OHAC - Draft Strategic Commissioning Plan

Bringing Health and Social Care
together to improve outcomes for
the people of Orkney
Working together to make a real difference
Strategic Commissioning Plan 2016 - 2019
1
Contents
ORKNEY HEALTH AND CARE PARTNERSHIP
DRAFT STRATEGIC PLAN 2016 - 2019
FOREWORD...................................................................................................................................4
FOREWORD BY CHIEF OFFICER CAROLINE SINCLAIR .........................................................4
1.
EXECUTIVE SUMMARY ......................................................................................................5
2.
THE ORKNEY ISLANDS ......................................................................................................7
2.1.
Who are we? .....................................................................................................................7
2.2.
Where do people live? ......................................................................................................9
2.3.
Households .......................................................................................................................9
2.4.
Growing up in Orkney .....................................................................................................10
2.5.
Carers in Orkney .............................................................................................................11
3.
CASE FOR CHANGE: WHY WE NEED TO CHANGE .......................................................12
3.1.
Reason 1: National and Local strategic policy drivers .....................................................12
3.2.
Reason 2: Demographic change .....................................................................................12
3.3.
Reason 3: Increase in Chronic Health Conditions ...........................................................14
3.4.
Reason 4: The demand for healthcare is increasing .......................................................17
3.5.
Reason 5: Financial Context ...........................................................................................17
4.
STRATEGIC COMMISSIONING ARRANGEMENTS..........................................................18
5.
HEALTH AND SOCIAL CARE SPENDING.........................................................................19
Scottish Budget Financial Settlement 2016/17...........................................................................20
6.
HOW ORKNEY HEALTH AND CARE, ORKNEY ISLANDS COUNCIL AND NHS ORKNEY
FIT TOGETHER............................................................................................................................23
7.
LOCALITY PLANNING .......................................................................................................24
8.
HOW ORKNEY HEALTH AND CARE AND ACUTE SERVICES FIT TOGETHER ............. 26
9.
HOW ORKNEY HEALTH AND CARE AND HOUSING FIT TOGETHER ............................27
10.
HOW ORKNEY HEALTH AND CARE AND OTHER KEY PLANNING GROUPS FIT
TOGETHER ..................................................................................................................................28
10.1.
Community Planning Partnership (CPP) ......................................................................28
10.2.
Alcohol and Drugs Partnership (ADP) .........................................................................28
10.3.
Integrated Children’s Services Group ..........................................................................29
10.4.
Child and Adult Protection Committees .......................................................................29
11.
HOW WILL THE BOARD OF ORKNEY HEALTH AND CARE COMMUNICATE? .............. 30
12.
WORKFORCE PLANNING AND ORGANISATIONAL DEVELOPMENT ............................31
13.
ORGANISATIONAL DEVELOPMENT PLAN ......................................................................32
14.
HOW DO WE ENSURE THE QUALITY OF OUR SERVICES? ..........................................33
14.1.
Clinical and Care Governance .....................................................................................33
14.2.
Performance Measures ...............................................................................................34
14.3.
Performance Framework .............................................................................................34
15.
COMMUNITY JUSTICE IN ORKNEY .................................................................................35
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16.
WHAT YOU SAID AND OUR PLANS .................................................................................36
16.1.
What shifts do we need to make? ................................................................................36
16.2.
Objective 1 ..................................................................................................................38
16.3.
Objective 2 ..................................................................................................................40
16.4.
Objective 3 ..................................................................................................................42
16.5.
Objective 4 ..................................................................................................................44
16.6.
Objective 5 ..................................................................................................................46
16.7.
Objective 6 ..................................................................................................................48
16.8.
Objective 7 ..................................................................................................................50
16.9.
Objective 8 ..................................................................................................................52
16.10.
Objective 9 ..................................................................................................................54
16.11.
Objective 1: Children and Families ..............................................................................56
16.12.
Objective 2: Children and Families ..............................................................................58
17.
COMMUNITY JUSTICE IN ORKNEY .................................................................................60
18.
APPENDIX A: SUMMARY OF NATIONAL AND LOCAL POLICY DRIVERS ......................61
18.1.
National .......................................................................................................................61
18.2.
Local Policy Context and Implementation ....................................................................62
19.
APPENDIX B: LOCALITY PLANNING PROFILES .............................................................65
20.
APPENDIX C: SERVICES THAT ARE INTEGRATING ......................................................71
20.1.
Which health and social care services are we integrating? ..........................................71
21.
APPENDIX D: ORGANISATIONAL DEVELOPMENT PLAN ..............................................72
22.
APPENDIX E: CLINICAL AND CARE GOVERNANCE FRAMEWORK ..............................74
23.
APPENDIX F: LOCAL PERFORMANCE INDICATORS .....................................................75
24.
FEEDBACK QUESTIONAIRE ............................................................................................99
3
FOREWORD
FOREWORD BY CHIEF OFFICER CAROLINE SINCLAIR
Integration aims to ensure that health and social care provision across Scotland works together in
partnership. Working in this way is essential for Orkney if we are to equip ourselves to meet
changing needs now and in the future. This draft plan sets out how the Integration Joint Board
(IJB), which we call Orkney Health and Care, is going to achieve what it needs to do in Orkney.
While the plan is formally a three year plan, spanning 2016 to 2019, at this early stage of
development of the IJB, the plan is focused on the first year of formal operation as an integrated
partnership and it will be reviewed and refreshed for the following years.
Planning and commissioning services through this new authority is intended to reduce duplication
and to enhance people’s experiences of services in response to the changing needs of our
population. For example, people are living longer and most want to remain independent for as
long as possible and preferably live in their own home. As the needs of society evolve, the way
future public services are designed will also need to change. Integration is also about including
the organisations who deliver and the people who use health and social care services in designing
and planning them. This includes involving partner agencies, local communities and people with a
range of types of professional and personal experiences.
Orkney is well placed to build on the work that has been established through NHS Orkney and
Orkney Islands Council joint approach under the banner of Orkney Health & Care. The new
integration authority will pick up this banner and take on the role of planning, commissioning and
overseeing the delivery of services which have been delegated to it by the Health Board and
Council. This new authority intends to provide a seamless response to everyone who uses Orkney
Health & Care services-putting the person at the heart of the decisions made.
Caroline Sinclair
Chief Officer
January 2016
4
1. EXECUTIVE SUMMARY
The Public Bodies (Joint Working) Scotland Act 2014 sets out a significant programme of
reform for the public sector, notably Local Authorities and NHS Boards. The reform will be
directed by a number of new public organisations (in Orkney this new legal entity will be
known as Orkney Health & Care) whose overarching role will be to improve the delegated
services delivered by the Local Authority and NHS Board.
This new organisation will now direct resources previously managed separately by Orkney
Islands Council and NHS Orkney and commission the NHS Board and Council to deliver
services in line with this local strategic plan.
Plans are expected over time to change the way how services are provided, allowing people
to receive care and support in their own homes or local community rather being admitted to
hospital. Developing locality based health and care services will be at the heart of our local
plan.
In Orkney the new authority, Orkney Health & Care will be responsible for planning,
commissioning and governing or overseeing a range of delegated health and social care
functions relating to adults, children and community justice.
The Orkney Health & Care Board comprises of 6 voting members appointed in equal
numbers from Elected Members of the Council and NHS Board Non-Executive Directors, as
well as a number of non-voting professional advisors and stakeholders, such as the Third
Sector, Patients and Service Users and Carers.
These arrangements are set out in the Integration Scheme (Partnership Agreement) which
has been prepared and approved by Orkney Islands Council and NHS Orkney. They are
provided for in an Order of the Scottish Parliament on the recommendation of Scottish
Ministers.
The Orkney Health & Care Board view this first plan as a foundation for ongoing work and as
such this initial document will continue to be further developed over forthcoming months and
years to ensure that the Board continue to meet the needs of our population within available
resources. This plan will be supported by a detailed implementation plan to provide direction
to Orkney Islands Council and NHS Orkney whose responsibility will be to deliver health and
care services in ways that improve outcomes as described within the Plan.
Russ Madge, Chair of the Integration Joint Board, has commented that, “I am delighted to
see the first version of the Strategic Commissioning Plan. This paves the way for us; along
with NHSO, the Council and our other planning partners to be able to realise real change to
the benefit of all of us living in Orkney. The plan is an exciting first step forward.”
5
The Orkney Health & Care Board approved this Strategic Plan at its meeting on XX/XX/2016.
Figure 1: Voting Members of the Orkney Health & Care Board (From Left to Right: Jeremy Richardson,
Vice Chair IJB; Russ Madge, Chair IJB; John Richards, Councillor; David Drever, Non-Executive Board
Member; Alan Clouston, Councillor; and Gillian Skuse, Non-Executive Board Member).
6
2. THE ORKNEY ISLANDS
2.1.
Who are we?
Understanding the needs and issues of people and communities across Orkney is critical in
the planning, commissioning and provision of better health and social care services. In this
section, we look at how the population structure and characteristics impact on health and
social care services. This highlights some of the challenges we need to address.
As the Figure 2 shows, we have a higher percentage of older people than the rest of
Scotland. Orkney’s population has fallen over the last century from around 29,000 to the
level it is now which is around 21,570. In the last 10 years, births have been outnumbered by
deaths. However, inward migration has prevented population decline. Population growth is
predicted with an increase of 12% being expected up until 2031.
The profile of the population varies by age group with the highest levels of growth being in
the oldest age group and population decline in the younger age groups. The trend, within
Orkney as elsewhere in the Scotland, is currently towards an ageing population; however
there are proportionately more older people in Orkney than in Scotland.
POPULATION 2012
Orkney Scotland
Age 0-15
3572
16.5%
17%
All people
Age 16-49
8810
41%
45%
21, 530
Age 50-64
4698
22%
20%
Age 65-74
2601
12%
10%
Age 75 +
1849
8.5%
8%
50.5% 49.5%
FIGURE 2
Source: National Records of Scotland, mid-year population estimates
Furthermore there are proportionately fewer younger people and the effects of the changing
population demographics will become more evident over the next 5 – 10 years. Currently
8.9% of the total population is estimated to be aged 75 years or over. This will impact on the
ability of NHS Orkney and Orkney Islands Council to deliver the Boards plans.
7
PROJECTED CHANGES IN POPULATION
BY AGE GROUP 2012 TO 2037
9%
decrease
Age 16-64
37%
increase
Age 65+
3%
decrease
Age 0-15
FIGURE 3
Source: National Records of Scotland 2012-based population projections
WHAT THIS MEANS…
This has a significant impact on how we plan, commission and deliver health and social care
services as there will be more people requiring services and fewer working age people to
deliver them. We need to promote positive ageing, and self-care, and address the range of
needs of older people. When commissioning services we need to take this into account to
ensure we have the necessary services in place. We also need to think about our workforce
in light of these changes, and how we support carers.
You can see what we will be doing in more detail in the Objectives on pages 36-54.
8
2.2.
Where do people live?
The Urban/Rural profile of the Orkney Islands presents challenges in terms of both the
accessibility and cost of services. These challenges are very different in nature to those
facing densely populated cities such as Glasgow, Edinburgh or Dundee.
The Orkney Islands are a remote group of islands that lie approximately 7 miles off the north
coast of Scotland. 80% of our population lives on the Mainland with the main towns of
Kirkwall and Stromness having a population of 6351 and 2055 respectively. The remaining
Mainland populations live in smaller villages or in the countryside. Around 15% of the
population lives on the remote islands that are located to the north and south of the
Mainland. The table below displays the population information and is based on the 2011
Census.
Orkney Location
Eday
Egilsay
Flotta
Graemsay
Hoy
North Ronaldsay
Papa Westray
Rousay
Sanday
Shapinsay
Stronsay
Westray
Wyre
Mainland
TOTAL
2.3.
2011 Population Figures
160
26
80
28
419
72
90
216
494
307
353
588
29
18,487
21,349
Households
Orkney also has a significantly higher proportion of lone pensioner’s households but a lower
proportion of unpaid carers who provide more than 20 hours a week of care than Scotland as
a whole. This will have major implications for housing, health and social care.
Over the next 20 years there will be a projected ‘extra’ 2573 people aged 65+ and 1573
additional people aged 85+. The corresponding changes (2012-35) are 61% for people 65+
years old and 123% for people 85+ years old. This will be in the context of continued low
numbers of people of working age compared to the rest of Scotland, meaning that there will
be fewer people to provide care to the ageing population either as paid or unpaid carers.
Percentage of Lone Households
This is a national
statistic and not
specific to Orkney but
there is no reason to
assume Orkney will not
experience a similar
shift in position.
9
2.4.
Growing up in Orkney
The Children and Young People (Scotland) Act 2014 places a duty on local authorities and
health boards to develop joint children's services plans, in co-operation with a range of other
service providers, such as the Police, Children's Hearing system and the Third Sector.
In Orkney we already undertake our integrated planning in conjunction with a number of
service providers who have an effect on the well-being of children and we will continue to
plan our services jointly, while ensuring we include the views of service users and the
voluntary sector.
We are committed to ensuring that our children and young people are well supported as they
grow up and that they get the right help, at the right time, in the right way. We will continue to
endeavour to Get It Right for Every Child and will implement the Named Person service in
August 2016 to ensure that services are brought together more effectively to provide help
and support for children, young people and their parents when they need it. This approach
supports children and young people's rights and we will involve children and young people
wherever possible in any decisions that affect them.
Most children and young people get the support they need from their parents, wider families
and communities and from universal services, like health and education. However, because
children and families can experience difficulties that may affect well-being, our approach will
ensure that children, young people and their parents have a single point of contact they can
turn to if they need additional advice or support.
We have based our plans on two of the national outcomes for children. The remaining
national children’s outcome is education based and will be led by officers from Education
with NHS Orkney and Orkney Islands Council staff contributing as appropriate.
WHAT THIS MEANS…
This means that we will ensure we commission services that meet the needs of our children
and young people and provide the best possible outcomes.
For the universal services we will ensure our children have the best start in life and will
promote and enhance the well-being of children and young people by providing the right
help, at the right time, in the right way.
For targeted services we will focus on maintaining and strengthening families by providing
help as early as possible, so that we can improve the life chances for children, young people
and families at risk.
You can see what we will be doing in more detail in the Children’s Objectives on pages 5559.
10
2.5.
Carers in Orkney
Carers play a crucial role in the delivery of the health and social care in Orkney and this role
will become more important as a result of the demographic and social changes we outline in
this draft Plan. Carers, therefore, need to be at the heart of a reformed health and social care
system which promotes a shift from residential, institutional and crisis care to community
care, early intervention and preventative care. In making these radical changes to the health
and social care system, it is crucial carers are supported and sustained in their caring role.
Caring Together: The Carers Strategy for Scotland 2010 – 2015 identified a broad number of
areas where action was required to increase support to unpaid carers. The strategy
highlights the vital contribution made by informal carers and set out a national commitment to
supporting carers:
•
•
•
recognition that families and unpaid carers constitute Scotland’s largest care force.
the need to harness the contribution of unpaid carers for future care provision.
the need to make caring a more positive life-choice.
The principles of strengthening independent living and self-care, and improving quality of life
and the quality of care, are part of the national policy to support people in their own
communities as far as possible. Following on from this strategy was the introduction of the
Carers (Scotland) Bill in March 2015 which is currently going through parliamentary
processes.
The Bill will:
•
•
•
•
•
Introduce the Adult Carer Support Plan.
Introduce a Young Carers Statement to recognise the unique needs of young carers.
Place a duty on local authorities to provide support to carers and young carers based
on local eligibility criteria.
Ensure that carers and young carers will be at the centre of decision making on how
services are designed, delivered and evaluated.
Place a duty on local authorities to create an information and advice service.
Local health and social care services will include the requirements of any legislative changes
for Carers following the guidance produced Scottish Government as part of ongoing service
planning.
WHAT THIS MEANS…
A range of easily accessible information and carers support needs to be a key priority to
ensure the wellbeing of carers to support them in their caring role.
You can see what we will be doing in more detail in Objectives 2, 3 and 6 on pages 38-42
and 47-48.
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3. CASE FOR CHANGE: WHY WE NEED TO CHANGE
There are a number of reasons why we need to change the way health and social care
services are planned and commissioned in future and these are explained more below.
These include the aging population and increasing number of people with long term conditions
and complex needs is already putting pressure on local health and social care services. The
Scottish Government estimate that in any given year just two percent of the population (around
100,000 people) account for 50 percent of hospital and prescribing costs and 75 percent of
unplanned hospital bed days.
In addition, the expectations of older people, their carers and families are also changing as
more and more people look to access self-directed support to improve their personal outcomes
and situation.
Other factors that impact on the need to do things differently is that we wish to ensure that our
young people receive the best possible start in life within supportive family settings. We also
wish to promote community safety by emphasizing the need to reduced offending
reoccurrence.
3.1.
Reason 1: National and Local strategic policy drivers
National, regional and local policy direction across health and social care is undergoing a
period of major change. This draft Strategic Commissioning Plan recognises the need to
reflect this context and has been developed in response to a number of strategic policy drivers.
The common themes across these policies culminate in service developments which are
designed with and for people, their carers and communities; are safe, effective, and personcentered led; involves partnership and whole systems working to improve care; and are aimed
at reducing inequalities and promoting equality. A summary of the key features of these
policies are outlined in Appendix D.
3.2.
Reason 2: Demographic change
In Orkney and across Scotland people are living longer due to improvements in our living
standards and levels of care and support. The National Records of Scotland (NRS) 2014
estimate reported the population of Orkney as 21,590, of which 84% (18,080) were over 16 yrs.
(Figure 4).
12
Figure 4: Population of Orkney by age group
40%
Percentage of Population
35%
30%
32%
30%
25%
20%
37%
15%
28%
16%
10%
13%
17%
5%
9%
10%
8%
0%
0-15
16-44
45-64
Orkney
65-74
75+
Scotland
Source: NRS 2014 Population estimate
The population of Orkney includes a higher than national average proportion of older people.
Between the 2001 and 2011 censuses, the number of people in Orkney aged 65 and over grew
by 32.5% (the highest of all Boards). Recent population estimates projects that our overall
population will increase by 5.5% in 2037 and the largest increase will be seen in the older
population aged 75 and over
As seen in the Figure 5, the number of children and adults is projected to decrease between
2012-2037, people aged 65-74 are projected to rise by 20%, while those aged 75+ are
predicted to rise by 116% 1. . People in the older age groups are the ones most often in need
of health and social care services therefore we can fairly confidently predict a steadily growing
demand for health and social care services.
Figure 5: Orkney Population Projections 2012-2037
16,000
14,000
Population
12,000
10,000
8,000
6,000
4,000
2,000
0
2012
2017
2022
2027
2032
2037
0-15
3,572
3,477
3,621
3,652
3,611
3,463
16-64
13,508
13,164
12,855
12,662
12,242
12,152
65-74
2,601
2,769
2,841
2,903
3,143
3,119
75+
1,849
2,294
2,819
3,279
3,675
3,990
Source: National Records of Scotland 2014 population estimate
1
Extract from NHS NSS (ISD) document produced for Orkney Health and Care integration. Aug 2015
13
Although this challenge is not unique to Orkney our population of older people is increasing
faster than the national average. In addition, significant numbers of our working age population
are leaving the islands, and so we have fewer people available to provide the care and support
required due to the predicted levels of chronic illness and disabilities. NHS Orkney the clinical
services strategy notes that “If nothing else changes in the way we deliver care, this means
that for every 10 people over 85 currently accessing health and social care services, there will
be 31 people over 85 accessing it by 2033. And equally, if nothing else changes, for every 10
people providing care to people over 85 we will need 31 people by 2033” 2
Rapidly ageing population
The contribution that older people make to our society needs to be recognised as a major
asset and their contribution to family and communities should be valued. People over 65 years
of age deliver more care than they receive – acting as unpaid carers, child minders and
volunteers. We need to harness this contribution and ensure it influences the priorities and
decisions of the Board. It is also recognised that in future people will live longer, which is good,
but as they are living longer many will have health and social care issues related to their frailty.
In 2013/14, 36.6% (60) of people aged 65 and above with high levels of care needs received
10 or more hours of care at home (ScotPHO). Supporting and caring for older people is not just
a health or social care responsibility – we all have a role to play: families, neighbours and
communities; providers of services like housing, transport, leisure, community safety,
education and arts; and the commercial sector. People using services and their carers need to
be involved with service providers in designing that care and support.
3.3.
Reason 3: Increase in Chronic Health Conditions
Attached at Appendix B are the locality profiles for health and wellbeing. This data is captured
nationally and produced for analysis by the Scottish Public Health Observatory. It shows how
Orkney residents compare to the Scottish average in terms of various measures of health and
social status.
2
Our Orkney, Our Health - transforming clinical services (2011)
³ National Records of Scotland (NRS) 2014
⁴ Alzheimers Scotland 2015 -
14
People living in Orkney tend to live longer and enjoy a high level of wellbeing, with 86.4%
reporting their health as good or very good (Census 2011). Life expectancy at birth for males in
Orkney is 78.7yrs (Scotland 77.1yrs) and for females 82.8yrs (Scotland 81.1 yrs.) based on the
2012-2014 estimates. Rates of teenage pregnancy and children living in poverty are among the
lowest in Scotland. Broadly speaking, people living in Orkney enjoy low levels of crime and
income deprivation. However, Orkney faces specific health challenges in relation to levels of
hypertension and obesity, along with a rapidly aging population. There are also some
appreciable economic and environmental inequalities between Orkney’s local communities,
such as accessibility of services and standards of accommodation and fuel poverty.
Orkney has one of the lowest percentages of children of a healthy weight in Schools (NHS
Orkney 2013/14 Annual Public health report). In 2013/14, there were 34 children in Primary 1
whose BMI was within 5% of the UK reference range for their age and sex. This relates to
15.7% of Primary 1 children in Orkney in 2013/14 compared to 10.1% across Scotland
(ScotPHO). There has been an increasing pattern of childhood obesity in primary 1 over the
years, higher than the Scottish average.
The rate of alcohol related hospital stays in Orkney has historically been higher than the
Scottish average. In 2014/15, there were 159 alcohol related hospital admissions in Orkney
(ScotPHO). This amounts to 724.5 per 100,000 population alcohol related hospital stays in
Orkney (compared to 671.1 per 100,000 population in Scotland). It should be noted however
that the rate in 2014/15 reflects a continuous decrease in the overall rate of alcohol stays
recorded since 2011/12 which could be a result of people drinking within recommended alcohol
limits or better management.
Using the Chronic Disease pyramid of intervention (illustrated in Figure 6), almost one in three
people in Orkney are currently supported to live with a long term condition.
Figure 6
•
•
In the 2011 Census, 29.5% of the population in Orkney reported they had at least one
long term health condition.
The GP Quality and Outcome Framework (QOF) register is the most reliable indication
of diagnosed long term conditions (LTC). The chart below shows the number of people
on the GP QOF register across Orkney with a long term condition as of March 2015.
15
Figure 7: Long Term Conditions - Number of people on the GP QOF register (March 2015)
Patients on Register
4000
3500
3436
3000
2500
2000
1500
1000
500
1378
1075
868
577
528
454
404
355
194
185
133
0
Source: QOF, ISD
•
•
•
•
•
•
•
•
•
•
•
CHD – Coronary hearts disease.
CKD – Chronic kidney disease.
COPD – Chronic obstructive pulmonary disease.
Hypertension – Hypertension remains a health challenge within the general population.
There were 3,436 people known to Orkney GP practices with a diagnosis of
hypertension. This equates to 16.4 per 100 patients registered, approximately one out
of six patients. Hypertension has the highest prevalence of health conditions recorded
on QOF.
Asthma – A total of 1,378 individuals were registered with a diagnosis of asthma. This
amounts to 6.6 per 100 patients registered. There were 12 patients hospitalised with
asthma from 2011-2013.
Coronary Heart Disease – There were 868 individuals on the GP register in Orkney with
a diagnosis of CHD, which accounts for 4.1 per 100 patients registered. The rate of
hospitalisation per 100,000 population was higher in Orkney (471.6) compared to
Scotland (440.3). This amounts to a total of 108 patients discharged from hospital with
CHD in 2011-2013. The incidence and mortality from stroke is also expected to rise.
Depression – There were 577 people with a diagnosis of depression recorded on the
GP practice list, which equates to 2.8 per 100 patients registered.
There is an increasing prevalence of Chronic Obstructive Pulmonary Disease (COPD),
and although lower than the national average, means we anticipate a rise There were
355 patients on the GP register with a diagnosis of COPD, and 128 people were
discharged from hospital with COPD from 2011-2013.
Mental health – Identifying the number of people suffering from mental health issues
remains a challenge. The Mental Health Strategy for Scotland 2012-2015 has a wide
range of commitments focused on mental health improvement, recovery and to ensure
delivery of effective, quality care and treatment for people suffering from mental illness,
their carers and families. In March 2015 there were 185 individuals with a diagnosis of a
mental health condition on the GP register.
The number of people with dementia in Orkney remains unknown. Alzheimer’s Scotland
estimates there are 401 individuals living with dementia in Orkney in 2015. It is
estimated that 388 of these people will be 65 yrs. and over. The rate of dementia is
expected to rise with an increase in the number of older people in Orkney.
The number of people in Orkney who have cancer will increase from an estimated
2.9% to 3.3%. The predicted average annual number of cases in Orkney will rise from
16
•
3.4.
114 (in the period 2001-2010) to 128 (in the period 2016-2020) due to the
combination of an ageing population and the fact that the incidence of some cancers is
increasing. Generally the incidence of the more common cancers increases with age.
The number of people with diabetes in Orkney will increase due to the ageing
population. Further, if the levels of obesity continue to rise then this will also impact on
the number of people with diabetes, as obesity is a key risk factor for this disease.
Using the QOF data there were 1,075 people registered with a diagnosis of diabetes.
Reason 4: The demand for healthcare is increasing
Partly because of the increasing numbers of people over the age of 85, if we don’t make
changes to the way we do things, then we are predicting significant increases in demand,
which we will struggle to meet, across a range of health and care services.
•
•
•
•
The number of hospital admissions per thousand residents in Orkney is
approximately the same as the Scottish figure at about 33 admissions per thousand
residents, and is expected to increase by 15% over the next 10 years if we continue to
provide services in the way we do now.
The use of primary care services will increase as the population is “ageing” with
an estimated 8% more contacts per annum from 2007 to 2017; a rise from 102,320
practice contacts to 110,862.
There were 1,287 patients discharged from hospital following an emergency
admission (2011-2013).
A total of 171 patients aged 65+ with 2 or more emergency admissions, discharged
from hospitals (2011-2013).
The future model of health and social care is one which is able to meet the dual challenge of
increasing demand on health and care resources and is deliverable within a challenging
environment, both economically and geographically, as well as from a workforce perspective.
3.5.
Reason 5: Financial Context
Basically, demand is rising significantly while, in real terms, available public spending is falling.
Over the next 3 years both NHS Orkney and Orkney Islands Council will require to deliver year
on year efficiencies to sustain priority services. This means that carrying on with ‘business as
usual’ is not sustainable and will impact on our aspiration to improve outcomes as described
within this plan.
Due to increasing resource constraints there is more need to work together to make best use
of our collective workforce, facilities and financial resources so that we continue to improve
outcomes for people who will require care and support in the future.
In summary, our current service provision will not meet the future health needs of the
population, with the predicted rise in long term conditions, and health and care presentations
associated with an ageing population. We must move to services which have a stronger
focus on prevention and enablement and a stronger community focus. Put simply our services
cannot continue to be planned and delivered in the way they have been; the current situation is
neither desirable in terms of optimising wellbeing, nor financially viable.
17
4. STRATEGIC COMMISSIONING ARRANGEMENTS
“Strategic commissioning is the term used for all the activities involved in assessing and
forecasting needs, links investment to all agreed desired outcomes, considering options,
planning the nature, range and quality of future services and working in partnership to put
these in place.” – National Steering Group for Strategic Commissioning 2012.
This Strategic Commissioning Plan describes how the Board of Orkney Health and Care, will
make changes and improvements to develop health and social services for adults and children
and their families, over the coming three years. It explains what our priorities are, why and how
we decided them and how we intend to make a difference by working closely with partners in
Orkney and across Scotland. The Plan is underpinned by a number of national and local
policies, strategies and action plans. It will provide the strategic direction for how health and
social care services will be shaped in this area in the coming years and describes the
transformation that will be required to achieve this vision.
The Board of Orkney Health and Care will build on the partnership working already established
between NHS Orkney and Orkney Islands Council. The delegated services which have been
commissioned in the past will continue to be supported in the immediate future. There will
however be an opportunity to review services and determine whether the commissioning of
different ways of working would lead to service improvement. This review would, where
appropriate, include consideration of disinvestment in services where it is shown that the needs
of the population are not being met.
In addition we will produce a market facilitation plan which will set out the changes driven by
Self Directed Support and which have the potential to create a shift in the role of
commissioners and procurement staff by bringing a new focus on facilitating the local market
for services and supports.
Other services which are provided externally are commissioned via the procurement
arrangements of Orkney Islands Council or NHS Orkney. The Board will look to have these
reviewed over time to ensure they are providing the best ourcomes for those in receipt of the
care or service.
WHAT THIS MEANS…
Is that we need to ensure the services we provide best meet needs and are as efficient as
possible.
We will develop an action plan to undertake reviews of our directly provided services to ensure
that going forward we are commissioning the services we require to meet the needs of the
population. Given the wealth of comments received as part of the high level consultation we
will begin with Homecare, which was an area identified as requiring further development and
investment given its core role in supporting people who have care needs to remain at home.
We will also review the senior structure within our care homes and look specifically at the
management structure which spans Learning Disability and Physical Disability
We will develop an action plan to review our externally provided services.
You can see what we will be doing in more detail in Objectives 2, 3 and 6 on pages 38-42 and
47-48.
18
5. HEALTH AND SOCIAL CARE SPENDING
The Financial Plan, is an integral part of this Strategic Commissioning Plan will be further
developed in the first full year following the creation of the Orkney Health & Care Board. The
plan sets out the resources that are available during the period and priorities how these will be
utilised in supporting the needs of the Orkney population for those services and functions
delegated.
As set out below the total available revenue funding in 2015-16 was £33.2M
As functions, strategies and services are reviewed and integrated, it is likely that the current
pattern of spend will alter as the Board seeks to operate in accordance with the Integration
Planning Principles and takes steps, along with the two Statutory Partners and other sectors, to
shift the balance of care from reactive to preventative and early intervention spend.
47%
Orkney Islands Council £17,676K
53%
Orkney Islands Council
NHS
Total
NHS £15,524K
Net Budget
£'000
17,676
15,524
33,200
%
53
47
100
In addition to the core funding described above there has also been additional funding received
from Scottish Government during 2015/16. It is anticipated that this funding will also be
available during 2016/17 although this is yet to be confirmed and exact allocations are not
known at the time of writing. The additional funding comprises:
• The Integrated Care Fund (ICF) is focussed on supporting innovations and change that
enable more people to remain in the community, rather than in hospital settings. We are
using the Strategic Commissioning Plan process to work with partners and stakeholders to
decide how this fund should be utilised and we will monitor how well it is meeting its
objectives through the same process. This total sum available for 2015/16 was £410,000.
This fund follows on from the Reshaping Care for Older People initiative and the approved
projects stem from various consultation events and opportunities with the Third Sector.
• The Technology Enabled Care fund (TEC) commenced in 2015/16 and the projects we are
delivering locally supported by this fund have been match funded from the ICF. For
2015/16 a total sum of £100,000 is being utilised to improve our Telehealth utilisation.
Again, we will use the Strategic Commissioning Plan process, in partnership with NHS
Orkney’s work towards the development of the new hospital and the changes to services
that will make, to plan any bids we put forward to this fund in the future.
• The Mental Health Innovation Fund (MHIF) – is available to develop and innovate in
mental health services and following a successful bid in 2015/16, sees us establishing
additional support for children and young people with mental health needs through our
19
Child and Adolescent Mental Health Service (CAMHS) and improved support to adults
accessing mental health services through primary care. The total successful bid was for
£67,153K per year up to March 2018.
Scottish Budget Financial Settlement 2016/17
The recent Scottish budget announcement sets out significant revenue reduction for Local
Authorities during 2016/17 and beyond; the ramifications of which are currently being worked
through. At the time of writing negotiations are still taking place and we are not able to offer
further clarity of what that might mean for Orkney at this time.
We have been advised of a proposal that as part of that 2016/17 settlement there will be a
realignment of funds from Health for the purpose of augmenting the availability of social care to
build capacity and reduce hospitalisation.
At the time of writing we are therefore taking 2015/16 as a starting point and projecting forward
for the year of 2016/17 only. Our planning assumption is that once we have taken account of
the need of efficiencies and savings targets our allocation could be represented as follows:
Direct overheads and support
services
11%
17%
Services for children
Services for older people
2%
16%
5%
Services for people with
disabilites
2%
Mental health services
Other community care
20%
27%
Occupational therapy
Home care
Community Mental Health
2%
3%
5%
4%
5%
Primary Care
Therapy Services
4%
Midwifery
9%
Obsetetrics
Non-Core funding
Children and Family Services
68%
Direct Overheads and Support
Services
20
In addition to the resources that Orkney Health and Care has direct responsibility for, there is
also a requirement to jointly plan wider aspects of the local overall health service alongside
NHS Orkney’s acute services.
This includes the following services
NHS ORKNEY – SEGMENTATION OF SERVICE AREAS
Services
Provided in the
Balfour Hospital
£9.3m
Services Provided
out of Orkney and
Visiting Services
£9.7m
Facilities £3.0m
Support £4.6m
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Medical staff
Visiting services
Wards
Acute Receiving
Acute
Assessment &
Rehab
Renal
Macmillan
High
Dependency Unit
Theatre
Day surgery
Labs
Radiology
Audiology
Infection control
Clinical
Administration
Pharmacy spend
of £5.3M is
inclusive of both
hospital and
primary care
services
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Service Level
Agreements
Grampian
Acute block
Mental health and
Learning Disability
Services
Cardiac services
Workforce
Visiting specialists
Electrophysiology
Film reporting
Lab support
Eden Unit
Greater Glasgow
Highland
Ophthalmology
Tayside
SCC project
Shetland
Labs
Pharmacy
Lothian
Unplanned Activity
Patient travel
Estates
Energy
General services
Portering
Catering
Domestics
Laundry
Switchboard
Clinical
Decontamination
Unit
•
•
•
•
•
•
Chief Executive
Medical Director
Nursing
Midwifery and
Allied Health
Professionals
Director
Public Health
Director
Public Health
Health
Intelligence and
Clinical
Governance
Finance Director
Human
Resources
Board Secretary
21
Shifting the Balance of Care towards Prevention and Early Intervention
The aim of integrated health and social care services is to shift the balance of care towards
prevention and early intervention to ensure that individuals have better health and well-being.
Services need to be redesigned around the needs of the individual.
In Figure 8, services that promote health and well-being are shown at the bottom of each
triangle, whilst intensive support services (such as acute hospital inpatient care) are shown at
the top. The triangle on the left shows that a small number of people need the intensive
support and care provided within the hospital. However the triangle on the right shows that this
small group of people uses a large amount of total resource available for health and social
care.
If we are able to improve health and well-being through preventive and supportive communitybased care, such that we are able to provide the right services in the right place at the right
time thereby reducing the need for hospital and institutional care.
What this means is that we will consider how best to use our available resources on an annual
basis linked to longer term planning.
Intensive supports including
hospital inpatient care
Intensive
supports
including
hospital
inpatient
care
Intensive supports including
hospital inpatient care
Integrated
rehabilitation
and
enablement
services
Staying independent
and self management
of health conditions
Staying
independent and
self management of
health conditions
Promoting
community
wellbeing
Figure 8:
Promoting community
wellbeing
Going up this triangle:
decreasing proportion of
population supported
Going up this triangle:
increasing cost of care
per person
You can see how we will utilise our various financial resources in the Objectives section of this
plan.
22
6. HOW ORKNEY HEALTH AND CARE, ORKNEY ISLANDS COUNCIL
AND NHS ORKNEY FIT TOGETHER
As previously described particular resources managed separately by Orkney Islands Council
and NHS Orkney will come together within the new integration authority. This will build on the
achievements of the earlier partnership work and will take on the role of planning,
commissioning and monitoring the delivery of services within its remit.
The Integration Joint Board cannot, of course, work in isolation and will therefore work with and
contribute to the strategic priority of both of the parent organisations. In NHS Orkney terms this
means strategic contribution to the NHS services not included within the Scheme of
Integration. A list of all services included within Orkney Health & Care is provided in Appendix
C. This is described more fully in section seven. Within the Council, Orkney Health and Care
will contribute to the overarching work and strategic priorities of the Council. This is particularly
important in relation to both education and housing where care needs can impact directly on
educational attainment and where housing needs can affect health and wellbeing. In day to day
operational terms Orkney Health and Care will have business with many of the Council and
NHS Orkney support functions such as HR and Finance as well as Estates and Transport.
Orkney Health and Care will also have responsibility for ensuring that the workforce delivering
the health and care services is undertaking appropriate training such as data protection and
PREVENT which raises awareness in relation to counter terrorism.
Orkney Health and Care is of course responsible for planning and overseeing delivering of
services within a much wider context. We therefore need to work in partnership with other
public services such as our local police and fire services, third sector organisations, transport
providers and housing associations.
23
7. LOCALITY PLANNING
The statutory guidance states that each Partnership must consist of a minimum of two
geographical localities and that locality planning is the key to ensuring the greatest areas of
concern of each locality is considered and acted upon. For this purpose it has been decided to
divide Orkney into the two localities of the Mainland and the Isles. This is in recognition that the
services available on the mainland cannot always be replicated on the Isles and that different
ways of working and solutions are often required. For planning purposes the Mainland locality
will be subdivided into East and West in recognition that again issues can differ as evidenced
by the SCOTPHO profiles discussed previously.
Figure 9: Map showing the localities of mainland and isles with the mainland split into East and West sublocalities.
Following the formal inception of Orkney Health and Care Board in April 2016 locality planning
will be the way in which we will engage to identify local priorities and develop the future
strategic plans. Localities have been created to ensure that we maximize the benefits of better
integration and improve health and wellbeing outcomes. This is by providing a forum for
professionals, communities and individuals to inform service redesign and improvement at
local level. The localities agenda promotes the development services within communities.
24
Community empowerment is therefore at the heart of the integration agenda. We will therefore
establish the Locality Planning Groups to:
•
•
•
Oversee the development of integrated service planning at a locality level.
Develop a locality plan, which will set out how the resources are being used within the
locality and how services will evolve to meet the needs of the changing population.
Deliver the Board’s Strategic Plan and ensure there is a strong connection between
the planning done at locality and Board level.
WHAT THIS MEANS…
A range of areas of greatest concern will be identified for further analysis to enable future
commissioning of services to meet the gaps identified in meaningful planned interventions.
That we will work even more closely with our staff, the people who use services, partners in the
third sector and communities to deliver the best services we can.
You can see what we will be doing in more detail in Objective 5 on pages 45-46.
25
8. HOW ORKNEY HEALTH AND CARE AND ACUTE SERVICES FIT
TOGETHER
Although a range of health services will be delegated to the Orkney Health & Care Board,
hospital services not delegated will be planned to ensure we continue to reduce unplanned and
people ready to be discharged home or into a community setting. Currently, in Orkney there is
already established integrated planning and this will continue. The work being led by NHS
Orkney to transform health services will continue in line with migration requirements advance
of the new hospital and healthcare facility.
Since 2012 there has been a significant whole system change programme underpinning the
approval of the Outline Business Case for the new hospital and health care facility. This has
included a move to a consultant led hospital model of care in four specialties, notably:
anaesthesia, medicine, obstetrics/gynaecology and surgery to support the repatriation of
services. In addition, there has been investment in acute services to respond to feedback from
inspections and patients, ensuring improved patient experience and both the quality and safety
of service provision.
The Board of Orkney Health and Care will play a major role in strategic planning relating to the
work surrounding unscheduled care attendances at the Emergency Department and
subsequent hospital admission and the prevention of delayed discharge.
Furthermore people in Orkney utilise a range of clinical services which are provided out with
Orkney by other Board areas. In recent years much work led by NHS Orkney has been
undertaken to repatriate, where appropriate, investigations and treatments that can be carried
out within the Balfour Hospital; however it is accepted that the use of other Boards to support
more specialist clinical provision is likely to be an ongoing feature of healthcare in Orkney.
Further information on the changes within NHS Orkney and the key planned actions can be
found within the “Our Orkney, Our Health -Transforming Services: Our Plan of Action”
document which is available by clicking the link here.
WHAT THIS MEANS…
We will ensure that changes within primary and community health and care services and those
within the hospital will be planned in a coordinated fashion to ensure negligible impact on
service delivery whilst ensuring those who need care receive it in the most appropriate setting
closest to home.
You can see what we will be doing in more detail in Objectives 2 and 9 on pages 38-40 and 5354.
26
9. HOW ORKNEY HEALTH AND CARE AND HOUSING FIT
TOGETHER
Orkney’s Housing Stock is made up as follows:
Local Authority Rent
Orkney Housing Association Rent
Private Rent
Owner Occupied
Low Cost Home Ownership
Other (Govt Property etc.)
958
690
1005
8112
162
14
8.8%
6.3%
9.2%
74.1%
1.5%
0.1 %
Orkney Islands Council also owns some 70 dwellings which it furnishes for use as temporary
accommodation for homeless households.
Recent analysis has shown that Orkney has the second worst rate across Scotland of the
numbers of people living in fuel poverty.
The main aim of Orkney’s Local Housing Strategy 2011 – 2016 is:
“Orkney Islands Council is committed to ensuring that every citizen has access to a
warm, dry, secure, and affordable home, suited to their particular needs and, wherever
possible, in a community of their choice.”
The objectives are as follows:
•
•
•
•
•
•
To ensure Orkney’s citizens have access to a range of affordable housing options,
suited to their requirements.
To reduce the energy requirements of houses to eliminate fuel poverty and achieve a
positive impact on the environment
To provide appropriate housing with holistic packages of support (as required) to
enable those with particular needs to lead independent lives in their own communities.
Prevent homelessness from occurring in the first place wherever possible.
To eradicate residence in substandard and below Tolerable Standard Housing and to
encourage even closer links with the Private Rented Sector.
That every effort will be made to ensure a sufficient supply of housing is available to
ensure the continued survival, and future growth, of Orkney’s island communities.
HOUSING CONTRIBUTION STATEMENT
The new partnership will aim to strengthen the connections between housing and
health and social care, to improve the alignment of joint planning and to support the
shift to prevention. We will, therefore, actively consult with and work with housing
colleagues as the development of their Housing Contribution Statement progresses
with an estimated completion date of 1st April 2016. Once completed, the Housing
Contribution Statement will be available here via a hyperlink.
WHAT THIS MEANS…
Housing options need to be a key feature of our integrated health and social care services as
we move forward. We need to ensure the services we commission such as aids and
adaptations truly maximise the independence of the most vulnerable living in our communities.
You can see what we will be doing in more detail in Objective 2 on pages 37-39.
27
10. HOW ORKNEY HEALTH AND CARE AND OTHER KEY
PLANNING GROUPS FIT TOGETHER
10.1. Community Planning Partnership (CPP)
We recognise that the health and social care services that the Board of Orkney Health and
Care is responsible for planning and commissioning cannot be considered in isolation. In the
same way that we need to plan jointly with NHS Orkney’s acute services, and with Housing
services, we also need to work more widely with partners through the local Community
Planning Partnership where issues that underpin all local services, and the needs and
wellbeing of the population, can be brought together, such as transport, IT connectivity, and
business development ideas. The Chief Officer will represent the Board of Orkney Health and
Care within the Community Planning Partnership established Board and delivery groups. You
can see the current CPP strategy here.
Figure 10: CPP Structure
Source: Orkney Communities
10.2. Alcohol and Drugs Partnership (ADP)
Substance misuse can have significant impacts on the health and welfare of individuals,
families, carers and the wider community. It is important that the Board of Orkney Health and
Care is represented in this key partnership group, both for the need to link into this generally
very relevant agenda but also as a provider of relevant services. We ensure that good links to
this group are maintained and the Chief Officer is currently the Vice Chair of the group. You
can see the current ADP strategy here.
28
10.3. Integrated Children’s Services Group
The Orkney Childcare and Young People’s Partnership was formed in July 2015, from an
integration of the Childcare Partnership and the Services for Children and Young People
Development Group.
It provides a meeting point for all those working with and providing services to children and
young people in Orkney.
The Board will be responsible for planning, commissioning and retaining oversight of Orkney’s
Integrated Children’s Services Plan and in this respect it is an advisory group, a stake-holder
group and a consultation group.
The current Chair of the partnership is the Head of Children Services and Criminal Justice.
10.4. Child and Adult Protection Committees
The Board of Orkney Health and Care as part of its governance arrangements will seek
reassurance that services delivered by NHS Orkney and Orkney Island Council (and other key
partners) protect people who are at risk of harm, of all ages. Orkney’s Child and Adult
Protection Committees, and their Chief Officers’ Groups are well established and staff from
both NHS Orkney and Orkney Island Council take regular part in these groups, and their
associated training and quality assurance groups. You can see the current Child Protection
Committee work plan here and Adult Protection Committee work plan here.
In addition there are a number of other multiagency groups which look at matters of welfare
reform, domestic abuse and community safety and link to the care of vulnerable people,
Officers from Orkney Health and Care will contribute to these fora and in operational terms will
ensure appropriate signposting to services as appropriate.
29
11. HOW WILL THE BOARD OF ORKNEY HEALTH AND CARE
COMMUNICATE?
As a newly formed Board, it is important that Orkney Health and Care Board communicates its
role, its ambitions, and how these will be achieved. The integrated community health and social
care services the Board will plan, commission and oversee are of importance and interest to
people across our community. With this in mind, the Board of Orkney Health and Care will
communicate in a variety of ways through local media and social media channels such as
Facebook and Twitter. An Orkney Health and Care Board section has already been created on
the www.orkney.gov.uk website and this is updated regularly with newsletters, case studies
and news stories. The Chief Officer is contributing a regular blog aimed at service users and
NHS Orkney and Orkney Island Council staff who work in partnership to deliver integrated and
coordinated health and care services. Innovative ways to reach people across Orkney, such as
live discussions on Facebook, will also be used.
In addition, there will be communication through a range of groups, forums and meetings,
including those that inform the Strategic Commissioning Plan. Where changes to services are
proposed, there will be a formal process of consultation and engagement that will meet any
respective legislative requirements or organisational policies.
30
12.
WORKFORCE PLANNING AND ORGANISATIONAL
DEVELOPMENT
At this stage, the development of a staffing plan still requires further work and engagement
across the employing organisations and with the relevant staff and trade union representatives.
What we can say is there are some obvious high priority strategic issues in respect of the
workforce that will require to be addressed. Across the health and social care services
provided by Orkney Islands Council and NHS Orkney some 837 people employed with
contracted hours with additional staff performing casual or relief work.
Whilst staff will remain in the employment of either of the parent organisations, workforce
planning is an issue for the Board as well as for each separate organisation. As previously
discussed the demographic changes are such that our older population are increasing and in
need of care whilst our workforce age population is diminishing. We are aware that the
increasing numbers of older people are such that we could not provide sufficient numbers of
carers to meet the needs of the future population.
In Orkney, with some exceptions, it is not possible to have a range of specialist health or social
care staff to care for specific conditions as would be the experience elsewhere in Scotland.
Instead we have invested in generalist health and social care staff who, by use of obligate
networks and telehealth technology, are able to care for specific conditions without close
proximity to specialist care.
It is anticipated that the integration agenda will bring about a still greater degree of blending
with much needed flexibility with the result that a more generic form of care worker will emerge
– skilled and able to perform a range of both health and social care tasks, with sufficient
knowledge to understand and identify when there is a need to bring a specialist more directly
into an individual’s care.
It will be necessary that this is taken forward as an early piece of work at the direction of the
Board of Orkney Health and Care in order that it can commission a workforce which will be in
place to meet the growing need at the earliest possible date.
Furthermore, in order to support this, steps will need to be undertaken to address the potential
staffing shortages faced in the short, medium and longer term. This will involve both
employers working together and critically health and care career paths must be clearly
established and promoted to young people using links with local schools and Orkney College in
order to ensure we have a fit for purpose workforce in the future.
31
13.
ORGANISATIONAL DEVELOPMENT PLAN
It is acknowledged that membership of the Shadow Integration Board and the Board which will
succeed it, is drawn from across the sectors and voting and representative members alike will
have varying degrees of knowledge of those functions and services which will be delegated by
the Health Board and the Local Authority. Given this, and in advance of assuming responsibility
as a corporate body for the matters delegated under the terms of the Public Bodies (Joint
Working) (Scotland) Act 2014, members need to consider their development needs and
aspirations.
As with any new ‘team’, the Board members will need some support to develop a shared
identity, underpinned by an agreed vision, values and behaviours. In order to assist the Board
in this crucial development stage, it is proposed that a number of discussion topics be
considered and covered through facilitated session or briefings from professional officers prior
to 1st April 2016. These will include:
•
•
•
•
•
•
•
•
Board composition and scope – roles, responsibilities, governance and accountability
Vision and purpose – communication, culture, purpose, priorities and outcomes;
Board development – working together, relationships, strengths and values.
Governance including clinical and care governance
Board operation, leadership and teamwork
Accountability, reviewing performance and delivery
Strategic Plan
Programme work streams
WHAT THIS MEANS…
We will take forward a range of actions related to workforce and organisational developments
focused on the following areas
•
•
•
•
•
•
•
•
Vision and strategic direction
Governance
Working with others
Overseeing and Improving Services
Planning and Performance
Workforce Support
Strategic Commissioning
Communication and Engagement
You can see the action plan that has been developed at Appendix C on pages 70-71.
32
14.
HOW DO WE ENSURE THE QUALITY OF OUR SERVICES?
14.1. Clinical and Care Governance
Clinical and care governance is the system by which Health Boards and local authorities are
accountable for ensuring the safety and quality of health and social care services, and for
creating appropriate conditions within which the highest standards of service can be promoted
and sustained.
The Scottish Government’s Framework for Clinical and Care Governance states that: “the Act
does not change the current regulatory framework within which health and social care
professionals work, or the established professional accountabilities that are currently in place
within the NHS and local government. These arrangements may need adaptation to the
circumstances of each Integration Authority to reflect the services and local circumstances of
each partnership. What the Act does is draw together the planning and delivery of services to
better support the delivery of improved outcomes for the individuals who receive care and
support across health and social care.”
At the moment, both Orkney Islands Council and NHS Orkney have a responsibility for
delivering certain services, this responsibility will remain unchanged. However with the
delegation of services and functions to the new integration Board of Orkney Health & Care the
planning and commissioning of services will become its responsibility.
However, it is important to remember that both the Council and NHS Orkney have
responsibilities and duties for making sure that services are of the highest quality and, most
importantly, safe. In common with local authorities and health boards throughout Scotland, the
Council and NHS Orkney do this by using a system called Clinical and Care Governance. The
national group charged with producing the Clinical and Care Governance national guidance
has developed and published a Clinical and Care Governance Framework, and this can be
found at Appendix E.
Those responsibilities and duties remain and, for those functions delegated to the Board will
also require to be reassured that the quality of care and services delivered by both Council and
NHS Orkney meets national and local standards.
The duties and responsibilities of Orkney Health and Care, within the Clinical and Governance
framework, mean that it will be accountable for commissioning improved quality of services and
high standards of care, which it will do by creating and maintaining an environment that will
encourage and safeguard excellence in care. The Board of Orkney Health and Care will
consider the Clinical and Governance framework when making decisions; developing and
reviewing the Strategic Commissioning Plan, especially as it applies to the planning and
commissioning of services; in the instructions and directions that it gives to Orkney Islands
Council and NHS Orkney; and in monitoring and reporting on performance and service
delivery.
To achieve this, the Board will participate through the Chief Officer in a new joint Clinical and
Care Governance Group (CCGG). The CCGG will include Orkney Islands Council and NHS
Orkney staff and representatives of the relevant professional groups for all health and social
care professions. The CCGG will ensure that there is appropriate assurance for both NHS
Orkney and Orkney Islands Council, as well as the Board of Orkney Health and Care, on the
standards of health and care services provided.
The CCGG will fulfil the role with regard to the Clinical Governance arrangements of all the
health services delivered or commissioned by the Health Board, including health services
directed by the Board of Orkney Health and Care. The CGCG will also oversee the Care
Governance arrangements for all social care services provided or commissioned by the
Council under the direction of the Board of Orkney Health and Care.
33
The CCGG will provide advice and information through direct reporting and will take account of
input and advice from professional advisory groups, such as Area Clinical Forum, Adult and
Child Protection Committees and from Professional Lead Officers. Minutes of the CCGG will be
available and will form part of the business agenda for Orkney Health and Care.
14.2. Performance Measures
In addition to its statutory responsibilities, it is important that clear performance measures are
put in place by the Integration Joint Board to enable them to assess the quality and
effectiveness of services.
To achieve this, both local and national indicators and targets are in place which the Integration
Joint Board will use to measure service performance. The following are the types of
performance reports that will be looked at by the Integration Joint Board when scrutinizing
performance:
•
•
•
•
•
•
•
•
•
•
The Chief Officer’s Annual Work Plan.
Finance Reports.
Reports detailing performance compared to national health and wellbeing outcomes.
Regulation activity.
Child and adult protection committee reports.
Clinical and Care Governance reports.
Community co-production and engagement report.
Staff governance and workforce planning report.
Improvement plans and reports.
Risk management reports.
14.3. Performance Framework
The Scottish Government has produced a framework against which all Integration Joint Boards
must measure their success. These are called the 9 Health and Wellbeing Outcomes for adults
and older people. The framework also delivers accountability against the key national
Children’s Outcomes, along with those for Criminal Justice Services. Details of the national
Outcomes can be found at Appendix F.
The performance framework will also provide information on current performance and will look
at changes in performance trends. This information will support the preparation of the Annual
Performance Report. This will report on subjects and areas required within the Regulations,
including:
•
•
•
•
•
Progress on delivery of the national health and wellbeing outcomes.
How the principles of local authority and NHS board integration are being delivered
through strategic planning.
Review of the Strategic Plan.
Financial performance overview.
The extent to which the Integration Authority has moved resources from institutional to
community-based care and support, by reference to changes in the proportion of the
budget spent on each type of care and support.
34
15.
COMMUNITY JUSTICE IN ORKNEY
The Council through the Integration Scheme will delegate criminal justice social work (CJSW)
Services to the Board of Orkney Health & Care.
The Scottish Government specifically funds Scotland's local authorities to provide CJSW
Services, responsible on behalf of Scottish Courts and the Parole Board for supervising those
offenders aged 16 and over who have been subject to a community disposal from Court, or
post-custody licence in the community, this funding will be transferred to the Board of Orkney
Health & Care. CJSW provide reports to Courts to assist with sentencing decisions, and a
range of other services, such as the provision of Unpaid Work for the benefit of the community.
They also work jointly with the Police and other agencies to provide Multi Agency Public
Protection Arrangements (MAPPA), primarily in relation to registered sex offenders.
Criminal Justice Social Work fulfills a key role in the delivery of Community Justice, which is
defined as, “The collection of agencies and services in Scotland that individually and in
partnership work to manage offenders, prevent offending and reduce reoffending and the harm
that it causes, to promote social inclusion, citizenship and desistance.”
The co-ordination of the activities of this range of agencies (such as Police, Prisons, Courts,
Prosecutors, Social Work and Third Sector providers) has, since 2007, been the responsibility
of 8 regional Community Justice Authorities (CJAs). In 2017, however, these regional bodies
will be replaced by 32 Community Justice Partnerships, one in each local authority area.
Legislation and guidance is being put in place for “shadow” versions of these new bodies to be
put in place in 2016-17.
WHAT THIS MEANS…
Will proceed during 2016-17 to establish a local Community Justice Partnership.
This is set out in the Objective on pages 36-54.
35
16.
WHAT YOU SAID AND OUR PLANS
16.1. What shifts do we need to make?
This section builds on the feedback we have received from people over the past year as
opportunities arose. Each of our Strategic Objectives is based upon the Scottish Government
National Outcomes and are set out on the following pages with:
•
•
•
•
•
a summary of your feedback relating to each objective.
an outline of how we intend to deliver what is needed to achieve the objective.
the activity identified in our current service strategies which relate to the objective.
related projects which are already underway.
what people can expect to see in terms of targets and outcomes against each objective
over the next 3 years.
Orkney Health and Care has both strategic planning and operational oversight in remit. Some of
the following objectives are in relation to direct service delivery and therefore the responsibility
of the delivery agency. In these cases the Board of Orkney Health & Care will expect the
service provider organisation (Orkney Islands Council or NHS Orkney) to ensure delivery and
also the meeting of any associated standards.
Where an activity that is already underway, or is planned in the next three years, has to be
funded, this section also shows where the funding for the activity is coming from, or will come
from. Many of the activities are supported by funding from more than one source therefore there
may be a number of funding sources noted against a specific item. Not all the activities require
specific funding; rather they are achieved through changes to the way that all our services work,
or as a result of providing the right services, in the right way.
The following abbreviations are used in the table to identify funding sources:
OHAC – refers to the new Board also known as the Integration Authority or Integration Joint
Board.
ICF – this means the Integrated Care Fund – a Scottish Government provided budget which is
made available to partnerships to plan and commission services and projects that help to
support people in the community and ‘shift the balance of care’. At the time of writing
confirmation of continuation of this funding has not yet been received. If this does not continue,
plans will need to change to take account of this.
TEC – this means the Technology Enabled Care project budget – a Scottish Government
provided budget which NHS Orkney and Orkney Island Council had to bid to, for the funding to
deliver projects that meet the fund specification.
MHIF – this means the Mental Health Innovation Fund - a Scottish Government provided budget
which NHS Orkney had to bid to, for the funding to deliver projects that meet the fund
specification.
ADP – this is the ring fenced funding allocated to Health Boards. Alcohol and Drug Services
have been delegated to the Board of Orkney Health & Care to plan and commission services
that minimise, address and support recovery from substance misuse issues.
Alzheimer’s Scotland – this is funding specifically provided to NHS areas to support the
36
provision of dementia specialist nursing care through a contribution to the cost of providing a
dementia specialist nurse post. Dementia services are delegated to the Board of Orkney Health
& Care.
You can see more about most of these budgets in section five.
37
16.2. Objective 1
Healthier Living - People are able to look after and improve their own health
and wellbeing and live in good health for longer
What we heard you say is important to you:
•
You want to be supported to look after your own health and wellbeing needs.
What the aims are:
•
Develop skills and resilience within all communities to support health and wellbeing,
through advice and education by promoting self-management and community based
services
•
Develop local responses to local needs in collaboration with communities and with
partners in the third and private sector (where applicable)
•
Embed an approach in all our services that is health promoting
•
Promote and support health and wellbeing self-help groups for people with specific
needs such as people with learning disabilities, people with mental health needs, and
people with dementia
Here are some examples of how this will be done:
•
Engage with national immunisation programmes to ensure everyone is offered protection
from preventative diseases
•
The Oral Health team, working through the Child Smile programme, will continue to
engage with schools and dental service providers throughout Orkney (the Caring for
Smiles programme)
•
Health and social care practitioners will use each consultation as an opportunity to
promote and improve overall health and well-being with people who use their service,
focusing on issues such as physical activity, nutrition and mental well-being
•
Work to develop more low level, easily accessible, psychological therapy support
focused on helping people with mental health needs to support themselves
These are some of the changes that have begun:
How we are
funding this:
•
Investigation into ways that we can make self-help and selfmanagement information more easily available through use of on
line provision such as NHS24 – Living it Up, and other sources
such as podcasts
ICF
•
Work with community connections worker to support the delivery of
falls prevention programmes on the isles
OHAC Board
ICF
•
Allied Health professionals such as physiotherapists are using the
Physical Activity Questionnaire with the people they see
OHAC Board
•
Develop nurse leadership roles in specialist clinical practice for
specific services user groups such as older people, people with
dementia and people with learning disabilities
OHAC Board
Alzheimer’s
Scotland
•
Involve people who use our services in recent service reviews
through groups and forums such as the mental health stakeholder
OHAC Board
38
group, and the all age learning disability conference, to develop an
inclusive approach to the plans we produce
What you can expect to see over the next three years:
•
Maintain the 92% of respondents who rated the overall help, care
or support services they received as either excellent or good. This
is higher than the Scottish average of 84%. (Source: Health and
Care Experience Survey 2013/14, Scottish Government)
•
Increasing the use of community connections worker for a range of
health interventions, e.g. healthy eating, personal foot care and
extension of the falls prevention programme
How we will
fund this:
OHAC Board
ICF
•
Take forward the Active and Independent Living Programme
(AILIP) focusing on prevention early intervention, rehabilitation and
promoting self-care
•
Achieve a minimum of 60% of all 3-4 year olds having fluoride
varnish applied twice per year
OHAC Board
•
Clearly identify the Learning Disability population of Orkney and
we will have commenced a system of annual health checks for this
population, leading to personal health action plans
OHAC Board
•
Psychological therapy services will be available through a range of OHAC Board
routes including third sector services and will link into mental health
MHIF
service user groups, to provide a joined up service
ICF
39
16.3. Objective 2
Independent Living - People, including those with disabilities, long term
conditions, or who are frail, are able to live, as far as reasonably
practicable, independently and at home or in a homely setting
What we heard you say is important to you:
•
You want us to be more proactive about providing early intervention and prevention
based services
•
You want to see more efforts on planning ahead and anticipating the needs of patients
and their main carers
•
You said we needed to improve hospital discharge planning processes to ensure there is
clearly communication and co-ordination
•
You felt that more could be done to prevent hospital admissions and that more people
should be able to have their health and care needs met in Orkney, and not have to travel
south
•
You told us that you didn’t think people with learning disabilities and complex health
needs, and people with acute mental health needs, are not provided with an adequate
range of local support options
What the aims are::
•
Focus services towards the prevention of ill health, to anticipate early need for support
and to react where possible to prevent crisis
•
Provide equipment including aids and adaptations to help people to manage at home in
a timely manner
•
Provide ‘enabling’ services i.e. services that help people to manage their daily lives as
best they can, such as rehabilitation and re-ablement services across health and social
care
•
Improve the response to people who fall or are at risk of falls, and to develop a fracture
care pathway
•
Develop a strategy that sets out how we will support people with learning disabilities in
the community, building on the existing All Age Learning Disabilities blueprint
•
Work to support older people and those with disabilities and complex needs to live
independently for as long as possible, delaying or reducing admissions into institutional
care
Here are some examples of how this will be done:
•
Health and Social Care practitioners will continue to work on ensuring anticipatory care
plans are in place
•
Engage collaboratively with secondary care and out of hours services to prevent
unnecessary admissions and provide early supported discharge
•
Health and Social Care Practitioners will work in a culture which enables and promotes
self-care
•
Make use of data that helps us identify people who may be at risk of hospital admission
40
to identify where we should focus our efforts on avoiding admissions
These are some of the changes that have begun:
How we are
funding this:
•
The Intermediate Care Team now provide an on-call service inhours to the Balfour Hospital Accident & Emergency Department
to prevent unnecessary admission to hospital
OHAC Board
•
Development of the falls programme, working with partner
agencies
OHAC Board
ICF
•
The pilot of a role specifically focused on ensuring third sector
services are properly taken into account and involved in
supporting hospital discharges and avoiding unnecessary
hospital admissions
ICF
•
Piloting the concept of a residential care bed that a GP practice
can use to refer people to as an alternative to hospital admission
where this is appropriate
OHAC Board
ICF
•
Engagement with service users and carers regarding the new
learning disabilities strategy in order to determine their thoughts
and to shape and inform the planning process
OHAC Board
What you can expect to see over the next three years:
How we will
fund this:
•
Aim is to see more people supported to live as independently as
possible in their own homes or another homely setting, currently
90% in Orkney and 84% in Scotland overall. (Source: Health and
Care Experience Survey 2013/14, Scottish Government)
•
An increase in the availability and uptake of self-management
programmes
OHAC Board
ICF
•
Shortened lengths of hospital stay
•
An increase in services being delivered at home or in a homely
setting
OHAC Board
ICF
OHAC Board
•
Reduction in falls related admissions to hospital
OHAC Board
•
Development of new strategy to support people with learning
disabilities in the community
•
Make better use of data to inform our work and service
developments e.g. data about people at risk of hospital admission
and data on length of hospital stay
OHAC Board
MHIF
ICF
OHAC Board
ICF
41
16.4. Objective 3
Positive Experience and Outcomes - People who use health and social care
services have positive experiences of these services and have their dignity
respected
What we heard you say is important to you:
•
You want to be more involved in designing services and planning change
•
You want a service that is person-centred and reflects your individual needs
What the aims are:
•
Plan service improvement using data and experiences gathered from people who use
services, their families and carers
•
Services will monitor quality of service delivery by including user experience information
•
Enable people to have more control over their health needs and services
•
Ensure that people with learning disabilities and people with mental health needs are
enabled to co-design their health and social care delivery, and that they are listened to
throughout the planning, delivery and review of care and support
Here are some examples of how this will be done:
•
Develop a locality planning approach that includes and involves people who use
services, and carers of people who use services, in planning and monitoring services
•
Use the information contained in compliments and complaints to improve and change
services and have clear and simple process for people to give compliments and make
complaints
•
Develop mechanisms to measure and demonstrate safety and effectiveness
These are some of the changes that have already begun:
How we are
funding this:
•
Locality consultation events are being undertaken in January and
February 2016
OHAC Board
•
Continue to improve the collecting of data and feedback of data to
demonstrate the quality of services we are providing
OHAC Board
ICF
•
Monitor waiting times and taking action where these are not up to
standard, to ensure timely access to services for people who need
them
OHAC Board
•
Monitor complaints and incidents to inform continuous
improvement
OHAC Board
What you can expect to see over the next three years:
•
How we will
fund this:
Maintain the current number of service users (92%) who
responded in a survey that they had received excellent or good
help, care or support from services when required. (Source: Health
and Care Experience Survey 2013/14, Scottish Government)
42
•
Service user and carer direct engagement in our key planning
forums and groups including locality groups through the
development of a virtual engagement network
OHAC Board
ICF
43
16.5. Objective 4
Maintaining an Improved Quality of Life - Health and Social care services
are centered on helping to maintain or improve the quality of life for people
who use those services
What we heard you say is important to you:
•
You say we need to ensure that the right staff are in place to support people who need to
access services
•
You believe we could work more closely with our communities and organisations, and
make better use of local knowledge
What the aims are:
•
Support people to live independently and healthily in local communities wherever
possible
•
Commission responsive and sustainable services that have the capacity to listen to and
respond to service user views and needs
•
Commission an All Age Learning Disability service that reflects the priorities and needs
of people with learning disabilities as evidenced and articulated in the new Scottish
Learning Disability strategy, ‘Keys to Life’
•
Ensure the Council and NHS Orkney have a workforce with the right mix of skills to
respond to service change as outlined in the Board’s commissioning plans
Here are some examples of how this will be done:
•
Encourage service and patient participation in the planning and commissioning decision
making.
•
Identify, communicate, and act upon agreed priorities that come from any form of service
review that we undertake for example the review of our Mental Health Service and the
review of our Speech and Language Therapy Service
•
Commission a review of health inequality and health access issues affecting the learning
disabled population in Orkney
These are some of the changes that have already begun:
How we are
funding this:
•
Building service user and carer involvement in strategy and
practice development through existing interest groups
OHAC Board
•
Developing local action plans to take forward new or updated
national strategies and plans such as the National Allied Health
Professional Delivery Plan and the Keys to Life
OHAC Board
•
Roll out a programme of dementia skills training in our residential
care settings and have established a number of ‘dementia
champions’ across our services
OHAC Board
What you can expect to see over the next three years:
•
How we will
fund this:
Increased liaison and dialogue with our locality communities to
assist with joined up thinking around developments and
44
sustainability
•
Maintain 98% of patients who felt that the help care or support
improved their quality of life ‘very well’ or ‘quite well’ (higher than
the Scottish average of 85%). (Source: Health and Care
Experience Survey 2013/14, Scottish Government)
•
Plan and commission local services in response to the findings of
reviews such as the review of the mental health services and the
speech and language therapy service, ensuring NHS Orkney and
Orkney Islands Council keep moving forward and make necessary
changes
OHAC Board
•
Commission the development of a Learning Disability strategy that
reflects the priorities identified in the Keys to Life
OHAC Board
45
16.6. Objective 5
Reduced Health Inequalities - Health and Social care services contribute to
reducing inequalities
What we heard you say is important to you:
•
You want access to a GP when required and access to 24 hour care when it is needed
•
You want people with enduring mental health needs to receive an holistic service that
addresses this population’s significant physical health needs
•
You want an ‘on island’ specialist learning disability health resource to address this
population’s health access needs
•
You want services closer to home, with less unnecessary travel
What the aims are:
•
Commission 24 hour care where needed so that people are not inappropriately delayed
in hospital or living in unsafe scenarios at home
•
Commission services that are ‘generalist’ services ie non specialist, to be able to support
people with specialist needs through providing appropriate clear links between specialist
local points of contact and / or specialist off island points of contact, to reduce health
inequalities
•
Where we do not currently have clearly identified appropriate specialist contact points or
links, either locally or off island, we want to commission these
•
Be assured that providers are best use of IT and technology opportunities to contribute
to the services they can provide
•
Commission services locally where this is possible, to reduce the inequality created by
our geography
Here are some examples of how this will be done
•
Ensure that all new developments have an equality and diversity impact assessment
carried out, so that we identify potential inequalities at an early stage and take action to
address them
•
Commission a locally based learning disability nurse post
•
Expect linkage between specialists for GP practices for mental health, social work, and
occupational therapy services
•
Expect awareness of specific local areas of inequality in service planning by ensuring
that planning groups have access to inequalities data
These are some of the changes that have already begun:
How we are
funding this:
•
Commission the establishment of a locally based Learning
Disability nurse post
OHAC Board
•
We will commission more residential care capacity for the care of
older people – in line with growing local needs
OHAC Board
•
Work closely with, and are part of, the local Alcohol and Drugs
Partnership through the Chief Officer to focus on the significant
OHAC Board
ADP
46
impact that substance misuse, particularly alcohol misuse, has in
Orkney
•
Work closely through the Chief Officer with the local Community
planning Partnership, through the Orkney Partnership Board and
its sub groups, to focus on the equalities issues Orkney, and its
population, have as a whole
•
We will respond to the findings of a pilot based on using Video
Conferencing for health consultations where this is appropriate
rather than have people travel to Kirkwall from the isles, or to the
mainland from Orkney
What you can expect to see over the next three years:
TEC
ICF
How we will
fund this:
•
There will be stronger links between primary and community care
services, and specialist services, and liaison points will be clear
and used to support the delivery of specialist services
OHAC Board
ICF
•
Utilise Video Conference approaches routinely for an appropriate
range of consultations, discussions and group work, and
unnecessary travel will be minimised
OHAC Board
TEC
ICF
•
Commission additional local residential care places to ensure
waiting list reduction
OHAC Board
47
16.7. Objective 6
Carers are supported - People who provide unpaid care are supported to
look after their own health and wellbeing, including to reduce any negative
impact of their caring role on their own health and wellbeing
What we heard you say is important to you:
•
The Orkney Carers’ Centre is a valued resource for the provision of direct care,
dissemination of information and equipment loans they provide
•
Your needs as a carer should be clearly assessed and your views should be listened to
•
Carers need to be recognized as key partners in case along with health and social care
professionals
What the aims are:
•
Ensure unpaid carers are aware and are receiving all the support that is available to
them
•
Improve support for carers so they can avoid deterioration in their own health and wellbeing and prevent crisis
•
Encourage people to recognise their roles as carers and ensure carers are involved in
decision making and planning
•
Ensure that Carers’ needs and views are listened to at an individual care planning and
wider service planning level
•
Improve the communication with carers where hospital discharges are taking place
Here are some examples of how this will be done:
•
Continue to use the Carers strategy group which has representatives from community
services, 3rd sector and has a carer representative to advise on the development and
implementation of work to support for carers
•
Promote the Care Aware training for health and care staff to increase awareness of role
of carers
•
Involve carer representation in service planning development as a key member of the
Orkney Health and Care Board
•
We expect consistent and equitable practice obtains with regard to assessing and
responding to carer need
These are some of the changes that have already begun:
How we are
funding this:
•
Unpaid carers can be referred for a carers assessment via their GP OHAC Board
Practice
•
A survey of Carers needs has been commissioned and is being
undertaken in partnership with Orkney College
OHAC Board
•
NHS Orkney and Orkney Islands Council have involved carer
groups in service specific strategy days and conferences
OHAC Board
ADP
48
What you can expect to see over the next three years:
How we will
fund this:
•
We expect the number of carers who feel supported to continue
caring ‘very well’ or ‘quite well’ from 54% (currently the Scottish
average 44%). (Source: Health and Care Experience Survey
2013/14, Scottish Government) to increase
•
We will invite comment and respond to the anticipated new Carers
Bill which is likely to be enacted in this time scale
•
We will seek reassurance through the receipt of audits of carer
assessment practice across our commissioned services is
consistent
OHAC Board
•
We expect carers to be recognised as equal partners in care and
communication points in transitions improved
OHAC Board
ICF
49
16.8. Objective 7
People are Safe - People who use health and social care services are free
from harm
What we heard you say is important to you:
•
You want to be confident that services you receive are safe in terms of your physical and
mental wellbeing
•
If something does go wrong, you want to know what happened and why, and to be
ensured that it will not happen again
What the aims are:
•
Ensure we receive assurance that our commissioned services are engaged with the
Scottish Patient Safety programme
•
Ensure that providers of commissioned services respond to any audit, reviews or
inspections of our services, to improve where they need to
•
Ensure providers of commissioned services capture information when something does
go wrong, or there is a ‘near miss’ and ensure they learn from it and share their findings
•
Ensure our Board related risk assessment and risk management processes are effective
•
Ensure providers of commissioned are responsive to incidents of alleged harm to
individuals through their established child, adult and public protection arrangements
•
Ensure the staff of commissioned services are aware of the PREVENT training initiative
and of programmes to deal with any individual who is vulnerable to being drawn into
terrorism.
Here are some examples of how this will be done:
•
NHS Orkney is engaged with the Scottish Patient Safety Programme and provides
reassurance that it is providing safe and effective care
•
We will expect providers to have systems in place to report and investigate any adverse
incident and share any learning outcomes
•
We will expect providers of commissioned services to use incident and near miss
reporting to learn and implement new practices to reduce risk
•
We will regularly seek reassurance through our Board performance report that providers
of commissioned services are responding to any audit, review or inspection finding,
requirement or recommendations, to ensure they are taking appropriate action
•
NHS Orkney and Orkney Islands Council will continue to develop their child, adult and
public protection training approach
•
Providers of commissioned services are expected to identify staff members who have
undertaken facilitation training and with the plan to cascade to other staff.
These are some of the changes that have already begun:
How we are
funding this:
•
We attend a range of national Patient Safety Events and engage
with the full range of Patient Safety work streams
OHAC Board
•
We work collaboratively with Safe and Effective teams and ensure
OHAC Board
50
any adverse events are being reported and managed appropriately
•
We are reviewing and revising our Board approach to risk
assessment and risk management
OHAC Board
•
We are seeking assurance that findings from incidents and near
misses are being reviewed and actions taken to prevent / reduce
future incidents
OHAC Board
•
We expect joined up child and adult protection training to be
delivered to staff that we commission services from
OHAC Board
What you can expect to see over the next three years:
How we will
fund this:
•
We want to continually reduce the percentage of patients who
believe a mistake was made in their treatment or care by their GP
Practice. This is currently 3% which is lower than the Scottish
average of 6%. (Source: Health and Care Experience Survey
2013/14, Scottish Government)
•
We will seek reassurance that incidents and near misses are
reviewed and action taken. We expect clear routes for
disseminating the findings and learning from this process
OHAC Board
•
We will regularly monitor how providers of commissioned services
are responding to any review, audit or inspection, finding,
requirement or recommendation to ensure they are taking
appropriate action
OHAC Board
•
We will through the Chief Officer in established child, adult and
public protection committee and chief officers group process
OHAC Board
ICF
51
16.9. Objective 8
Engaged workforce - People who work for health and social care services
feel engaged with the work they do and are supported to continuously
improve the information, support, car and treatment they provide
What we heard you say is important to you:
•
Staff want to feel they are listened to with good communication links
•
Staff want to be treated with respect and dignity at work by colleagues and people who
use services
•
You want to a workforce that is skilled and competent, with person centred values
•
Staff want access to training and development to keep their skills up to date and to help
them develop
What the aims are:
•
We expect that staff receive relevant training
•
We expect annual appraisals to be undertaken and personal development plans to be
completed and reviewed
•
We expect providers of commissioned services to have relevant skill mix within their
services, able to address local need
Here are some examples of how this will be done:
•
Use feedback from staff surveys to inform communications with our providers about their
workforce and their development
•
We will engage and network with our colleagues in other areas to share areas of best
practice and innovation
•
We will attend national strategic meetings and engage with practice and learning
networks to allow us to ensure that the complexities of providing care in remote and rural
settings are taken account of when planning and commissioning services, and that we
are informed and linked into national developments
•
We will build leadership skills in our Board
•
We will provide Board staff with regular supervision and appraisals
•
We expect providers of commissioned services to meet the registration requirements of
our various relevant professional registration bodies
These are some of the changes that have already begun:
How we are
funding this:
•
Regular contact with our health and social care counterparts in
other rural areas of Scotland including Shetland and Western Isles
OHAC Board
•
GP Practices are currently undertaking access surveys with results
being shared from all boards throughout Scotland
OHAC Board
•
NHS Orkney engages with a nursing liaison group within the
Highlands and Island area
OHAC Board
52
•
NHS Orkney has regular contact with our Learning Disability
counterparts in NHS Grampian
What you can expect to see over the next three years:
OHAC Board
How we will
fund this:
•
We expect providers of commissioned services to maintain or
improve staff morale and improve on the number of employees
with an annual appraisal and personal development plan
completed.
OHAC Board
•
We expect providers of commissioned services to develop a skill
mix across their services in response to local needs
OHAC Board
•
We expect providers of commissioned services to have training
plans that focus on priority areas
OHAC Board
53
16.10. Objective 9
Effective use of resources - Resources are used effectively and efficiently
in the provision of health and social care services
What we heard you say is important to you:
•
Why do we have to travel off island for a 5-10 minute appointment when this could be
done using various technologies?
•
We could be making more use of the skills and resources of the third sector and other
options
•
You feel that services need to be more responsive to people with a variety of types of
acute needs such as people with Learning Disabilities who have complex needs, people
with complex Mental Health issues and people who require end of life care
•
We need to have the right staff in the right places
What the aims are:
•
Ensure the Board thinks imaginatively to allow us commission services to meet need
•
We will continue to liaise with national strategic meetings around developments in
telehealth care
•
We will continue to raise the issue of poor IT broadband links in the remote and rural
regions
•
We will use SPARRA data and other published information to review why people are
admitted to hospital and commission different ways to meet their care needs including
the use of the third sector
•
We will expect to see the roles of rehabilitation support worker, healthcare assistant and
home carer maximised in services we commission
•
Through our commissioning plan we will reduce the number of delayed discharges
Here are some examples of how this will be done:
•
NHS Orkney and Orkney Islands Council currently collate information on their workforce
to allow us to plan and commission new service models
•
We would be keen to see NHS Orkney build on their established working relationship
with the armed services to enhance the care they provide
•
We will commission rural generic support worker role development and evaluation
•
We will commission the use of new technology options to support repatriation of services
These are some of the changes that have already begun:
How we are
funding this:
•
We are looking at how technology can be used to allow
consultations to take place at your GP Practice instead of having to
travel off island
OHAC Board
TEC
ICF
•
NHS Orkney is in negotiations regarding implementing technology
based options to support a self-management tool that patients can
use to obtain additional information about their condition
TEC
ICF
54
•
NHS Orkney has successfully piloted closer working between GPs
and Nurse Practitioners to allow for a shared collaborative way of
providing care
OHAC Board
•
NHS Orkney has piloted having Army personnel provide medical
services to some of our small island populations
OHAC Board
British Army
What you can expect to see over the next three years:
How we will
fund this:
•
More emphasis on ensuring providers of commissioned services
have workforce planning in place to allow us to plan appropriately
for future services
OHAC Board
•
Commission increased use of telehealth care to allow patients to
attend appointments by video conference or other virtual means
•
We will expect providers of commissioned services to have robust
succession planning in place
OHAC Board
TEC
ICF
OHAC Board
•
We will commission a web based self- management tool that
patients can use to obtain additional information about their
condition
ICF
•
We expect NHS Orkney’s Isles Network of Care to further support
and develop services on the isles
OHAC Board
55
16.11. Objective 1: Children and Families
We will ensure our children have the best start in life - By providing the
right help, at the right time in the right way
What we heard you say is important to you:
•
Information on parenting support held in one place would make it easier for you to
access
•
Childhood obesity is an issue locally
•
Services provided locally where possible
What the aims are:
•
Strengthen support for families, reduce risks and increase resilience for children and
young people
•
Recognise and celebrate the role of parents and to provide support for parenting
•
Address the number of children being identified as out with the healthy weight range
•
Develop new pathways to enable more women to remain in Orkney to give birth
•
Reduce social isolation
Here are some examples of how this will be done:
•
NHS Orkney will provide a Named Person service to all babies and pre-school children
by the Health Visiting Service
•
NHS Orkney is implementing the new Health Visiting Pathway
•
We will commission child healthy weight solutions
•
We will commission direct access to midwifery care and earlier antenatal bookings for
pregnant women
These are some of the changes that have already begun:
How we are
funding this:
•
Health Visiting Pathway –implementation of the revised pathway
offering additional visits to families
OHAC Board
•
Staff have trained in parenting programmes to enable them to
provide support
TEC
•
Information provided within early years settings, such as toddler
groups, to raise awareness portion size, healthy snacks and
hidden sugars
OHAC Board
•
Multi agency working to encourage healthier eating and increase
activity levels
OHAC Board
•
Introduction of Growth Assessment Protocol and other Scottish
Patient Safety Programme developments to reduce the rate of
stillbirths
OHAC Board
What you can expect to see over the next three years:
How we will
fund this:
56
•
Increased home visiting offered by Health Visitors
OHAC Board
•
Named person service offered to families from birth to provide a
single point of contact
OHAC Board
•
Continued promotion of healthy weight initiatives and child healthy
weight programmes, on an individual and school basis
OHAC Board
•
Continued engagement with Early Years Collaborative projects and OHAC Board
initiatives so that we keep up to date with best practice and use
evidence to provide the best services
•
On-line parenting support information hosted on Orkney
Communities website
OHAC Board
•
Maintenance of baby friendly accreditation with the maternity unit
and health visiting team
OHAC Board
•
Internet and social media being used more to offer services
OHAC Board
•
Continued development of the Maternity Scottish Patient Safety
programme
OHAC Board
57
16.12. Objective 2: Children and Families
We will improve the life chances for children, young people and families at
risk – by providing the right help, at the right time in the right way
What we heard you say is important to you:
•
Meeting face to face to explain formal health or social work processes is helpful
•
Written information is appreciated
•
To have earlier confirmation of diagnosis of the additional support needs of my child
•
Asking and valuing my opinion of diagnosis of the additional support needs of my
child is important
What the aims are:
•
Ensure that the most vulnerable children and young people are safer and well
supported and that services have the capacity to meet current and forecasted
pressures
•
Ensure that children and young people remain connected to their community and
reduce the use of Out of Orkney placements
•
Make a real difference by engaging meaningfully with families
Here are some examples of how this will be done:
•
Continue to develop the Intensive Fostering Service to meet the needs of our most
vulnerable children and young people
•
Respond to the Parenting Support consultation undertaken over the summer of 2015
by delivering actions that meet the identified needs of parents and families
•
Implement approaches across services that focus on family strengths and solutions
•
Increase the availability of mental health support to young people who need it
These are some of the changes that have already begun:
How we are
funding this:
•
The new Children’s House opened in September 2015
OHAC Board
•
The Intensive Fostering Service is up and running
OHAC Board
•
Consulted widely across Orkney about the needs of parents both in OHAC Board
local communities and in Orkney as a whole
•
Committed to implement a new service model based on evidence
into best practice, to deliver better outcomes for Looked After
Children and children at risk of becoming looked after
What you can expect to see over the next three years:
•
Continued development of the Intensive Fostering Service and
core Fostering Service, so that we can keep our children and
young people in Orkney, wherever possible
•
Focus activities on early identification of children at risk to enable
OHAC Board
How we will
fund this:
OHAC Board
Scottish
Government
funded training
programme
OHAC Board
58
us to work with families at an earlier stage
•
Reduction in the use of formal care and protection proceedings
OHAC Board
•
Practitioners being supported to focus their time on preventative
and therapeutic interventions
OHAC Board
•
The development of systemic therapy approaches
OHAC Board
Scottish
Government
funded training
programme
59
17.
COMMUNITY JUSTICE IN ORKNEY
The model chosen for Orkney’s Integration Joint Board incorporates Criminal Justice Social
Work Services.
National Outcomes for Criminal Justice Social Work Services
Community safety and public protection.
The reduction of reoffending.
Social inclusion to support desistance from offending.
Criminal Justice Social Work fulfills a key role in the delivery of Community Justice, which is
defined as, “The collection of agencies and services in Scotland that individually and in
partnership work to manage offenders, prevent offending and reduce reoffending and the harm
that it causes, to promote social inclusion, citizenship and desistance.”
Objective for 2016/17
By March 2017, to put in place new arrangements for local Community Justice Partnerships, coordinating the work of the above agencies and services, such as Police, Courts, Prisons, Social
Work, Third Sector organisations and others, at Local Authority level. Work will proceed during
2016-17 to establish a local Community Justice Partnership, to work with the newly established
body, Community Justice Scotland.
60
18. APPENDIX A: SUMMARY OF NATIONAL AND LOCAL POLICY
DRIVERS
18.1.
National
The Christie Commission on the future delivery of public services 2011,
outlined a reform programme for public services based on four key objectives:
•
•
•
•
services should be built around people and communities.
working together to deliver outcomes.
prioritising prevention, reducing inequalities and promoting equality.
improving performance and reducing cost.
These objectives were applied to develop the Government’s investment in the change fund that
followed, and have been embraced in the development of the legislation for the integration of
health and social care services; Public Bodies (Joint Working) (Scotland) Act, 2014.
National Dementia strategy 2013-2016 - This strategy places emphasis on early diagnosis; the
provision of information to people and their informal carers immediately after diagnosis; and
improving care in hospitals so they experience, on every occasion, safe, effective, dignified and
person-centred care which includes the development of alternatives to admissions and effective
discharge planning.
Caring Together: The Carers Strategy for Scotland 2010-15 - Carers are recognised as
equal partners in the delivery of care, and services should ensure that they are fully supported in
their caring responsibilities to enable people with dementia to live at home and in their own
communities safely, independently and with dignity.
Social Care (Self Directed Support) Act 2013 & Wider Framework - The legislation on selfdirected support empowers people to have greater choice and control of their supports available
to them. People should be able to choose the extent to which they involve themselves in their
own care arrangements which can be assisted through direct payments; exercising greater
choice in care and service provision, but with statutory agencies still arranging care; care being
chosen and arranged through the statutory sector; or a combination of these three.
Palliative Care - National Action Plan for Palliative and End of Life Care (2008) and Living
and Dying Well: Building on Progress. Work (2011) - These plans promote the provision of
palliative and end of life care to all, regardless of diagnosis, and is consistent with, and highly
supportive of, improvements in care for people with dementia and their families. Focusing on
early identification of palliative care needs, holistic assessments, and effective communication
across agencies and providers to ensure effective continuity of care.
Age, home & community: A strategy for housing for Scotland’s Older People: 2012-21 Older people, including those with dementia, wish to live in their own homes for as long as
possible, rather than in hospitals and care homes. This strategy emphasises the role of housing
and housing-related support in ‘shifting the balance of care’ towards independent living in the
community and reducing the use of institutional care settings.
The Healthcare Quality Strategy and Efficiency and Productivity Framework - The Quality
Strategy provides the vision for NHS Scotland as a world leader in healthcare quality. The
Efficiency and Productivity Framework is a companion to the Quality Strategy providing the
baseline for the changes that will deliver improved quality and efficiency. This Implementation
Plan embraces the 3 quality ambitions of mutuality, no avoidable injury or harm to people from
the healthcare they receive and access to the most appropriate treatments, interventions,
support and services at the right time to everyone who will benefit, and eradicating wasteful or
harmful variation
61
Children & Young People (Scotland) Act 2014 - The Children and Young People (Scotland)
Act 2014 has a similar duty to that in the Public Bodies (Joint Working) (Scotland) Act to create
joint plans, based on the local authority area, which covers all children’s services that have a
significant impact on their wellbeing. This Act requires NHS Boards and local authorities to
develop Joint Children’s Services Plans every three years and to report on progress annually.
Early Years Framework (2009) – This framework seeks to maximise positive opportunities for
children to get the best possible start in life and addresses the needs of those children whose
lives, opportunities and ambitions are being constrained by poverty, poor health, poor attainment
and unemployment.
Getting It Right for Every Child (2006) – The national approach to improving outcomes
through public services that support the wellbeing of children and young people. Based on
children's and young people's rights, it supports children, young people and their parents to work
in partnership with the services that can help them.
Protecting Children and Young People: Framework for Standards (2004) - This Framework
for Standards for child protection has been developed for children and young people, their
parents and for all adults and agencies that work with children in Scotland. It is a means for
translating the commitments made to children in the Charter into practice. It sets out what each
child in Scotland can expect from professionals and agencies to ensure that they are adequately
protected and their needs are met. It also sets out what parents or other adults who may report
abuse and neglect can expect.
Criminal Justice Services future delivery - New arrangements for local Community Justice
Partnerships, coordinating the work of the above agencies and services, such as Police, Courts,
Prisons, Social Work, Third Sector organisations and others, at Local Authority level.
18.2.
Local Policy Context and Implementation
Remote and Rural Healthcare
The Final Report set out a vision for the development of a sustainable health system for remote
and rural Scotland. The Report intended access to healthcare should be as local as possible
with NHS Boards invited to deliver a strategy for sustainable healthcare that took account of the
role and function of Rural General Hospitals alongside a viable primary care that would operate
in remote settings that overall would be supported by an Emergency Medical Retrieval Service
and obligate networks provided by neighbouring Mainland Boards.
In line with this Orkney NHS has developed a team based approach built around 3 service
delivery responses that reflect need and clinical urgency: ambulatory or primary care;
community care and rehabilitation and hospital.
All of these are reliant on good anticipatory care planning, robust communication and telehealth
infrastructure and access to clinical decision making support and retrieval both in and out of
hours. The Emergency Care Network will provide clinical decision making support to
Practitioners at an individual (Isles) primary care and hospital level.
Our Orkney, Our Health 2009
NHS Orkney’s corporate strategy set the context, framework and direction to deliver clinically
safe, sustainable and affordable services to treat ill health, as well as improve health and reduce
health inequalities. Integral to the Corporate Strategy is a clinical strategy and a redesign plan
around 4 key themes namely; building services around patient needs; safeguarding and
improving patient safety; partnership and whole systems working; providing services that are
responsive accessible and accountable
Reshaping care for older people: a programme for change 2011-2021
The Older People’s Change Fund is a Scottish Government fund to provide 'bridging finance' to
each of the 32 local authority areas in Scotland to work in partnership with NHS, private sector
62
and third sector partners to deliver better outcomes for older people in their homes or in homely
settings. Within Orkney the funding has been used to deliver a range of projects focussed on
achieving the overall goals set by the Scottish Government which are to reduce the number of
older people admitted to hospital, reduce hospital stays for older people, and focus spending
increasingly on preventative and early intervention areas, rather than admissions and crisis
response driven services. Spending has been allocated across NHS, Orkney Islands Council
and 3rd sector projects and, in line with requirement, at least 20% of the funding each year has
been targeted at supporting carers. Specific developments have included:
•
•
•
Commissioning of a local re-ablement service which has been effective in achieving
reductions in dependency levels and promoting independence and confidence.
Investment in care and repair services including the provision of a mobile workshop and
a rapid response minor adaptations and equipment service.
Establishing barrier free ‘step down’ accommodation for up to 6 weeks for discharge
patients who live in rural and island locations.
Orkney Health and Care: Joint Commissioning Strategy
Older People Blueprint, Making Care Personal: Your Choice, Your Life.
This strategy endorsed the major shifts required not just in the location of care from institutional
to home and/or budgets from acute care to community care to one which recognises the need
for preventative and anticipatory care approaches and in the maintenance of people’s
independence and potential in service delivery. Specific actions directed at achieving shift in the
balance of care have been to develop:
•
•
•
•
•
•
•
•
•
•
Single point of access for health and social care, whereby assessments are carried out
by one individual with the support of the integrated health and social care team.
Improved access to self- care advice and support.
Self- management courses and groups to support individuals to manage ill health and
long term conditions.
Extension of the Falls and fracture Prevention programme.
Partnership with the third sector on some aspects of self -management, including post
diagnostic support for people affected by dementia.
Enablement approach to support people with rehabilitation requirements to reach as full
independence as possible.
Targeting of individuals with more complex health problems who require "complex case
management" and disease management programmes involving both health and social
care support.
NHS Orkney to conduct a polypharmacy review programme extended across Orkney
Health and Care.
Enabling telehealth and telecare solutions for people with complex health needs to
support them in their homes
Identifying care pathways for people who require more specialist support.
All Age Learning Disability Services: High Level Blueprint
The key changes included in this strategy includes:
•
•
•
•
Developing a model providing services in the community based on the principles set out
in ‘Same as You?’
Working with key partners to build and develop a pathway of support to provide younger
people with a range of opportunities to develop and maintain skills.
Equipping staff with the skills and knowledge to meet the needs of those people with a
learning disability who have complex health needs or challenging behaviour.
Developing a service model for the new short breaks service.
63
•
•
•
•
Developing a service model for new day opportunities for people with learning
disabilities, focused around the Lifestyle Service.
Reviewing the current staffing models, in consultation with staff and Unions, to bring
consistency in service delivery and, appropriate skill mix across the service, increased
efficiency and greater capacity to meet future demand and deliver modernised services.
Developing consistent and transparent eligibility criteria for access to services, based
upon national best practice.
Tracking the impact of the implementation of the proposed changes upon service users
and other involved stakeholders, using clear, and well researched outcome measures.
64
19.
APPENDIX B: LOCALITY PLANNING PROFILES
Orkney IJB locality profiles - Spine chart
Select an area
Isles Locality
Select a comparator
NHS Orkney
Group/Indicator
Population breakdown by age group
Live Births
Population all ages
Population 0-15 years
Population 16+
Population 16-64 years
Population 65-74 years
Population 75+
Population 85+
Life Expectancy & Mortality
Life expectancy (females)
Life expectancy (males)
Death all ages
All-cause mortality among the 15–44 year olds
Early deaths from coronary heart disease (< 75s)
Early deaths from cancer (< 75s)
Behaviours
Estimated smoking attributable deaths
Smoking prevalence (adults 16+)
Alcohol related hospital stays
Deaths from alcohol conditions
Drug related hospital stays
Active travel to work
Ill Health & Injury
Patients registered with cancer
Patients hospitalised with chronic obstructive
pulmonary disease (COPD)
Patients hospitalised with coronary heart disease
Patients hospitalised with asthma
Patients with emergency hospitalisations
Patients (65+) with multiple emergency
hospitalisations
Road traffic accident casualties - all ages
Economy
Population income deprived
Working age population employment deprived
Working age population claiming out-of-work
benefits
Young people not in education, employment or
training (NEET)
Child Poverty
60+ pop'n claiming pension credits
Mental Health
Population prescribed drugs for
anxiety/depression/psychosis
Patients with a psychiatric hospitalisation
Deaths from suicide
Return to contents
Area Rate Comparator
measure type
measure
Period
Count
2013
2013
2013
2013
2013
2013
2013
2013
17
3,286
482
2,804
1,894
559
351
78
5.2
n/a
14.7
85.3
57.6
17.0
10.7
2.4
2011
2011
2012
2012
2012
2012
n/a
n/a
36
1
3
6
988.0
74.4
56.6
125.6
2012
2012
2013
2011
2012
2012
17
1
465.2
24.0
31.3
-
2012
2012
26
21
2012
2012
2012
2012
16
1
191
24
2012
9.3
n/a
16.3
83.7
62.5
12.3
8.9
2.4
-4.15
n/a
-1.67
+1.67
-4.88
+4.72
+1.83
+0.00
years
years
sr
sr
sr
sr
81.8
79.7
1,048.9
92.1
39.3
121.5
-60.92
-17.63
+17.23
+4.12
sr
%
sr
sr
sr
%
248.6
19.9
1,406.7
25.1
45.2
18.0
-941.56
-1.15
-13.91
-
637.3 sr
469.9 sr
527.7
582.4
+109.61
-112.54
sr
sr
sr
sr
471.6
57.4
5,913.0
4,074.1
-96.20
-32.90
-644.80
-1088.30
3
95.2 sr
101.5
-6.35
2013
2013
2013
345
195
175
10.5 %
10.3 %
9.2 %
7.2
6.4
6.6
+3.29
+3.88
+2.64
2013
-
-%
4.9
-
2012
2013
30
75
4.9 %
6.3 %
6.1
5.7
-1.21
+0.58
2013
-
- sr
14.6
-
149.1 sr
20.0 sr
128.1
13.2
+20.97
+6.80
2012
2011
-
375.4
24.5
5,268.2
2,985.8
cr
n/a
%
%
%
%
%
%
Difference
65
Group/Indicator
Social Care & Housing
Adults claiming incapacity benefit/severe
disability allowance
People aged 65+ with high levels of care needs who
are cared for at home
Children looked after by local authority
Single adult dwellings
Education
Average tariff score of all pupils on the S4 roll
Primary school attendance
Secondary school attendance
Working age adults with low or no educational
qualifications
Crime
Crime rate
Prisoner population based on residence of
Referrals to children's reporter for violencerelated offences
Domestic Abuse
Violent crime
Drug offences
Environment
Population within 500 metres of derelict site
People living in 15% most 'access deprived' areas
Adults rating neighbourhood as very good place to
live
Woman's & Children's Health
Teenage pregnancies
Mothers smoking during pregnancy
Low weight live births at term
Babies exclusively breastfed at 6-8 weeks
Child dental health in primary 1
Child dental health in primary 7
Child obesity in primary 1
Immunisations & Screening
Breast screening uptake
Bowel screening uptake
Immunisation uptake at 24 months - 5 in 1
Immunisation uptake at 24 months - MMR
Period
Count
Area Rate Comparator
measure type
measure
Difference
2013
140
4.3 %
3.0
+1.22
2013
-
-%
36.6
-
2013
2013
528
- cr
27.7 %
2.3
31.8
-4.12
2012
2010
2010
2012
n/a
176
199
-
95.1
91.1
-
197.0
95.4
90.8
8.9
-0.30
+0.33
-
2013
2012
2012
22
-
16.4
72.1
6.7
-9.67
-
2012
2012
2013
-
44.1
6.5
14.4
-
2013
2013
2013
44
3,286
-
1.3 %
100.0 %
-%
22.0
61.8
85.0
-20.66
+38.19
-
2011
2012
2012
2012
2013
2013
2013
3
1
8
21
8
4
13.2
3.1
55.6
72.4
53.3
14.8
cr
%
%
%
%
%
%
21.8
12.4
1.1
41.2
73.1
52.8
15.7
+0.85
+1.95
+14.33
-0.70
+0.57
-0.93
2011
2011
2013
2013
142
427
25
22
77.4
58.4
91.6
80.7
%
%
%
%
84.7
62.3
97.4
92.8
-7.25
-3.95
-5.87
-12.05
The difference column shows the crude difference between the rates for the two
areas. This has not been scaled.
Click here for notes on the data displayed in this profile.
mean
%
%
%
6.7 cr
- sr
- cr
- cr2
- cr2
- cr2
Rate
type
key:
% - percentage of total population
cr - crude rate per 1,000 population
cr2 - crude rate per 10,000 population
sr - age-sex standardised rate per 100,000
population to ESP2013
66
Orkney IJB locality profiles - Spine chart
West Mainland Locality
Select an area
Group/Indicator
Population breakdown by age group
Live Births
Population all ages
Population 0-15 years
Population 16+
Population 16-64 years
Population 65-74 years
Population 75+
Population 85+
Life Expectancy & Mortality
Life expectancy (females)
Life expectancy (males)
Death all ages
All-cause mortality among the 15–44 year olds
Early deaths from coronary heart disease (< 75s)
Early deaths from cancer (< 75s)
Behaviours
Estimated smoking attributable deaths
Smoking prevalence (adults 16+)
Alcohol related hospital stays
Deaths from alcohol conditions
Drug related hospital stays
Active travel to work
Ill Health & Injury
Patients registered with cancer
Patients hospitalised with chronic obstructive
pulmonary disease (COPD)
Patients hospitalised with coronary heart disease
Patients hospitalised with asthma
Patients with emergency hospitalisations
Patients (65+) with multiple emergency
hospitalisations
Road traffic accident casualties - all ages
Economy
Population income deprived
Working age population employment deprived
Working age population claiming out-of-work
benefits
Young people not in education, employment or
training (NEET)
Child Poverty
60+ pop'n claiming pension credits
Mental Health
Population prescribed drugs for
anxiety/depression/psychosis
Patients with a psychiatric hospitalisation
Deaths from suicide
Return to contents
NHS Orkney
Select a comparator
Area Rate Comparator
measure
measure type
Period
Count
2013
2013
2013
2013
2013
2013
2013
2013
63
6,605
1,069
5,536
4,078
845
613
171
9.5
n/a
16.2
83.8
61.7
12.8
9.3
2.6
2011
2011
2012
2012
2012
2012
n/a
n/a
68
1
2
9
974.8
33.5
28.4
136.6
2012
2012
2013
2011
2012
2012
31
1
421.5
16.0
4.4
-
2012
2012
37
36
2012
2012
2012
2012
35
2
373
49
2012
9.3
n/a
16.3
83.7
62.5
12.3
8.9
2.4
+0.22
n/a
-0.15
+0.15
-0.78
+0.50
+0.43
+0.22
years
years
sr
sr
sr
sr
81.8
79.7
1,048.9
92.1
39.3
121.5
-74.08
-58.52
-10.95
+15.12
sr
%
sr
sr
sr
%
248.6
19.9
1,406.7
25.1
45.2
18.0
-985.20
-9.08
-40.82
-
543.0 sr
509.8 sr
527.7
582.4
+15.30
-72.59
sr
sr
sr
sr
471.6
57.4
5,913.0
4,074.1
+8.87
-25.40
-388.53
-459.20
6
92.2 sr
101.5
-9.28
2013
2013
2013
360
200
245
5.5 %
4.9 %
6.0 %
7.2
6.4
6.6
-1.76
-1.51
-0.59
2013
-
-%
4.9
-
2012
2013
85
105
6.1 %
5.4 %
6.1
5.7
+0.02
-0.26
2013
-
- sr
14.6
-
116.3 sr
11.9 sr
128.1
13.2
-11.82
-1.39
2012
2011
-
480.5
32.0
5,524.5
3,614.9
cr
n/a
%
%
%
%
%
%
Difference
67
Group/Indicator
Social Care & Housing
Adults claiming incapacity benefit/severe
disability allowance
People aged 65+ with high levels of care needs who
are cared for at home
Children looked after by local authority
Single adult dwellings
Education
Average tariff score of all pupils on the S4 roll
Primary school attendance
Secondary school attendance
Working age adults with low or no educational
qualifications
Crime
Crime rate
Prisoner population based on residence of
Referrals to children's reporter for violencerelated offences
Domestic Abuse
Violent crime
Drug offences
Environment
Population within 500 metres of derelict site
People living in 15% most 'access deprived' areas
Adults rating neighbourhood as very good place to
live
Woman's & Children's Health
Teenage pregnancies
Mothers smoking during pregnancy
Low weight live births at term
Babies exclusively breastfed at 6-8 weeks
Child dental health in primary 1
Child dental health in primary 7
Child obesity in primary 1
Immunisations & Screening
Breast screening uptake
Bowel screening uptake
Immunisation uptake at 24 months - 5 in 1
Immunisation uptake at 24 months - MMR
Period
Count
Area Rate Comparator
measure type
measure
Difference
2013
165
2.5 %
3.0
-0.54
2013
-
-%
36.6
-
2013
2013
968
- cr
31.1 %
2.3
31.8
-0.78
2012
2010
2010
2012
n/a
397
369
-
95.7
91.2
-
197.0
95.4
90.8
8.9
+0.23
+0.39
-
2013
2012
2012
44
-
16.4
72.1
6.7
-9.70
-
2012
2012
2013
-
44.1
6.5
14.4
-
2013
2013
2013
489
4,547
-
7.4 %
68.8 %
-%
22.0
61.8
85.0
-14.55
+7.03
-
2011
2012
2012
2012
2013
2013
2013
7
0
16
44
33
10
13.7
0.0
40.2
72.1
55.9
15.4
cr
%
%
%
%
%
%
21.8
12.4
1.1
41.2
73.1
52.8
15.7
+1.28
-1.13
-1.06
-0.98
+3.17
-0.36
2011
2011
2013
2013
262
696
58
56
83.5
60.0
97.2
94.4
%
%
%
%
84.7
62.3
97.4
92.8
-1.12
-2.36
-0.24
+1.61
The difference column shows the crude difference between the rates for the two
areas. This has not been scaled.
Click here for notes on the data displayed in this profile.
mean
%
%
%
6.7 cr
- sr
- cr
- cr2
- cr2
- cr2
Rate
type
key:
% - percentage of total population
cr - crude rate per 1,000 population
cr2 - crude rate per 10,000 population
sr - age-sex standardised rate per 100,000
population to ESP2013
68
Orkney IJB locality profiles - Spine chart
East Mainland Locality
Select an area
Group/Indicator
Population breakdown by age group
Live Births
Population all ages
Population 0-15 years
Population 16+
Population 16-64 years
Population 65-74 years
Population 75+
Population 85+
Life Expectancy & Mortality
Life expectancy (females)
Life expectancy (males)
Death all ages
All-cause mortality among the 15–44 year olds
Early deaths from coronary heart disease (< 75s)
Early deaths from cancer (< 75s)
Behaviours
Estimated smoking attributable deaths
Smoking prevalence (adults 16+)
Alcohol related hospital stays
Deaths from alcohol conditions
Drug related hospital stays
Active travel to work
Ill Health & Injury
Patients registered with cancer
Patients hospitalised with chronic obstructive
pulmonary disease (COPD)
Patients hospitalised with coronary heart disease
Patients hospitalised with asthma
Patients with emergency hospitalisations
Patients (65+) with multiple emergency
hospitalisations
Road traffic accident casualties - all ages
Economy
Population income deprived
Working age population employment deprived
Working age population claiming out-of-work
benefits
Young people not in education, employment or
training (NEET)
Child Poverty
60+ pop'n claiming pension credits
Mental Health
Population prescribed drugs for
anxiety/depression/psychosis
Patients with a psychiatric hospitalisation
Deaths from suicide
Period
Return to contents
NHS Orkney
Select a comparator
Count
Area Rate Comparator
measure
measure type
2013
2013
2013
2013
2013
2013
2013
2013
121
11,679
1,973
9,706
7,514
1,247
945
263
10.4
n/a
16.9
83.1
64.3
10.7
8.1
2.3
2011
2011
2012
2012
2012
2012
n/a
n/a
117
5
4
12
1,124.0
120.0
37.9
109.7
2012
2012
2013
2011
2012
2012
272
4
8
-
2,463.3
32.5
67.6
-
2012
2012
54
72
2012
2012
2012
2012
57
9
730
95
9.3
n/a
16.3
83.7
62.5
12.3
8.9
2.4
+1.04
n/a
+0.56
-0.56
+1.82
-1.61
-0.76
-0.12
years
years
sr
sr
sr
sr
81.8
79.7
1,048.9
92.1
39.3
121.5
+75.07
+27.91
-1.42
-11.82
sr
%
sr
sr
sr
%
248.6
19.9
1,406.7
25.1
45.2
18.0
+1056.53
+7.33
+22.39
-
484.2 sr
672.3 sr
527.7
582.4
-43.48
+89.93
sr
sr
sr
sr
471.6
57.4
5,913.0
4,074.1
+38.32
+19.95
+544.74
+647.88
2012
12
109.0 sr
101.5
+7.51
2013
2013
2013
850
470
470
7.3 %
6.3 %
6.3 %
7.2
6.4
6.6
+0.07
-0.16
-0.34
2013
-
-%
4.9
-
2012
2013
165
165
6.4 %
5.6 %
6.1
5.7
+0.27
-0.06
2013
-
- sr
14.6
-
2012
2011
15
125.6 sr
13.7 sr
128.1
13.2
-2.49
+0.50
509.9
77.3
6,457.8
4,722.0
cr
n/a
%
%
%
%
%
%
Difference
69
Group/Indicator
Social Care & Housing
Adults claiming incapacity benefit/severe
disability allowance
People aged 65+ with high levels of care needs who
are cared for at home
Children looked after by local authority
Single adult dwellings
Education
Average tariff score of all pupils on the S4 roll
Primary school attendance
Secondary school attendance
Working age adults with low or no educational
qualifications
Crime
Crime rate
Prisoner population based on residence of
Referrals to children's reporter for violencerelated offences
Domestic Abuse
Violent crime
Drug offences
Environment
Population within 500 metres of derelict site
People living in 15% most 'access deprived' areas
Adults rating neighbourhood as very good place to
live
Woman's & Children's Health
Teenage pregnancies
Mothers smoking during pregnancy
Low weight live births at term
Babies exclusively breastfed at 6-8 weeks
Child dental health in primary 1
Child dental health in primary 7
Child obesity in primary 1
Immunisations & Screening
Breast screening uptake
Bowel screening uptake
Immunisation uptake at 24 months - 5 in 1
Immunisation uptake at 24 months - MMR
Period
Count
Area Rate Comparator
measure type
measure
Difference
2013
350
3.0 %
3.0
-0.04
2013
-
-%
36.6
-
2013
2013
1,914
- cr
33.6 %
2.3
31.8
+1.81
2012
2010
2010
2012
n/a
727
677
-
95.4
90.5
-
197.0
95.4
90.8
8.9
-0.05
-0.31
-
2013
2012
2012
287
-
24.6 cr
- sr
- cr
16.4
72.1
6.7
8.21
-
2012
2012
2013
-
44.1
6.5
14.4
-
2013
2013
2013
4,201
5,499
-
36.1 %
47.1 %
-%
22.0
61.8
85.0
+14.09
-14.72
-
2011
2012
2012
2012
2013
2013
2013
13
1
40
90
45
20
11.6
1.3
39.5
73.8
50.6
16.1
cr
%
%
%
%
%
%
21.8
12.4
1.1
41.2
73.1
52.8
15.7
-0.78
+0.14
-1.68
+0.66
-2.20
+0.39
2011
2011
2013
2013
421
1,194
119
114
88.2
65.4
98.9
94.8
%
%
%
%
84.7
62.3
97.4
92.8
+3.52
+3.08
+1.46
+1.97
The difference column shows the crude difference between the rates for the two
areas. This has not been scaled.
Click here for notes on the data displayed in this profile.
mean
%
%
%
- cr2
- cr2
- cr2
Rate
type
key:
% - percentage of total population
cr - crude rate per 1,000 population
cr2 - crude rate per 10,000 population
sr - age-sex standardised rate per 100,000
population to ESP2013
70
20.
APPENDIX C: SERVICES THAT ARE INTEGRATING
20.1.
Which health and social care services are we integrating?
Our partnership will be responsible for planning and commissioning integrated services and
overseeing their delivery. These services are all adult social care, primary and community
health care services and elements of hospital care which will offer the best opportunities for
service redesign. The partnership has a key relationship with acute services in relation to
unplanned hospital admissions and will continue to work in partnership with Community
Planning Partners. This includes charities, voluntary and community groups so that, as well
as delivering flexible, locally based services, we can also work in partnership with our
communities.
SOCIAL CARE SERVICES
•
•
•
•
•
•
•
•
•
•
•
•
Social Work Services for adults and
older people
Services and support for adults with
physical disabilities and learning
disabilities
Children and Families services
Criminal Justice services
Mental Health Services
Drug and Alcohol Services
Care Home Services
Re-ablement Services
Aspects of housing support including
aids and adaptations
Day Services
Respite Provision
Community Occupational Therapy &
Rehabilitation Officer
HEALTH SERVICES
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Primary Care and Out of Hours
Resource transfer
Change fund, other
Dental Services
Community nursing
Health visiting
School Nursing
Specialist services
Long term conditions
Maternity
Allied Health Professionals
• Physiotherapy
• Occupational Therapy
• Speech & Language Therapy
• Dietetics
• Podiatry
• Intermediate Care
Mental Health
Dementia
Alcohol, Drugs and Detox Services
Learning disabilities
71
21.
APPENDIX D: ORGANISATIONAL DEVELOPMENT PLAN
Organisational
Development
Theme/Shared
Outcome
1. Vision & Strategic
Direction
Actions
•
•
•
•
2. Governance
•
•
•
•
•
3. Working with others
•
•
•
Apply knowledge to set future direction and
development/agreement of our shared vision, values and
behaviours including early priorities whilst maintaining a
focus on OIC and NHSO corporate objectives
Develop and agree our shadow arrangements and plans
for the establishment of our Integration Joint Board
including membership
Arrange Shadow Board Development Event
Arrange integrated development events for agreed
stakeholders to communicate our ideas and enthusiasm
about the new integrated arrangements and allow time to
build to critical support and ownership for our strategic
direction
Establish CEO/Officers Group to drive the service
improvement and change process that will support our new
integrated arrangements
Develop and agree Integration Scheme including delegated
functions
Develop Professional Framework (Clinical and Care)
Develop Staff side/union engagement framework to reflect
differences in organisational approach
Develop and agree Financial Planning and Budgetary
Framework including where appropriate procurement
Build and maintain relationships and strategic alliances
with key stakeholders – service users, carers, staff, Third
sector, wider interface partners notably – e.g. housing,
education, leisure, hospital, ICT, Finance, Legal,
Procurement and Asset Management and community
planning partners
Integrate the contribution of a stakeholders and being open
and honest about the extent to which contributions can be
acted upon
Working with Teams to help lead others reach a common
understanding of our shared vision, common goals and
early priorities
72
4. Managing and
Improving Services
•
•
•
5. Planning &
Performance
•
•
•
•
6. Workforce Support
•
•
•
•
•
•
•
•
7. Strategic
Commissioning
•
•
8. Communication &
Engagement
•
•
•
•
Determine resource requirements, including delegated
functions associated with delivering new integrated
arrangements
Manage and motivate people during transition
arrangements to ensure that we continue to improve
health
and
address
inequalities,
and
improve
patient/service user experience
Facilitate transformation to help drive change whilst
acknowledging and addressing the impact of change on
people and services
Develop and agree our Integration Fund submission
Develop programme of work to direct and oversee
integration arrangements
Determine our approach to locality based planning/ working
Undertake self-evaluation and self-assessment awareness
exercises as part of performance management system
(refer to recent OH&C evaluation findings)
Develop a Performance Framework for Integrated Services
Test out workforce structure being fit for purpose
Establish employee communication and engagement
system. Inc JT Staff Forum
Respond to OH&C evaluation findings
Ensure adequate HR and OD capacity /capability to
support our change process and new integrated
arrangements and improvement agenda
Develop and agree approach to Workforce Strategy and
annual workforce plans
Develop and agree approach to joint Learning &
Development within the new integrated arrangements
Consider opportunities to share HR, Finance and OD
functions within the new integrated arrangements and with
NHS Grampian
Develop and agree Strategic Plan in response to the
requirements as outlined in the Integration Act (to include
acute / hospital services)
Develop and agree local outcomes and measures to inform
our strategic commissioning decisions and performance
management framework
Develop and agree our external Communication &
Engagement Strategy
Determine whether we stay with Orkney Health & Care
‘brand’ – Move to Shadow IJB, IJB decision
Agree our engagement processes to ensure stakeholder
involvement
Develop a briefing newsletter for internal and external use
73
22.
APPENDIX E: CLINICAL AND CARE GOVERNANCE FRAMEWORK
Orkney Island
Council
NHS Orkney
Board
CSWO
Adult
Protection
Committee
Child Protection
Committee
Integration
Joint Board
NHS Orkney’s other
Governance
Committees Staff/
Finance and
Performance/ Audit
Area Clinical
Forum
(Advisory)
Professional
Fora
The Clinical and
Care Governance
Group
Managed Clinical
Networks
Public/ Service
User Groups
Sub Groups of the
CCGG
Strategic Planning
Group
2 Locality Groups
Outer Isles &
East/West
Mainland
74
23.
APPENDIX F: LOCAL PERFORMANCE INDICATORS
Performance Indicators Supporting National Outcome for Adults: 1. Healthier Living - People are able
to look after and improve their own health and wellbeing and live in good health for longer.
Indicator
Name
Indicator Description
Source identified
Orkney Islands
Council
NHS Orkney
NHS
Percentage of people
who say they are able to
look after their health
very well or quite well.
GP Patient
Experience Survey
Annual
Yes
NHS
Proportion of adults who
assess their general
health as good or very
good.
Scottish Health
Survey
Yes
NHS
Alcohol Brief
Interventions.
ABIs
Yes
NHS
Percentage of Adult
population who smoke.
Ash Scotland
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q52.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q51.
2013/14 Health &
Care Experience
Survey Q49.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q48.
Matches LDP
indicator No 14 ISD
Yearly 2014/15.
Scotpho - % adults
who smoke –
Annual 2014.
75
Indicator
Name
NHS
NHS
NHS
NHS
NHS
Indicator Description
Number of general acute
inpatient and day case
drug-related discharges
(any position), age-sex
standardised rates
(EASR).
Number of general acute
inpatient and day case
alcohol-related
discharges (any
position), age-sex
standardised rates
(EASR).
Naloxone Dispensing.
Numbers of deaths, with
age-standardised
mortality rates, by year
of death registration for
cancer.
Numbers of deaths, with
age-standardised
mortality rates, by year
of death registration for
CHD.
Source identified
Scotpho
Orkney Islands
Council
NHS Orkney
By request
Reporting ability
ISD Dashboard
currently showing
2014/15 data
ISD Publication –
Annual
Scotpho
Local
National Records
Scotland
Cancer Deaths
National Records
Scotland
CHD Deaths
By request
Yes
Yes
Yes
ISD Publication –
Annual
PRISIM ??
ISD – current
published data
2014
ISD – current
published data
2013
76
Indicator
Name
NHS
NHS
Indicator Description
Number of deaths, with
age-standardised
mortality rates, by year
of death registration for
Stroke.
Rate of emergency
admissions to hospital
for people aged 75+.
Source identified
National Records
Scotland
Stroke Deaths
LDP Standard
NHS Health ISD
Scotland
Orkney Islands
Council
NHS Orkney
Yes
Yes
Reporting ability
ISD – current
published data
2013
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
77
Performance Indicators Supporting National Outcome for Adults: 2. Independent Living - People,
including those with disabilities, long term conditions, or who are frail, are able to live, as far as
reasonably practicable, independently and at home or in a homely setting in their community.
Indicator
Name
Indicator Description
Community
Care
% of service users who
report that they are
supported to live as
independently as
possible.
Community
Care
Proportion of service
users (75+)with a
Telecare Package.
Community
Care
Percentage of adults
supported at home who
agree that they had a
say in how their help,
care or support was
provided.
NHS
Rate of emergency
admissions to hospital
for people aged 75+.
Source identified
Orkney Islands
Council
GP Patient
Experience Survey
Annual
SG Social Care
Survey
GP Patient
Experience Survey
Annual
LDP Standard
NHS Health ISD
Scotland
NHS Orkney
Yes
Yes
Yes
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q36f.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
SG Social Care
Survey 2015 Table
10 – users 75+
Annual
2013/14 Health &
Care Experience
Survey Q36b.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
78
Indicator
Name
Indicator Description
Source identified
NHS
Emergency inpatient bed LDP Standard
day rates for people
NHS Health ISD
aged 75+
Scotland
NHS
Number of
Readmissions to
hospital within 28 days
of discharge.
NHS
Proportion of last 6
NHS Health ISD
months spent at home or
Scotland
in a community setting.
NHS
Falls rate per 1,000
population in over 65s
NHS Health ISD
Scotland
Percentage of adults
18+ with intensive needs
receiving care at home.
Local Government
Benchmarking
Framework
Number of days people
spend in hospital when
they are ready to be
discharged.
NHS Health ISD
Scotland
Community
Care
NHS
Orkney Islands
Council
NHS Orkney
Yes
NHS Health ISD
Scotland
Yes
Yes
Yes
Reporting ability
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
Check ISD
Discovery?
ISD Published yearly
Contact Ambulance
Service
Check ISD
Discovery?
LGBF Annually
Yes
Yes
ISD – Monthly
current Sep 15
Delay discharge
information – ISD
report monthly
79
Indicator
Name
Indicator Description
NHS
Percentage of total
health and care spend
on hospital stays where
the patient was admitted
as an emergency
NHS Health ISD
Scotland
NHS
Percentage of people
who are discharged from
hospital within 72 hours
of being ready.
NHS Health ISD
Scotland
Delayed Discharge
Task Force
Source identified
Orkney Islands
Council
NHS Orkney
Reporting ability
Need to check?
No
Yes
No
ISD provide figures
for delayed
discharges
between 1 and 3
days monthly.
Current Oct 15
80
Performance Indicators Supporting National Outcome for Adults: 3. Positive Experience and
Outcomes - People who use health and social care services have positive experiences of those
services, and have their dignity respected.
Indicator
Name
Indicator Description
Source identified
Orkney Islands
Council
NHS Orkney
Community
Care
Percentage of adults
supported at home who
agree that they had a
say in how their help,
care or support was
provided.
GP Patient
Experience Survey
Annual
Yes
Community
Care
Percentage of people
receiving care and
support who report that
they were treated with
compassion and
understanding.
GP Patient
Experience Survey
Annual
Yes
Community
Care
Percentage of people
receiving care and
support who agree they
were treated with
respect.
GP Patient
Experience Survey
Annual
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q36b.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
2013/14 Health &
Care Experience
Survey Q36d.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
2013/14 Health &
Care Experience
Survey Q36c.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
81
Indicator
Name
Community
Care
Indicator Description
Source identified
Percentage of service
users who said that
people took into account
what was important to
them.
GP Patient
Experience Survey
Annual
Orkney Islands
Council
NHS Orkney
Yes
Community
Care
Percentage of adults
supported at home who
agree that their health
and care services seem
to be well co-ordinated.
GP Patient
Experience Survey
Annual
Yes
Community
Care
Percentage of people
receiving any care or
support who rate it as
excellent or good.
LDP Standard
GP Patient
Experience Survey
Annual
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q36a.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36
2013/14 Health &
Care Experience
Survey Q36e.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
2013/14 Health &
Care Experience
Survey Q37.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q37.
82
Indicator
Name
Community
Care
NHS
NHS
Indicator Description
Percentage of people
with a positive
experience at their GP
practice.
Number of
Readmissions to
hospital within 28 days
of discharge.
Proportion of last 6
months spent at home or
in a community setting.
Community
Care
Proportion of Adult Care
services graded ‘good’4- or better in Care
Inspectorate Inspections
NHS
Number of days people
spend in hospital when
they are ready to be
discharged.
Source identified
Orkney Islands
Council
GP Patient
Experience Survey
Annual
NHS Orkney
Yes
NHS Health ISD
Scotland
Yes
NHS Health ISD
Scotland
Yes
Care Inspectorate
NHS Health ISD
Scotland
Reporting ability
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q24 How you
are treated by Staff
at GP Q25 Care
provided by GP
practice.
Check ISD
Discovery?
ISD Published yearly
Currently Captured,
possible to report.
Yes
Yes
ISD – Monthly
current Sep 15
Delay discharge
information – ISD
report monthly
83
Indicator
Name
NHS
Indicator Description
Source identified
Percentage of people
who are discharged from
hospital within 72 hours
of being ready.
NHS Health ISD
Scotland
Delayed Discharge
Task Force
Orkney Islands
Council
NHS Orkney
Reporting ability
No
ISD provide figures
for delayed
discharges
between 1 and 3
days monthly.
Current Oct 15
84
Performance Indicators Supporting National Outcome for Adults: 4. Maintained or Improved Quality of
Life - Health and social care services are centred on helping to maintain or improve the quality of life
of people who use those services
Indicator
Name
Indicator Description
Community
Care
Percentage of adults
supported at home who
agree that their services
and support had an
impact in improving or
maintaining their quality
of life.
NHS
Rate of emergency
admissions to hospital
for people aged 75+.
Source identified
GP Patient
Experience Survey
Annual
LDP Standard
NHS Health ISD
Scotland
NHS
Emergency inpatient
bed day rates for people
aged 75+
LDP Standard
NHS Health ISD
Scotland
NHS
Falls rate per 1,000
population in over 65s
NHS Health ISD
Scotland
Orkney Islands
Council
NHS Orkney
Yes
Yes
Yes
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q36h.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
Contact Ambulance
Service
Check ISD
Discovery?
85
Indicator
Name
Indicator Description
Community
Care
Proportion of Adult Care
services graded ‘good’4- or better in Care
Inspectorate Inspections
NHS
Number of days people
spend in hospital when
they are ready to be
discharged.
NHS Health ISD
Scotland
NHS
Percentage of total
health and care spend
on hospital stays where
the patient was admitted
as an emergency
NHS Health ISD
Scotland
Source identified
Orkney Islands
Council
NHS Orkney
Currently Captured,
possible to report.
Care Inspectorate
Yes
Yes
No
Reporting ability
ISD – Monthly
current Sep 15
Delay discharge
information – ISD
report monthly
Need to check?
Yes
86
Performance Indicators Supporting National Outcome for Adults: 5. Reduced Health Inequalities Health and social care services contribute to reducing health inequalities.
Indicator
Name
NHS
NHS
NHS
Indicator Description
Numbers of deaths, with
age-standardised
mortality rates, by year
of death registration for
cancer.
Numbers of deaths, with
age-standardised
mortality rates, by year
of death registration for
CHD.
Number of deaths, with
age-standardised
mortality rates, by year
of death registration for
Stroke.
Source identified
National Records
Scotland
Cancer Deaths
National Records
Scotland
CHD Deaths
National Records
Scotland
Stroke Deaths
Orkney Islands
Council
NHS Orkney
Reporting ability
Yes
ISD – current
published data
2014
Yes
ISD – current
published data
2013
Yes
ISD – current
published data
2013
87
Performance Indicators Supporting National Outcome for Adults: 6. Carers are Supported - People
who provide unpaid care are supported to look after their own health and wellbeing, including to
reduce any negative impact of their caring role on their own health and wellbeing
Indicator
Name
Indicator Description
Source identified
Orkney Islands
Council
NHS Orkney
Community
Care
Percentage of carers
who feel supported to
continue in their caring
role.
GP Patient
Experience Survey
Annual
Community
Care
Percentage of carers
who have a say in the
services provided for the
person they look after.
GP Patient
Experience Survey
Annual
Yes
Community
Care
Percentage of carers
who report that services
are well coordinated.
GP Patient
Experience Survey
Annual
Yes
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q45f.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q45
2013/14 Health &
Care Experience
Survey Q45d.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q45
2013/14 Health &
Care Experience
Survey Q45e.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q45
88
Indicator
Name
Indicator Description
Source identified
Orkney Islands
Council
NHS Orkney
Community
Care
Percentage of carers for
whom caring has had a
negative impact in their
own health and
wellbeing.
GP Patient
Experience Survey
Annual
Yes
Community
Care
Percentage of carers
who report they have a
good balance between
caring and other things
in their life.
GP Patient
Experience Survey
Annual
Yes
NHS
Rate of emergency
admissions to hospital
for people aged 75+.
LDP Standard
NHS Health ISD
Scotland
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q45c.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q45
2013/14 Health &
Care Experience
Survey Q45a.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q45
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
89
Performance Indicators Supporting National Outcome for Adults: 7. People are Safe - People who use
health and social care services are safe from harm
Indicator
Name
Indicator Description
Community
Care
Percentage of adults
supported at home who
agree that they felt safe.
Community
Care
Talking Points: Feeling
safe (various wording).
NHS
Rate of emergency
admissions to hospital
for people aged 75+.
Source identified
GP Patient
Experience Survey
Annual
Orkney Islands
Council
NHS Orkney
Yes
Yes
LDP Standard
NHS Health ISD
Scotland
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q36a.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36
2013/14 Health &
Care Experience
Survey Q36g.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
90
Indicator
Name
Indicator Description
Source identified
NHS
Emergency inpatient bed
day rates for people
aged 75+
LDP Standard
NHS Health ISD
Scotland
NHS
Number of
Readmissions to
hospital within 28 days
of discharge.
NHS Health ISD
Scotland
NHS
Falls rate per 1,000
population in over 65s
NHS Health ISD
Scotland
Community
Care
NHS
Proportion of Adult Care
services graded ‘good’4- or better in Care
Inspectorate Inspections
Percentage of total
health and care spend
on hospital stays where
the patient was admitted
as an emergency
Care Inspectorate
Orkney Islands
Council
NHS Orkney
Yes
Yes
Yes
Yes
Reporting ability
Heat target – ISD
report updated
quarterly. Only
previous years data
in publication.
Check ISD
Discovery?
Contact Ambulance
Service
Check ISD
Discovery?
Currently Captured,
possible to report.
Need to check?
NHS Health ISD
Scotland
No
Yes
91
Performance Indicators Supporting National Outcome for Adults: 8. Engaged Workforce - People who
work in health and social care services feel engaged with the work they do and are supported to
continuously improve the information, support, care and treatment they provide
Indicator
Name
Indicator Description
Source identified
NHS
Percentage of staff who
have had a PPD
interview in last 12
months.
LDP Standard
NHS Scotland Staff
Survey
Yes
Yes
Percentage of staff
satisfied with
supervision process.
OIC
NHS measure
No
Yes
Community
Care
NHS
Orkney Islands
Council
NHS Orkney
Reporting ability
Reported 6 monthly
to OHAC Board –
NHS (OHAC) staff
included
NHS available .
OIC - Possible to
develop in the
future if required.
92
Performance Indicators Supporting National Outcome for Adults: 9. Effective Resource Use Resources are used effectively and efficiently in the provision of health and social care services
Indicator
Name
Community
Care
Indicator Description
Percentage of adults
supported at home who
agree that their health
and care services seem
to be well co-ordinated.
Source identified
GP Patient
Experience Survey
Annual
Orkney Islands
Council
NHS Orkney
Yes
NHS
Number of
Readmissions to hospital NHS Health ISD
within 28 days of
Scotland
discharge
NHS
Proportion of last 6
months spent at home or
in a community setting.
NHS Health ISD
Scotland
NHS
Falls rate per 1,000
population in over 65s
NHS Health ISD
Scotland
Yes
NHS
Number of days people
spend in hospital when
they are ready to be
discharged.
NHS Health ISD
Scotland
Yes
Yes
Yes
Reporting ability
2013/14 Health &
Care Experience
Survey Q36e.
2015/16 Survey
being carried out
Nov 15 – Jan 16
results in summer
16 Q36.
Check ISD
Discovery?
ISD Published yearly
Contact Ambulance
Service
Check ISD
Discovery?
ISD – Monthly
current Sep 15
Delay discharge
information – ISD
report monthly
93
Indicator
Name
Indicator Description
NHS
Percentage of total
health and care spend
on hospital stays where
the patient was admitted
as an emergency
NHS Health ISD
Scotland
NHS
Percentage of people
who are discharged
from hospital within 72
hours of being ready.
NHS Health ISD
Scotland
Delayed Discharge
Task Force
Community
Care
Home care costs for
people aged 65 or over
per hour £.
Local Government
Benchmarking
Framework
Source identified
Orkney Islands
Council
NHS Orkney
Reporting ability
Need to check?
No
Yes
No
ISD provide figures
for delayed
discharges
between 1 and 3
days monthly.
Current Oct 15
LGBF Annually
Yes
94
Performance Indicators Supporting National Outcome for Children: 1. - Our children have the best
start in life
Indicator
Name
Indicator Description
NHS
Percentage of babies
exclusively
breastfeeding at First
Visit/6-8 week review by
year of birth.
NHS
Estimated percentage of
children in P1 at risk of
obesity.
Child Health
NHS
Percentage of Children
in Primary 1 with no
obvious Dental Caries.
NDIP
SOA
Source identified
Orkney Islands
Council
NHS Orkney
Reporting ability
ISD Publication –
currently 2014/15
Child Health
Yes
Yes
No
Yes
ISD Publication –
currently 2013/14
ISD Publication –
currently 2014
95
Performance Indicators Supporting National Outcome for Children: 2. - We have improved the life
chances for children, young people and families at risk
Indicator
Name
Children &
Young People
Children &
Young People
Children &
Young People
Children &
Young People
Children &
Young People
Indicator Description
Balance of Care for
looked after children:
percentage of children
being looked after in the
community.
Percentage of fostered
LAAC who are fostered
by an in-house
placement.
Number of out of area
placements
a)foster care
b) residential
No of C&YP on CP
Register.
The gross cost of
‘children looked after’ in
residential based
services per child per
week £.
Source identified
Orkney Islands
Council
NHS Orkney
Reporting ability
LGBF – Annually
Local Government
Benchmark
Framework
SG Annual Return
Yes
Yes
Looked after
Children survey –
Annually
Looked after
Children survey –
Annually
SG Annual Return
Yes
Child Protection
Yes
Child Protection
survey – Annually
Local Government
Benchmarking
Framework
Yes
LGBF – Annually
96
Indicator
Name
Indicator Description
Children &
Young People
The gross cost of
‘children looked after’ in
a community setting per
child per week £.
Source identified
Local Government
Benchmarking
Framework
Orkney Islands
Council
NHS Orkney
Reporting ability
LGBF – Annually
Yes
97
Performance Indicators Supporting National Outcome for Criminal Justice: 1. - Community safety,
public protection and the reduction of reoffending.
Indicator
Name
Criminal
Justice
Criminal
Justice
Criminal
Justice
Criminal
Justice
Indicator Description
Percentage of Social
Work Reports submitted
by noon on the working
day before the adjourned
hearing.
Percentage of new CPO
clients with a supervision
requirement seen by a
supervising officer within
a week.
Percentage of CPO
Unpaid work
requirements
commenced induction
within five working days.
Percentage of
individuals on new CPO
unpaid work requirement
began work placements
within seven days.
Source identified
Orkney Islands
Council
NHS Orkney
Reporting ability
NCJA – Quarterly
NCJA
Yes
SG Annual Return
Yes
CJ return –
Annually
SG Annual Return
Yes
CJ return –
Annually
SG Annual Return
Yes
CJ return –
Annually
98
24.
FEEDBACK QUESTIONAIRE
We want to hear your thoughts and views and help us shape our Strategic Plan. What
matters to you is important to us and this is your opportunity to influence the way our services
are delivered through Health and Social Care.
Please return this response sheet by Friday, 12 February, 2016
Question 1: Does the plan reflect what you would consider to be the key priorities for planning
and developing health and social care services?
Question 2: Is there anything we have missed or overlooked? If so what?
Question 3: Is there enough detail or information in this plan for you and, if not, what more
would you like to see?
Question 4: Are there any other comments you would wish to make?
99