NHS Forth Valley

New Zealand Visit 2014

Jane Grant CEO

Profile of Scotland

• 5m population declining and ageing

• Urban central belt, remote areas in North

• Reliance on public sector-higher than UK

• Health status-lower than UK

• Inequalities-higher than UK

• Health spend-reaching European average

Health system

• 11 mainland Boards• Responsible for health improvement and service

delivery• Strong governance & public accountability• Board membership• Integrated / regional / CHP approach within

health• Increasing emphasis on public sector

partnership working

NHS Forth Valley

Co-terminous with 3 Local AuthoritiesFalkirkStirlingClackmannanshire

Forth Valley

Population of Scotland

The changing demographic nationally

Projected bed days by age band (All FV Residents only)

Facts and Figures NHS Forth Valley

• Spending just under £500m per annum

• Around 8000 direct employees

• Serving a population of 300 thousand

• Covering an urban and rural area

• Operating 1 major hospital, 4 community hospitals, wide range of primary care and community based services

Facts and Figures(2)

• 45,000 In Patients/Day cases in acute• 260,000 Hospital Out-patients• C1.5 m primary care consultations• 450,000 community nursing contacts• Many other community contacts for

children, psychology etc.• Staffing resource is therefore most

significant

Generic Care Pathway

Tier 0Well

Tier 1Development of Symptoms

Tier 2Established Long Term Condition or Health Problem

Care managed in Community

Tier 3Enduring or complex problem.

Care mostly managed in community but requiring specialist input

Tier 4More serious exacerbations

or single episodesCare needs more complex

Tier 5End of

life care

Home and Community

Primary CareCommunity Pharmacy

Diagnostic, Outreach & Rehab Services

Community Hospital

Acute Hospital

HospiceCommunity HospitalCommunity

DiagnosisEvidence-based System awareness

Self managementRisk assessment Co-ordinated care

Co-ordinated admission, discharge and alternatives

Referral management

Health promotion Signposting

Integrated 24/7 partnership working

Focus on Quality & Safety

• Quality & Safety Priorities– Reducing avoidable mortality– Reducing avoidable harm– Improving patient experience– Ensuring evidenced based care– Contributing to safely reducing costs and

increasing increasing time to care

• Demographic

• Financial context

• Integration of all Health and Social Care

• Delivery of the 2020 Vision

Further Challenges

More on Quality

Peter MurdochInterim Medical Director

Much more than buildingsDesign Principles 2004 • Improved patient flow and separation of

streams

• Ambulatory bias

• Community and integrated focus

• Right care by right person, right place, first time every time

• Multidisciplinary team working

• Flexibility

Challenges

• Continuing drive to improve Quality & Safety• Person centred approach• Community focus• Consistency• Improving access• Optimising efficiency• Demographics and co-morbidity• Information driven improvement

Encouraging Culture Change

• Openness, honesty and candour• Striving for excellence • Reflective learning • Commitment to Improvement and Quality-• Continue to learn and embed range of QI

methods• Effective leadership • Information driven • Clarity and communication

New Vision

• Beyond boundaries – working together for a healthier future

• Radically reviewing systems across all sectors

• Commitment and momentum to radical and transformational change needed

Tom Steele

Director of Strategic Projects & Property

Responsibilities Include

• Operational estates and facilities management services

• Strategic asset planning and development

• Operational services are delivered in house as well as contracted out

• Strategic priorities:– Locality service and infrastructure planning– Current projects:

• Stirling care village• Doune Health Centre• FVRH CHP power plant• IMT strategy• Vehicles and fleet management• Medical Equipment

Fiona Ramsay

Director of Finance

Community Health Partnership £ 92.7mSpecialist and Ambulatory Care £ 78.6mEmergency and Inpatient Services £ 72.0mWomen and Children £ 22.5mPrimary Care Prescribing £ 53.7mGeneral Practitioners £ 40.5mDentists, Pharmacists, Opticians £ 30.1mArea Wide Services/PFI £ 84.2mSpecialist Services outwith Forth Valley £ 43.4m

Total £ 517.7m

Finance

Estimated Scottish Government DEL Expenditure – June 2010 Budget Results (2010/11 Prices)

20,000

22,000

24,000

26,000

28,000

30,000

32,000

£ M

illio

ns

(20

10

-11

Price

s)

2009-10 2025-2616 years

£42 billion

Key issues- Pension Changes- Demographic pressures- Delivery of Waiting Times Targets- Emergency Care demand and flow- Deliver more care in home/community- Prescribing / Technology

Need to reduce costs by 3% per annum to ‘stand still’ and expected to move resources to community…

Finance

Helen Kelly

Director of Human Resources

NationalNHSScotland

• Staff Governance Standard

• Partnership Working with Trade Unions

• Workforce Vision & Implementation PlanEveryone Matters

LocalNHS Forth Valley

• Workforce Strategy

• Staff Experience

• Values Matters Programme

• Workforce Planning

Our PeopleNHS Forth Valley Workforce by Job Family (headcount)

ADMINISTRATIVE SERVICES, 989, 17%

ALLIED HEALTH PROFESSION, 542, 9%

DENTAL, 14, 0%

HEALTHCARE SCIENCES, 189, 3%

MEDICAL (TRAINED), 327, 6%

MEDICAL (TRAINING GRADES), 202, 3%

MEDICAL AND DENTAL SUPPORT, 89, 1%

NURSING / MIDWIFERY, 2122, 37%

NURSING / MIDWIFERY (UNQUALIFIED), 849, 14%

OTHER THERAPEUTIC, 182, 3%

PERSONAL AND SOCIAL CARE, 13, 0%

SENIOR MANAGERS, 28, 0%

SUPPORT SERVICES, 398, 7%

ADMINISTRATIVE SERVICES

ALLIED HEALTH PROFESSION

DENTAL

HEALTHCARE SCIENCES

MEDICAL (TRAINED)

MEDICAL (TRAINING GRADES)

MEDICAL AND DENTAL SUPPORT

NURSING / MIDWIFERY

NURSING / MIDWIFERY (UNQUALIFIED)

OTHER THERAPEUTIC

PERSONAL AND SOCIAL CARE

SENIOR MANAGERS

SUPPORT SERVICES

Challenges

• Workforce Planning and Development – right person, right skills, right time, ensuring our workforce has time to learn

• Developing Leaders and Succession Planning for Emerging Leaders to address the workforce demographic

• Supporting a culture of Quality and Improvement whilst still responding to demand and pace of service delivery

• Embedding Staff Governance Standard and workforce values in practice and recognising staff for ‘Values-based’ performance and achievement

• An integrated future and developing a multi-professional and multi-agency approach to team working