Common use of Drivers for Change Clause in Contracts

Drivers for Change. The following section details the need for change as identified in the 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 the existing situation and confirmed that these remain valid. Increased future service demand due to population growth East Calder is 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 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 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 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 service users. 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 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 the accommodation issue is not 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 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.  Commission on the Future Delivery of Public Services (The following section details 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. 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. 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 identified 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 Strategic Assessment 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 (included in Appendix 1fabric and infrastructure) and Initial Agreement (IA) as approved issues Currently service model development is constrained by the Scottish Government Capital Investment Group in October 2018. The project team have reviewed the drivers for change in the context physical capacity of the existing situation and confirmed that these remain validbuilding being 100% utilised. Increased future Future service demand due model looks to population growth East Calder is 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 provide elements 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 hub model allowing co-location of service providers including the local community it is possible to deliver 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 services will inevitably increase. Sustainability of primary care is a key priority for the IJB and NHS Lothian There is a need to plan Third Sector to provide a sustainable more patient centred approach. Building specific (including statutory compliance and backlog maintenance) issues Increased safety risk from outstanding maintenance and inefficient service for the future Poor functionality performance. Building condition, performance 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 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 service users. 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 associated risks will continue to increase as the practice requires deteriorate if action is not taken now. Additional opportunities for improvement Develop easy access to expand discuss and the Primary healthcare team is further developed Existing There is no scope for enhancing the Pressure on accommodation facilitate care from Social Care. Necessary to support increased and arrangements do not support the transfer of healthcare services to primary improved integrated care primary care services provided at home/ in the existing accommodation including transferring the right care closer to patients’ homes. services is going to increase and if the accommodation issue is not 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 Change Planning Strategic Assessment Initial Agreement Outline Business Case Final BusinessCase Implementation Phasecommunity.

Drivers for Change. The following section details is a full list of the main drivers causing the need for change as identified in change, the Strategic Assessment (included in Appendix 1) effect that these issues are having on the current service provision and Initial Agreement (IA) as approved by the Scottish Government Capital Investment Group in October 2018an assessment of why it is believed action is required now. The project team clinical and social care model have reviewed developed and implementation is being circumscribed Primary, Community and Voluntary sector services cannot provide the drivers integrated model of care they and the community recognise is required now and for change in the context future. Existing facilities lack the number and range of support areas necessary to deliver safe and effective services, the physical capacity of the existing situation building is 100% utilised and confirmed that these remain valid. Increased future service demand due to population growth East Calder is experiencing significant population growth and the Medical Practice cannot meet the service requirements of the growing populationoversubscribed. The practice model of integrated care is already experiencing population growth from 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 Calderwood development Board in key areas such as Healthcare Associated Infections and this is predicted to increase significantlypatient safety that can only be addressed through significant investment. Time from Initial Agreement to occupation of a new facility will could take circa 4 years. Services cannot be delivered locally based on for local patient demand, but instead need; Existing physical capacity is unable to deliver essential baseline change and re-design. Local health inequality issues will need continue to be based on where beyond the local community it is possible difficult to deliver servicessupport. NHS Lothian Fife/Fife H&SCP will fail to provide treatment for all patients in deliver the future 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 IJB Partnership and NHS Lothian 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 don’t do not meet current standards due to the conversion of small rooms/ store cupboardsstandards. These can be are very restrictive/ restrictive / unsuitable for patients and staff. No further scope exists to reconfigure service design or the existing building to improve the experience. Poor patient and staff experience. Do Does not meet current recommended standards. Not DDA compliant The building Clinical and social care functionality (capacity) issues Capacity is not fully DDA compliant - discriminating between 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 experiences of service userslocal area. Service arrangements do not 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 the existing workforce Staff accommodation is restricted with staff working in suboptimal conditions – these impacts poorly on staff moraleareas 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 need wider range of visiting community services to plan to provide suitable 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 prevent safe and effective patient care: small treatment rooms below minimum standards. 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 the futureimproved care, especially as staff numbers experience and financial performance. Building condition, performance and associated risks will continue to increase as deteriorate if action is not taken now. This section identified the practice requires ‘business need’ in relation to expand 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 Primary healthcare team difference between ‘where we are now’ and ‘where we want to be’. Existing service arrangements are affected by lack of clinical support service facilities. Ensure equal access to a patient centred approach by enabling delivery of and access to local integrated anticipatory and preventative care for patients. Secure accommodation to deliver required group based activities. Implementation of integrated models of care is further developed Existing There is no scope for enhancing undeliverable locally in the current environment Ensure equal access to modern integrated care with provision driven by patient need rather than limitations in capacity. Pressure on existing staff, accommodation and arrangements do not support the transfer of healthcare services to primary care primary care services provided in the existing accommodation including transferring will inevitably increase. Ensure the right care closer staff skill mix and service capacity are available to patients’ homes. services is going deliver and strengthen local capacity to increase and if manage people’s health within the accommodation issue is not addressed it will not be possible to transfer further services to primary care, it may even result in restrictions on the services already providedlocal community. The facilities available, 100% occupancy, combined with significant increase in populationpopulation change, restrict the ability of the parties to transfer deliver the full range of integrated services locally. Enable earlier access to primary proactive and anticipatory care through local delivery via integrated seamless service across health and work effectively across 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 sites. Service Change Planning Strategic Assessment Initial Agreement Outline Business Case Final BusinessCase Implementation Phaseestate.

Drivers for Change. The following section details A key driver locally is the proposed expansion in house building in Lochgelly. Section 3 provides detailed narrative in support of the demonstrable cause and effect of the need for change and investment. The table below (page7) summarises this information. 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 is not 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 identified 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 Strategic Assessment community The Investment Objectives for the Lochgelly Health Centre Project were discussed at the Architecture & Design Scotland (included in Appendix 1A&DS) facilitated workshop to develop the project Design Statement. A wide range of stakeholders including clinical and Initial Agreement (IA) as approved by managerial staff along with community representatives attended the Scottish Government Capital Investment Group in October 2018workshop. Current service capacity utilisation is at 100%. The project team have reviewed the drivers for change in the context full range of the existing situation and confirmed that these remain valid. Increased future service demand due to population growth East Calder is 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 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 on local 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 demand, but instead groups. Care should be provided at home or as close to home as possible. Delivering services in a group environment will need to allow a greater number of NHS Fife residents be based on where beyond the local community it is possible to deliver services. NHS Lothian will fail to provide treatment for all patients supported in the future unless this is planned formanagement of their own well-being. Pressure on existing staff, accommodation and 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 To provide a sustainable 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 future Poor functionality facility. [Ref 4 in SA] To contribute to achievement of the National Outcomes on Integration, in particular Outcomes 3, 5 and space restrictions 9. Increased safety risk from outstanding maintenance and inefficient service performance. [Ref 4 and 5 in existing SA] Improve safety and effectiveness of accommodation Some consulting rooms by improving the physical condition, functional suitability and quality of the healthcare estate. In order to ensure that resources are very small effectively exploited and don’t meet current standards due 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 the conversion of small rooms/ store cupboardseach benefit. These can A Benefits Realisation Plan will be very restrictive/ unsuitable for patients and staff. No further scope exists to reconfigure service design 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 service users. 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 developed 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 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 the accommodation issue is not 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 Change Planning Strategic Assessment Initial Agreement Outline Business Case Final BusinessCase Implementation Phaseproject progresses.