nhs western isles local delivery plan 2015-16...7.7 ~ ivf treatment 7.8 ~ reduce healthcare...

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NHS WESTERN ISLES

LOCAL DELIVERY PLAN2015-16

Filename LDP Version 3

Owner Dr Maggie WattsDirector of Public Health

Author Michelle McPhailBusiness Manager

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CONTENT

Strategic Priority 1 – Health Inequalities and Prevention

1.1 ~ NHS Procurement Policies1.2 ~ Employment policies supporting people to gain employment1.3 ~ Supporting staff to support most vulnerable populations1.4 ~ Health improvement actions

Strategic Priority 2 – Antenatal and Early Years

2.1 ~ Duties consequent to Children and Young People (Scotland) Act 2014 –a) Work programmesb) Staff development

Strategic Priority 3 – Person Centred Care

3.1 ~ Person centred care (“Must do with Me”)3.2 ~ Staff and public feedback3.3 ~ Feedback and complaints – closing the loop

Strategic Priority 4 – Safe Care

4.1 ~ HAI – cross referenced with 7.34.2 ~ Scottish Patient Safety Programme rollout of acute programme into primary

care, maternity, neonates and paediatrics and mental health services4.3 ~ Response to the Vale of Leven Inquiry Report

Strategic Priority 5 – Primary Care

5.1 ~ Strategic Intentions –5.1.1 ~ Leadership and workforce5.1.2 ~ Prioritised local actions to increase capacity5.1.3 ~ Technology and data5.1.4 ~ Contracts and resources

Strategic Priority 6 – Integration

6.1 ~ Effective involvement of clinical and care staff in joint planning

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Section 7 – HEAT STANDARD

7.1 ~ First Stage Cancer7.2 ~ 12th week pregnancy appointment7.3 ~ Operate within the RRL & CRL – reported within the financial

performance narrative report Appendix 1 & 27.4 ~ CAMHS7.5 ~ 18 week RTT Psychological Therapies7.6 ~ Newly diagnosed with dementia7.7 ~ IVF treatment7.8 ~ Reduce Healthcare Associated Infection – SABs7.9 ~ Rate of CDiff7.10 ~ Smoking cessation – referred to in section 1.47.11 ~ Diagnosed with cancer – 31 day treatment7.12 ~ Begin treatment of urgent cancer within 62 days7.13 ~ Commence treatment within 18 weeks of referral7.14 ~ 48 hr access to GP7.15 ~ GP appointment in 2 days7.16 ~ A&E 4 hour wait7.17 ~ RTT7.18 ~ Sickness Absence7.19 ~ Alcohol Brief Interventions7.20 ~ 12 week Treatment Time Guarantee7.21 ~ 12 week for first Outpatient Appointment

Section 8 – Financial Performance Narrative & Template - Appendix 1 & 2

Section 9 - Workforce

9.1 ~ Implementation Plan for “Everyone Matters”9.1.1 ~ Healthy organisational culture9.1.2 ~ Sustainable workforce9.1.3 ~ Capable workforce9.1.4 ~ Integrated workforce9.1.5 ~ Effective leadership and management

9.2 ~ Wider Workforce Plan – Use of workload and workforce planning tools

Section 10 – Community Planning

10.1 ~ Community Empowerment (Scotland) Bill10.2 ~ Health and wellbeing outcomes

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1. STRATEGIC PRIORITY: HEALTH INEQUALITIES AND PREVENTIONExecutive Director lead: Dr. Maggie Watts, Director of Public Health

We intend to review the contracting policy during 2015-16 and consider the specific inclusionof corporate and social responsibility. The current contracting policy is predominantlygoverned by national legislation. The Procurement Reform (Scotland) Act covers communitybenefits clauses and SPPN 06/2014 (Scottish Procurement Policy Note) – “Deliveringcommunity benefits in public procurement” are encompassed within the current practice. Wehave already signed up to the “Suppliers Charter”.

Outline key activities underway and / or planned. Encouraging national contract suppliers to sub-contract with local companies. (e.g.

MFDs, frozen food etc) Collaborating with the local authority in supplier information events. Holding contract awareness events for significant local contracts (e.g. Fresh food,

taxis) Encouraging registration on Public Contracts Scotland (PCS) to give local companies

access to all contract opportunities. Using PCS Quick Quote to access local suppliers directly with Invitations to Quote. Working proactively with supported businesses to explore contract opportunities (e.g.

Highland Blindcraft)How will progress be demonstrated? Please give key measurables and milestones.

Development of contracting policy to include corporate responsibility by end of March 2016

How will key stakeholders and partners be engaged and involved?

As part of routine process for development of policy. We will continue our current contactswith local suppliers.Key plans are ~ (embed document or give hyperlink)

Contracting policy.

Area for specific action 1.1 NHS procurement policies

Produced by:Contributors:

Dr. Maggie WattsAdrian Trevor

Please provide a short paragraph on what the plans are for 2015-16

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1. STRATEGIC PRIORITY: HEALTH INEQUALITIES AND PREVENTION

In 2015/2016 NHS Western Isles will continue to provide placements to young people fromvarious organisations (schools, Lews Castle College, universities and Job Centre Plus).Skills Development Scotland is intending to have a Careers Event in March 2015 and NHSWestern Isles will attend the event to promote careers and placements.Outline key activities underway and / or planned.In 2014-2015 NHS Western Isles provided 71 work experience placements to young people.These placements were provided in Nursing, HR, AHP, Pharmacy, Laboratory, HotelServices, I.T, Finance, Works and Health Promotion.The work experience placements are provided in the three Hospitals on the Western Isles,St Brendan’s Hospital, Uist and Barra Hospital and the Western Isles Hospital. Theplacements were requested by fourth year and sixth year school pupils, Lews Castle Collegestudents, AHP University students and Job Centre Plus clients. Applicants also came fromSkills Development Scotland and Cothrom. A long term placement is provided for a personwith Learning Disabilities under the Local Area Co-ordination Programme.We had several Nursing Elective placement requests from students attending Universities inEngland who were requesting a Remote and Rural placement experience.

How will progress be demonstrated? Please give key measurables and milestones.Measurables – number of placement requested and number delivered.We will seek qualitative feedback from those who have completed a placement to continueto monitor appropriateness.


A system is in place for contacts with local schools and colleges and with Job Centre Plus,which will be maintained.

Key plans are ~ (embed document or give hyperlink)Nil specific

Area for specific action 1.2 Employment policies supporting people to gainemployment


Dr. Maggie WattsJanet Tierney


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1. STRATEGIC PRIORITY: HEALTH INEQUALITIES AND PREVENTION

In 2015/2016 we will continue to support staff in a range of ways to support the mostvulnerable in the community. We will continue to deliver Poverty Awareness training for staffin the NHS and beyond. This multi-agency training course focuses on removing some of themyths surrounding poverty in the Western Isles and giving staff the skills to identify someonewho might be struggling and up to date information on what services are there to supportpeople. As part of this work we are piloting a joint referral form for professionals to use torefer individuals who need support by doing this we hope to reduce bureaucracy andstreamline services to make it easier for people to access support and advice

Outline key activities underway and / or planned. 4 Poverty Training courses have been run and 4 more are planned for 2015/2016. Completion of the joint referral form pilot with NHS Lothian. Evaluation of the Pilot and roll out of the key learning. Implementation of the learning from the pilot.

How will progress be demonstrated? Please give key measurables and milestones. Number of training courses run and the number of people who attended. Findings of the pilot and evaluation report for the pilot. Implementation of the key findings from the pilot.


The content of the training course has had input from CNES and Citizens AdviceBureau

The poverty awareness training is co-delivered by Citizens Advice Bureau The single referral form pilot has been developed in partnership with NHS Lothian CNES are contributing to the pilot by providing a central point for the referrals and

disseminating them where appropriate The pilot is using a small test of change methodology and testing the form and

pathway with community nurses and families.

Key plans are ~ (embed document or give hyperlink)

WR bid.pdf poverty awarenesscourse.doc

Area for specific action 1.3 Supporting staff to support most vulnerable populations


Dr. Maggie WattsSara Aboud


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1. STRATEGIC PRIORITY: HEALTH INEQUALITIES AND PREVENTIONExecutive Director Lead: Dr. Maggie Watts, Director of Public Health.

1. Health inequalities (see also Community planning partnership section 10)In 2015- 2016 we will continue to focus on reducing health inequalities in the Western Islesby targeting work on alcohol misuse, tobacco use, obesity and cancer prevention. Althoughthese are diverse areas of work, we will use a methodology of targeted universalism toreduce the impact of inequalities by building the capacity and resilience of individuals andcommunities to make informed health choices and support those with long term conditions.

2. Priority – alcoholThe Outer Hebrides ADP will continue to provide alcohol and drug services locally focusingon the strategic priorities of Early Years, Early Intervention, Problem drinkers and substanceusers and Assist in the promotion of a healthy Outer Hebrides. The ADP will commencework on a commissioning strategy and the implementation of a Recovery OrientatedSystems of Care. The first stage of this will be a Needs Assessment which will take place in2015/16. The ADP will also compile a Workforce Development Strategy for alcohol and drugservices in the Outer Hebrides in partnership with STRADA.

3. Priority - TobaccoFollowing the successful implementation of smoke-free NHS grounds in November 2013, wewill continue to evaluate the programme. We will seek to engage with wider partners in thecreation of a local tobacco action plan to extend the impact of the work already undertakenby NHS Western Isles and Comhairle nan Eilean Siar.

Work with clinical teams to encourage referral to smoking cessation services across theislands will be maintained and we will meet our HEAT target for successful quit attempts.We will continue to place an emphasis on 1:1 sessions with clients and increase the timespent with them in order to ensure that we will meet the 12 week target. We are going tofocus more on quality quits rather than quantity. As part of No Smoking Day we will uselocalised campaign materials using client journeys and experiences in materials as previousexperience of this methodology for Detect Cancer Early has been highly positive andeffective in generating interest. The joint working with Maternity and Acute Psychiatry will bereinforced and we will deliver ‘raising the issue of tobacco’ training with these groups.The majority of our smoking cessation will continue to derive from non-pharmacy sources as

Area for specific action 1.4 Health improvement actions


Dr. Maggie WattsSara AboudEmelin CollierKaren France


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capacity of the local pharmacies to deliver in accordance with the programme is very limited.We will continue to meet regularly with the pharmacists and have identified a localchampion. We will also continue to provide regular updates and training for the localpharmacists.We are currently developing a drama project with the local secondary school pupils focusingon smoking prevention and will roll this out across the islands.

4. Priority - Obesity reductiona) Physical activity - Increasing the levels of physical activity in the Western Isles is anintegral part of reducing levels of obesity and also increasing mental wellbeing. A range ofactivities will take place to encourage the inactive to become active these include a calendarof walks. The 3x30 challenge will also be held again and the Men’s 5K as well as events toraise awareness of the BHF. The physical activity strategy is currently being reviewed andwill be developed with partners from the third sector and local authority.b) Healthy eating – the Department of Nutrition and Dietetics continue to support a range ofweight management programmes, mainly focusing on weight reduction and maintenance ofweight loss. A weight management programme for staff was introduced during 2014-15,which is proving successful. This will be maintained during 2015-16 and consideration givento broadening it out to community groupsChild Healthy Weight interventions will continue. One to one programmes are to be the

main focus but there will also be school based programmes. In the upcoming year there willbe an additional focus on younger children.C) Early years nutrition - Work is ongoing to ensure that the Maternal and Infant

Nutrition(MIN) Strategy Action Plan, Child Healthy Weight, the Maternity Framework and theEarly Years Collaborative are working in synchrony to avoid duplication of effort and that themost effective use is made of all available resources. Activities include:

Peer Support Service for breastfeeding with continuation of the Mulaidh Groupand Bosom Buddies

Stage 2 of UNICEF Baby Friendly Accreditation maintenance and work towardsnext/final stage, focusing on community action

Roll out and evaluation of the HENRY(Health, exercise, nutrition in really young)programme

Support for the ongoing Young Mums Groups, including REHIS certificate courseon community food and health

Support for the development of the first Fathers Group Improving the uptake of Healthy Start Vouchers, aiming to achieve 92% uptake by

end of 2016-17 Continuation of the successful distribution of vitamins

5. Priority - Mental healthPromoting mental wellbeing is entwined with all aspects of health promotion activity.However, over the next year we will be increasing the pool of trainers for Asist and deliveringMental Health in the Workplace we will continue to promote Steps for Stress and are

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exploring how. We can use mindfulness techniques in the workplace.

6 Priority - Cancer awareness and supportLocally the Detect Cancer Early Programme has taken a broader focus than the nationalprogramme. The main focus has been raising awareness of cancer and the small lifestylechanges that can reduce the risk of developing cancer as well as the importance of gettingchecked. We will continue to run campaigns on the different cancers and work withcommunity groups to build support mechanisms. This will take the form of ladies nights toraise awareness of female cancers, articles in the local press, a TV documentary on men’scancers, events for Men’s Health Week and Movember and cancer road shows.

Outline key activities underway and / or planned.Alcohol –

Establish a Recovery ADP sub group to focus on recovery system of care Establish a Commissioning ADP sub group ADP winter and summer campaigns FASD awareness Day Recovery Walk Allocate funding to Alcohol and Drug Services Monitor and evaluate the effectiveness of services Support the development of the Uist and Barra Substance Misuse Partnership Provide Workforce Development Training for Services Needs assessment Workforce development

Obesity - Review Physical Activity Strategy 3x30 challenge Walk Calendar Men’s 5 K One to one adult weight management programmes Potential rollout of pilot staff weight management group in the Western Isles Hospital

to community groups Evaluation of recently implemented HENRY (Health, exercise, nutrition in really

young) programme Maintenance of Healthy Start vitamin programme.

Tobacco - Review of NHS Smoking Policy and smoke free grounds No Smoking Day Events Smoking Cessation service to meet HEAT Targets Training courses for specific staff groups and pharmacies

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Drama project with schools.

Cancer awareness and prevention - Movember events Cancer Road shows Woman’s Night event to raise awareness of female cancers TV documentary on Men’s Cancer Group Cancer Group established and up and running in Uist Mental Health in the Workplace training course DCE media campaigns.

How will progress be demonstrated? Please give key measurables and milestones.Alcohol -

First meeting of ADP recovery sub group meeting and setting quarterly meeting dates Action Plan for Recovery sub group and setting quarterly meeting dates First meeting of the ADP Commissioning sub group Action Plan of Commissioning sub group Completed outcomes data base for Drug and Alcohol services with reports for

services Completed SWOT analysis for Drug and Alcohol Services 6 monthly and annual service visits for Drug and Alcohol services Completed campaign descriptors for all events, training projects and campaigns Campaign and evaluation reports for all events, training projects and campaigns Needs assessment produced Workforce development strategy written.

Tobacco - Meeting the Smoking Cessation HEAT target Training courses for specific staff groups and pharmacies Drama project with schools Review Smoking Policy.

Obesity – Completed Physical Activity Strategy Number of people attending events/ training and participating in projects MIN Group meet bi-monthly to receive updates of funded projects. This will include

the use of allocated funding, numbers of attendees, activity programme, evaluationsthroughout programmes in relation to improvements in diet, lifestyle, knowledge, self–confidence and mental resilience and measureable outcomes. A progress report issubmitted to the Scottish Government. every six months.

The EYC activity is monitored by the Leadership Group who meet fortnightly and thenmeet monthly with the Workstream Leaders.

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Mental health – Rise in number of trainers for ASIST training to 4 Completion of mindfulness training for at least 2 community and 1 staff group,

programme evaluated.

Cancer prevention - Completed TV Documentary Feedback from participants and stories such as individuals cancer journeys


Partners and stakeholders are integral to the successful implementation of healthimprovement programmes and are already engaged in all of the strands identified above.We will continue to consult with partners including staff and patients, carers and the widerpopulation on the development of projects and strategies such as the development ofphysical activity strategy. Steering groups consisting of partners are essential to ensuringthe success of projects such as Men’s Health Week.

The Maternal &Infant Nutrition Strategy (MIN) Group and the Early Years Collaborative areboth multi-agency/disciplinary groups comprising representation from relevant disciplines inhealth and social care, education and Action for Children. As well as membership of thesegroups they also have individual projects or PDSAs in line with the activity above for whichthey are responsible.


ADP delivery plan 2012-2015Item 4 - ADP

Delivery Plan 2012-15.pdf

ADP delivery plan 2015-18 (in development)

Maternal and Infant Nutrition Action planAction

Plan_WI_Completed June14.DOC

Early Years Collaborative PDSAs

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2. STRATEGIC PRIORITY: ANTENATAL AND EARLY YEARSExecutive Director Lead: Dr Maggie Watts, Director of Public Health

Plans for 2015-16 focus on:a) implementation of the relevant provisions of the Act and consolidating the work

undertaken in the multiagency introductory sessions on the Act from 2014-15b) development of the new Integrated Children’s Services Plan to be completed by May

2015c) preparation for the joint inspection of children’s servicesd) ratifying and implementing the child protection and public protection training

programme for 15/16e) introduction and successful implementation of the single Child’s Plan documentation.

Outline key activities underway and / or planned.a) A comprehensive training/information programme on the Act is planned involving key

people from the Scottish Govt. and other health boards. This will include training onthe role of the named person and the establishment of a named person service.Alongside this, awareness raising with children, carers and families on therequirements of the Act and its local provision will be developed over 2015-16 inreadiness for full implementation from 1st August 2016.

b) ICSP Strategy group leading on agreement of ISCP and formal adoption by statutoryagencies. Subgroups established for key thematic areas.

c) Self-evaluation of children’s services, championed by the Child Protection Committee.

How will progress be demonstrated? Please give key measurables and milestones.Key staff groups aware of responsibilities and changes as result of implementing Childrenand Young People’s Act; NHS Board to receive regular updates to assure on progress withimplementation and compliance.

ICSP Strategy group well established, with agreed shared workplan and ICS Plan in place.Subgroup membership agreed with clear roles and responsibilities in ensuring child welfare,child protection and child wellbeing.

Positive learning environment for joint inspection of children’s services with shareddiscussion on progressing recommendations arising from inspection.

Area for specific action 2.1 Duties consequent to Children and Young People(Scotland) Act 2014a) Work programmes

Produced by:Contributor:

Dr. Maggie WattsEmelin Collier


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Child’s Plan introduced across partner agencies in the Western Isles.


ICSP Strategy group is engaging with service providers, service users, children and familiesas the strategy has developed. This will be maintained.Further work will be progressed with families around the specific requirements of the Act.


Integrated children’s service plan (in development)

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2. STRATEGIC PRIORITY: ANTENATAL AND EARLY YEARSExecutive Director Lead: Dr. Maggie Watts, Director of Public Health

The key elements of staff development relate to: ensuring that workforce planning prepares for the delivery of the Named Person

service from 1st August 2016 training for staff on their responsibilities under the Act ensuring information is shared across and within agencies to uphold the requirements

of the Act reviewing and revising where appropriate the staff and care governance frameworks

in the light of the Act.

These will be implemented through: training and developing staff as health visitors ensuring structures are in place to enable HVs to carry out HV role as outlined in the

HV implementation plan in order to comply with GIRFEC principles working in partnership with local authority and third sector partners to ensure shared

understanding of the practice of GIRFEC across services in the Western Islesincluding data sharing, documentation and the roles of the lead professional andNamed Person

assessing and reviewing governance structures and procedures within the NHS.

Outline key activities underway and / or planned.Significant recent staffing changes have provided an opportunity to redevelop and increaseresources for health visiting and implementation of the Act. Highlighted elements include:

the use of GIRFEC funding to support HV training for 1 WTE from existingestablishment in 2015 and continue to support the development of further HVs in2016

Training of one Community Practice teacher during 2015 (a necessary requirement tofacilitate HV training locally)

The creation of a coherent team structure for the health visiting and school nursingteam that provides professional, strategic and operational leadership togethercreating a drive to implement GIRFEC across the organisation

The reconfiguration of skill mix within HV team to facilitate the use of HV time

Area for specific action 2.1 Duties consequent to Children and Young People(Scotland) Act 2014b)Staff development

Produced by:Contributed by:

Kathleen McCullochDorothy Macdonald


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effectively (to focus on the statutory requirements of the Act) Further application of the caseload weighting tool, workload tool and professional

judgement to inform practice requirements Scoping exercise to assess administrative, information and information technology

needs of the HV service Provision of ‘long arm’ mentorship.

How will progress be demonstrated? Please give key measurables and milestones.Key measurables include:

One HV student place funded in 2015 provision of 2 long arm mentors to support CPT to deliver HV training locally –

ongoing in 2015-16 Qualitative feedback from HV students, CPT students and Long arm mentors – by

end of 2015-16 Training places offered and delivered – by end of 2015 Findings from scoping exercise identified by end of September, action plan developed

by end of December 2015 Results of caseload weighting tool and work load tool by end July 2015 leading to

development of more balanced caseloads than currently by end of November 2015.


Developing key relationships across other agencies and within own organisation toimplement and support GIRFEC principles through creation of appropriate strategic andoperational leadership structures.


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3. STRATEGIC PRIORITY: PERSON CENTRED CAREExecutive Director Lead: Mrs. Chrisanne Campbell, Nurse Director (Interim)

A cornerstone of the Person Centred Health and Care Programme is supporting staff toensure they are able to deliver the best care. Initiatives to support this and future reporting tothe national team are:

Patient Perspectives - Your Views – A Real Time Survey (flash report)A quantitative and qualitative experience survey will be tested in Surgical Ward by a thirdyear student nurse supported by the Practice Education Facilitator and the eMrec ProjectManager. Paediatric Services are planning on using this with children admitted to MedicalWard 1. The survey will be completed using a digital pen and, once completed, theinformation is uploaded and analysed. The results will be shared with the senior chargenurse and actions taken where necessary. The surveys will be tabled at the patientexperience group who will monitor progress.

Playlist for LifePlaylist for life encourages families and caregivers to create a playlist of personallymeaningful music for people with dementia. Training is being planned with the intention ofhaving champions who will gather this information. We have organised two training events;One will be on the 13th April in Alzhimers Scotland premises from 17:00 21:00 to allow thecarers to attend and the other one will be on 14th April Lecture Room, Education UnitWestern Isles Hospital for the Health and Social Care professionals to attend. Staff whohave shown an interest and received the training will be encouraged to support families andcarers to create playlists for patients service users.

Hotboards – Provision of Patient InformationFunding received to provide Infection Control compliant display boards for clinical areasproviding patient information to meet Customer Care Standards.

HelloMyNameIsThe Government are providing a funding stream to all NHS Boards to address this and planswill be implemented.

Values Based Reflective PracticeWork has already commenced and will continue in the form of group reflective practiceproviding either drop in sessions or individual departmental support. We have three qualifiedVBRP facilitators in NHS WI: the Lead Chaplain & Strategic Diversity Lead, the WI HospitalChaplain and the Uist & Barra Hospital Chaplain and the fourth one under training that isCPNs Manager Lewis & Harris.

Area for specific action 3.1 Person centred care (‘Must do with me’)3.2 Staff and public feedback

Produced by: Marion Conway


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In terms of the promotion of VBRP, Chaplains have made presentations to groups such asSenior Charge Nurses, Mental Health Team, AHP Team. Departments that are interestedcontact the Chaplains to set up VBRP groups.Support for measurement has been sought from the Health Intelligence and InformationTeam at NHS Western Isles and they will work alongside the national team to establish anumber of suitable performance measures.

IMatter (Everyone Matters)Future reporting will be through this method

Outline key activities underway and / or planned.A range of Initiatives have been developed including the following:

What Matters to MeThe MS Specialist Nurse is testing the “What Matters to Me” posters in both acute andcommunity settings. This has been carried out in partnership with patients and carers andthe Stroke Liaison Nurse is testing this tool as a method of improved communication.

Jabber ClinicsPilot of Jabber Clinics for MS Patients within community settings is underway and patientsown homes reducing stress and travel time and uptake of appointments.

Information Sheets for Patients And Families (flash report)This is being tested by the Stroke Liaison Nurse to improve a two way flow ofcommunication between patients and families and clinical staff.

Welcome to the Ward(flash report)Medical Ward 1 has developed and tested a “welcome to the ward leaflet” whichincorporates teachback to ensure patients and family members are clear on patients careplans and incorporates information for discharge. This ward leaflet continues to be tested asfurther developments are being made to the leaflet. The next version of the leaflet willinclude a photograph of the SCN for the ward, following feedback on its usefulness the planis encourage other wards to use the leaflet.

Person Centred Walkrounds

Person centred walkrounds have been carried out by the Associate COO Acute care andHead of Clinical Governance. A walkround is also planned involving patients to look atissues highlighted by MS and Parkinsons patients which will also incorporate patientinformation and address issues picked up in our response to the recent Audit Scotlandreport on Customer Care Standards. Over the last year a number of walkrounds have takenplace including walkrounds by the chairman, as part of our response to Vale of Levenrecommendations further walkrounds (weekly) are being planned with a senior manager anda member form the infection control team currently work is being undertaken to co-ordinateall walkrounds in a manageable and achievable manner.

How will progress be demonstrated? Please give key measurables and milestones.One of the components of the programme will be the ability to demonstrate success.Measurement is also a critical part of testing and implementing changes; measures tell ateam whether the changes they are making actually lead to improvement. The measurement

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framework to support this programme will be aligned with the Quality Outcomes Framework.Support for Measurement has been sought from the Health Intelligence and InformationTeam at NHS Western Isles and they will work alongside the national team re suitablemeasures.


This will be promoted and taken forward through the Patient Experience Group and beoverseen by the Board PFPI Committee both these groups have Partner and layrepresentation.


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3.3 FEEDBACK AND COMPLAINTS – CLOSING THE LOOPExecutive Director Lead: Mr. Gordon Jamieson, Chief Executive.

We will continue to encourage and promote the receipt of comments, concerns, complaintsand feedback.In addition to learning, responding effectively and closing the loop, we will introduce asystem to ensure that stated improvements to system and services are in fact sustained.We will develop a live “real time” satisfaction survey and enhance patient carercommunication and information.e-Learning modules and sessions with student nurses will continue.Outline key activities underway and / or planned.

1. Test a Realtime Survey ~ “Your Views” All 5 “Must Do” elements are included Test site surgical ward Survey carried out at point of discharge, during the care episode or within two weeks

following discharge.2. Test improved patient and carer/family written information. Areas include, Multiple

Sclerosis, Stroke patients and general “Welcome to the Ward”.3. To carry out Person Centred Walkrounds using the 15 Steps Challenge, Involving

Patients and Careers/visitors.4. Develop action plans in response to Scottish In-Patient Experience Survey.5. Encourage, learn and respond to Patient Opinions postings.6. Continue to optimise the use of Social Media, for example, “Get Involved” initiatives.

How will progress be demonstrated? Please give key measurables and milestones.Summary feedback, action plans and outcomes reported quarterly to CorporateManagement Team and annually to the Board.


Locality Planning and patient participation group engagement.


Area for specific action 3.3 Feedback and Complaints ~ Closing the Loop

Produced by : Gordon Jamieson


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4. STRATEGIC PRIORITY: SAFE CAREExecutive Director Lead: Mrs. Chrisanne Campbell, Nurse Director (Interim)4.1 HAI (cross referenced to 7.3)

Acute CareReview the 10 essentials and stop reporting on areas that there is 100% reliable complianceand only do spot audits.Spread and embed the 9 Point of Care Priorities to all clinical areas in Acute care.

Primary CareOnce the areas for measurement have been agreed, develop a local enhanced service withG.P. practices and commence reporting.

Mental HealthContinue to implement the Patient Safety Climate Tool Communication (SBAR) and RiskAssessment and identify other areas for improvement.

Maternal Care & Neonates

Embed the bloodspot screening SBAR, handover Bespoke SBAR for intra uterine, andpatient feedback.

PaediatricsTest the documentation what is important to me form for the Children and Young people andtheir families to pictorially complete.

Outline key activities underway and / or planned.The Scottish Patient Safety Programme (SPSP) is one of the national improvementprogrammes, developed over recent years in relation to the national Healthcare QualityStrategy.

• Acute Adult Care• Primary Care• Mental Health• MCQIC (incorporating Paediatrics, Maternal Care & Neonates)

Area for specific action 4.2 Scottish Patient Safety Programme rollout of acuteprogramme into primary care, maternity, neonates andpaediatrics and mental health services

Produced by: Marion Conway


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Acute Adult CareThe 10 Scottish Patient Safety Programme essentials are embedded elements of work andwe continue to measure and report on the following Essentials:

Hand Hygiene Leadership Walk-rounds Surgical Brief & Pause General Ward Safety Brief Early Warning Scores Central Venous Catheter Insertion Central Venous Catheter Maintenance Peripheral Venous Catheter Intensive Care Unit Daily Goals (Not applicable to Western Isles) Ventilator Associated Pneumonia (Not applicable to Western Isles).

Work continues to be embedded on the following 9 Point of Care Priorities:Deteriorating patients

• Sepsis• Venous thromboembolism (VTE)• Heart failure• Safer medicines• Pressure ulcers• Surgical site infections• Catheter associated urinary tract infections (CAUTI)• Falls with harm.

Progress No ward base cardiac arrests for more than 300 days in Western Isles

Hospital Compliance with PVC bundle and Hand Hygiene remains high Safety Briefings are being conducted.

Areas for Improvement Treatment Escalation Plan and structured response to deterioration for all

areas Completion of Venous Thromboembolism risk assessment. Documentation

has been revised and in line with quality improvement methodology and tosupport the Acute measurement plan. There is focus in one area to ensurereliability prior to implementation and spread.

Falls process measures Reliability of sepsis six.

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Primary Care A measurement plan has been issued from the national team discussion is

taking place with the Medical Director and Primary care Clinical Lead andG.P. sub committee to determine what areas to measure.

Maternity

MCQIC incorporating Paediatrics, Maternal Care & Neonates Challenges around the small numbers in reporting to a national template For Paediatrics no dedicated team

Maternal Care & Neonates Testing bloodspot screening, SBAR handover Bespoke SBAR for intra

uterine, Person dependant for reporting.

How will progress be demonstrated? Please give key measurables and milestones.Reporting on to Lanquip (electronic reporting system) which can produce reports that arethen reported to the SPSP national team.


Display screens are going to be installed in each ward to show up to date information on allthe areas that are being measured. The information will be presented in a user friendly waythat will be easy to understand.


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4. STRATEGIC PRIORITY: SAFE CAREExecutive Director Lead: Mrs. Chrisanne Campbell, Nurse Director (Interim)

The Vale of Leven Inquiry report was set up by Scottish Ministers in April 2009 to investigatethe occurrence of Clostridium Difficile infection at the Vale of Leven Hospital, assessing theperiod from 1st January 2007 onwards.

The findings made 65 recommendations that the Vale of Leven Hospital must address,however the recommendations were sent onwards to all NHS Boards by the ScottishGovernment seeking assurance as to the position within other NHS Boards. Of therecommendations, NHS Western Isles has fully implemented 35, mostly implemented 18,partially implemented nine and not started implementation of three.

NHS Western Isles response to the Vale of Leven Inquiry report along with the action plan isassessed, monitored and progress reported to the Infection Control Committee. The PatientExperience Group has been established and has lay representation. The Vale of Levenrecommendations action plan will also be tabled through this committee. For all HAI andCDIs a Critical Incident Review form is completed and further assessment of the incidenthas been added to take account of the recommendations in the Vale of Leven Report.Outline key activities underway and / or planned.An action plan to address those recommendations that are other than fully implemented isunder development.

How will progress be demonstrated? Please give key measurables and milestones.Progress will be self-assessed and measured at regular intervals throughout the year and inline with Government requirements.


Monitoring, progress and development of control measures is taken forward with continuousreview by the Infection Control Team as well as the Patient Experience Group.Staff areinformed of the updates to practices through the Senior Charge Nurses and specific updatesdepending upon the working location, are directed to individual staff members, wards anddepartments.


Area for specific action 4.3 Vale of Leven Inquiry Report


Dr. Maggie WattsMarion Conway


24

STRATEGIC PRIORITY: PRIMARY CAREExecutive Director Lead: Dr. Angus McKellar, Medical Director

5.1 STRATEGIC INTENTIONS5.1.1 leadership and workforce5.1.2 planning and interface5.1.3 technology and data5.1.4 contracts and resources

5.2 PRIORITISED LOCAL ACTIONS TO INCREASE CAPACITY

1. The role of Clinical Lead primary care will be re- established and redefined to meet theBoard and primary care strategy priorities. The role will also be aligned to the work ofthe committees and workstreams of the Integrated Joint Board.

2. Establish Multi-disciplinary teams based around GP practices to enhance the effectiveuse of resources that support adult health and social care. The teams will coordinateassessment and care management as well as the proactive implementation ofanticipatory care plans to facilitate a greater focus on outcomes for person-centredcare.

3. To develop the role of a community practitioner/physician to provide clinical support forpatients in intermediate care/virtual wards/community setting. The aim is to improvethe identification of older people in the community at risk of escalation or hospitaladmission; this will then facilitate and provide proactive case management for those atrisk of admission by the most appropriate service. The developments will facilitate thedischarge and prevent later readmission of patients from hospital following a plannedor emergency admission. To identify areas for further improvement, collaboration andjoint working and to develop a vision for future ways of working, including a ‘virtualward’ ‘hospital at home’ model.

4. There is a lack of access to integrated community pharmacy. Eight of the ten GPPractices within the Western Isles are Dispensing Practices, one of the remaining twodispenses at the branch surgery. Consequently over 50% of the population do nothave access to Pharmaceutical services. Using Prescription for Excellence as a driverfor change, the Board is working with the GP Sub group to find ways in which somepharmaceutical services can be provided to all patients. We are developing currentsecondary care pharmacy capacity to cover primary care practices for the duration of aSG funded Prescription for Excellence pilot.

Area for specific action 5.1.1 leadership and workforce


Dr A McKellarDr V Strong


25

5. We will develop the Independent Dental Practitioner workforce in the Western Isles.The aim is to encourage either Independent dental practitioners to establish a newdental practice or use established Health Board facilities (if available) to provide NHSGeneral Dental Services.

Outline key activities underway and / or planned.1. Interim clinical lead in post with revised remit until end June. In June, JD completed

and permanent post advertised.Scheme of establishment and shadow arrangements established April 2015; clinicallead role in governance in place by May and potential role on IJB established byJune.The clinical leadership team within the medical directorate will be strengthened(prescribing advisor, development lead, clinical lead primary care) with regularmeetings established to ensure that workplans are aligned with strategic needs. Therole of advisor will be established as a permanent post.

2. The existing arrangements in localities are being collated. A standardised multi-agency assessment and care management process will be established that meets theneeds of GPs and Primary care in all areas of the Western Isles. It is expected thatthe panels will identify cohorts of patients previously identified as being at higher riskof admission or complex multi-morbidity.

3. There are proposals to develop more integrated care that support the needs of frailolder people in more appropriate settings The role would work across the Board areasupporting the patients through frailty assessment, cognitive assessment, advisingstaff and providing a single point of contact for general practitioners. A short-lifeworking group to be established to examine medical staffing needs in WIH and thepotential for a community facing post.

4. We are piloting a system which will enable NHS Western Isles to providepharmaceutical care for those patients living in remote rural areas who are patients ofdispensing doctors and do not have access to a Community Pharmacy. We areworking with two Dispensing GP Practices in two of our more remote and rural islandcommunities in the Uists. It is anticipated that during the year we will roll out the pilotto one more practice. We will work with a Practice based caseload of patients withlong term conditions and/or polypharmacy, including a review of those patients onhigh risk medication or using compliance aids.

5. We are supporting Independent General Dental Practitioner’s eligibility for ScottishDental Access Initiative grants in Stornoway and Benbecula to establish or expandNHS Dental practices.

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How will progress be demonstrated? Please give key measurables and milestones.1. Post advertised by June and filled by Sep 2015. The integration aspects will be

monitored by the Joint Planning Group as committees and representation on IJBestablished

2. Assessment of existing arrangements completed April 2015. Multi-agency panelsand teams established August 2015. Standardised assessment and caremanagement processes October 2015.

3. Initial team established attached to designated ward within Western Isles Hospital bySep 2015.

4. The purpose of the pilot is to trial and assesses the effectiveness of providing remotepharmaceutical services to patients living in remote rural areas and improves two waycommunication between primary and secondary care using telephone and video-conference links and remote access to the GP medical records. Data will becollected on an ongoing basis. Robert Gordon University are evaluating the pilot (Mar2016).

5. Uptake of Independent Dental Practitioners.


1. Interim arrangements agreed in collaboration with Primary Care Steering Group whoaligned roles and responsibilities in line with 20:20 vision, this will continue and reportto Corporate Management Team and consult with Joint Planning Group/IJB.

2. A collaborative approach to establishing multi-disciplinary teams is being taken inpartnership with CNES. The integration module of Releasing Time to Care is beingutilised as a methodology to ensure LEAN processes.

3. A multi-agency steering group has been established and will oversee developmentsand report to the Corporate Management Team. SLWG established involvingrelevant staff.

4. The selection of the Practices has been in consultation with the GP Sub group and adedicated steering group has been established. There is scope within the pilot towork with care homes within the area and to possibly advise multi-disciplinarymeetings. There are monthly video conference updates with Scottish Governmentrepresentatives.

27


IntermediateCare_virual ward (CMT 20.01.15).pdf

Multi-DisciplinaryActivity - H&SC.doc

28

1. A Clinical strategy to be developed that will provide clear direction for primary careand will enable links to the Integrated Joint Board strategic plan. The aim of theclinical strategy is to provide effective and efficient clinical services with minimumdelay and as close to the patient as practicable, maximising the use of medical andcommunication technologies. The clinical strategy will support greater prevention ofill-health and disease, anticipate when conditions may develop or deteriorate,intervene promptly, appropriately and assertively, and the provision of effectivemaintenance and supportive therapies including palliative and end of life care. TheLong Term Care steering group will oversee the work of the Managed ClinicalNetworks and drive through recommended changes.

2. A short-life working group has been established to develop proposals to developcapacity within the Out Of Hours provision.

3. Proposals for joint working with SAS will be developed.Outline key activities underway and / or planned.1. The Clinical Strategy will emphasise the planned move from reactive care to

anticipatory care that shifts District General Hospital and Community Hospital care toclinical care based in the community close to the patient. Planned activity includes:

Development and promotion of telecommunications services to providepatient-led teleclinics

The establishment of practice-attached staff as locality teams including healthvisiting, community psychiatric nursing and social work

The development of seamless care across primary and secondary services, forexampleo consultant physicians and surgeons being involved in the primary care

management of patients (such as telecare for patients with COPD; routinediscussion of referrals and patient management to develop more effectiveoutpatient services)

o the development of a ‘virtual ward’ model utilising the skills of theorthopaedic rehabilitation and stroke team to work as part of the integratedprimary care team with home care staff

o Enhancement of the off-island secondary and tertiary care links withprimary care

Area for specific action 5.1.2 planning and interface




29

o Development of advice only referrals

2. A full capacity analysis and evaluation of the current service has been completed. Along term proposal for a sustainable combined Acute and Primary Care Out of Hours(OOH) service will be submitted to CMT for approval in April 2015.

3. Establishment of first responder teams in Harris. Increasing the utilisation of ‘see andtreat’ practitioners. Utilisation of a primary care nurse practitioner by SAS to provide alocal emergency response in Harris. Further development of proposals to co-locateSAS staff within A and E in the WIH. Development of an MoU in relation to SASpersonnel working within the Uist and Barra Hospital.

How will progress be demonstrated? Please give key measurables and milestones.1. The Clinical strategy will be developed and consulted upon by Mar 2016

Teleclinics are being piloted in dietetics and for neurological patients. The activity willbe reported upon at 3 month intervals to the Community Operational ManagementGroup.Locality teams established by August 2015Virtual ward model by Sep 2015Patient services will report directly re progress on transforming patients(TOPSproject)A funding application has been made to enable employment of a VC expert to enablechange.

2. A six month review of progress will be completed by October 2015 that will identifyservice utilisation and evaluate cost and performance measures.

3. LUCAP team will monitor progress at its quarterly meetings. Within the year 2015-16:We would expect the training of the Harris first responder team to be completed, theM of U to be agreed, a decision to have been taken re co-location within WIH, thenurse practitioner in Harris to be used as back up by the local SAS team, and the ‘seeand treat’ utilisation to be increased.


1. The Clinical strategy development will be widely consulted upon with all relevantstakeholders and the public.

2. The current OOH short life working group is representative of acute and primary care.Proposals will be shared with all stakeholders before finalising the implementationplan.

3. SAS area manager will attend LUCAP meetings, which has good representation byother staff groups. Engagement with public in Harris via Locality Planning Group, andby leaflets to patients.

30


MOU Uist &Barra.pdf

OOH_CMT_January_15th_2015.docx

31

1. Option appraisal to be made for universal case record.Through new and existing eHealth systems, we will develop a health record that isaccessible across primary, community and secondary care services, comprised of currentaccurate information from the range of sources contributing to the record of healthcare. Wewill seek to standardise approaches to record keeping to ensure best practice in maintaininghigh quality record content.The universal health record will provide access to a secure, appropriately accessibledatabase of health related information, which can be made appropriately available to a widerange of healthcare professionals.The universal health record will link to and from information sources across existingsecondary care based patient administration and information systems and primary carebased health records.

2. To promote shared care (generalists and specialists working together)Delivering patient-centred care that is financially sustainable and operationally feasible forthis population requires the development of new models of care delivery that maintain highquality care delivery. GP referrals are made to the Specialist Consultant, following which thepatient is invited to attend the Western Isles Hospital Out-patient Department (OPD) for theirinitial assessment consultation, which for approximately 22% of the population of theWestern Isles would involve an inter-island journey. To ensure that these journeys to OPDconsultations are only required for those patients who are deemed to require specialist testsor interventions, it is proposed that a new innovation is feasibility-tested that introduces apost-referral contact (via phone) between the referring GP and the Consultant (CollaborativeAdvance Local Liaison, CALL).

3. Respiratory specialist linking in proactively to GP’s to discuss COPD pathway.

Outline key activities underway and / or planned.1. We have prepared a project initiation document to inform stakeholders and to

maintain awareness of project status and have included plans within our ehealthstrategy. Key activities include:

To plan and deliver the transition of existing paper based records into an electronicformat.

To complete existing eMRec work to deliver and implement a record access model,

Area for specific action 5.1.3 technology and data




32

with a range of document classifications to match the current and envisaged range ofdocument types.

To undertake options appraisal for potential system solutions. This should includecognisance of national drivers and procurement frameworks, and be informed by thestatus of systems adequacy in other NHS Scotland boards.

A member of planning team to join the eHPB to ensure the development of primarycare data and the implementation of a universal health record.

2. A feasibility pilot will be introduced to 1 GP practice in one of the Southern Isles(proposal is North Uist) collaborating with the Consultant for patients referred to aselected OPD clinic. The efficacy, efficiency and acceptability of the pilot will beassessed using the Plan, Do, Study, Act (PDSA) methodology.

3. Call discussing 6 patients with COPD for 1 hour utilising emailed notes. Extended toall practices during 2015-16.

How will progress be demonstrated? Please give key measurables and milestones.1. The delivery of an accessible universal health record that provides a holistic view of

health information to practitioners, with an appropriate model of security andaccessibility, serving a range of healthcare services.In the interim the provision of an options appraisal to CMT to obtain permission toproceed through detailed requirements analysis, towards preparation of a businesscase for selection of solutions. March 2015.To form a steering group, undertake detailed requirements analysis including productdemonstrations and site visits, in order to prepare a detailed business case. Theobjective is to guide final selection of system solutions. Sep 2015.We would expect to be prepared to begin implementation of the selected solutionthrough 2016-2017.

2. The project hypotheses stated above will be measured. Progress will be evaluatedagainst percentage of patients required to inter-island-travel to Stornoway for OPDattendance (both more patient-centred and more cost-effective) and the proportion ofpatients who could be remotely managed via their own GP (more patient-centred).Reduce the number of non-attenders (DNA) and cancellations (CNA) at OPD(increasing the efficiency of the clinic)

3. Feedback from GPs via evaluation questionnaire.How will key stakeholders and partners be engaged and involved?

1. Work with software vendors and with internal stakeholders including Medical Recordsteam to enable completion of development to currently agreed and funded outcomes.

2. The results of the pilot will be shared with all key stakeholders with a view toconsidering implementation across all specialties.

33


wih.pdf copdreport.pdf

eHealth Plan wp2update (CMT 17.03.15).pdf

34

We will continue GMS contract with the 10 practices anticipating the forthcomingredesign. This year we intend to see the merger of 2 practices introducing greatereconomies of scale and increasing capacity to provide efficiencies and range of servicesfor those patients within the areas. The strategy in our remote and rural setting is todevelop the enhanced role of General Practitioners. We will complete a workforceassessment in partnership with the practices. In response to a) lack of capacity withinone practice 2) lack of capacity within the enhanced role GP OOH service, we areestablishing a Memorandum of Understanding with one practice enabling NHSWI toemploy up to 2 GPs working as rural enhanced OOH practitioners as well as GMS workwithin the practice.

The NHS WI has a suite of LESs in place which will continue into 2015-16. They addcapacity within the remote and rural context. In view of the fact that over half thepopulation do not have easy access to an A and E, we will continue a minor injury LESwith most of the practices. Patients will continue to benefit from the other LESs whichinclude: INR clinics, near patient testing, and immediate response in emergency.We will continue the visiting optometry services to those areas that have difficulty inaccessing Stornoway and Benbecula. We will maintain existing retinal screeningarrangements. Development of electronic referrals from optometry to ophthalmology willtake place during 2015-16.

1. To assess the viability of directly employing salaried GPs to support the Out Of HoursService and to establish the requirements and benefits of combining with an existingmedical practice.

2. Rural fellowship: We will be making an application to the rural fellowship scheme. Theproposal is in partnership with a practice from Stornoway for a rural fellow post to beavailable from August 2015. The post will involve them taking part in the Out of HoursService in WIH, working in a GP practice, being trained up in aspects of rural medicineand taking part in an agreed Quality Improvement project. This will have the additionalbenefit of increasing our capability for long term recruitment and retention.

Area for specific action 5.1.4 contracts and resources




35

Outline key activities underway and / or planned.1. The OOHs short life working group will assess the financial implications, ensure

contracts are drawn up and post advertised by April 2015. The OOH working groupwill also establish how many posts are viable.

2. Full details will be available through the Rural fellowship website in April 2015. Amemorandum of understanding will be in place between the Board and a GP practiceby July 2015.

We will establish direct access to SCI gateway from within the optometrist premises.EMREC will provide the platform for sharing relevant records.

How will progress be demonstrated? Please give key measurables and milestones.1. Salaried GPs in post and contributing to the Out of hours service by Sep 2015.

2. Rural trainee in post by August 2015.

We will complete the workforce assessment by July 2015. The LESs have3 -6 monthlyreporting arrangements to monitor activity and spend.


1. Through membership of short life working group and local GP practices.2. Practices invited to participate and detailed discussions with those who express

interest.


GP for Broadbay andOOH JD .doc

NHSWI FellowshipFinal Submission March 2015.pdf

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6. STRATEGIC PRIORITY: INTEGRATIONExecutive Director Lead: Mr. Gordon Jamieson, Chief Executive

NHS Western Isles and the Comhairle are required by legislation to develop and implementan integration scheme, which establishes a new, independent body to oversee the deliveryof health and social care functions. The Integration Scheme defines which functions with bedelegated to the new body (an Integration Joint Board). There are a number of planningrequirements set out by legislation, not least the development and implementation of astrategic plan which will need to be put in place over the course of 2015/16.

The main purpose of integration is to improve the wellbeing of people in the Western Isles.This will better support those who use health and social care services, particularly thosewhose needs are complex and involve support from health and social care at the same time.In addition we will seek to develop further the provision of preventative and anticipatoryapproaches.

Outline key activities underway and / or planned.The process of integration is defined by the Public Bodies (Joint Working) (Scotland) Act2014. In line with the requirements of the Act, recent work has focussed on thedevelopment of an Integration Scheme – essentially an agreement between NHS WesternIsles and the Comhairle which sets out the form in which the Integration Joint Board (IJB)will be established and which NHS and Local Authority functions will be delegated to it. TheIntegration Scheme is currently subject to public consultation (during February 2015).Following the consultation process, the Integration Scheme will be finalised for agreementby NHS Board and the Comhairle, and submitted to the Scottish Ministers for approval nolater than 1st April 2015.

Meanwhile, individual groups have been established to examine and plan for the delivery ofClinical and Care Governance; Performance; Workforce; and wider governance issues.Their plans of work for the coming year are in the process of development (see milestonesbelow).

In particular Clinical and Care staff will be involved in the development of plans andgovernance processes. Recent consultation in relation to the draft Integration Scheme hasindicated a strong desire by many organisations and individuals to be involved in the

Area for specific action 6.1 Effective involvement of clinical and care staff in jointplanning

Produced by: Tom Dodd


37

development of plans for services in their localities. We would anticipate that thisenthusiasm for change is supportive to the IJB in development of its plans.

Looking forward, the Integration Authority is required by the Act to develop strategic plansfor health care and wellbeing across the Western Isles. These plans must divide the areainto localities and set out arrangements for the delivery of the nine national outcomes, takingaccount of the principles of integration.

How will progress be demonstrated? Please give key measurables and milestones.The first major milestone is the establishment of the IJB, which is subject to the approval ofthe Integration Scheme by the Ministers. It is anticipated that the first meeting of theIntegration Authority will take place in early April.

Thereafter, the steps required and key milestones are largely defined in legislation:The IJB is to appoint a Chief Officer and an officer responsible for the proper administrationof its financial affairs.The IJB must establish a group (its “strategic planning group”) and develop a strategic plan.The strategic plan is to include provision to divide the area of the Local Authority into two ormore localities. At present it appears that there are at least four identifiable localities, withstrong community and third sector engagement in each.

In preparing a strategic plan, the IJB must have regard to the integration delivery principles(see section 25 of the Act), and the national health and wellbeing outcomes.As soon as practicable after the finalisation of the plan, the IJB must publish its strategicplan and a statement of the action which it took in pursuance of preparing it.

Once the IJB and the strategic planning group are satisfied that the strategic plan and thelocality arrangements are fit for purpose, the integration authority must notify the HealthBoard and Local Authority of the date on which the responsibility of integrated services andthe associated resources should be delegated to the IJB. This must take place by 1st April2016.


The Integration Scheme has been subject to public consultation, and discussed withstakeholder groups (such as staff representatives, providers, carers groups). Both elementsof the consultation process elicited enthusiasm for engagement, and strong views fromcommunity and third sector representatives as well as individual respondents. As part of theconsultation process, explanation of the future steps of the IJB was explained, not least theneed for it to consult and engage in relation to the development of the strategic plan. Theresponses to that consultation give confidence that more detailed engagement will be metwith similar enthusiasm as the Strategic Plan is developed.

In addition, it is anticipated that a key part of the Chief Officer’s role will be to engage

38

effectively with professional leadership throughout the integrated services, as well as morewidely. While it is not possible to pre-empt the decisions of the IJB at this stage, NHSWestern Isles and the Comhairle recognise the importance of ensuring engagement acrossprimary, secondary and social care services. Engagement with and planning by existinggroups (noted above) will continue, with additional steps taken according to the needs andpreferences of the IJB.


The integration scheme consultation is available at: www.hsci-wi.org.ukFurther detail on strategic planning, etc. will be reported via the IJB

39

Section 7 – HEAT standards7.1 HEAT STANDARD - First Stage Cancer

Locally, with low numbers of cancer diagnoses annually, the Detect Cancer EarlyProgramme has taken a broader based preventative and anticipatory focus than the nationalprogramme. The main drive has been on raising awareness of cancer and the small lifestylechanges that can reduce the risk of developing it together with an emphasis on theimportance and necessity of getting any abnormal findings checked. We will continue to runcampaigns on the different cancers and work with community groups to build supportmechanisms. This will take the form of ladies’ nights to raise awareness of female cancers,articles in the local press including local cancer survivor stories, a TV documentary on men’scancers and events for Men’s Health Week and Movember, alongside cancer preventionroad shows.

Outline key activities underway and / or planned.Cancer awareness and prevention -

Movember events Cancer Road shows Woman’s Night event to raise awareness of female cancers TV documentary on Men’s Cancer Group Cancer Group established and up and running in Uist Mental Health in the Workplace training course DCE media campaigns.

How will progress be demonstrated? Please give key measurables and milestones. Completed TV Documentary Number of events and attendance at same Feedback from participants Press coverage and publication of cancer stories such as individual cancer journeys.

Area for specific action The LDP Standard is for NHSScotland to achieve a 25%increase in the percentage of breast, colorectal and lung cancercases that were diagnosed at stage 1 in 2010/2011 (this refersto the two calendar years combined from January 2010 toDecember 2011). This is to be achieved by 2014/2015 (January2014 through to December 2015).


Dr. Maggie WattsSara Aboud


40


Partners and stakeholders are integral to the successful implementation of cancerprevention and awareness, and are already engaged. We will continue to consult withpartners including staff and patients, carers and the wider population on the development ofprojects and strategies such as the development of physical activity strategy. Steeringgroups consisting of partners are essential to ensuring the success of projects such asMen’s Health Week.


41

7.2 HEAT Standard – 12th week pregnancy appt

Continue to encourage early booking.

Maternity website being developed to provide patient access to early access video creatednationally for this purpose.

Continue to target all women.Outline key activities underway and / or planned.Continue to work with Health Intelligence to correct data from other boards who report onour figures for Uist and Barra patients in mainland hospitals.

Continue to work with ward clerk in ensuring that local data is coded correctly and timely.

Continue to work with Patient Services Manager and staff to ensure that all data is exportedtimeously.

Ensure that posters are still visible throughout key areas and that cards and leaflets aredistributed throughout all islands.How will progress be demonstrated? Please give key measurables and milestones.By improvement in ISD and local data


As above continue to advertise via national posters ‘Pregnant speak to a midwife’.Include all GP practices and Practice managers into this national campaign.


Follow all national drivers from Early Years Collaborative and Early Access to Ante-natalCare.

Area for specific action At least 80% of pregnant women in eachSIMD quintile will have booked for antenatalcare by the 12th week of gestation by March2015.


Catherine Macdonald


42

7.3 HEAT STANDARD – Operate within RRL & CRL limits – Reported within theFINANCIAL PERFORMANCE NARRATIVE.7.4 HEAT STANDARD - CAMHS

To build on the capacity of the CAMHS workforce to ensure there is equity of service acrossall the islands in Western Isles, by increasing hours for CAMHS worker in the Uists andBarra.

The needs of children and young people with complex, severe and persistent behavioural,physical health and mental health needs are met through a multi agency approach within theGIRFEC framework. Contingency arrangements are agreed at senior officer levels betweenhealth, social services and education to meet the needs and manage the risks associatedwith this particular group and to promote new ways of working for CAMHS acrossprofessional boundaries.

To promote the mental health of all children and young people who are Looked After,Accommodated and Adopted by providing early mental health assessment and interventionand ensuring Looked After Children’s need for long term therapeutic intervention andcontinuity of professional care, (which may continue into adulthood) are met through multiagency planning and provision.Outline key activities underway and / or planned.

All children, young people and their families have access to psychological therapiesbased upon the best available evidence and provided by staff with an appropriaterange of skills and competencies

Training based upon identified needs that accord with service demands. Further develop infant mental health CAMH services, through a multi-agency

partnership Strengthen transition process from CAMHS into Adult mental health services (AMHS). Ongoing development and co-ordination of care pathways for Anorexia Nervosa and

Self harm Maximise use of resource through more targeted service contracts.

Area for specific action Deliver faster access to mental healthservices by delivering 26 wks referral totreatment for specialist Child and AdolescentMental Health Services from March 2013,reducing to 18 wks from December 2014.


Joan Tilley


43

How will progress be demonstrated? Please give key measurables and milestones.By April 2016

Increase in the number of referrals to psychological therapies particularly CBT (HEATtarget data)

Increase in the type of psychological therapies that can be offered in accordance withPsychological matrix (HEAT target data)

Increase in joint working with health visitors/GIRFEC meetings (diaried meetings) Ratified integrated care protocols for Transition to Adult services, Anorexia and self

harm (Policy group) Average length of contacts reduced for patients through focussed interventions

(TOPAS)


Services planned using service users feed back and with a view to improving the userexperience in relation to focussed therapies.


Review and development of CAMHS strategy 2015-2020.

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7.5 – HEAT STANDARD – 18 wk RTT Psychological Therapies

The service will be reviewing the challenges around the sustainable provision ofpsychological therapies in regards to capacity issues. The modernisation of mental healthservices’ implementation plan will require a review of extant workforce requirements whichwill include psychological therapy provision.

Outline key activities underway and / or planned.A psychological therapy steering group, chaired by the Head of Planning, reviews thestrategic direction vis-à-vis psychological therapy provision, which includes training. Amember of staff has started CBT training for older people.

How will progress be demonstrated? Please give key measurables and milestones.Progress will be monitored in regards to compliance with waiting times. Capacity for theprovision of psychological therapies in the community is currently tied into the hospitalinfrastructure.


The Head of planning reports on progress to the mental health services OperationalManagement Team.


Area for specific action 18 weeks referral to treatment forPsychological Therapies from December2014.


Mike Hutchison


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7.6 – HEAT STANDARD – Newly diagnosed with dementia

In order to increase capacity in relation to post diagnostic support the service is beingreconfigured to focus on link worker activity with Band 3 posts across the islands. Plans toincrease awareness of post diagnostic support locally in development.

Outline key activities underway and / or planned.Band 3 posts for banding and funding identified.Posts will be managed by the CPN Service.Aiming to have posts filled by Spring 2015.How will progress be demonstrated? Please give key measurables and milestones.Fill posts by Spring 2015.Monitor waiting times, number of referrals, clients seen and nature of provision.Maintain level of uptake against the monthly monitoring reports.


Strong links locally with Alzheimer’s Scotland ensures involvement of partners andstakeholders.


To increase capacity in the post diagnostic service by replacing the current model with x2Band 3 posts of 30hours and 1 post of 7.5 hours.

Area for specific action By 2015/16, all people newly diagnosed withdementia will have a minimum of a year'sworth of post-diagnostic support co-ordinated by a link worker.


Dr. Maggie WattsAnne Hutchison


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7.7 – HEAT STANDARD - IVF

Data from 2014 indicates that no patients were referred for IVF in that period. NHS WesternIsles patients are referred to the Dundee service which has a 100% record for maintainingIVF treatment within 12 months.

Outline key activities underway and / or planned.

Continue to refer to Dundee as required.

How will progress be demonstrated? Please give key measurables and milestones.

ISD reports to show Dundee performance.


E-mail communication to the Obs/ Gynae Consultants.


Continue as before.

Area for specific action Eligible patients will commence IVFtreatment within 12 months by 31 March2015.


Chris Anne Campbell


47

7.8 – HEAT STANDARD - SABS

Currently reporting low rates of SAB infection, rates below 0.24 per 1000 acute occupiedbed days. Continue with current actions for all SABs:

Perform a Critical Incident Review on all cases Continue to monitor invasive device compliance Act upon and escalate any key findings in relation to SAB infections.


Critical Incidents Reviews currently in place;The Infection Control Team performs Invasive Device Audits – reported monthly in theInfection Control Monthly Activity Report (ICMAR) to operational and senior management forinformation and action.


Continued low rate of infection.


SCNs currently engaged and involved as they perform monthly PVC and CVC bundlesaudits. (see section 4.2)


Area for specific action Further reduce healthcare associatedinfections so that by March 2014/15, SAB(including MRSA) cases are 0.24 or less per1000 acute occupied bed days.


Jennifer Macdonald


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7.9 – HEAT STANDARD - Clostridium Difficile

Continue progress with CDI reduction. To reduce Cephalosporin prescribing in NHSWestern Isles, this work has been taken on by the Antimicrobial Management Team (AMT).AMT will now be chaired by the Medical Director who will drive this work forward.

Continue Infection Control education session on appropriate sampling for CDI in line theHealth Protection Network (2014) Guidance on Prevention and Control of ClostridiumDifficile Infection (CDI) in Care Settings in Scotlandhttp://www.documents.hps.scot.nhs.uk/about-hps/hpn/clostridium-difficile-infection-guidelines.pdf

Continue to perform Critical Incident Reviews of all new CDI cases with lessons learnedshared through the Learning Review Group.Outline key activities underway and / or planned.Rolling programme of Infection Control education including Priority Training andWard/Clinical Area based sessions.

Critical Incident Review of all new cases as per current practice.

Cephalosporin reduction built in to AMT work plan.How will progress be demonstrated? Please give key measurables and milestones.Rates will continue to reduce.

Cephalosporin prescribing will reduce to levels in line with the national average.How will key stakeholders and partners be engaged and involved?

Key stakeholders already engaged with this work through the Infection Control educationprogram and AMT work plan.


Area for specific action The rate of Clostridium Difficile infections inpatients aged 15 and over is 0.32 cases orless per 1000 total occupied bed days.


Jennifer Macdonald


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7.10 - HEAT STANDARD – Smoking cessation, information is noted within theinequalities information.7.11 – HEAT STANDARD – Cancer 31 days

Continue to develop links with colleagues in mainland health boards who provide most ofcancer treatment for NHS Western Isles residents. It is worth noting that our two mainproviders on the mainland have capacity issues, which may affect NHS Western Islesperformance against cancer targets.

Outline key activities underway and / or planned.Continue with the present monitoring arrangements and escalation of individual cases toachieve target.

How will progress be demonstrated? Please give key measurables and milestones.Performance against the 31 days target will be measured at the end of each quarter(published data), and locally at weekly meetings.


Theatre scheduling, Performance Group, Clinical Management Teams and Single OperatingDivision meetings ensure all relevant partners are engaged and involved in delivering cancertargets locally.


Review departmental structure and review escalation policy.

Area for specific action 95% of all patients diagnosed with cancer tobegin treatment within 31 days of decision totreat.


Lachlan MacPherson


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7.12 – HEAT STANDARD – Cancer 62 days

Continue to develop links with colleagues in mainland health boards who provide most ofcancer treatment for NHS Western Isles residents. It is worth noting that our two mainproviders on the mainland have capacity issues, which may affect NHS Western Islesperformance against cancer targets.

Outline key activities underway and / or planned.Continue with the present monitoring arrangements and escalation of individual cases toachieve target.

How will progress be demonstrated? Please give key measurables and milestones.Performance against the 62 days target will be measured at the end of each quarter(published data), and locally at weekly meetings.


Outpatient scheduling, Theatre scheduling, Performance Group, Clinical ManagementTeams and Single Operating Division meetings ensure all relevant partners are engagedand involved in delivering cancer targets locally.


Review departmental structure and review escalation policy.

Area for specific action 95% of those referred urgently with asuspicion of cancer to begin treatment within62 days of receipt of referral.


Lachlan MacPherson


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7.13 – HEAT STANDARD – Commence treatment within 18wks of referral

Target has been achieved May 2014 through to January 2015. Continue weekly outpatientand theatre scheduling meetings to maximise resources to ensure performance ismaintained.

Ensure 8 key diagnostic tests are delivered with 6 weeks target, to enable patients tocommence treatment within 18 weeks of referral.

Outline key activities underway and / or planned.Modelling activity will be developed to ensure capacity is sufficient for service demand. Thismay include new software.

How will progress be demonstrated? Please give key measurables and milestones.18WRTT progress is measured by monthly performance against combined 90% target


Outpatient scheduling, Theatre scheduling, Performance Group, Clinical ManagementTeams, and Single Operating division meetings ensure all relevant partners are engagedand involved in delivering key target.


Model activity to match capacity against demand. Continue working with stakeholders tomaintain performance.

Area for specific action 90% of planned/elective patients tocommence treatment within 18 weeks ofreferral.


Lachlan MacPherson


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7.14 & 7.15 – HEAT STANDARDS – 48 hr access & GP appt in 2 days

A Quality Outcomes Framework requirement in place for all GP Practices for 2014/15 is theanalysis of patient access. This is likely to remain a requirement for 2015/16.

Outline key activities underway and / or planned.A Quality Outcomes Framework requirement in place for all GP Practices for 2014/15 is theannual analysis of patient access. This is an exercise whereby Practices are asked todiagnose the root cause of problems with demand and access in order to identifyopportunities for improvement. This involves mapping patient journey flow and analysingvolume and demand type. Practices are required to submit their reports by 15th March 2015.There is one Practice already identified as having patient access problems due to GPrecruitment issues. The Board has supported this Practice through the provision ofConsultancy advice. Further to this, the Board has developed a proposal to recruit a GP whowill work part-time in the Practice and part-time in the Out of Hours Service. This post is inthe process of being approved and advertised.How will progress be demonstrated? Please give key measurables and milestones.The reports will be analysed to create an Island-wide analysis of patient access. At presentthere are no reported problems with access to appointments within 48 hours or forappointments 2 days in advance. This will be monitored to ensure that slippage is identifiedearly.How will key stakeholders and partners be engaged and involved?

The recent National Publication – the Health and Care Experience Survey recorded patientsatisfaction. There were no issues recorded for patient access.http://www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey/Survey1314Key results from the patient Access Analysis will be shared in the Practice Manager NetworkGroup and learning points shared.


Annual patient access reviews will continue. Patient registrations are reviewed monthly tomonitor for patient drift.

Area for specific action 48 HOUR Primary care access (and abilityto book an appointment with a GP morethan 2 days ahead)


Dr. Angus McKellarDr. Vanessa Strong


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7.16 – HEAT STANDARDS – A&E 4hr wait

There were busy periods in the last year when the AAU would close to admissions and GPreferrals were going to A&E. The reasons for delay have been audited and the steps belowput in place to reduce those and prevent breachesOutline key activities underway and / or planned.1. Inform bed manager as soon as admission is anticipated and reduce wait for bed

time2. Anticipate any Radiological investigations and alert radiographers to receive any

direction and reduce waiting time3. Escalate to the ACOO or Capacity Planner where waits are over 2 hours to facilitate

the patient journey which will include medical attendance where that is the reason fordelay.

4. Revisit reasons for delay OOH and make any changes supportive to early admissionor discharge.

How will progress be demonstrated? Please give key measurables and milestones. Consistent performance above 98% Weekly returns through ISD Monthly returns through HI and monitored at the Activity Group.How will key stakeholders and partners be engaged and involved?

Through active discussion with A&E staff, Activity Group, CSNs, Senior Nurse andDischarge Manager on a daily basis with themes explored through the activity group.The LUCAP Group will also explore support to reduce admissions to A&E with close workingwith GPs and SAS.


Area for specific action A&E waits to be a maximum of 4 hours.


Chris Anne Campbell


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7.17 & 7.19 – HEAT STANDARD – RTT & Alcohol Brief Interventions (ABIs)

The current service is meeting referral to treatment guarantees and is close to the ABItarget.

The intentions for 2015-16 are to ensure these standards are maintained whilst reviewingservice needs and introducing a recovery based model of care. This work will be led by theOuter Hebrides Alcohol and Drug Partnership.

Outline key activities underway and / or planned. Review and update ADP alcohol needs assessment Work with service providers to develop recovery model of care and explore its impact

on access to services, preventative activities such as ABIs and wider treatmentmodalities

Implement recovery model during 2016-17.

How will progress be demonstrated? Please give key measurables and milestones. Revised Needs assessment produced Recovery model descriptors produced Training plan for recovery model in place Model implemented (for 2016-17).


Primary and secondary care partners are crucial to the successful implementation of boththe RTT and ABI standards and will be involved at all stages of the changes.


Area for specific action ALCOHOL AND DRUG SERVICESa) RTT guaranteeb) ABIs


Dr. Maggie WattsKaren Peteranna


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7.18 – HEAT STANDARDS - Sickness Absence

Reduce Sickness Absence towards 4% target.


A range of measures within the Healthy Organisational Priority of the 20:20 Vision arecurrently being scoped.


Priorities for action will be detailed in the amalgamated Staff Governance Action Plan andthe Everyone Matters Action Plan.

Progress will be monitored through the Staff Governance Committee and the AreaPartnership Forum.


Staff Governance Committee and Area Partnership Forum.


Amalgamated Staff Governance and Everyone Matters Action Plan.

Area for specific action Boards to achieve a sickness absencerate of 4%


Jennifer PorteousRichard Curry


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7.20 – HEAT STANDARDS – 12wk TTG

Treatment Time Guarantee for in-patients and day cases has been achieved sinceintroduction in 2012. Continue with daily reports and proactive management to ensuretarget performance is maintained.

Outline key activities underway and / or planned.Daily reports produced and monitored. Weekly theatre scheduling meetings to ensuredemand is matched with capacity to ensure patients are prioritised to achieve the treatmenttime guarantee.

How will progress be demonstrated? Please give key measurables and milestones.Treatment time guarantee is measured on a daily basis against 12-week target for in-patientand day case activity.


Theatre scheduling, Performance Group, Clinical Management Teams and Single OperatingDivision meetings ensure all relevant partners engaged and involved in delivering key target.


Model activity to match capacity against demand. Continue working with stakeholders tomaintain performance.

Area for specific action 12 weeks Treatment Time Guarantee


Lachlan MacPherson


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7.21 – HEAT STANDARDS – 12wk first OPA

Review capacity against projected demand levels. Model specialty data to identify shortfall atspecialty level. Work with providers to fill shortfall. Plan to clear long waiters and get to100% performance by end of March 2016. Introduce a maximum of 16 weeks wait forpatients who breach mid year by end of June 2015.

Outline key activities underway and / or planned.Modelling activity (specialty level) to identify capacity shortfall against projected demand.Work with providers to identify additional capacity required to meet Mar 2016 targets.

How will progress be demonstrated? Please give key measurables and milestones.Outpatient progress is measured by monthly performance against planned trajectory, andfinal position at end of March 2016.


Outpatient scheduling, Performance Group, Clinical Management Teams, and SingleOperating division meetings ensure all relevant partners are engaged and involved indelivering outpatient target,


Model activity to match capacity against demand. Continue working with clinicians andmainland providers to fill projected shortfall in capacity.

Area for specific action 12 weeks for first outpatient appointment(Previously reported as numbers waitingagainst target of zero)


Lachlan MacPherson


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Section 8 – Finance – see separate documents – Financial PerformanceNarrative Appendix 1 & 2Executive Director Lead: Mrs. Marion Fordham, Director of Finance

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Section 9 – WorkforceExecutive Director Lead: Ms. Jennifer Porteous, Director of Human Resourcesand Workforce Development.

9.1 IMPLEMENTATION PLAN FOR EVERYONE MATTERS (5 PRIORITIES)9.1.1 Healthy organisational culture9.1.2 Sustainable workforce9.1.3 Capable workforce9.1.4 Integrated workforce9.1.5 Effective leadership and management

9.2 WIDER WORKFORCE PLAN will be developed and published in line withnational timescales – to be confirmeda) use of workload and workforce planning tools

Building on the work of 2014/15 we will: continue to make use of performance information and sources of intelligence, such as

iMatter, staff and patient survey results, to inform the work we do and how weprioritise actions.

engage with staff, stakeholders and partner organisations in planning work, buildingon the collaborative approach adopted.

ensure that the way we take work forward reflects the NHS Scotland core values andthe Staff Governance Standard

ensure that effective arrangements are in place locally to monitor progress undertake tests of change in relation to new ways of working and delivering services ensure that all learning and development programmes reflect the vision, values and

five priorities in Everyone Matters.

Over 2015/16 and beyond NHS Western Isles will embed the learning andrecommendations from the NHS WI led Recruit and Retain Northern Periphery Programmeproject. This work is aimed at supporting effective and efficient recruitment and retentionactivity and will be incorporated into the 2015/16 Staff Governance and Everyone Mattersaction plan.

Area for specific action Workforce –9.1.1 Healthy organisational culture


Jennifer PorteousDeanne Gilbert


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Outline key activities underway and / or planned.Priority 1Healthy organisational cultureAs part of the Person Centred Health and Care Programme, a benchmarking process hasbeen undertaken to identify work being carried out across the organisation towardsimproving staff, patient and carer experience. The aim for 2015/16 will be to align the staffgovernance, staff experience and staff survey work into the same work stream as patientexperience. This will be further enhanced by the implementation of the I-Matter system andprocess, which will be rolled out across the organisation during 2015/16.

As part of the Staff Governance action plan and the Management development programme,work will be carried out during 2015/16 to support managers to develop an increasedunderstanding of Staff Governance and manager’s and individual’s responsibilities withinthese standards. An annual manager’s Staff Governance report will be completed by eachmanager. This will be used to inform the development of the integrated StaffGovernance/Everyone Matters Action plan priorities for 2015/16 and onwards. Learning fromthese reports will also help to identify areas of “good practice” and enable sharing of learningacross the organisation. The management development programme will be reviewed toensure that all programmes will support the promotion and recognition of behaviours ofindividuals and teams to reflect the NHS S and NHS WI values.

The Occupational Health department is currently under review and is in the process ofreviewing standards with regard to dignity at work and will be liaising closely withLanarkshire Health Board to develop and embed best practice across the organisation.

The Healthy Working Lives Awards, administered by the Scottish Centre for HealthyWorking Lives, encourage employers to promote a healthier workforce and cover a widerange of topics including health promotion, mental health and wellbeing and occupationalhealth and safety. NHS Western Isles achieved the Gold Award in November 2013 - thesecond workplace in the Western Isles to achieve the award. In order to achieve the GoldAward, NHS Western Isles developed a partnership-approved three year health, safety andwellbeing strategy and three year rolling action plan. An Employee Well Being Survey hasbeen completed by staff, the results of which will inform the development of an action plan tobe rolled out across NHS Western Isles during 2015/16.

Progress against the Health Working Lives action plan includes:The promotion of local and national health campaigns to staff, and availability of regulartraining opportunities, these include Cancer Awareness and No Smoking AwarenessCampaigns. The benefits of, and opportunities to participate in, physical activity continue tobe promoted to NHS Western Isles staff, which has resulted in excellent staff participation inlocal and national physical activity campaigns. The Step Challenge and the FIT 14campaigns were very popular and the Step Challenge will continue through 2015.

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Mentally Healthy Workplace training for managers is offered throughout the organisation,with an Alcohol and Drug Workshop planned for 2015. Lifestyle checks are planned for2015. The Healthy Weight programme which is run by the Dietetics department will continuethrough 2015. Healthy choices continue in NHS Western Isles canteens. Commitment tomaintaining a smoke-free environment, as NHS Western Isles is now smoke free in allpremises and grounds from 30th November 2013.

The NHS WI approach to Induction and support of staff has been informed by the work ofthe Recruit and Retain programme. The Induction period now includes a face to faceCorporate Induction period – where, along-side other statutory and mandatory requirements,information is given to staff about the newly constituted NHS WI Staff Social group.Membership of this group is automatic for all staff on commencement of work within theorganisation. The group organises social events for staff and families and works particularlyto support individuals new to the organisation and the islands to help them to settle into theirnew working and living environment. For 2015/16 the work of the group will be furtherdeveloped with the priorities for action to be aligned with Healthy Working Lives and theHealth Promotion campaigns to be run in 2015/16.

How will progress be demonstrated? Please give key measurables and milestones.Priorities for action throughout 2015/16 will be detailed in the amalgamated StaffGovernance and Everyone Matters Action plan. Timescales will be detailed within the plan.Progress will be monitored via reporting through the Staff Governance Committee and AreaPartnership Forum.


The Staff Governance committee has Staff-side representatives as members. The Employee Director is joint lead with HR for the i-Matter implementation project. The iMatter system is designed to ensure that “staff voice” is heard. A Partnership

group will be developed to ensure that learning from the feedback of the system isacted upon. The findings of the iMatter will be used to support the development ofthe Staff Governance and Everyone Matters Action plan for 2015/16.

The Healthy Working Lives group has members from both management and staff-side. All decisions are taken in Partnership.


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Building on the work of 2014/15 we will:

continue to make use of performance information and sources of intelligence, such asiMatter, staff and patient survey results, to inform the work we do and how weprioritise actions.






Outline key activities underway and / or planned.Priority 2Sustainable workforceWe will continue to further develop and enhance workforce information – ensuring thatinformation is available to support managers to effectively support and manage staff, aswell as to support workforce planning across departments and the organisation.

We will continue to develop and build relationships with partner organisations: Comhairlenan Eilean Siar, local Universities, the Third sector and others to ensure that a joined upapproach is taken towards workforce planning.

As part of the workforce planning process all areas will be supported throughout 2015/16 todevelop their own 2020 plans.

Area for specific action Workforce -9.1.2 Sustainable workforce


Deanne Gilbert


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Working Longer ReviewNHS Western Isles is committed to implementing the recommendations from the NHSWorking Longer review. Whilst it is acknowledged that there are benefits for working longerincluding financial, social and physical and mental well being there are also potentialdownfalls as people age they may encounter challenges with regards to their health. It istherefore vital that Occupational Health as a stakeholder have measures in place to monitoremployee health and ensure that any occupational hazards associated with jobs arereduced to as low as is reasonably practicable.

As part of the Occupational Health and Safety review within NHS Western Isles therecommendations of the review will be considered in relation to the possible impact of theraised pension age on staff – actions to address these issues will be embedded within theOccupational Health and Safety action plan for 2015/16. Activities will include implementingactions to address the findings of the Health Needs Assessment Survey.

An organisational change process, including flow chart, will be developed to support andembed Best Practice across Workforce planning and change processes.

A number of key workforce related activities are currently underway across NHS WesternIsles – these include:

development of new roles and new skills to support the move towards care closer toindividual’s homes and /communities.

further developing and enhancing the model for the provision of unscheduled care development of more integrated health and social care working.

In order to deliver these activities a number of workforce changes will be required to delivernew models of care across primary, secondary and social care. This will include roles suchas Advanced Practitioners in both Nursing and Allied Health Professions and furtherdevelopment of the role of General Practitioners to support the delivery of the Out of Hoursservices.

The development of new and enhanced skills and competencies will be required across anumber of different staff groups - some of these skills will be specific specialist skills relatedto small groups of practitioners and some more generic such as the development of anincreased number of non-medical prescribers and advanced clinical assessment (ACE).These advanced practitioners are, and will continue to contribute to, the development of amulti-skilled, multi professional and multi-agency workforce to deliver appropriate care toindividuals.

Work currently underway in several different services has also identified the requirement todevelop an increased number of support worker roles in A4C bands 2 – 3. The developmentof the new roles will be carried out as part of the wider workforce planning process and will

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ensure that the requirements for skill mix, staffing numbers, training requirements etc aretaken into consideration.

To support the recruitment process, particularly for hard to recruit to posts including nursing,AHPs, and medical staff, NHS Western Isles will work to implement the recommendations ofthe NHS Western Isles led Recruit and Retain project. As part of this work the recruitmentprocess will be reviewed during 2015/16 to ensure a streamlined, effective efficient processis in place.


Priorities for action throughout 2015/16 will be detailed in the amalgamated StaffGovernance and Everyone Matters Action plan. Timescales will be detailed within the plan.Progress will be monitored via reporting through the Staff Governance Committee and AreaPartnership Forum.


Workforce planning has been undertaken across the organisation over the past 4 years. Allchange processes have partnership representatives involved. All change processes willcontinue to be managed by the Organisational Change policy and relevant workforce planswill be progressed through the Area Partnership Forum.

The workforce planning training, tools and template will be reviewed in Partnership during2015/16 to ensure they meet future workforce planning requirements. As part of themanagement development programme modules on 6 steps workforce planning methodologywill be developed.


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Outline key activities underway and / or planned.Priority 3Capable workforceAs part of the development of the NHS WI management development programme, themanagers/Reviewers training for KSF/PDP+R was reviewed to support managers andreviewers to have meaningful performance and developmental review conversations.

As part of the workforce planning and change management processes, particularly for teamsand services undergoing change in primary, secondary and health and social careintegration, learning and development plans will be developed – identifying the learning anddevelopment needs. All training programmes will be reviewed to ensure that they reflect theknowledge, skills and behaviours required by all staff to carry out their posts.

Area for specific action Workforce -9.1.3 Capable workforce


Deanne Gilbert


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The HR department developed a Workforce planning/Learning Needs Analysis templatewhich the Nursing, midwifery and Allied Health professionals (NMAHP) group require allNMAHP managers and team leaders to complete on an annual basis. This information isused to ensure appropriate training is delivered and sourced by the Professional PracticeDevelopment Team (PPDT). This has streamlined requests for funding from the TrainingBudget and ensured appropriate use of resources and is a continuum of the KSF/PDP +Rprocess. This process has also enabled the NMAHP forum to have an overview of learningneeds across all NMAHP teams and the PPDT can therefore source training to be deliveredin-house to large groups of staff e.g. Leadership and Management Training.

The NHS Western Isles Hospital as a Local Education Provider (LEP) is responsible forquality control of undergraduate and postgraduate education. The Quality Education(Undergraduate and Postgraduate) Department ensures that the education and theenvironment in which it is delivered meets local, national and professional standards.

The Western Isles Health Board promotes high standards and ensures that quality medicaleducation and training reflects the needs of patients, medical students and trainees, and thehealth service as a whole. The Medical Directorate regulates all stages of doctors andmedical student training and professional development whilst in the Western Isles Hospital.

To do this, the LEP works with a range of experts including the GMC, Royal Colleges,Universities and Deaneries to ensure that quality assurance arrangements are in place.

NHS Western Isles also works closely with other initiative such as the Strategy for Attractingand Recruiting Trainees (START) Alliance, a Scottish initiative working hard to identify andaddress the needs of future doctors in training and the Shape of Training (SHOT) Review.The latter is led by the GMC, in conjunction with the Royal Colleges, and is currently in theearly stages of mapping out the review to ensure the training posts of Junior Doctors deliverthe best education available in the right place at the right time, and where possiblerecognising the needs of the changing shape of the NHS and the services it offers.

Special consideration needs to be taken in relation to ensuring that support staff have theright skills and competencies in order to carry out these new and enhanced roles, particularlyin light of the Francis report.

Healthcare Support Workers (HCSW) in Nursing and Midwifery attend annual priority trainingdays along with their registered colleagues. Clinical training is facilitated by the PracticeEducation Facilitator (PEF) and supported by the Clinical Practice Trainer. Development ofHCSW in Nursing and Midwifery are encouraged and supported to undertake relevantqualifications such as SVQs and/or the Open University Certificate in Healthcare Practice.All new HCSW undertake a clinical induction programme which consists of practical skillstraining, facilitated by the PEF and delivered in partnership with the Clinical Practice Trainer.

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As well as attending in-house training, AHP support workers can apply for funding fortraining through the NES AHP Careers Fellowship Scheme, whose focus over the pastnumber of years has been on supporting learning opportunities for AHP HCSWs. A numberof NHS WI staff have been successful with their funding bids and as a result of their learninghave been able to support/deliver services that they were previously not able to undertake.

The AHP Practice Education Lead has been tasked with exploring the learning needsof AHP HCSW and this is currently in the early stages of planning.

NHS Western Isles supports the training and development of future staff in a number ofways.

Work Placements:In 2014-2015 NHS Western Isles provided 71 work experience placements to young people.These placements were across clinical and non clinical areas across the NHS Western Isles.Placements are available to fourth and sixth year school pupils, Lews Castle Collegestudents, AHP University students and Job Centre Plus clients, Skills Development Scotlandand Cothrom. A long term placement is provided for a person with Learning Disabilitiesunder the Local Area Co-ordination Programme.

We had several Nursing Elective placement requests from students attending Universities inEngland who were requesting a Remote and Rural placement experience.In 2015/2016 NHS Western Isles will continue to provide placements to young people fromthe various organisations. Skills Development Scotland is intending to have a Careers Eventin March 2015 and NHS Western Isles will attend the event to promote careers andplacements.

The nursing Practice Education Facilitator works with the HR department to offer qualitywork experience placements for school pupils in S4 and S6 both in Stornoway and Uist andBarra.

NHS Western Isles works in partnership with the University of Stirling to deliver practiceplacements for pre-registration nursing students in Adult and Mental Health fields, as well asplacements for Health Visiting training. We also work with Robert Gordon university (RGU)to offer midwifery placements and the Open University for practice placements for HCSWundertaking pre-registration nursing programmes in our more remote and rural communities.We are currently setting up practice placements for Learning Disability Field nursingstudents with Glasgow Caledonian University. NHS Western Isles also offers placements forAccess to nursing students from the University of the Highlands and Islands (Stornowaycampus).

In common with other health board areas in Scotland a Practice Placement Agreement[PPA] has been negotiated and signed off between AHPs in NHS Western Isles and three

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universities in Scotland to support AHP placements. In partnership with the universities, NESand other health boards there is also a bi-annual meeting to further progress this work toensure that there is a robust mechanism agreed to support quality practice placements. AHPpractice educators receive training and updates from Robert Gordon University as part of thePPA. One of the ongoing challenges of attracting AHP students on placement to theWestern Isles is the costs associated with placements here which some students are unableto claim back [accommodation (they are usually already paying for term timeaccommodation), travel and having to give up work]. This has resulted in a number ofstudents cancelling placements and negotiations are ongoing with the parties involved to tryand resolve this.

AHP placement quality is audited using the NES Quality Standards for Practice Placement[QSPP] audit tool. For students the QSPP audit is supplemented by usingEmotional Touchpoints to provide AHPs with qualitative information about the student’splacement experience.

In common with the nurses and midwives, AHPs provide work experience placements for 4th

and 6th year school pupils and also to students who are undertaking placements as part ofthe health care courses delivered by Lews Castle College.




The integration workforce group, responsible for the development of workforce plans,including joint training plans have both management and staff-side representatives.

As part of the Staff Governance standards the KSF PDP+R process is the responsibility ofboth managers and staff to ensure that reviews are undertaken and Personal Developmentplans are developed. Therefore all learning needs are identified in Partnership with staff.


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Outline key activities underway and / or planned.Priority 4Integrated workforceNHS WI will continue to work collaboratively with all partners working towards achieving thenational Health and Wellbeing Outcomes. As the integration agenda develops,organisations and teams will be supported to develop a shared culture, values and ways ofworking.Leadership systems and processes will be further developed to support the integration ofprimary and secondary care, recognising the role of GPs, dentists, pharmacists and othersas part of the workforce.

An integrated workforce group has been developed in Partnership with Staff-side in order toidentify and address workforce issues related to integration of Health and Social Care.

Area for specific action Workforce -9.1.4 Integrated workforce


Deanne Gilbert


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How will progress be demonstrated? Please give key measurables and milestones.Priorities for action throughout 2015/16 will be detailed in the amalgamated StaffGovernance and Everyone Matters Action plan. Timescales will be detailed within the plan.Progress will be monitored via reporting through the Staff Governance Committee and AreaPartnership Forum.A joint workforce plan, based on the 6 steps workforce planning methodology, will bedeveloped, in Partnership to support the integration agenda – this will include an action planwhich will outline the actions and timescales.


A workforce group has been developed jointly with the Comhairle nan Eilean Siar, inPartnership with Staff-side, in order to identify and address workforce issues related tointegration of Health and Social Care.

A joint workforce plan, based on the 6 steps workforce planning methodology, will bedeveloped, in Partnership to support the integration agenda – this will include an action planwhich will outline the actions and timescales.


An organisational change process, including flow chart, will be developed to support andembed Best Practice across Workforce planning and change processes


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Over 2015/16 and beyond NHS Western Isles will embed the learning andrecommendations from the NHS WI led Recruit and Retain Northern Periphery Programmeproject. This work is aimed at supporting effective and efficient recruitment and retentionactivity and will be incorporated into the 2015/16 Staff Governance and Everyone Mattersaction plan.Outline key activities underway and / or planned.Priority 5Effective leadership and managementNHS Western Isles will develop and deliver a management and leadership developmentprogramme over 2015/16. For 2015/16 this programme will prioritise: the delivery ofprogrammes aimed at supporting managers to embed and promote the NHS S and NHSWI values and behaviours and the development of skills and competencies to lead anddrive Quality improvement and change. Emphasis will be on managers supporting staffthough the major change processes.


Area for specific action Workforce -9.1.5 Effective leadership andmanagement


Deanne Gilbert


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All leadership management development modules will be available for managers,supervisors and Partnership to attend.


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Outline key activities underway and / or planned.Since 2011, there has been a requirement for NHS Boards to demonstrate the use of thenationally developed workload and workforce tools for nursing and midwifery staff, as part ofthe workforce planning process CEL 32 (2011). In 2013, the Local Delivery Plan Guidancemade the use of the tools mandatory, where available, to inform Boards for workforceplanning purposes, at least annually.

NHS Western Isles uses the Professional Judgement and Adult Acute Tools for the acutewards during the budget setting process. More recently the same platform tools on SSTShave been used on two wards and the plan is to use those routinely in 2015 as part of theannual workforce projections process as well as to inform the staffing ratios for wards anddepartments.

Area for specific action 9.2 WIDER WORKFORCE PLANa) use of workload and workforceplanning tools


Deanne Gilbert


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Training on the use of the tools was delivered by the SSTS National Support team.

The “small wards” tool is used alongside the adult acute tool in medical wards to supportrobust workforce planning.

The nursing model at Uist & Barra Hospital has been reviewed in light of difficulty recruitingto a number of posts and the requirement to provide nurses with a more advanced level ofknowledge and skill to support in particular the OOH periods. The professional judgementtool was utilised to plan this alongside revised bed capacity.

Future developments include plans to revitalise intermediate care with a new dynamicapproach incorporating the virtual ward concept. This will include multi-disciplinary teamworking – including Nurses, Allied Health Professionals and unscheduled care, out of hoursteams.

In Barra we are working with the nursing team to provide more integrated working withinhealth between hospital and community. This includes the development of a new health andsocial care facility within the community.

We were involved in piloting the maternity workforce tool for a 3 month period from July toSeptember 2014. Future use of the tool will build on the national feedback received followingthe pilot period. Future plans will include further training on the use of the tool.

To ensure that the outputs of the workforce planning process are robust the tools are used inconjunction with clinical professional judgement –this includes local knowledge of servicesand qualitative information regarding quality of care.

How will progress be demonstrated? Please give key measurables and milestones.The use of the workforce tools will be monitored by the Senior nurses. Reporting on its usewill be embedded as part of the Staff Governance and Everyone Matters actions plan.


The workforce tools are used by managers, in conjunction with staff within the wards anddepartments, as part of day to day and longer term workforce planning and deployment.


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Section 10. COMMUNITY PLANNINGExecutive Director Lead: Dr Maggie Watts, Director of Public Health

We recognise the changing nature of the NHS Western Isles’ role within the Outer HebridesCommunity Planning Partnership (OHCPP) with the forthcoming legislation, making the NHSrole that of a statutory partner and will drive forward our leadership and engagement acrossthe agenda of the OHCPP.In particular, we will work with the Community Planning Partnership in the development andimplementation of community participation and empowerment pilots in two communitiesacross the Western Isles. These projects are intended to help communities identify their ownstrengths and challenges, needs and services so that they can challenge existing serviceproviders and increase their role in service provision. If successful they will provide us with amethodology through which this programme can be rolled out.

In addition, the NHS is supporting a proposal for participatory budgeting which includestraining and subsequent development of PB approaches in communities of interest. This willprovide a financial framework for services to meet the self-identified needs of communities.

Outline key activities underway and / or planned.We have strengthened NHS input to community planning through the additional membershipof the recently appointed Director of Public Health, alongside the membership of the ChiefExecutive and Chairman, and are reviewing the input to localities with the intention ofincreasing our community engagement and supporting participation in local decision making.We will continue with membership of the CPP Executive Group and support the effectivemonitoring and goal setting contained within the Single Outcome Agreement and actionplans associated with the current five outcomes groups.

How will progress be demonstrated? Please give key measurables and milestones.a) Presuming proposal for participatory budgeting is approved, we will support the

training and plan for shifting the focus of the public health team to place communityempowerment and participatory budgeting at the centre of what we do. Key featuresinclude:

Identification of key outcomes and intermediate indicators Support for programme development including resource requirements and timelines

in line with agreement at CPPb) Community engagement and participation – work with CPP to develop plan for

Area for specific action 10.1 Community Empowerment (Scotland)Bill


Dr. Maggie Watts


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engagement in pilot areas including public health and health improvement specialistinput

c) Consistency with Integration Board – we will support the work of the CPP with theshadow integration board to ensure a consistent approach to implementation of theBill across all sectors.


NHS Western Isles is engaged at a wide range of levels across operational and strategicteams. This will be further developed through the communications plan that will follow thesuccessful application for the PB pilot.As the Integration Joint Board takes shape in shadow form, we will work with the OHCPPand Comhairle nan Eilean Siar to ensure that the integration partnership is involved in thecommunity planning projects as appropriate.


OHCPP Single Outcome Agreementhttp://www.cne-siar.gov.uk/cxdir/executiveoffice/documents/Single%20Outcome%20Agreement%202013-23.pdf

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The NHS will continue to chair the Health and Wellbeing Outcomes subgroup of the CPP. Itwill build on the health inequalities workshop undertaken in 2014-15 and develop a robustaction plan for implementing change in relation to reducing inequalities. This plan willinvolve negotiated action by all the CPP subgroups and with the Integration Board.


Build on the action plans for health and wellbeing (around older people; the best start in lifefor children and young people; addressing and reducing the harmful effects of alcohol;tackling poverty and reducing inequalities) and ensure engagement with the health andsocial care integration board as it develops.

Over 2015-16, we will raise the profile of inequalities, especially health inequalities, and theirdevelopment with all the outcome groups so that a refreshed approach can be developed toaddressing the underlying factors presenting as health inequalities.

How will progress be demonstrated? Please give key measurables and milestones.Action plans reviewed and updated during 2015-16.Meeting with all outcome groups to explore health inequalities impact of their plans and toencourage undertaking a health inequalities impact assessment of major plans.Health and wellbeing approach to action on fuel poverty developed through attendance atstudy day and development of action plan in conjunction with relevant agencies.


There is good partner engagement at present, and this will be built on through discussion atthe outcome group meetings. Wider engagement and involvement will be undertaken asplans develop. We will encourage the introduction of health inequalities impact assessmentCPP Executive Group and the CPP.Key plans are ~ (embed document or give hyperlink)

Single Outcome Agreement Action plan for health and wellbeing outcome group.

Area for specific action 10.2 Health and wellbeing outcomes


Dr. Maggie Watts


nhs western isles local delivery plan 2015-16...7.7 ~ ivf treatment 7.8 ~ reduce healthcare...

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