Common use of Drivers for Change Clause in Contracts

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 and functional in-efficiency. Clinical functionality (fabric and infrastructure) issues Currently service model development is constrained by the physical capacity of the building being 100% utilised. Future service model looks to provide elements of a hub model allowing co-location of service providers including the Third Sector to provide a more patient centred approach. Building specific (including statutory compliance and backlog maintenance) issues Increased safety risk from outstanding maintenance and inefficient service performance. Building condition, performance and associated risks will continue to deteriorate if action is not taken now. Additional opportunities for improvement Develop easy access to discuss and facilitate care from Social Care. Necessary to support increased and improved integrated care at home/ in the community.

Drivers for Change. A variety of national strategies outline The following section details the way forward need for Health and Social Care Services and have been considered change as identified in the development Strategic Assessment (included in Appendix 1) and Initial Agreement (IA) as approved by the Scottish Government Capital Investment Group in October 2018. The project team have reviewed the drivers for change in the context of local Fife Strategiesthe existing situation and confirmed that these remain valid. National  Commission on the Future Delivery Table 1: Summary 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 ? Increased future service demand due to population growth East Calder is unable experiencing significant population growth and the Medical Practice cannot meet the service requirements of the growing population. The practice is already experiencing population growth from the Calderwood development and this is predicted to increase significantly. Time from Initial Agreement to occupation of a new facility will take circa 4 years. Services cannot be delivered locally based on local patient demand, but instead will need to be based on where beyond the local community it is possible to deliver essential baseline change services. NHS Lothian will fail to provide treatment for all patients in the future unless this is planned for. Pressure on existing staff, accommodation and re-services will inevitably increase. Sustainability of primary care is a key priority for the IJB and NHS Lothian There is a need to plan to provide a sustainable service for the future Poor functionality and space restrictions in existing accommodation Some consulting rooms are very small and don’t meet current standards due to the conversion of small rooms/ store cupboards. These can be very restrictive/ unsuitable for patients and staff. No further scope exists to reconfigure service design (before any assessment or the existing building to improve the experience. Poor patient and staff experience. Do not meet current recommended standards. Not DDA compliant The building is not fully DDA compliant - discriminating between the experiences of future growth)service users. Local health inequality issues Service arrangements do not support the existing workforce Staff accommodation is restricted with staff working in suboptimal conditions – these impacts poorly on staff morale. There is a need to plan to provide suitable facilities for the future, especially as staff numbers will continue to increase as the practice requires to expand and the Primary healthcare team is further developed Existing There is no scope for enhancing the Pressure on accommodation and What is the cause issues of the need for change? What effect is it having, or likely to have, on the local population organisation? Why action now? arrangements do not support the transfer of healthcare services to primary care primary care services provided in the existing accommodation including transferring the right care closer to patients’ homes. services is going to increase and if this proposal the accommodation issue is not implemented now addressed it will not be possible to transfer further services to primary care, it may even result in restrictions on the services already provided. The facilities available, combined with significant increase in population, restrict the ability of the parties to transfer services to primary care and work effectively across both healthcare sites. 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 and functional in-efficiency. Clinical functionality (fabric and infrastructure) issues Currently service model development is constrained by the physical capacity of the building being 100% utilised. Future service model looks to provide elements of a hub model allowing co-location of service providers including the Third Sector to provide a more patient centred approach. Building specific (including statutory compliance and backlog maintenance) issues Increased safety risk from outstanding maintenance and inefficient service performance. Building condition, performance and associated risks will continue to deteriorate if action is not taken now. Additional opportunities for improvement Develop easy access to discuss and facilitate care from Social Care. Necessary to support increased and improved integrated care at home/ in the community.Change Planning Strategic Assessment Initial Agreement Outline Business Case Final BusinessCase Implementation Phase

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 following is the proposed expansion in house building in Lochgelly. Summarising the Need for Change The preceding sections have provided the detailed narrative in support a full list 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 main drivers causing the need for change? , the effect that these issues are having on the current service provision and an assessment of why it is believed action is required now. Table 7 Driver for change: What effect is it having, or likely to have, on the organisation? Why action now: Service redesign enablement issues Existing physical capacity The clinical and social care model have developed and implementation is unable to deliver essential baseline change being circumscribed Primary, Community and re-design (before any assessment Voluntary sector services cannot provide the integrated model of future growth). Local health inequality issues will continue to cause issues care they and the community recognise is required now and for the local population if this proposal is not implemented now future. 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, the physical capacity of the building is 100% utilised and oversubscribed. A lack The model of integrated care is being undermined now: preventing locally based, proactive care. Lack of essential support areas (e.g. clean and dirty utility areas) represents a real and unacceptable risk to the Board in key areas such as HAI Healthcare Associated Infections and patient safety that can only be addressed through significant investment. Clinical Time from Initial Agreement to occupation of a new facility could take circa 4 years. Services cannot be delivered locally for local patient need; Existing physical capacity is unable to deliver essential baseline change and re-design. Local health inequality issues will continue to be difficult to support. NHS Fife/Fife H&SCP will fail to deliver the GMS (2018) and the community health and wellbeing hub model within Lochgelly unless this is planned for. Pressure on existing staff, accommodation and services will inevitably increase. Sustainability of primary care is a key priority for the Partnership and NHS Fife. There is a need to plan to provide a sustainable service for the future Poor clinical and non clinical functionality and space restrictions in existing accommodation (configuration) Existing facilities fall far below the required standards in terms of how they are configured and laid out. The Equality Act (2010) compliance within the building is poor. Existing facility configuration and layout presents unacceptable risks, as well as poor local performance, functional in-efficiency and suboptimal patient experience. Wheelchairs, mobility scooters and double buggies cannot access parts of the building, including the waiting area. The waiting areas are too small. Premises are functionally inadequate and compromise pro-active patient care. No scope exists to re-organise parts of the service to improve the experience. Some consulting rooms are very small and do not meet current standards. These are very restrictive / unsuitable for patients and staff. Poor patient and staff experience. Does not meet current recommended standards. Clinical and social care functionality (capacity) issues Capacity is unable to cope with current, let alone future projections of need. Patients are required to make repeated appointments to meet with different members of their multi disciplinary team and to access healthcare out-with the local area. Service sustainability and development is at risk and an increasing number of patients will travel to other venues for appointments. Facilities lack the number and range of support areas necessary to deliver modern, integrated, safe and effective services There are no rooms available to deliver training, accommodate local multi disciplinary team meetings, etc. There is no accommodation to support local access to a wider range of visiting community services to support for example income maximisation. Building issues (Including statutory compliance and backlog maintenance) Existing facilities fall far below the required standards in terms of how they are configured and laid out. Physical characteristics of the building prevents prevent 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 and functional in-efficiency. Clinical functionality (fabric and infrastructure) issues Currently service model development is constrained by the physical capacity of the building being 100% utilised. Future service model looks to provide elements of a hub model allowing co-location of service providers including the Third Sector to provide a more patient centred approach. Building specific (including statutory compliance and backlog maintenance) issues Increased safety risk from outstanding maintenance and inefficient service performance. Building configuration and layout present unacceptable risks as well as poor performance and functional inefficiency. Redesign of building will allow for improved care, staff experience and financial performance. Building condition, performance and associated risks will continue to deteriorate if action is not taken now. Additional opportunities INVESTMENT OBJECTIVES This section identified the ‘business need’ in relation to the current arrangements described in section 2.1. These were discussed at the Architecture & Design Scotland (A&DS) facilitated workshop to develop the project design statement. A wide range of stakeholders including clinical and managerial staff along with community representatives were involved in a workshop to describe the difference between ‘where we are now’ and ‘where we want to be’. Table 8 Effect of the need for improvement Develop easy change on the organisation: Investment Objectives Existing service arrangements are affected by lack of clinical support service facilities. Ensure equal access to discuss a patient centred approach by enabling delivery of and facilitate access to local integrated anticipatory and preventative care from Social Carefor patients. Necessary Secure accommodation to support increased and improved deliver required group based activities. Implementation of integrated models of care is undeliverable locally in the current environment Ensure equal access to modern integrated care at home/ with provision driven by patient need rather than limitations in capacity. Pressure on existing staff, accommodation and services will inevitably increase. Ensure the right staff skill mix and service capacity are available to deliver and strengthen local capacity to manage people’s health within the local community. The facilities available, 100% occupancy, combined with significant population change, restrict the ability of the parties to deliver the full range of integrated services locally. Enable earlier access to proactive and anticipatory care through local delivery via integrated seamless service across health and social care. This will reduce referrals to other services. Care will be driven by patient need rather than limitations on capacity. Existing configuration, as a result of a circa 1970’s building, which has been modified and extended with a ‘best fit’ approach means poor accommodation e.g. service users who rely on wheelchair access or have a mobility problem have extreme difficulty in both accessing and traversing the facility. Delivery of safe and effective care with dignity by providing facilities which comply with all legal standards and regulatory requirements and gives equality of access for all. Improved staff wellbeing. Increased safety risk from outstanding maintenance and inefficient service performance. Improve safety and effectiveness of accommodation by improving the physical condition, quality and functional suitability of the healthcare estate.

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 Section 3 provides detailed narrative in support of the demonstrable cause and effect of the need for change and investment. The table below (page 51page7) 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. demand Short-term service sustainability will be at risk if this proposal isn’t is not implemented now. 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. 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. investment Clinical functionality (configuration) issues Existing facilities fall far below the required standards in terms of how they are configured and laid out. out Physical characteristics of the building prevents safe and effective patient care: small treatment rooms below minimum standards. standards Existing facility configuration and layout also presents unacceptable risks for the Board as well as poor local performance and functional in-efficiency. efficiency Clinical functionality (fabric and infrastructure) issues Currently service model development is constrained by the physical capacity of the building being 100% utilised. Future service model looks to provide elements of a hub model allowing co-co- location of service providers including the Third Sector to provide a more patient centred approach. Building specific (including statutory compliance and backlog maintenance) issues Increased safety risk from outstanding maintenance and inefficient service performance. performance Building condition, performance and associated risks will continue to deteriorate if action is not taken now. now Additional opportunities for improvement Develop easy access to discuss and facilitate care from Social Care. Necessary to support increased and improved integrated care at home/ in the community.community Investment Objectives The Investment Objectives for the Lochgelly Health Centre Project were discussed at the Architecture & Design Scotland (A&DS) facilitated workshop to develop the project Design Statement. A wide range of stakeholders including clinical and managerial staff along with community representatives attended the workshop. Effect of the need for change on the organisation: Investment Objectives Current service capacity utilisation is at 100%. The full range of services required cannot be delivered as required locally for patients resulting in patients requiring additional referrals and attendances. [Ref 2 in Strategic Assessment (SA)] To provide current clinical service requirements locally and reduce the number of referrals to other service providers and additional attendances required as appropriate. The care provided will be driven by patient need rather than limitations in capacity Existing service arrangements affected by lack of clinical support service facilities. The current service delivery model is unable to support group based activities. Services proposals include group based activities in e.g., mental health and speech and language therapy. [Ref 1 in SA ] Deliver group based activities locally. e.g., a key strand of NHS Fife’s Clinical Strategy is to reduce health inequalities by reconfiguring services and resources so that there is equity of access to services across Fife and across all patient groups. Care should be provided at home or as close to home as possible. Delivering services in a group environment will allow a greater number of NHS Fife residents be supported in the management of their own well-being. To provide a more patient centred approach by delivering improved anticipatory and preventative care for patients. To allow a more integrated approach to service delivery for patients. Existing configuration, as a result of a circa 1970’s building, being modified and extended with a ‘best fit’ approach. e.g., Service users who rely on wheelchair access or have a mobility problem have extreme difficulty in both accessing and traversing the facility. [Ref 4 in SA] To contribute to achievement of the National Outcomes on Integration, in particular Outcomes 3, 5 and 9. Increased safety risk from outstanding maintenance and inefficient service performance. [Ref 4 and 5 in SA] Improve safety and effectiveness of accommodation by improving the physical condition, functional suitability and quality of the healthcare estate. Benefits Register In order to ensure that resources are effectively exploited and that any investment made provides agreed benefits a register has been developed. This register (see page 54) identifies the expected benefits, indicates a baseline and target measurement and also gives a priority level to each benefit. A Benefits Realisation Plan will be developed as the project progresses. Risk Management