the key actions that NHS Boards are focusing on which support delivery of the Scottish Government’s purpose and outcomes. NHS Boards have also agreed a range of local commitments through their Community Planning Partnerships to support delivery of their local Single Outcome Agreements. Scotland Performs : NHS Scotland Performance

Health Improvement Coronary Heart Disease NHS dentist registration : child Child healthy weight. Alcohol brief interventions Smoking cessation Suicide prevention training Children exclusively breastfed

Efficiency & Governance NHS Boards : sickness absence Financial balance Cash efficiency Efficiency basket KSF personal development plan CHI Online GP outpatient referrals

Access to Services Ambulance Cat A calls GP access: 48 hour Cancer treatment: 62 days Outpatient max wait: 15 wk Inpatient max wait: 15 wk Diagnostic wait : 6 week A&E attenances & 4hr wait

Treatment Emergency bed days : 65yr+ Long term conditions Antidepressant prescribing Psychiatric re-admissions Dementia QIS clinical governance and risk Healthcare associated infection Complex care at home Health care experience

Scotland Performs : NHS Boards’ Performance

Menu links to other parts of Scotland Performs.

NHS Ayrshire & Arran

NHS Borders NHS Dumfries & Galloway

NHS Fife NHS Forth Valley

NHS Grampian

NHS Greater Glasgow & Clyde NHS Highland

NHS Lanarkshire NHS Lothian

NHS Western Isles

NHS Orkney NHS Shetland NHS Tayside

Scotland Performs : NHS Scotland sample webpages

Scotland Performs : NHS Scotland Performance Menu links to

other parts of Scotland Performs.

Healthcare Associated I nfection (MRSA/ MSSA) To reduce all staphylococcus aureus bacteraemia (including MRSA) by 30% by 2010 Why is this HEAT target important? Acquiring a healthcare associated infection (HAI) is a dangerous and distressing experience for patients already in hospital. Proper procedures can significantly reduce the risk of these infections being spread. Reflecting the importance attached to tackling HAI in Scotland, a new HEAT target has been announced for 2009/10 which requires health boards to reduce the rate of C.Difficile for the over 65s by at least 30 per cent, by 2011. How is NHS Scotland Performing? The measure records the number of identifications of Staphylococcus aureus bacteraemias (including MRSA and MSSA) as detailed in Health Protection Scotland's Scottish Surveillance of Healthcare Associated Infection Programme (SSHAIP) protocols. The baseline for this target is 2005/06, during which there were 2,774 infections. In 2007 there were 2,531 infections, an improvement of 8.8 per cent.

Other information? This information is due to be updated in XXXX. Further information can be found at the Scottish Superbug Statistics website.

[DN: Information from chart depicted as a table.]

Scotland Performs : NHS Scotland sample webpages

Scotland Performs : NHS Boards’ Performance How is NHS Greater Glasgow & Clyde performing? The following table provides a snapshot of Greater Glasgow & Clyde’s performance as at XXX. For further information please visit NHS Greater Glasgow & Clyde’s website.

Performance

Baseline Latest Target ID Performance Measures Units

Date Value Date Actual Date Target

H1.1 Health Inequalities - CHD Deaths per 100k/yr Dec-04 141 Dec-07 116 Dec-11 86 H2.1 Dental registrations % Mar-07 75 Jun-08 88 Mar-11 80 H7.1 Breastfeeding at 6-8 weeks % Mar-07 24 Jun-08 23 Mar-11 30 E1.1 Community Health Index Usage % Apr-08 94 Nov-08 96 Mar-11 97 E2.1 Sickness Absence % Oct-07 5.90 Nov-08 5.13 Mar-09 4.00 E3.1 Knowledge and Skills Framework - PDP % Apr-08 31 Nov-08 79 Mar-09 100 E4.1 Day case rates % Mar-07 63 Jun-08 64 Mar-10 83 E4.2 Emergency inpatients average length of stay Days Mar-07 4.34 Jun-08 3.67 Mar-11 3.97 E4.3 Review to New Outpatient Attendance Ratio Ratio Mar-07 2.49 Jun-08 2.56 Mar-11 2.41 E4.4 New outpatient appointment DNA rates % Mar-07 12.62 Jun-08 12.97 Mar-10 11.34 E6.1 Cash Efficiencies £ 000s Mar-08 N/A Nov-08 29867 Mar-11 114600 E7.1 Online triage of new outpatient referrals % Mar-08 0 Nov-08 0 Dec-10 90 A2.1 All Cancer Waiting Times (62 days) % Jun-07 89 Jun-08 93 Mar-08 95 A4.1 Outpatients waiting over 15 weeks from GP referral Patients Apr-08 574 Nov-08 0 Mar-09 0 A5.1 Inpatients/Day Cases waiting over 15 weeks Patients Apr-08 330 Nov-08 5 Mar-09 0 A6.1 Key Diagnostic Tests waiting over 6 weeks Patients Apr-08 1569 Nov-08 770 Mar-09 0 A7.1 A&E Attendances Patients/100k pop/yr Sep-07 3095 Nov-08 2876 Mar-11 3213 A7.2 A&E waits to be a maximum of 4 hours % Apr-08 98 Nov-08 98 Dec-07 98 T1.1 Multiple Emergency Admissions (aged 65+) Patients per 1000/yr Mar-05 52 Mar-08 58 Mar-09 42 T1.2 Reduction in emergency bed-days for patients aged 65+ Days per 1000 Pop/yr Mar-05 3851 Mar-08 3811 Mar-09 3466 T3.1 Prescribing of anti-depressants DDDs per capita Jun-06 35 Sep-08 40 Dec-09 37 T5.1 Healthcare Associated Infection Infections/yr Mar-06 934 Sep-08 720 Mar-10 607 T6.1 Hospital admissions for long term conditions Admission/100k Pop/yr Mar-07 2057 Mar-08 2106 Mar-11 1962 T9.1 Dementia Patients on register Mar-07 6601 Mar-08 6758 Mar-11 8779

There will be links to the NHS Scotland HEAT target page that will provide further details about the specific

targets.

NHS Board Annual Reviews 2008-09

Any questions & further info

Robert Williams

* mailto: robert.williams@scotland.gsi.gov.uk