Drivers for Change. A variety of national strategies outline the way forward for Health and Social Care Services and have been considered in the development of local Fife Strategies. National Commission on the Future Delivery of Public Services (The Christie Report) (June 2011) 2020 Vision for Health and Social Care (September 2011) Healthcare Quality Strategy (2012) A National Clinical Strategy for Scotland (February 2016) Health and Social Care Delivery Plan (December 2016) Property Asset Management Strategy (2017) NHS in Scotland 2016 – Audit Scotland Report (October 2016) Local Health and Social Care Partnership Strategic Plan for Fife 2016-19 (May 2016) NHS Fife Clinical Strategy (2016-21) NHS Fife Estates Rationalisation Strategy (2017) Local Delivery Plan (2017) Another key driver locally is the proposed expansion in house building in Lochgelly. Summarising the Need for Change The preceding sections have provided the detailed narrative in support of the demonstrable cause and effect of the need for change and investment. The table below (page 51) summarises this information. What is the cause of the need for change? What effect is it having, or likely to have, on the organisation? Why action now: Service redesign enablement issues Existing physical capacity is unable to deliver essential baseline change and re-design (before any assessment of future growth). Local health inequality issues will continue to cause issues for the local population if this proposal is not implemented now . Service capacity related issues Existing capacity is unable to cope with future projections of demand. Short-term service sustainability will be at risk if this proposal isn’t implemented now. Clinical functionality (capacity) issues Aside from primary clinical capacity, existing facilities lack the number and range of support areas necessary to deliver safe and effective services. A lack of essential support areas represents a real and unacceptable risk to the Board in key areas such as HAI and patient safety that can only be addressed through significant investment. Clinical functionality (configuration) issues Existing facilities fall far below the required standards in terms of how they are configured and laid out. Physical characteristics of the building prevents safe and effective patient care: small treatment rooms below minimum standards. Existing facility configuration and layout also presents unacceptable risks for the Board as well as poor local performance...
Drivers for Change. The Caithness economy is fragile, with 12% dependent on the former Nuclear Power Station, Dounreay, which is now undergoing decommissioning with a loss of up to 2,000 jobs over the next 15 years. There are pockets of high deprivation, and 10% of the population lives in the most deprived 20% of areas in Scotland. In remote and rural Caithness there are pockets of disadvantaged individuals and households who live at some distance from service access points and struggle to access health and social care. A consequence of deprivation and poverty is generally poorer health and an increased demand for health and social care services. The population is ageing, and younger people of working age are migrating to urban areas, adding to our workforce pressures. In 2018 there were 26 people of working age for every 10 people over 65 years. By 2041 this is projected to reduce markedly to 15 people of working age for every 10 people over 65 years. Recruitment of nursing and social care staff in Caithness is challenging, with only two-thirds of posts filled on first advert. Locum and agency use is high, accounting for a significant overspend, and in Highland overall nearly 10% of consultant posts were vacant (March 2020). Half of the 600 staff employed in the Caithness area are over the age of 50.
Drivers for Change. 2.1 The existing broadband provision in the county is currently failing to deliver the national universal service commitment of 2Mbps to 23.8% of premises in Herefordshire (Ofcom1 2011) with the same data revealing that there is no access to Superfast Broadband in Herefordshire (though BT have announced superfast deployment for Hereford as part of a commercial roll-out).
Drivers for Change. Cause of the need for change: Effect of the cause on the organisation: Why action now: Inadequate facilities including lack of enough isolation rooms with en-suite facilities Increased risk of infection and adverse events Facilities are non-compliant Physical space constraints and poor environment- not able to safely observe patients Effect on staff safety and morale Need to retain trained workforce Future service demand predicted to increase Existing capacity is unable to cope with future projections of demand Service sustainability will be at risk in the future if this proposal isn’t implemented now Inefficient layout of Unit, inadequate waiting rooms Ineffective service arrangements Inefficient service performance. Poor patient flow Continuation of the existing service performance is unsustainable Service arrangements not person centred – Non-DDA compliant toilets, lack of privacy and patient space Service is not meeting current or future user requirements A service that isn’t meeting user requirements is unsustainable, even in the short term Accommodation with high levels of backlog maintenance and poor functionality Increased safety risk from outstanding maintenance and inefficient service performance Building condition, performance and associated risks will continue to deteriorate if action isn’t taken now
Drivers for Change. For a number of years the IW Council has grant funded the voluntary sector to deliver advice, information and guidance (AIG). This arrangement has helped independent organisations support people who face a range of problems including debt, housing, employment, consumer rights and welfare benefits. Together with information and advice services provided by the council, advice providers assist and empower people to resolve their problems, which in turn prevents unnecessary distress and/or otherwise unnecessary demand for public services. Provision of independent information and advice services is therefore most effective when it is aligned to the IW Council’s corporate priorities and those of other public sector organisations. In recent years there has been a notable increase in levels of demand for community based advice, information and guidance. This can be attributed to the current economic environment and concomitant increases in household debt, changes to welfare benefits and pressures on housing. Further increases in demand should be expected following the introduction of Universal Credit and the Care Act 2014. To address these increased pressures a partnership of voluntary sector agencies was formed in 2013 following a national programme to make services more robust through local partnerships. The ‘Isle Help’ consortium successfully competed for Advice Services Transition Fund (ASTF) money from the Big Lottery to introduce a range of shared services to improve outcomes for clients and improve sustainability. Since the Isle Help project began it has introduced a shared advice services hub, increased digital and telephone service delivery for clients, and provided a networked referral system assisting clients to always make contact with the agency that best meets their needs. Isle Help has produced its own three year strategy which is both ambitious in terms of intended outcomes for clients and connected in terms of its correlation with the council’s own three year plan. This ensures further alignment with major changes in the way that public services on the Island will be provided arising from pressure on public funding and new more collaborative ways of delivering public services. IW Council grants to key local voluntary and community AIG providers ended in March 2015. The funding of AIG providers could be discontinued as the services are discretionary. However, the council recognises the potentially costly implications of a loss of independent provis...
Drivers for Change. There has been a long standing ambition to shift more health care from the acute sector to settings closer to people’s homes, and from reactive care to prevention and proactive models based on early interventions The new pathway model components are: Prevention and early intervention Assessment and triage Support for people with long term health conditions It is envisaged that to deliver this ambition integrated community teams working with GPs, specialist services and the voluntary sector will assist those people living in their communities who have long term conditions or are frail due to disability or age. A first key step will be to remove complexity by delivering a simple pattern of services delivered by a multi- disciplinary team based around localities and primary care supported by specialist services from the community and hospital setting. This will offer Island residents a more complete and less fragmented service. The model needs to include both health and social care. To be successful each locality will need to undertake systematic, targeted case-finding using risk stratification tools. The ambition of this Agreement is to enable the creation of a Partnership Agreement which enables the delivery of integrated care.
Drivers for Change. The Isle of Wight NHS Trust and Isle of Wight Council are investing in new models of health and social care that will be better able to meet the current and future needs of Island people, communities and visitors. Integration of services will enable partners to benefit from the limited resources across health services, social care, and related public services., A single point of public access is intended to contribute to these efficiencies through integrating multiple organisations under one management structure that will pursue common person-centred goals. There is a need for public access and triage that will provide a fast and effective response. Integration is intended to bring together various emergency and non-emergency services in a seamless and efficient way. Further integration of contact centre services will build on the experience and benefits of the current co-location of health and social care services such as 999 / 111 service, Adult First Response (Social Care) and district nursing coordination. Although currently co-located in a shared hub, these services continue to be managed within their own respective organisational management structures. There is now a need to remove organisational barriers and implement a single management structure and the sharing of technologies and processes currently used by single services. This is intended to lead to a more holistic, co-ordinated and consistent point of contact for all people needing services. The benefits of integration must include:
Drivers for Change. A variety of national strategies outline the way forward for Health and Social Care Services and have been considered in the development of local Fife Strategies.
