Welcome from Sir Robert Smith

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Delivering Better Health Paul Martin Dean,
Education, Health Social Sciences HMI/IHM
Joint Leadership Event Leadership for Service
Modernisation 15 May 2009
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The Context

• Budget 10 billion
• Staffing 166,000
• Population 5 million approx
• NHS Boards
• 14 Territorial
• Special

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The Policy Pathway

• 1997 Designed to Care
• 1999 The NHS Plan and the way forward for care
• 2000 Our National Health A plan for action, a
  plan for change
• 2005 Delivering for Health
• 2007 Better Health Better Care

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Partnership

• Partnership creates the conditions for the most
  effective employee relations that support the
  improvement of health and healthcare services and
  the wellbeing of the people of Scotland.
• Partnership Delivering the Future
• Scottish Executive
  2005

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Mutuality

• A Mutual NHS
• a clear vision of a mutual NHS where ownership
  and accountability is shared with the public and
  staff
• Scottish Government

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Scottish Government

• PURPOSE
• To focus Government and public services on
  creating a more successful country, with
  opportunities for all of Scotland to flourish,
  through increasing sustainable economic growth.
• WEALTHIER FAIRER - Enable businesses and people
  to increase their wealth and more people to share
  fairly in that wealth.
• SMARTER - Expand opportunities for Scots to
  succeed from nurture through to life long
  learning ensuring higher and more widely shared
  achievements.
• HEALTHIER - Help people to sustain and improve
  their health, especially in disadvantaged
  communities, ensuring better, local and faster
  access to health care.
• SAFER STRONGER - Help local communities to
  flourish, becoming stronger, safer places to
  live, offering improved opportunities and a
  better quality of life.
• GREENER - Improve Scotland's natural and built
  environment and the sustainable use and enjoyment
  of it.

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Drivers for ChangeCummulative use of inpatient
bed days
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Drivers for ChangeAge composition of bed days
usage groups

• Bed days usage group
• Age Group Top 1 Top 3 Top 5 Top 10 All
  patients Population
• 0 to 64 20.3 20.7
  21.7 24.8 63.7 83.8
• 65 to 79 35.2 35.8
  36/3 37.6 23.3 12.2
• 80 44.5 43.4
  41.9 37.6 13.0 4.0
• All ages 100 100
  100 100 100 100

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Drivers for ChangeChange in male life
expectancy, 1991-2001, best and worst
constituencies
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Moving to the Future

• The NHS in Scotland can meet that challenge by
• Building a new relationship of partnership and
  trust with the public.
• Equipping frontline staff to design service
  change and to develop new roles and skills.
• Ensuring all staff are working to a shared vision
  with a sense of pride in what they are doing.
• Providing modern information and communications
  technology to improve access, quality and
  effectiveness.
• Maximising services in the community delivering
  care that is as local as possible and as
  specialised as necessary.

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Moving to the Future

• Current View Evolving model of care
• Geared towards acute conditions Geared towards
  long-term conditions
• Hospital centred Embedded in communities
• Doctor dependent Team based
• Episodic care Continuous care
• Disjointed care Integrated care
• Reactive care Preventative care
• Patient as passive recipient Patient as
  partner
• Self care infrequent Self care encouraged and
  facilitated
• Carers undervalued Carers supported as
  partners
• Low tech High tech

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Moving to the Future A Workforce Response

• All staff will be ambassadors for health
  improvement, safety and quality, using every
  interaction with individuals, communities and
  populations, and every patient care episode to
  maximise their public health and education role.
• NHSScotland will develop and implement
  multi-disciplinary and multi-agency models of
  care which are more responsive, more accessible
  and more joined up to meet the needs of local
  communities and ensure efficient utilisation of
  skills and resources.
• NHSScotland will be an employer of choice which
  acquires the best talent, motivates employees to
  improve their performance, keeps them satisfied
  and loyal, and provides opportunities for them to
  develop and contribute more.

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• All staff in NHSScotland will work together to
  promote the benefits of preventative action and
  measures of self care for patients and the public
  across a range of health issues, supporting them
  in ensuring that they have the knowledge and
  understanding to undertake this and where
  appropriate to seek expert advice and treatment.
• We will work together with Universities, Further
  Education and the wider education sector to
  encourage and maximise flexible access to
  education and training, for people already
  working in NHSScotland and those with aspirations
  to join, that is reflective of the changing
  demography and increasing diversity of Scotland.

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Performance ManagementTriangulation

• Local Delivery Plan

HEAT
Workforce Plans
Finance Plans
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Performance Management

• Health Improvement for the people of Scotland
  improving life expectancy and healthy life
  expectancy
• Efficiency and Governance Improvements
  continually improve the efficiency and
  effectiveness of the NHS
• Access to Services recognising patients need
  for quicker and easier use of NHS services and
• Treatment Appropriate to Individuals ensure
  patients receive high quality services that meet
  their needs.

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NHSScotland Performance Targets - Efficiency

• Efficiency Targets for 2009/10
• NHS Boards to deliver agreed improved
  efficiencies for 1st outpatient attendance DNA,
  non-routine inpatient average length of stay,
  review to new outpatient attendance ratio and day
  case rate by March 2011.
• NHS boards to operate within their agreed revenue
  resource limit operate within their capital
  resource limit meet their cash requirement.
• NHS boards to meet their cash efficiency target.
• To increase the percentage of new GP outpatient
  referrals into consultant led secondary care
  services that are managed electronically to 90
  from December 2010.
• NHS Scotland to reduce emissions over the period
  2011.
• Achieve universal utilisation of CHI (radiology
  requests).
• NHS Boards to ensure at least 80 percent of staff
  covered by Agenda for Change to have their annual
  Knowledge Skills Framework development reviews
  completed and recorded on e-KSf by March 2011.

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NHSScotland Performance Targets Health
Improvement

• Health Improvement Targets for 2009/10
• 80 of all three to five year old children to be
  registered with an NHS dentist by 2010/11.
• Achieve agreed completion rates for child healthy
  weight intervention programme by 2010/11.
• Achieve agreed number of screenings using the
  setting-appropriate screening tool and
  appropriate alcohol brief intervention, in line
  with SIGN 74 guidelines by 2010/11.
• Reduce suicide rate between 2002 and 2013 by 20,
  supported by 50 of key frontline staff in mental
  health and substance misuse services, primary
  care, and accident and emergency being educated
  and trained in using suicide assessment
  tools/suicide prevention training programmes by
  2010.
• Through smoking cessation services, support 8 of
  your Boards smoking population in successfully
  quitting (at one month post quit) over the period
  2008/9 2010/11.
• Increase the proportion of new-born children
  exclusively breastfed at 6-8 weeks from 26.6 in
  2006/07 to 33.3 in 2010/11.
• Achieve agreed number of inequalities targeted
  cardiovascular Health Checks during 2009-10.

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Governance Structures Responsibility
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The Martin Model for Organisational Harmony

• Hierarchy Leadership
• Accountability Governance
• Recognition Reward
• Management
• Organisational Development
• Nous
• Yearning

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• Thank you.