NHS Forth Valley Annual Review
Self Assessment
2012/13
NHS Forth Valley Annual Review 2013 Self Assessment
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NHS Forth Valley Annual Review Self assessment – Core Agenda 2013
Agenda item 1: Introduction and Chairman’s Report
PROGRESS ON THE 2012 ANNUAL REVIEW LETTER
There were 9 Action Points highlighted in the Annual Review held on 18th September 2012.
Action point 1: Keep the Health Directorates informed of progress with the local
implementation of the Quality Strategy and Health and Social Care Integration
Communication has been maintained in respect of both the local approach to the
implementation of the Quality Strategy e.g. the recent Person Centred Health and Care
Launch and Health and Social Care Integration. The integration agenda is a key priority for
the Board and the Partnership Boards with Local Authorities. A rolling programme of
engagement has been developed with key stakeholders.
Action point 2: Continue to review, update and maintain robust arrangements for controlling
Healthcare Associated Infection and ensure sustainable progress is made against
requirements and recommendations in Healthcare Environment Inspectorate reports.
NHS Forth Valley continues to have one of the lowest Clostridium difficile rates in NHS
Scotland. The HEAT target for March 2013 was 39 cases per 100,000 occupied bed days;
NHS Forth Valley rate was 18 cases per 100,000 occupied bed days and as a result,
achieved the target.
Staphylococcus aureus bacteraemias (SABs) continue to decrease every year. The HEAT
target for March 2013 was 26 cases per 100,000 acute occupied bed days; unfortunately
NHS Forth Valley rate was 36.9 cases per 100,000 acute occupied bed days and did not
achieve the target. Meticillin resistant Staph aureus (MRSA) bacteraemia cases have fallen
by 33% compared to the same period April 2011-March 2012.
Forth Valley Royal Hospital had an announced inspection in April 2012 by the Healthcare
Environment Inspectorate (HEI); the published report did not highlight any major issues or
concerns and all actions have now been closed. Monitoring through audit to maintain
standards and to give assurance of compliance continues in preparation for the next
inspection.
Action point 3: Sustain performance against all HEAT targets and standards.
NHS Forth Valley has worked towards delivery and sustainability of all HEAT targets
throughout 2012/13 and onwards. Updates in respect of Key and Standard HEAT targets are
highlighted throughout the self assessment.
Action point 4: Ensure there are robust plans in place to reduce the wait for IVF treatment
and allow patients to undergo successive cycles of IVF treatment within a reasonable
timescale.
NHS Forth valley does not host a local IVF service but commissions IVF services
predominantly from NHS Tayside. n 2012/13 the Medical Director chaired a short life working
group to ensure plans were in place for the delivery of a maximum one year wait before the
end of this parliament. Additional funding was identified to deliver an immediate increase in
the number of level III cycles by 29 cycles per annum which had begun to decrease waiting
times.
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From 1st July 2013 NHS Forth Valley has fully adopted the new NHS Scotland revised ‘Acess
Criteria For NHS Funded IVF Treatment For All NHS Health Boards’. With the additional
funding provided alongside the revised national access criteria the NHS Tayside IVF service
is working to ensure the maximum one year wait is consistently delivered for all NHS Boards.
NHS Forth Valley Infertility Policy has always included a clear commitment to allow patients
to undergo successive cycles of treatment within a reasonable timescale and does not
support the practice of returning patients to the waiting list after each cycle of treatment.
NHS Forth Valley expects to be fully compliant with guidance including a maximum one year
wait by the end of this parliament and will continue to work with NHS Tayside to ensure this
target is realized.
Action point 5: Ensure there are robust plans in place to sustain performance against the 62
and 31 days cancer access standards and continue to plan local implementation of the
Detect Cancer Early Programme.
NHS Forth Valley is delivering well against the cancer access standards with delivery above
the 95% target for both the 62 and 31 days. This is not without on-going challenges in the
main due to general pressures in respect of capacity.
NHS Forth Valley Detect Early Cancer Steering and Implementation group is established.
The group includes Clinical and Managerial Leads from across Forth Valley, including Public
Health, Communications and Finance. Forth Valley is also represented on the National
Communications sub group.
Action point 6: Maintain an appropriate focus on delivery of the 12 week Treatment Time
Guarantee and ensure any emerging problems are highlighted at an early stage.
Under the Patient Rights (Scotland) Act 2011, from 1st October 2012, all eligible patients will
start to receive their day case or inpatient treatment within 12 weeks of the agreement to
treat. From October 2012 to June 2013 NHS Forth Valley had 78 breaches of the Treatment
Time Guarantee. Including the period July 2013 to September 2013 there were a further 58
breaches of the TTG. During the last 2 months significant further reductions in breaches
have been achieved.
The breaches were related to capacity issues in pain management and the orthopaedics
subspecialty of upper limb surgery. Focussed action is ensuring there will be no further
breaches from December onwards.
Action point 7: Take further steps to improve performance on staff sickness absence.
Work continues to deliver on the national HEAT standard of achieving a sickness absence
rate of 4%. This remains a challenging target and a high priority for managers across the
organisation. Activities to support this are detailed under Agenda item 5: Staff feel supported
and engaged.
Action point 8: Work with the local partnerships to improve performance on delayed
discharges, reducing the overall length of delays and bed days lost.
Forth Valley achieved the position of zero patients waiting over 28 days in April of this year
however has since experienced challenge across the partnerships noting an October 13
position of 12 over 28 days and a recent rise in bed days lost. There is ongoing focus on this
issue through NHS Board, Partnership Boards, Joint Management Teams, Capacity and
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Flow EPQ Workstream as well as the specific Forth Valley structures to support this policy
agenda.
Action point 9: Maintain focus on the achievement of in-year and recurring financial
balance; and keep the Health Directorates informed of progress in implementing the local
efficiency savings programme
Financial balance achieved and regular communication maintained.
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Agenda item 2
Everyone has the best start in life and is able to live longer healthier lives
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Agenda item 2: Everyone has the best start in life and is able to live longer healthier
lives
Key and standard HEAT targets in support of ‘Everyone has the best start in life and is able
to live longer healthier lives’ are highlighted. Consideration has been given to suicide rates,
alcohol brief interventions, infant nutrition, reducing health inequalities, early years, drug and
alcohol treatment, smoking cessation and cancer.
Sustain and embed Alcohol Brief Interventions in the
three established settings of Primary Care, A&E and
Antenatal whilst developing delivery in the wider setting
Reduce suicide rate between 2002 and 2013 by 20%
6423
@
quarter
end
September 2013 against an
annual target of 3676
11.4 @ December 2012
against a target of 14
Achieve agreed completion rates for Child Healthy Weight 458 @ March 2013 against a
interventions over the 3 year period ending March 2014
trajectory of 583
Number of successful smoking cessation attempts in the
40% most-deprived within-Board SIMD areas
Percentage of 3 and 4 year olds in each SIMD quintile to
have twice year Fluoride Varnishing
Increase Breast Feeding for 0-8week old babies to 27.7%
2740 @ June 2013 against
trajectory of 2252
6.65% @ March 2013 in the
lowest performing quintile
against a 40% target
22.7% @ March 2013
HEAT Targets
Alcohol Brief Intervention (ABI)
NHS Forth Valley continues to perform well in respect of Alcohol Brief Intervention. For
Quarter 2, July - September 2013, 3199 ABIs were delivered highlighting a cumulative total
for the year of 6423.
Within the priority settings of Antenatal, A&E and Primary Care, 2132 ABIs were carried out
with 1067 in wider settings e.g. Mental Health, Criminal Justice. Work continues to develop
delivery in these wider settings.
The overall target is to deliver 3676 alcohol brief interventions. A minimum 10% of that
requires to be delivered in the non priority settings.
Child Healthy Weight
Interventions are delivered through the two linked mechanisms of Max in the Middle and Max
in the Class which are interactive sessions involving dance and drama and are supported by
schools. Interventions run from September to December and January to March and are
recorded on the Child Health Surveillance System. Activity to March 2013 highlights that
NHS Forth Valley is on track to achieve the target number of interventions over the 3 year
period to March 2014 with 70.2% of the target number of interventions completed over the
first 2 years.
There is full participation of schools and it is expected that NHS Forth Valley will achieve the
target.
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Smoking Cessation
The Scottish Government set NHS Forth Valley Smoking Cessation Service the following
target for the period 1 April 2011 – 31 March 2014.
It was estimated that there were 66,721 smokers within Forth Valley in 2007 - 2008 and a
quit rate for the 4 week target of 5004 was based on 7.5% of this figure. The target contains
a measure of deprivation with 60% of the quits required to come from within the 40% most
deprived datazones which equates to 3002.
As at 30 October 2013 Forth Valley has achieved 4968 quits (99%) of the 3 year target and
3048 (101.5%) of these quits at 4 week follow up are from within the 40% most deprived
datazones. With 5 months left of the HEAT target period Forth Valley will achieve in both
areas of measurement.
NHS Forth Valley is committed to providing a smoke free environment for staff, patients,
visitors and contractors. It will continue to raise awareness in relation to the health risks
associated with smoking and to monitor its Tobacco Policy as part of the progression of the
Health Promoting Health Service agenda and attainment of the Health Working Lives (HWL)
Award.
Tobacco Control Officer for NHS Forth Valley Grounds
NHS Forth Valley has a responsibility to comply with the legal duties imposed by Smoking,
Health and Social Care (Scotland) Act (2005). A Tobacco Control Officer is now in post.
Smokefree Mental Health Unit
Staff briefings have been undertaken in the Mental Health Unit prior to the Unit becoming
smokefree. Implementation of the smokefree date is anticipated to be April 2014.
Fluoride Varnish
The Childsmile programme is now well established in Forth Valley with a full complement of
staff. The nursery and school programmes continue to progress with 100% of pre-school
establishments brushing daily. The nursery and school programmes are fully operational with
above target populations receiving Fluoride Varnish every six months.
The practice component continues to progress with staff from every general dental practice
now Childsmile trained. The practices are supported by Dental Health Support Workers and
the Regional Childsmile co-ordinator from the Salaried Service.
The HEAT target for Fluoride Varnish reports the poorest performing quintile which is 6.65%
for 4 year olds in SIMD 4 at March 2013. NHS Forth Valley delivers a programme that targets
SIMD quintiles 1 and 2. Performance in these areas ranges from 16.8% to 26% although this
is not as well as had been anticipated. A review of the way the programme is delivered is
being carried out to improve activity. The fluoride varnish activity in SIMD quintiles 3, 4 and 5
is delivered by General Dental Practitioners (GDPs). Work has been on-going with GDPs to
support an increase in activity.
Achieving a target of 60% at March 2014 is challenging however every effort remains to
ensure that the programme is reaching the appropriate children.
Breast Feeding
The statistics for year ending March 2013 highlight that NHS Forth Valley has a slight
decrease in the percentage of exclusively Breast feeding babies at their 6-8 week check.
Stirling and Falkirk areas are the same or show a slight improved from the previous year.
Clackmannanshire however, compared to the previous few years, has show a dip for both
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percentage breastfed and percentage exclusively breastfed at 6-8 weeks by around 5%.
There are wide variations in rates across the area due in the main to socio-economic factors.
Each CHP group along with acute services is working with partners to ensure focus on areas
of inequality e.g. through healthy start.
Reducing Inequalities
The Forth Valley Health Improvement and Health Inequalities Group chaired by NHS Forth
Valley Director of Public Health is committed to:
 Developing a strategic approach to early intervention and prevention
 Ensuring actions on priorities are informed by the best available evidence of need,
assets, effective public health practice and evaluation
 Ensuring the NHS contribution in Community Planning Partnerships is co-ordinated
and that NHS staff feel empowered to proactively engage and contribute their
knowledge and skills for achieving better outcomes through the Single Outcome
Agreements
 Building capacity for the NHS contribution to assets based approaches for improving
health and reducing health inequalities
 Providing visible, persistent and committed leadership for improving health and
reducing health inequalities
NHS Forth Valley contributes to the strategic and operational public health improvement
effort through professional leadership and a commitment to deliver effectively and efficiently
on partnership priorities identified through Community Planning. An integrated approach to
theory and practice informs the approach to addressing health inequalities and physical
activity through Community Planning. This ensures that the topic is a cross cutting theme in
the local community planning priorities for action. The actions of organisations, agencies and
individuals are influenced in ways that are focused on achieving outcomes for health
improvement and health inequality reduction, and are based on the best available evidence
of effectiveness and need.
The programme development of Keep Well is led within CHP areas across NHS Forth Valley
to ensure mainstreaming across core services as joint primary prevention anticipatory care
programmes of work. This is complimentary to shifting the balance of care and secondary
anticipatory care.
Keep Well
The Keep Well Forth Valley programme currently delivers approximately 3000 health
assessments per year with about 85% of those undergoing a health assessment
experiencing deprivation.
The health assessment invariably identifies some opportunity for improvement, and often
leads to health gains in a variety of ways. The focus is deprivation and vulnerable groups as
per the guidance for the programme nationally, enhanced by a local focus on men’s health
and employability. The programme in Forth Valley has been developed to build capacity and
enhance reach through core CHP service planning supported by (rather than delivered
through) GP practices. There is continued commitment to Keep Well Forth Valley from NHS
Forth Valley as a key component of primary anticipatory care work. A three month follow up
has been introduced this year, which indicates significant behaviour change associated with
goal setting.
Strategic outputs of the Keep Well programme are:
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Refined and implemented an operational support system to ensure appropriately
targeted activity is delivered to those at greatest risk of CHD within the diverse
context of deprivation in Forth Valley.
Increasing programme capacity and reach by development of joint high level strategic
short term outcome measures within other key health and community planning SOA
strategy areas i.e. carers, local employability partnerships action plans.
Developed an integrated model of work which will increase capacity and reach within
core NHS service plans in community dietetics, learning disabilities, community
mental health and pharmacies.
Standard Operating Procedures for non nursing posts developed to support improved
quality and safety in respect of implementation and delivery of the programme.
Improved the strategic alignment of the programme across NHS Forth Valley in ways
which build on the strength and assets of each CHP/CPP area to maximize resources
for primary prevention activity with the target groups.
Identified ongoing local learning from the programme of work to transfer into strategic
planning for targeted primary prevention activity within community planning. In
particular related to gender and health, employability and health and assets based
work in a clinical and community context.
Developed workforce capacity within core services to optimise ‘in kind’ resources
which ensure best value.
Work is currently being developed that will further inform early intervention and anticipatory
care. This includes proposed work with GP practices using the improvement methodology
and integrated working with cores services and Keep Well.
Employability
NHS Forth Valley continues to maximise health and employability. An exercise aimed at
mapping out the entire NHS contribution locally, to highlight areas where improvements can
be made, has been carried out. NHS Forth Valley delivers Working Health Service, a
programme aimed at helping people with health problems to stay in employment and
supports Healthy Working Lives.
In addition there is a long standing partnership with the employability service in Stirling which
has developed an integrated model of working with a specific client group who experience
barriers to employment. This work has been recognised at national level over the years in
terms of good practice. The work has been both externally evaluated and cost benefit
analysis has been undertaken, with both reports informing the current areas of development.
There is NHS representation on each of the Local Employability Partnerships and this will
allow actions to be progressed as NHS partners. An NHS Forth Valley Health and
Employability Working Group provides an overview to these elements, and work on a holistic
approach to health and employability where resilience underpins both.
Early Years Collaborative
The Early Years Collaborative (EYC) seeks to improve outcomes for children across
Scotland by adopting the improvement methodology historically utilised in NHS settings.
NHS Forth Valley is currently participating in the four workstreams to deliver on national aims
and outcomes. The initial focus has been to up-skill and familiarise front line staff in
improvement methodology by encouraging them to undertake small tests of change in each
of the existing workstream areas.
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The leadership group has supported the work of ‘home’ and ‘away’ teams in each
Community Planning Partnership area and as a Forth Valley wide organisation efforts are
being made to ensure consistency of approach and work across CPP areas.
CPP home and away teams will explore how to progress the new workstream.
Detect Cancer Early (DCE)
NHS Forth Valley Detect Early Cancer Steering and Implementation group is established.
The group includes Clinical and Managerial Leads from across Forth Valley, including Public
Health, Communications and Finance. Forth Valley is also represented on the National
Communications sub group.
Local links to the national programme board are managed through the Cancer Board
Structure, which is chaired by the Consultant Cancer Lead and attended by Clinical Leads
from each of the key tumour sites, diagnostics and senior managers. Local Issues are taken
through Regional Cancer Advisory Group (RCAG), attended by the Consultant Cancer Lead
and Senior Planning Manager.
Additional one-stop breast clinics have been undertaken to support an increase in demand
following the highly successful Breast campaign, with an average increase of 40 - 50%.
There are plans to air the campaign again early in 2014.
ISD has been working with NHS colleagues and Scottish Government to develop processes
for the receipt and reporting of invasive breast, colorectal and lung cancer data to support the
Detect Cancer Early (DCE) initiative. NHS Forth Valley is fully involved in this process.
The Bowel Screening campaign was launched in February 2013. The focus of the campaign
is to increase the uptake in Bowel Screening. Referrals to Forth Valley from the Bowel
Screening Centre have returned to normal levels following a spike in referrals in May 2013. A
repeat of the DCE Bowel Screening campaign has been aired on TV throughout September
2013.
Work is on-going in respect of a regional approach to endoscopy which will support this area
of increasing demand however some clinical issues need to be resolved in respect of this.
The Lung campaign is due to be launched at the beginning of November 2013. The focus will
be ‘a change in cough’. Stakeholder events are planned including events for GP’s and
Pharmacists. Due to the winter timing of the launch NHS Forth Valley is reviewing the
probable impact as there is likely to be a rise of respiratory illness in general during the same
period.
Primary Care
In recent years advances in cancer care have resulted in the principles of good cancer care
being aligned to those of other long term conditions. Due to an ageing population and more
successful cancer treatments, there will be many more people living with a diagnosis of
cancer in the years ahead.
Primary Care has a prominent part to play in the Scottish Government’s Detect Cancer Early
programme. GP practices are also asked to play a more proactive role in the bowel
screening programme to help increase uptake, particularly in areas of increased deprivation.
The national ‘Transforming Care after Treatment’ work plan will also have an impact on
Primary Care. As more people are now being discharged following their cancer treatment,
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GPs will be the point of immediate contact should a patient develop complications of cancer
or a suspected recurrence.
Within NHS Forth Valley there is a clinical lead for each tumour group, a primary care lead
and a consultant nurse lead. These leads meet regularly at the Forth Valley Cancer Board
alongside management from various directorates. Operational issues relating to the provision
of cancer services are discussed here.
Access to Insulin Pumps
Forth Valley started from a low baseline in terms of staffing, skills and numbers on pump
therapy. Furthermore, there was little evidence to say that the estimated level of demand
would manifest in such a short period. Therefore, the target has always been considered to
be a real challenge.
Forth Valley took an early decision to commit to the implementation of a new service that
would deliver the target. Local insulin pump services were developed significantly during
2012/13, in line with clinical recommendations. Clinical safety has always been the top
priority locally. Good progress was made against the target during 2012/13 i.e. 30 against a
target of 47.
Awareness of pump therapy is high amongst children and families.
Converting this awareness into patient demand for a pump is an issue locally. Many people
that may benefit from pump therapy simply choose to stick with their Multiple Daily Injections
(MDI) therapy rather than move to an insulin pump. Thus, Forth Valley did not fully meet the
Ministerial target at 31 March 2013, despite significant effort to deliver it.
Looking ahead, a good number of children/families with an interest in pump therapy were
identified for 2013/14 however further input and education is required before they may be
ready to start pump therapy. NHS Forth Valley supports patients/ families in their decision of
when to start the pump therapy process should they wish to do so. This has sometimes led
to delayed pump starts due to personal circumstances such as exams, holidays, other
commitments or plans and simply not being the right time for them to start.
The anticipated increase in numbers during 2013/14 has not manifested in line with the initial
plan. During the first 6 months of 2013/14, numbers did reduce, as patients were removed
from the start-up programme or pump therapy for various reasons. The schedule has been
reviewed several times to reflect on-going challenges however a number of patients have
expressed an interest in insulin pump therapy. It is anticipated that over the next 7 months an
additional 2 patients per month will start pump therapy.
Forth Valley had an informal visit from the insulin pump improvement team, Clinical Priorities
Team at the Scottish Government, on 29 October 2013 to provide support and advice on
working towards the target. NHS Forth Valley clinicians clearly explained that the necessary
service capacity and staff skills are in place and that the main issue is that the level of
demand for pump therapy from Forth Valley residents has not yet materialised at a level or
pace that would satisfy the target. It was recognised that the circumstances in Forth Valley
did appear to be different from other Boards, where lack of resource was a factor, and that
further effort would be required, to ensure patients and their families are fully supported.
NHS Forth Valley has continued to make excellent progress in terms of our planned
schedule for adults during the last 18 months and currently remain ahead of the planned
trajectory.
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Agenda item 3
Healthcare is safe for every person, every time
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Agenda item 3: Healthcare is safe for every person, every time
Key HEAT targets in support of ‘Healthcare is safe for every person, every time’ are
highlighted with consideration given to the healthcare associated infections. In addition there
is a focus on clinical governance, clinical effectiveness and risk management, and patient
safety.
Rate of Clostridium difficile infections in patients aged 15
per 1000 total occupied bed days.
Reduction in rate of MRSA/MSSA Bacterium infection
cases per 1000 acute occupied bed days
0.2 @ September 2013 against
trajectory of 0.25
0.3 @ September 2013 against
trajectory of 0.32
Clinical Governance and Clinical Effectiveness
Following the review of governance and the management reorganisation within Forth Valley
the arrangements for clinical governance were revised to reflect changes in operational units
along with NHS Forth Valley assuming responsibility for prison healthcare. The Clinical
Governance and Risk Management strategies have been reviewed and the opportunity was
taken to unify these into a single strategy ‘Quality Assurance in Forth Valley - Clinical
Governance and Risk Management’. This was approved by the Board in November 2012.
This Strategy describes how NHS Forth Valley will utilise effective systems of clinical
governance and risk management to assure the public of the quality and safety of patient
care provided in the Board area. These systems are underpinned by a robust and
accountablity framework with appropriate monitoring and reporting. The strategy also
highlights the broader elements of risk encompassing health and safety and the NHS Board
responsibilities for Civil Contingencies.
The Clinical Governance Committee continues to provide oversight and assurance to the
Board on the quality and safety of care. The agenda has been developed to consider the
following themes in a structured and systematic way - strategy and objectives; assurance
and improvement; person centred care; safe care; effective care and reports from the
associated clinical governance groups. In the past year a number of reports have been
developed for the committee which are standing agenda items. This includes a report on
serious adverse events which provides the Clinical Governance Committee with information
on the numbers and types of serious adverse events, and the actions being taken to
continually improve the quality of clinical care and reduce harm to patients. The report
continues to develop and takes account of the wider context of the learning from the
Healthcare Improvement Scotland review of the management of serious adverse events.
Another standing agenda item for discussion is the Clinical Governance Balanced Scorecard.
This report has been developed specifically for the Clinical Governance Committee with the
aim of providing a suite of indicators to provide assurance about the quality and safety of
clinical care within NHS Forth Valley. Work continues to build upon the approach thus
ensuring a deeper level of qualitative and quantitative information to elicit improvement and
provide assurance. The intention is that the report will be further developed over time, taking
account of feedback from members of the committee and additional balanced scorecard
measures that are being developed both locally and nationally.
Clinical governance arrangements have also been reviewed at operational level with the
development of a single system joint clinical governance working group. Membership is from
all the clinical units and CHP to provide assurance from an operational level to the Clinical
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Governance Committee. The working group works to the same structured agenda as the
Clinical Governance Committee and has developed an annual work plan which has been
incorporated into the overall quality improvement strategic framework.
The Quality Improvement Strategic Framework ‘Getting it right for people, first time, every
time’ sets out how the safety, effectiveness and experience of care will be improved and
underpins the overall strategic approach. It also describes the way in which outcomes of care
will be measured, using data and information as a tool for driving improvement, action and
continuous learning. The framework was launched in 2013 and links improvement activities
and programmes, including operational objectives for safe, effective and person centred
care. A key component of the strategic approach is the development of improvement
capacity and capability. This is being progressed through investment in a wide range of
education and training including clinical leadership and improvement skills, coaching, the
ongoing development of a local quality hub and clinical dashboards to provide information on
the quality and safety of care.
Staff and services in Forth Valley continue to be recognised for the quality of the care and
services they provide. NHS Forth Valley received and delivered the following awards and
achievements in 2012/13:
 BMJ Midwifery Practice Awards - Excellence in supervision of midwives award
 Sexual Health Services LGBT charter mark from LBGT Scotland
 NHS Forth Valley/ Scottish Prison Service - WHO award ‘Improving Prison Menus’
 NHS Scotland ehealth awards – ‘Best NHS Scotland use of innovative IT for patient
care’
 ROSPA Gold award - Forth Valley Royal hospital
 Healthcare Catering Association Catering Service Team of the Year award for Forth
Valley Royal Hospital
 SSSC Care Accolades 'Working Better, Working Together' Award 2013 - awarded to
the Falkirk Falls Management Project
 Scottish Learning Disability Nursing Network's (SLDNN) Excellence in Practice
Awards 2013 – award for person centered care
 NHS Scotland events – Cardiology team overall winner in the effective care category
 Shortlisted in 5 categories in the up and coming Scottish health Awards in November
Adverse Events and Risk Management
As stated above, in line with the review of governance and management structures
undertaken during 2012, the ‘Quality Assurance in Forth Valley – Clinical Governance and
Risk Management Strategy’ was approved and combines the strategic approach to Clinical
Governance and Risk Management. This covers all aspects of risk and includes aspects of
Staff Governance and wellbeing and also Health and Safety. The Strategy reaffirms the
approach to risk management in NHS Forth Valley which is a consistent approach to risk
identification, assessment, mitigation and reassessment of risks underpinned by the use of
Risk Registers. Supporting integration, coordination and organisational learning from risks is
also a core part of the process. This is a key role of the Risk Network.
Priorities for 2013/14 continue to be:
 Building on local systems further improve processes for the management of adverse
events in response to the Healthcare Improvement Scotland (HIS) Review Report on
the management of Adverse Events in NHS Forth Valley published in March 2013
and more recently the national framework.
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Development and agreement on the definition of the organisational risk tolerance in
line with internal audit recommendations.
Reflecting the new governance and management arrangements, establishing and
monitoring the Unit Service Improvement and Risk Management structures to support
reporting and management of risk at Unit level and sharing learning across Units.
Healthcare Associated Infection (HAI)
Effective governance reporting structures are in place to discuss any HAI issues; HAI reports
are submitted to ward staff, management and the NHS Board on a regular basis. All staff
have access to HAI data and information via the intranet.
Clostridium Difficile Infections (CDI)
Continued collaboration with the Antimicrobial Pharmacist and the Consultant Microbiologist
ensure appropriate antimicrobial therapy is prescribed to minimise the risk of developing CDI.
Robust surveillance for all cases, and accurate and rapid patient review and feedback to
clinicians and GPs ensures the continued reduction of CDI across NHS Forth Valley.
All CDIs isolated in Forth Valley for this period were related to antimicrobial treatments. No
CDI has been linked to cross infection (person to person spread) in the last 4½ years.
Staphylococcus Aureus Bacteraemia (SABs)
Every SAB is fully investigated to identify the cause of the infection; a full root cause analysis
is performed on all hospital and healthcare (where applicable) attributed SABs with ward staff
to help identify any issues that were, or potentially be related to the SAB acquisition. Results
of these findings are reported and presented by the Infection Prevention and Control Team
(IPCT) to the appropriate governance meetings for discussion and action.
Device associated Bacteraemia
In October 2012, the IPCT started monitoring all device associated bacteraemias i.e. patients
who have urinary catheters, vascular devices etc. This surveillance is not organism specific
unlike the SAB HEAT target which allows the IPCT to tackle and investigate all bacteraemias
associated with invasive devices.
Outbreaks
Seventeen incidences of increased gastrointestinal illness were investigated by the IPCT;
norovirus was confirmed in 14 wards for the period. This resulted in 9 full ward closures and
8 wards were controlled with bay closures and remained open. With the exception of two
mental health wards in FVRH, no acute ward was closed and service provision was
maintained.
No outbreaks of MRSA, CDI or any other pathogenic organism occurred for the period April
2012 – March 2013. This positive position has been maintained to end October 2013.
Ward visits and audit
To give the IPCT team assurance of compliance to Infection Control policies and procedures
in all clinical areas, the IPCT performs various audits and compliance checks every month.
These checks include ward cleanliness, adherence to standard infection control precautions
and practices. All acute wards are visited by the team at least on a weekly basis, community
hospital wards and mental health wards are visited on a monthly or biweekly basis.
Observations and issues identified from these visits are recorded and closely monitored by
the team; results are fed back on a monthly basis to all relevant stakeholders. In addition to
these audits, ward staff also perform a ward-based Infection Control Audit on a monthly
NHS Forth Valley Annual Review 2013 Self Assessment
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basis; results of these audits are discussed at a local level and provides additional assurance
of compliance to the HAI agenda.
Hand Hygiene
Hand hygiene is monitored continually both by ward staff and by the IPCT. The IPCT have
trained this year, over 200 hand hygiene trainers across NHS Forth Valley to maximise hand
hygiene compliance and to prevent potential infection. In addition, ward staff monitor 20
moments or opportunities of ward staff washing their hands appropriately every week as part
of the SPSI campaign; these results are reported both locally to the ward and to the board on
a bimonthly basis. Performance to end September 2013 was 99%.
Scottish Patient Safety Programme
NHS Forth Valley continues to progress all workstreams of the Scottish Patient Safety
Programme.
The following sustained improvements have been delivered locally through the
implementation of the Scottish Patient Safety programme:
 At quarter April to June 2013 there was an 18% reduction in HSMR - embargoed
until 26 November
 30% reduction in adverse events
 Sustained improvement in all general ward measures in pilot populations
 Spread of general ward workstream to all acute inpatient wards and relevant areas of
work to community hospitals
 Sustained reliability in hand hygiene and PVC measures at scale across all acute
wards. These are hospital wide measure.
 Sustained reduction in cardiac arrests in the Acute Admissions Unit. This work has
recently been published in BMJ Quality and Safety and the approach is being rolled
out across the acute hospital.
 Innovative work with the Scottish Simulation Centre supporting efforts to improve the
recognition and response to deteriorating patients and sepsis
 Sustained improvement in perioperative workstream safety briefings and pause,
antibiotic prophylaxis, normothermia and skin preparation. Spread and sustained
reliability is across all theatres.
 1218 days since last Ventilator-associated pneumonia (VAP), as at 30/10/13
 747 days since last catheter-related bloodstream infection (CRBSI), as at 30/10/13
 638 days since last SAB in critical care, as at 30/10/13
 NHS Forth Valley has participated in the Mental Health SPSP programme since
phase 1 and has the only mental health SPSP fellow in Scotland
 No surgical site infection in pilot population since 27 April 2012 for abdominal
hysterectomy
 2 areas of SPSP work shortlisted as finalists for the Scottish Health awards
 Active participation from the outset of the Safety Improvement in Primary Care
programme
 GP local enhanced service for Anticoagulation and Near Patient Testing has been
rolled out across Forth Valley with SIPC influencing development.
NHS Forth Valley Annual Review 2013 Self Assessment
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Scottish Antimicrobial Resistance Action Plan
The issues surrounding antimicrobial use both in terms of growing global resistance patterns
and unwanted consequences such as clostridium difficile infection are recognised fully
across secondary and primary care in Forth Valley. The high level of priority this agenda has
been given has enabled significant improvements in antimicrobial prescribing particularly in
primary care where Forth Valley was originally an outlier in several measures.
Compliance with the targets set around antimicrobial use is good and further work is planned
to improve and maintain these standards.
The priorities for 2013/14 and beyond have been agreed by the Antimicrobial Management
Group. The focus is on the following initiatives which are currently underway:
 Reducing overall antibiotic use within Primary Care in line with government targets
 Review prescribing of antibiotics within the Care Home setting to reduce overall use
 Promote the prompt switch from intravenous therapy to oral where clinically
appropriate to improve use of hospital resources and improve capacity. Ways to
maximise existing services and investigate novel ways in which to provide
intravenous antibiotic therapy to clinically stable patients either through ambulatory
care or within their own home or care home are being explored and developed
NHS Forth Valley Annual Review 2013 Self Assessment
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Agenda item 4
Everyone has a positive experience of healthcare
NHS Forth Valley Annual Review 2013 Self Assessment
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Agenda item 4: Everyone has a positive experience of healthcare
Key and standard HEAT targets in support of ‘Everyone has a positive experience of
healthcare’ are highlighted. The main focus is on the access and waiting times targets,
person-centred care and patient experience.
Deliver 18 weeks referral to treatment from 31 December
2011. This is a 90% target
95% of all patients diagnosed with cancer to begin
treatment within 31 days of decision to treat
95% of those referred urgently with a suspicion of cancer
to begin treatment within 62 days of receipt of referral
12 week outpatient wait for first appointment
80.8% @ March 2013 with a
position of 84.8% @ June 2013
97.7% @ March 2013 with a
position of 96.4% @ June 2013
95.5% @ March 2013 with a
position of 95.4% @ June 2013
2105 over 12 weeks @ March
2013 with a position at June
2013 of 2555
98% of patients should wait no longer than 4 hours 87.6% @ March 2013 improving
between arrival at A & E to admission, discharge or to 94.6% @ June 2013
transfer
90% of all patients admitted with a diagnosis of stroke will 71% for quarter end March 2013
be admitted to a stroke unit on the day of admission, or improving to 84.0% @ quarter
the day following presentation
end June 2013
90% of clients will wait no longer than 3 weeks from 97.8% @ March 2013 with a
referral received to appropriate drug or alcohol treatment position at June 2013 of 95.9%
that supports their recovery
Improving Access to Services
NHS Forth Valley has experienced ongoing challenge in respect of both elective and
emergency access targets.
Treatment Time Guarantee (TTG)
Under the Patient Rights (Scotland) Act 2011, from 1st October 2012, all eligible patients will
start to receive their day case or inpatient treatment within 12 weeks of the agreement to
treat. From October 2012 to June 2013 NHS Forth Valley has had 78 breaches of the
Treatment Time Guarantee. Cumulatively this is 99.1% compliance. Including the period July
2013 to September 2013 there were a further 58 breaches of the TTG, where Forth Valley
cumulative compliance fell slightly to 98.9%.
The breaches were related to capacity issues mainly in pain management and the
orthopaedics subspecialty of upper limb surgery.


The pain management issue has been resolved by providing further theatre sessions
for the consultant specialist.
As part of the sustainability programme NHS Forth Valley has, at October 2013,
recruited an additional upper limb surgeon.
At October 2013 there were 5 breaches of the TTG with 3 anticipated in November 2013. In
September 2012, NHS Forth Valley had 800 inpatients waiting over 9 weeks. At September
2013 this had reduced to 124. The aim is to have a 9 week stage of treatment target in place
and no TTG breaches from December 2013 onwards.
NHS Forth Valley Annual Review 2013 Self Assessment
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18 Week Referral to Treatment (RTT)
The RTT performance has also proved challenging with the June position at 84.8%. A further
decrease is noted for September which is due for publication in November. The reduction in
performance is related to the long waits Forth Valley has in the outpatient stage of treatment.
There are capacity challenges for the specialties of Orthopaedics, Audiology,
Ophthalmology, ENT, Gastroenterology, Respiratory Rheumatology and Audiology. Of note
is the low level of unavailability in Forth Valley which is extremely positive.
Forth Valley has reviewed the required activity with a recovery plan in place to ensure
significant progress is made towards delivery of the 12 week stage of treatment target for
outpatients by March 2014. The recovery plan for outpatients is focussing on ensuring that
the required capacity is available each week to deliver the required activity. This requires
Forth Valley to monitor the level of activity and demand to detect any changes early enough
to take action and secure delivery of this important target.
Diagnostics
The maximum wait for the 8 key diagnostic tests should be 42 days which is included as part
of the outpatient phase of the journey.
At the end of June 2013, the number of patients waiting over the 6 week target for the 8 key
diagnostic tests was 111 rising to 239 at end September. The majority of breaching patients
were waiting for an Endoscopy. Additional capacity is being utilised via in house sessions
and the Golden Jubilee National Hospital. Detailed capacity planning is underway to ensure
a sustainable activity plan is in place. MRI capacity has also been extended to provide
additional activity along with an increased allocation of capacity at the Golden Jubilee
National Hospital over the winter period.
4 hours A & E Target
For 2012/2013 NHS Forth Valley achieved 91.8% compliance with the 4 hour access target.
Compliance with the 95% target was challenging with ‘wait for a bed’, ‘wait for first
assessment’ and ‘wait for specialist’ the main reasons for delay in discharge, transfer or
admission. A key issue within Forth Valley is the significant variability in performance day on
day.
In October of 2012 Forth Valley established a local capacity and flow work-stream as part of
the overall Efficiency, Productivity and Quality (EPQ) priority programme. This work focuses
on improvements to whole system patient flow and internal working with the Emergency
Department, AAU and CAU. This work was further supported by the Scottish Government
with the development of the national focus on Unscheduled Care.
2013/2014
The Local Unscheduled Care Action Plan (LUCAP) building on the capacity and flow work
was agreed in August 2013. A revised trajectory to support the achievement of the 4 hour
access target was also agreed with the Scottish Government through the LUCAP. By
October 2013 a target of 92% compliance was agreed. This was achieved by September
2013 with a level of 93.5% sustained in October 2013. However variability in performance is
still a problem with significant clinical and managerial focus to address this. The Board’s
LUCAP looks at key actions to achieve consistency of performance. It focuses on
improvements to the workforce with additional senior medical staff within the Emergency
Department to ensure effective decision making and improvements to many aspects of
patient flow e.g. a focus on standardising the approach to discharge, ward rounds. The
development of the Frailty Unit is a key initiative which commenced in October 2013. The
aim of the frailty model is to improve outcomes for frail elderly patients by reducing avoidable
hospitalisation with the following key objectives:
NHS Forth Valley Annual Review 2013 Self Assessment
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





Provision of timely comprehensive Geriatric assessment – which allows streamlining
of patients to an Inpatient or Ambulatory (outpatient) Pathway
Reduce avoidable admissions through rapid access clinic assessment and treatment
Timely discharge from Inpatient pathway as soon as possible when acute care no
longer adds value
Reduce avoidable disability/harm – with potential associated ongoing burden of care
and loss of independence
Optimise partnership approach between health – patients/ carers/ GP/ Social Care/
community service/SN/ MH/ other specialities
Improve patient and carer experience
Cancer
Against a 95% target, quarterly statistics at June 2013 highlight that 95.4% of patients were
seen within 62 days and that 96.4% of patients were treated within 31 days. Most recent
management information indicates ongoing delivery of the targets. This is not without ongoing challenges in the main due to general pressures in respect of capacity. These are
within OPD, endoscopy, diagnostic reporting times, oncology and theatres. Work is on-going
to ensure that sustainable solutions are developed and implemented thus ensuring continued
timely delivery of treatment.
Drug and Alcohol Treatment
Forth Valley has continued to perform well in respect of Drug and Alcohol Waiting times. The
90% target was exceeded with a position at March 2013 of 97.8% of clients waiting no longer
than 3 weeks from referral received to appropriate drug or alcohol treatment that supported
their recovery. This positive position has continued into June 2013 with 95.9% of clients seen
within 3 weeks.
Forth Valley Alcohol and Drug Partnership (ADP) has recently appointed a quality
improvement support worker to support the delivery of ADP priorities, by utilising various
improvement methodologies, and to implement an integrated care pathway for third sector
substance misuse services to directly improve service user experience and overall quality of
care.
Stroke Unit Care
The Scottish Stroke Care Audit (SSCA) 2013 Annual National Report includes data
describing the quality of stroke care in each acute hospital, during 2012. The report
compares the position at 2011/12 with 2012/13 and highlighted that Forth Valley has made
good progress during this period which included the service moves from Stirling Royal
Infirmary to Forth Valley Royal Hospital (FVRH) and the creation of the integrated Stroke
Unit. Importantly, there was a significant improvement in timely access to the Stroke Unit at
FVRH.
There were also improvements in people getting timely access to swallow screen
assessments, brain imaging, aspirin administration and assessment at a neurovascular
clinic. It is recognised that some of these targets have been tightened recently and that this
will continue to be an ongoing focus in the coming months and years. In April 2013 a new
stroke bundle was introduced at FVRH, which will help to continue to ensure the highest
standards of care are achieved. It is with some encouragement that the number of those
diagnosed with stroke fell from 547 to 475 during this period, which is a 13% reduction.
NHS Forth Valley Annual Review 2013 Self Assessment
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The monthly performance for admission to a Stroke Unit has been variable over the last 12
months. This is mainly related to capacity and flow challenges at FVRH with timely access to
the stroke unit averaging 77% over the last 12 months. There is a clear picture of the
challenges and work will continue to review and improve performance.
Person-Centred Care and Patient Experience
NHS Forth Valley launched its Person Centred Health and Care Programme on 1st
November 2013 supported by Professor Jason Leitch-Clinical Director of Quality Unit,
Scottish Government & National Lead for Person Centred Health & Care.
The organisation has had a long and sustained focus on improving the care and experience
of patients, families and carers. The commitment has been single system wide and includes
acute inpatient services, community hospitals, midwifery, learning disabilities, mental health
and the community. Over the last 10 years NHS Forth Valley has continually sought patient
and public feedback, listened to people’s views, gathered information about their perceptions
of care and the things that matter to them, and have used that information to further improve
care and experience. Patients and the public have been involved in large scale changes to
the local model of health care and have had a key role in the design and delivery of these
services.
NHS Forth Valley continues to develop and implement person centred approaches to care,
and seeks feedback from service users, carers and staff members to shape changes,
improvements and to highlight what is being done well. Public Partners continue to support
ongoing work through the Patient Experience subgroup and Person Centred subgroup.
NHS Forth Valley has been working with the National Person Centred Health and Care
Collaborative, making wider connections with third part sectors, sharing learning across all
boards from Scotland and continuing to ensure that patient’s voices drive forward
improvement. This agenda has enabled reshaping of work streams and to stimulate further
enthusiasm form public partners who are keen to be involved in further initiatives.
There is continual monitoring and reporting of patient experience results, sharing data and
learning through for example, safety briefs, staff handovers and charge nurse meetings. This
helps the sharing of examples of good practice and identifies opportunities for improvement.
This information is shared quality boards which are available for the public to see within
clinical areas. This work is supported by national and local strategic drivers.
Participation Standard
The Participation Standard measures how well NHS Boards are doing in respect of ensuring
people:
 get involved in health service planning and development
 contribute to NHS decision-making on services and how they are provided
 receive information about health services and their own treatment and care
Progress against Section 3 of the standard reviewing governance arrangements for
participation can be seen in the table below.
NHS Forth Valley Annual Review 2013 Self Assessment
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NHS Forth Valley
2010/011
2012/2013
Section 3.1
Level 4 (Improvement)
Level 4 (Improvement)
Section 3.2
Level 3 (Evaluation)
Level 4 (Improvement)
Section 3.3
Level 1 (Development)
Level 2 (Implementation)
Older People in Acute Care (OPAC)
The Older People in Acute Care Inspection report for Forth Valley Royal Hospital was
published on the 18th September. This announced inspection was undertaken by NHS Health
Improvement Scotland. The report highlights many areas of good practice in the acute
hospital care provided to older people at Forth Valley Royal Hospital. Inspectors also
commented on the warm, caring and meaningful way which staff interacted with patients and
the strong leadership provided by senior nurses in the wards. Independent feedback from
patients about the care and help they received while in hospital was also very positive. Work
is already underway to address the report recommendations and the majority of these will be
completed within the next few months.
NHS Forth Valley Annual Review 2013 Self Assessment
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Agenda item 5
Staff feel supported and engaged
NHS Forth Valley Annual Review 2013 Self Assessment
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Agenda item 5: Staff feel supported and engaged
Activities in support of ‘Staff feel supported and engaged’ are highlighted with the main focus
on staff engagement and development, staff governance, workforce planning and staffing
challenges.
Standard HEAT Target
NHS Boards to achieve a sickness absence rate of 4%
4.88%
2013
@
August
Staff Engagement and Development
Staff experience project
NHS Forth Valley acted as a key partner and pilot Board within the national Staff Experience
(SE) Project. This is a collaboration between NHS Boards and the Scottish Government
Health Department Staff Governance Team to progress a leading edge and holistic approach
to defining and measuring ‘staff experience’ within NHS Scotland. Phase 1 of the project has
now completed and the final Project Outcomes and recommendations have been supported
by the Scottish Workforce and Staff Governance Committee and the Health Workforce and
Performance Directorate.
Throughout the pilot, which completed in July 2013, Forth Valley was instrumental in
developing and testing a robust, fully internally and later externally validated measurement
tool called iMatter, and supported the development of the Staff Experience Continuous
Improvement Cycle and Improvement Toolkit.
During the pilot:
 A multi professional Staff Experience Project Group was established with active input
from staff-side representatives
 Over 1200 NHS Forth Valley staff (78 teams from across the organisation) were involved
in 3 tests of change using the developing measurement tools
 All of those teams were involved in focus groups in relation to the tools and received
facilitated feedback sessions with reports provided for Managers and all staff relating to
the teams Staff Experience scores and employee engagement index
 Where necessary these teams were supported to develop Improvement Action Plans with
their staff
 All of the managers involved were offered a 1-day Staff Experience Managers
Development Programme
 These teams will be offered follow-up pulse surveys to further support the delivery of their
improvement plans
The Staff Experience Project Group has now evolved into the Staff Matters Group which is in
the process of developing a Staff Experience, Engagement and Involvement Framework for
NHS Forth Valley. This Framework details the excellent activity already underway across the
system and summarises how NHS Forth Valley, as an organisation will take forward a range
of activities designed to further improve in these areas.
Staff Engagement Events
 5% of staff engaged in Everyone Matters World Café events supporting the
development of the 2020 Workforce Vision
 20% of staff engaged in the Values Matter project; identifying the top 6 Values of staff
from across all professions, staff groups and service areas
NHS Forth Valley Annual Review 2013 Self Assessment
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

10% of staff engaged in events designed to identify the positive and negative behaviours
they associate with the top 6 Values
Well attended World Café Events aimed at engaging staff and managers in the Happy,
Healthy and at Work campaign to explore how NHS Forth Valley might further develop
initiatives to increase staff attendance at work and reduce absence
Engagement and Development Event held with the Area Partnership Forum (APF) and
Area Stewards Group reviewing the Culture within NHS Forth Valley in consideration of
Culture challenges identified in other NHS Systems. The APF supported several Culture
Development activities, some of which are outlined above.
Staff Governance and Staff Survey
The Board’s Staff Governance Self Assessment (SAAT) was published and submitted to
national colleagues in May demonstrating a range of important achievements under the Staff
Governance Standard.
External Assessment
Achievements have included the positive Audit Scotland report entitled Best Value Use of
Resources - People Management 2012/13 which confirms that they assessed our people
management arrangements as falling primarily within the ‘better practices category’ with a
number in ‘advanced practice’. Areas with scope for improvement were sickness absence
and measuring the effectiveness of training and development, both of which are being
addressed.
People Strategy
NHS Forth Valley has had its Workforce Modernisation Strategy in place since 2007, with a
review in 2009. It is currently under further review and the now renamed ‘People Strategy’
has as its key theme: ‘We care about Health, we care about you. An investment in our
workforce is an investment in patient care’. The continuing goals of having a modern
workforce, being a model employer within a modern culture are contemporary for 2013 and
beyond to 2020. The strategy continues to have a range of supporting workstreams, which
will be delivered in partnership to ensure positive developments across the range of Staff
Governance priorities. These will support both the Integrated Healthcare Strategy and the
Quality Strategy as well as the national 2020 vision for workforce.
Equality Outcomes
NHS Forth Valley takes equality and diversity seriously and in terms of its workforce both
potential and current, aspires to the highest levels of practice. The outcomes were published
in April of this year along with our Gender pay gap information and our commitment to Equal
pay. This journey requires ongoing commitment and energy to continue to achieve the
positive outcomes achieved so far and those aspired to.
Partnership Working
NHS Forth Valley has a strong history of partnership working. Local forums are in place that
meet on a bi-monthly basis and are jointly chaired by a General Manager and senior staffside colleague. All partnership interactions are measured against NHS Forth Valley’s
Partnership Agreement and all Fora members have generated a cooperative industrial
relations environment.
The Staff Governance Committee meets quarterly and receives reports on the full range of
activity to achieve the Staff Governance Standard. The Area Partnership Forum also meets
quarterly and is jointly chaired by the Chief Executive and Employee Director. Full time
officials are members of the Area Partnership Forum.
NHS Forth Valley Annual Review 2013 Self Assessment
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Staff-side representatives are involved in the evolving Health and Social Care Partnership
Agenda, and this is a regular item on local Partnership agenda. NHS Forth Valley has had in
place positive examples of joint working with Local Authority partners through the original
Forth Valley Joint Future Partnership Forum. Recent discussions have taken place on
refreshing this framework for future use with the inclusion of acute service colleagues. Work
is also underway with Local Authority colleagues on arrangements to support workforce
developments in respect of the Reshaping Care for Older People agenda.
Joint HR/Staff side events are organised as appropriate, for example, building on the Francis
inquiry report, a partnership event was held in December 2012 which resulted in clear
recommendations and positive development of Strategic Framework for Developing
Organisational culture 2013 - 15.
A process of ‘Red-flag meetings’ has been created where the HR Director and senior staff
meet with the Employee Director and senior staff side colleagues to assess and deal with
any emergent priorities of concern in relation to the workforce and the Staff Governance
Standard.
Facilities Time
The Associate Director of HR and Employee Director meet regularly and any request for
additional time out are agreed in partnership. Agreement was reached in January 2013 for
Unison officials to have 3 days out for Partnership working. Further requests are assessed in
line with agreed criteria balanced with service demands
Policy
The Area Policy Steering Group has representatives from staff-side and all policies are
developed in partnership before final approval by the Area Partnership Forum. NHS Forth
Valley has fully implemented all PIN Policy and works through an agreed programme of
activity to review and refresh NHS Forth Valley local policy in line with national PIN reviews.
Supporting Youth Employment
A growing priority both nationally and locally, NHS Forth Valley’s emerging framework
includes aspirations:
 To build on earlier work in 2012 with local authority partners, which saw NHS Forth
Valley provide work placements for local apprentices
 To assess the modern apprenticeship model further
 To continue to provide a range of work placements
 To support young carers in developing skills to support them in the employment
market
Staff Survey
The Survey ran from 27th May until 5th July 2013. The response rate for NHS Forth Valley at
the close of the survey period was 34%, which was 7% higher than the national average of
27%. This was a 5% increase on the last survey in 2010 when the response rate was 29%
(also 3% higher than the national average then of 26%). The National Report is due to be
published on the Scottish Government website on 19th November.
For NHS Forth Valley, the outputs of the Survey will be reported both on a Forth Valley wide
basis and also by individual units. This means that the General Managers for the units and
Directors of Corporate Departments will have rich local data with which to drive local
improvements in addition to the overall results. The results will be published on NHS Forth
NHS Forth Valley Annual Review 2013 Self Assessment
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Valley intranet and will therefore be widely available to staff, along with a commitment to take
the results and agree priority actions in partnership.
NHS Forth Valley’s analysis on the survey results will be taken forward by the Staff Survey
Steering Group which involves representatives from HR, Communications and Staffside. The
results of the Survey will be communicated to all staff and will further inform the current Staff
Governance Action Plan for 2013/14 which was submitted to the national Staff Governance
in May of this year.
The Survey outputs will also be linked to the other strands of staff experience feedback
which has been received this year from our ‘Investors in People’ assessment for Acute
Services, and also to the range of Staff Engagement Outputs during 2013 to ensure that the
most rounded assessment as possible of staff feedback is achieved. This will drive a range
of activities over 2013/14 and beyond.
Workforce Planning and Challenges
NHS Forth Valley has published its 8th Annual Plan which has been approved in partnership.
The annual workforce projections template was also approved in partnership and submitted
to Scottish Government Health Department colleagues. This forms part of the Workforce
Plan
During 2012/13 a senior management restructuring was concluded further reducing the
senior manager cohort. The operational structure changed from 5 units to 4, reducing the
cohort at General Manager level. In addition the Executive Director cohort reduced.
Appropriate redeployment arrangements were also put in place. Following this, the reporting
service manager structure was reviewed and the subsequent transfer of reporting staff and
bedding down of new models of care was achieved in partnership and within a positive
employee relations climate. As a consequence of this managed change the national target
set for a reduction in Senior Manager numbers has been achieved ahead of schedule.
Workforce planning improvements continue to be achieved through a focus on Service
Reviews, and in particular through skill mix and care pathways. This is evidenced through,
for example, the work in relation to Mental Health Services. There is a strong focus on
planning in support of the Local Unscheduled Care Action Plan (LUCAP). Challenges include
the national workforce demographic and NHS Forth Valley’s low turnover. Being clear on our
age profile and anticipated turnover however work is on-going to create a robust Recruitment
Strategy which minimises the associated risks.
NHS Forth Valley is working to achieve the national priorities whilst also balancing local
needs. This is relevant in terms of the national target for musculo-skeletal physiotherapy and
local needs around Paediatric Occupational Therapy. Having achieved improvements in
relation to medical paediatric pressures, pressures in relation to obstetrics and gynaecology
are being addressed.
Positively, NHS Forth Valley has a good track record in attracting and recruiting candidates,
and is seen as a good employer
NHS Forth Valley Annual Review 2013 Self Assessment
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Absence Management
NHS Forth Valley’s strategy for attendance management is based on a whole systems
approach delivered in partnership.
Work continues to deliver on the national HEAT standard of 4% which remains a challenging
target and a high priority for managers across the organisation. Significant work also
continues to be delivered against the national Staff Wellbeing Agenda.
Absence Rate
The latest NHS Forth Valley Attendance Management Report to end August 2013 shows that
the organisation achieved three consecutive months where absence has been below 5%.
However the September position noted a slight rise to just over 5%.
In terms of actual numbers of staff off sick (as opposed to percentage absence rate) the
trend since January 2013 is significantly downward from over 1000 instances of absence in
January 2013 to 686 in August 2013. This is a significant reduction in absence with work ongoing to maintain and improve upon this where possible particularly as the winter months
approach. Full analysis continues to understand seasonal pattern and variations and all
efforts continue to be focused on achieving further reductions.
Current Activities
Ongoing work to reduce absence includes:
 The winter attendance campaign for pre winter is being refreshed with leaflets, posters,
newsletters all aimed at highlighting the importance of staff being well and fit for work;
keeping themselves well; the support available to staff from the organisation and overall a
message of how working together to improve the health and wellbeing of staff will help to
support co workers and of course deliver the highest level of care for patients
 Detailed monitoring by HR Director’s Senior HR Group
 Revised Case Management processes reviewed and cascaded for each Unit to
implement and report on
 Unit Reviews include Absence as a key metric to ensure it has a high profile
 World Café Event for Managers involved 100 managers working through 5 themes with
more detailed work during October by 3 focus groups on training; staff wellbeing; and on
use of fit-slips and phased returns
 Additional trigger points have been negotiated in partnership for managing short term
absence which will further assist
During 2013/14 all efforts will continue to be made in partnership to achieve improvements in
absence rates, reducing absence across all departments and staff groups and to maximise
attendance and wellbeing at work.
NHS Forth Valley Annual Review 2013 Self Assessment
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Agenda item 6
People are able to live well at home or in the community
NHS Forth Valley Annual Review 2013 Self Assessment
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Agenda item 6: People are able to live well at home or in the community
Key and standard HEAT targets in support of ‘People are able to live well at home or in the
community’ are highlighted. In addition, focus is on developing primary care services, service
provision in primary and community care settings, developing quality in primary care and
mental health.
26 weeks referral to treatment for specialist Child and
Adolescent Mental Health Services (CAMHS) services
from March 2013
18 weeks referral to treatment for psychological therapies
from December 2014
Total number of patients on Forth Valley practice registers
diagnosed with Dementia
Emergency bed day rates for patients aged 75+
Rate of attendance at Accident and Emergency
No patients delayed in their discharge over 28 days
100% of patients were seen
within 26 weeks at March 2013
and at June 2013
62% @ June 2013 against a
55% trajectory point
2207 @ March 2013 against a
target of 2154
4674 @ March 2013 against a
trajectory of with a position of
4465 @ June 2013
1557 at March 2013 against a
trajectory of 1653 with a
position at June 2013 of 1844
against a trajectory of 1649
Zero @ April 2013
12 @ October 2013
Development of Primary Care Services through CHPs
Revised CHP arrangements between NHS Forth Valley and each of the three Local
Authorities, Stirling, Clackmannanshire and Falkirk have been in place since late 2010, with
Partnership Boards, Joint Management Teams and CHP Sub-committees. The Partnership
Boards include the respective Council Leaders, relevant elected members and the CEO of
each Local Authority and the Chair, Non Executives and CEO of the NHS Board supported
by senior offices. These arrangements have been designed to improve delivery of the
objectives of joint working, improve integration across organisational boundaries and help
both agencies to deliver better for service users. A key role for these bodies moving forward
is the Integration of Adult Health and Social Care.
The overarching workstream to ensure the development of quality services within primary
care is the Primary Care Development Plan which forms a major strand of the Forth Valley
Integrated Healthcare Strategy. Key priorities for delivery are incorporated within the CHP
Unit Management Plan.
It is recognised that there is a need to ensure development of a robust community
infrastructure fit for the purpose of delivering the 2020 vision and to recognise the value and
capability of primary care services as a major stakeholder in service delivery.
Clinical Leadership in Primary Care
NHS Forth Valley benefits from effective networking and excellent collaboration with a
supportive Primary Advisory Committee structure.
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A Primary Care Clinical Leadership Forum has been formed to act as a network that will
inform development of and raise awareness of a wide range of priorities being taken forward.
The role of the Forum is to provide a considered primary care perspective on key
developments, such as patient safety in primary care, and system challenges including the
Health and Social care Integration agenda, and to support effective networking and ensure
effective development and use of our clinical leadership resource.
Health and Social Care Integration
The integration of health and social care heralds a significant time of cultural and
organisational change for health and social care services. NHS Forth Valley is working
closely with respective Local Authorities to understand the requirements and consider the
implications. The aforementioned Partnership Boards are critical in this and are supported by
the Joint Executive Group comprising Chief Executives and Senior Officers from the four
organisations locally. A major focus has been sustaining progress in integration at the
frontline whilst acknowledging the need to consider overall governance models to support
effective integration of services to meet the needs of the people of Forth Valley. A rolling
programme of engagement with all stakeholders is underway with a very successful event
held on the 31st October with the two Partnership Boards (Falkirk and Stirling /
Clackmannshire as a combined partnership) and the CHP Sub Committees.
Consideration is being given to future models for locality development and planning as
prioritised in the Route Map for the 2020 vision and in the Health and Social Care Integration
legislation. Collaborative locality work provides an opportunity to productively draw together
several key initiatives including Reshaping Care, Early Years Collaborative and Anticipatory
Care Planning towards a common strategic objective.
Health and Social Care Integration and Locality Development
A number of initiatives taking place in Forth Valley are directly or indirectly contributing to
thinking on locality working including:
 Community Engagement and Community Asset Based initiatives
 Work with General Practitioners through the GP Contract and the Whole System
Working Project
 A pilot project in collaboration with Scottish Government to undertaken community
and primary care based service and asset reviews in two geographical areas in Forth
Valley
 A pilot “locality in practice” project to test out a model of locality working in Forth
Valley and building on the Bo’ness Community Empowerment Project
Delivering Quality in Primary Care (DQPC)
The framework for the development of primary care is based around the Quality Strategy
which focuses on ensuring that care is safe, clinically effective and person-centred as well as
linking to the other quality dimensions of efficiency, equity and timeliness.
The CHPs provide clinical and managerial leadership to enable delivery of this model of care
through cross system working and clinical engagement with primary and secondary care
clinicians as well as through the Professional Advisory Committee structure. The focus of
work includes integrated care pathway development and providing data and evidence to
allow understanding and management of variability.
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Continued Professional Development and Enhanced Service development have been
aligned with the key DQPC areas. The focus on Long Term Conditions management has
resulted in low admission rates for key conditions such as COPD and diabetes. Ongoing
dialogue with secondary care colleagues is focussed on the development of an increasing
range of ambulatory alternatives to admission. Through the community diagnostic users
group and the Whole System Working project there is a much more informed and effective
use of diagnostic services. Work associated with these workstreams is considered by the
Primary Care Leads Forum and is also reported to the Primary Care Quality Improvement,
Risk Management and CHP Professional Committee which in turn reports to the Clinical
Governance Working Group and Primary Care Unit SMT.
While a large number of important projects are underway, 5 substantive areas of work central
to improving quality are prioritised in response to DQPC.
These are:
 Long Term Conditions
 Whole System Working
 Prescribing Efficiency
 Scottish Patient Safety Programme
 Releasing Time to Care
Implementation of long-term conditions action plans
In Forth Valley the work outlined within the Long Term Conditions Collaborative has been led
by the Long Term Conditions Action Group (LTCAG). Significant progress has been made
around 3 main workstreams relating to Self Management, Complex Care and Condition
Management.
Shifting the Balance and anticipatory care
For most people their first, and perhaps only, ongoing contact with the NHS is within primary
care. This covers a wide range of professional staff. Shifting the balance of care away from
reactive episodic care in an acute setting to team based anticipatory care closer to people’s
homes is a vital part of implementing our strategy and is consistent with current national
thinking. This requires the development of an informed multidisciplinary workforce to support
patients and communities. Appropriate and effective workforce development to ensure a
model of care that is fit for future needs is dependant on strong partnership working. This
work is also supported by a focus on anticipatory care planning and development of tailored
care plans and supported by prioritising work around falls pathways, polypharmacy, self
management, ambulatory options to admission and improved discharge planning.
Anticipatory Care Plans are being developed for the most vulnerable patients and those with
most complex needs. These are being developed using the Key Information Summary which
can be shared with other parts of the healthcare system.
Integrated Working through Whole System Working Project and QIP QOF
There are two main workstreams linked with the GP contract to support quality improvement
and encourage practices to consider wider healthcare challenges from both national and
local perspectives. The Whole System Working project which started in Forth Valley in 2009
encourages GP practices to reflect on their clinical activity for prioritised workstreams using
comparative data and evidence based guidance. Patient lists along with demographic and
prevalence information are also used to provide a more informed context to the work. More
recently this way of working has been extended by the introduction of quality improvement
work within the Scottish GP Contract (QIP QOF).
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The work provides a useful opportunity to share good practice and requires individual
reflection by GPs followed by further discussion initially at a practice level and then with a
group of practices within the Locality or CHP that is focussed on improving ways of effective
working.
NHS Forth Valley has supported the QIP QOF and Whole System Working process by
providing significant organisational, technical and project management support. Specialist
services engaging with the process have also reported significant benefit from taking part.
The work has allowed both primary care and secondary care clinicians to develop a broader
perspective of the single system and for primary care to collaborate effectively with a wide
range of service improvement and redesign work.
These projects have delivered improved integrated service delivery through development
of referral and care pathways for patients with long term conditions such as dementia,
Chronic Obstructive Pulmonary Disease (COPD) and heart failure, linking with work around
anticipatory care. Bed days occupied by patients with long term conditions are below the
Scottish average. Work with diagnostic services has enabled practices to develop pathways
and criteria for use of services with specialist colleagues. New access pathways for CT head
and lumbar spine x-ray have been implemented and there has been significant reduction in
use of laboratory services by GPs working within local and national evidence based
guidelines. This methodology has also been used to support the Prescribing Efficiency
Project with practices.
The QIP QOF programme for practices is focussed on improving referral pathways, reducing
avoidable admissions and mainstreaming an anticipatory care planning approach. This is
complemented by the 2013/15 Whole System Working Project which is prioritising work
related to locality development, the health and social care integration agenda, patient safety
and improving communication at the primary-secondary care interface.
Patient Safety in Primary Care
A formal programme on patient safety is a relatively new focus for primary care teams. In
March 2013, the Scottish Patient Safety Programme – Primary Care (SPSP-PC) was
launched aiming to make Scotland a world leader in patient safety in Primary Care.
The goals of the Patient Safety are aligned with the Quality Strategy and Delivering Quality in
Primary Care Action Plan and their combined goals of safe and effective care.
Much effort has also been made to make the agenda patient focused, by including patients
as partners in all stages of the development work and continuing to encourage a patient
focus by, for example, formalising regular patient education about high risk medications, the
use of patient information leaflets, encouraging self-monitoring, and regularly asking patients
about side effects of high risk medications. Patient Focus Groups have been supported.
The work aligns with the Scottish Government’s ‘20-20 vision’ to provide the ‘highest
standards of quality and safety, with the person at the centre of all decisions’ by 2020.
Reliable care, a central belief of the bundle philosophy used in Patient Safety, will provide an
important support for the inevitable shifting the balance of care from secondary to primary
care. The profile of the Safety Improvements in Primary Care (SIPC) programme in Forth
Valley has been raised by integrating it with the Create programme and building on existing
workstreams through GMS Enhanced Services.
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Delayed Discharges
Forth Valley acknowledges the current and increasing challenge in respect of delayed
discharges, both in number and bed days lost. This is seen as a high priority across the
partnerships with significant work undertaken with all Local Authority partners at strategic
and operational levels.
There has been continued dedicated support from the Joint Improvement Team, focussed
particularly on the Falkirk Partnership, as well as on the processes in the single acute
hospital and the community hospitals relating to patient pathways and discharge. The
important ongoing role of the single system micro management team continues to be
supported.
It is recognised that meeting and sustaining the target is a challenge and that significant
redesign is required to meet the 2015 target. This forms part of the work already underway
through Reshaping Care for Older People and the work on Joint Commissioning Strategies.
Significant progress has been made in relation to workforce issues. The focus on creating a
discharge hub has led to the creation of a single team creating capacity by bringing together
the discharge coordinators from the acute sector with the delayed discharge post. The role of
the whole team has been refocused to include community hospitals as well as the acute
sector. The team is collocated on the same site with the Falkirk Council hospital social work
team and the rehabilitation, reablement ReACH team. It is anticipated that a model with
similar principles for the Stirling/ Clacks Partnership will be advanced.
This issue is a high priority for NHS Forth Valley, the Community Health Partnerships and the
Local Authorities.
HEI Older People in Acute Care
An announced inspection was carried out in July 2013 at Forth Valley Royal Hospital. The
inspection resulted in five areas of strength, eight areas for improvement and one area of
continuing improvement.
It was highlighted that NHS Forth Valley was performing well in relation to the care provided
to older people in acute hospitals. A number of areas of strength were noted in that staff
were caring and respectful, good management and leadership was in place and there was a
culture of patient centeredness and improvement.
Areas for improvement noted were in respect of
 Screening for cognitive impairment was not consistently carried out in patients over
65 years
 Ward environments need to be made more suitable for people with dementia and
cognitive impairment
 Documentation available for staff to use to document and evidence the care delivered
does not allow for demonstration of assessment, planning and evaluation of care
NHS Forth Valley is addressing all the areas for improvement prioritising those areas where
improvement is required to meet a recognised standard. An improvement action plan has
been developed to support this.
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Mental Health
HEAT Targets
Post Diagnostic Support for Dementia
The Post Diagnostic support (PDs) target expects all new patients diagnosed with dementia
will receive a minimum of 1 years post diagnostic support. In the past this has been carried
out in an ad hoc manner with patients and carers receiving input from a range of providers
and in a variety of formats. Formal recording of this aspect of care has proved challenging.
NHS Forth Valley wishes to preserve the rights of the individual to determine who and what
they receive, at the same time as working towards an Information Sharing Protocol with
Alzheimer’s Scotland that will provide a strong basis for partnership working and support a
patient centred approach to PDs. This will enable more accurate reporting and meaningful
outcomes. The current agreement is that all those newly diagnosed who consent will be
referred to Alzheimer’s Scotland for PDs. The local Community Mental Health Teams for the
elderly (CMHTE) are also holding a database to ensure unmet need due to demand and
capacity issues is measured.
Psychological Therapies
The Psychological Therapies Steering Group is actively taking forward key areas of work that
have been identified to improve access times for psychological therapies and Child and
Adolescent Mental Health Services (CAMHS), these include:
 Establish how people enter, move through, and leave the service, identifying the role,
remit and function of each constituent service within the system
 Complete Mental Health Activity Tracker tools
 Identify early areas for improvement from the above process
 Conduct an analysis of Demand, Capacity, Activity and Queue (DCAQ) for each part
of the service
 Using the DCAQ analysis, identify opportunities for service improvement
 To give some consideration to the mechanisms that may be useful in helping
clinicians to monitor quality of service provision throughout the system
Child and Adolescent Mental Health Services (CAMHS)
The 26 weeks access to CAMHS target was successfully delivered in March 2013 however
this is further reducing to 18 weeks by December 2014. There are particular challenges with
a very small CAMHS team to meet the needs of children and young people with complex
needs. Work is on-going to ensure that the needs of children from the local area, and looked
after children who move into residential or foster care placements in the area are met.
Treatment Time Guarantee (TTG)
Specialist services currently report on a quarterly basis in respect of Alcohol Inpatient
Detoxification and Electro Convulsive Therapy. There have been no breaches of the 12 week
TTG to date, with robust systems in place to support continued achievement of the target.
Patient Centeredness
A framework for patient experience has been develop and rolled out within Adult Mental
Health Services. This incorporates the Scottish Recovery Indicator 2. The framework has
been designed to gather valuable and qualitative feedback from service users and runs
alongside a clinical outcomes framework that is being worked on currently.
Scottish Patient Safety Programme
The inpatient admission and recovery service is now using eWard to support medication
reconciliation and will be moving shortly to utilise immediate discharge letters which will
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inform service users GPs of discharge summary and medication within six hours of a service
user discharge.
Dementia Strategy 2: Progress to date
There is significant work being carried out to map out Dementia Services to provide a
platform for shared care. Benchmarking has been carried out in relation to where NHS Forth
Valley is against the new Dementia Strategy. There are plans to develop an NHS Forth
Valley Framework document to take forward the key commitments.
Scottish Patient Safety Programme Update – Mental Health 2012/13
The Scottish Patient Safety Programme – Mental Health (SPSP-MH) is a 4 year programme.
It has been decided that year two will continue to be a testing phase, before implementation
and roll out, as much of the initial testing work is still ongoing and developing.
Ward staff, Allied Health Professions (AHPs), managers, users and carers are all involved
with the project, both at a local level (workstream operational groups, stakeholder group,
executive group) and at a national level (learning sessions, specialist groups, Webex
sessions). A significant momentum has been achieved by local ‘champions’, who have
embraced the SPSP-MH programme enthusiastically. The next challenge is to engage the
wider group of staff and patients, to ensure that the positive changes are embedded and
spread, as a more sustainable safety culture is influence across the mental health unit. The
focus has been on work streams in respect of Control and Restraint, and Medicine
Reconciliation.
Planned Developments to further support the SPSP-MH are in respect of patient safety
climate tool, staff safety climate tool, safety walk rounds, ward entrance and awareness
raising/engagement.
Prison Healthcare
Following the transfer of healthcare from the Scottish Prison Service (SPS) to the NHS in
November 2011, significant progress has been made in integrating prisoner healthcare from
HMPYOI Cornton Vale, HMP Glenochil, HMPYOI Polmont into the wider NHS Forth Valley
system.
HMP YOI Cornton Vale will continue to be the major facility for women in custody until its
anticipated closure in 2016 and the new prison at Inverclyde opens. SPS is presently taking
forward renovation work to improve facilities Cornton Vale in the interim period. Prior to 2016
there will be a requirement to regularly transfer prisoners out of Cornton Vale in order to
facilitate building work on this site. Recently 120 prisoners have been temporary moved from
Cornton Vale to HMI YOI Polmont.
This has challenged NHS Forth Valley in providing direct healthcare to female prisoners
within in a male prison establishment along with the requirement to make plans and put
resources in place to support the delivery of women’s healthcare services across two sites.
Another significant issue facing NHS Forth Valley is the increasing demand on resources to
support the cohort of Sex Offender Prisoners transferred from Peterhead to HMP Glenochil
in 2012. Over 300 Sex Offenders are now housed within Glenochil. This presents significant
challenges in respect of the delivery of healthcare as this population of prisoner cannot come
in close proximity of the mainstream prison population. Furthermore these prisoners tend to
be over 55 and present with a number of significant long term healthcare conditions. This is
further complicated when there is a requirement to provide end of life care as this group of
prisoners is unlikely to be released back into the community on compassionate grounds.
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Agenda item 7
Best use is made of available resources
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Agenda item 7: Best use is made of available resources
Finance and Efficiency
NHS Forth Valley had traditionally been in recurrent financial balance and achieved financial
targets each year. However radical changes in the economic landscape coincided with the
two years of major service change in NHS Forth Valley and this placed a considerable
burden on the local system. Dialogue during 2010/11 and 2011/12 with SGHD concluded
with a package of financial support totalling £12.100m across the two financial years to be
repaid from property proceeds including income from the Bellsdyke Development
Agreement. Repayment commenced in 2011/12 and is scheduled for conclusion no later
than 2015/16.
2012/13 Outturn
NHS Forth Valley achieved all three financial targets for 2012/13 with a revenue surplus of
£0.102m.
Brokerage of £2.572m was repaid in 2012/13 leaving a remaining balance of £7.980m
Building on work in 2011/12 progress was made delivering real cash savings in 2012/13
through for example:
 Continued progress with prescribing efficiencies in primary care
 NHS Forth Valley has relatively low staff turnover levels which meant delivering cash
savings in certain areas was challenging. A Voluntary Severance Programme was
actioned in 2011/12 with the cash benefits delivered in 2012/13
 Implementation of Stirling and Falkirk Community Hospitals configuration which
included ‘shrinking the footprint’ of properties to ensure the agreed model of care
was retained but that property costs were released. The final stage of this was
achieved in November 2012 with the transfer of services from Bannockburn Hospital
to Stirling Community Hospital
2013/14
The Financial Plan for 2013/14 – 2017/18 was approved at the April performance and
Resources Committee and ratified at the April Board Meeting. This included delivery of real
cash savings of £13.167m. Each Operational Unit and each Corporate Unit has been
required to deliver cash savings of 2% with the balance achieved through areas such as
reduced costs / increased income from cross boundary flow
Areas of investment include meeting the cost of the new national immunisation programmes,
auto-enrolment, additional medical staffing in both Accident and Emergency and in
Paediatrics and significant funding for delivery of Access Targets.
One of the challenges that NHS Forth Valley faces is that broadly, and in part due to below
parity position on NRAC funding, benchmarks indicate that the organisation is performing
well which makes the continued drive for cash savings more challenging.
For the period ended 30 September 2013 a balanced financial position is reported and a
balanced outturn is projected for both revenue and capital. Focus continues on minimising
costs in areas such as transport, stationery and postages. The spend on bank and agency
costs and overtime are subject to robust controls and are regularly scrutinised.
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2014/15 and beyond
The Financial Plan assumes continued relative protection for the NHS in line with the
Spending Review. Cash Savings are projected to be approximately 3% per annum taking
account of uplifts offset by increased pay costs : price inflation which for the NHS generally
exceeds the retail price index : pension changes : the demands of both an increasing
population and changing needs of an increasingly elderly population.
Whilst the drive continues for cash savings within the system, cash savings of 3% per annum
requires wider collaboration with partner agencies.
NHS Forth Valley is an NRAC ‘gaining’ Board i.e. actual funding is lower than the share
calculated on population needs by approximately £11.2m when 2013/14 Financial Plan was
approved. Additional funding to support the move to NRAC parity has been assumed within
the Financial Plan in line with the Spending Review however as NHS Forth Valleys
population is projected to increase above the Scottish average rate this parity move has in
part negated by the increasing population.
The Integration of Health and Social Care brings both benefits and risks from a financial
perspective with the aim of ensuring maximum value for money from public spending and
delivering improved outcomes for the local population.
The Capital Plan for the period is updated on a regular basis to reflect local priorities
improving community and primary care estate, medical equipment (significant investment in
acute hospital equipment was made as part of the Forth Valley Royal Project) and
Information Technology.
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