1. Opioid Replacement Therapy – Independent Expert Group Key findings and next steps – Quality Improvement

2. Key findings Approaches to working with people with drug problems should ensure that substance use is connected with wider work on health inequalities. Opiate replacement therapies are an essential treatment with a strong evidence base in reducing drug related harms (e.g. blood borne viruses and drug related crime). The delivery of opiate replacement therapies across Scotland is variable and there is a need to ensure that opiate replacement therapies are high quality. There is considerable variation in the delivery and development of recovery oriented systems of care (ROSC) across Scotland. Some good practice examples are identified in the report and these focus on the positive characteristics of what the report identifies as good practice in a prescribing service, GP service, residential rehabilitation team, a ROSC and data collection systems.

3. Key findings continued… The involvement of primary care/ GPs is presented in the report as a challenge The report suggests a lack of progress in the delivery of recovery focused services and a lack of accountability and quality assurance of service delivery by Alcohol and Drug Partnerships (ADPs). The report suggests that current data collection systems for drug treatment are ineffective, do not provide timely information and are unable to capture outcomes. The report calls for the urgent development of meaningful information systems, which are subject to accountable project management. Research and academic enquiry into problem drug use in Scotland is described in the report as being poorly developed and underfunded. The reports calls for the Chief Scientists Office to develop and coordinate a national research programme on problem drug use.

5. Life expectancy trends Portugal Scotland

6. Income deprivation - Liverpool

7. Income deprivation - Glasgow

8. All cause mortality males 15-44

9. Standardised mortality rates by cause, all ages: Glasgow relative to Liverpool & Manchester Source: Walsh D, Bendel N., Jones R, Hanlon P. Its not just deprivation: why do equally deprived UK cities experience different health outcomes? Public Health, 2010

10. Mans search for meaning Those who have a 'why' to live, can bear with almost any 'how'. Viktor Frankl 1902-97

11. Workers in the 1950s

12. Implementing at scale…. can it be done?

13. 1941, William A. Foster "Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.

14. The six questions to be asked of EVERY change programme… 1 Aim Is there an agreed aim that is understood by everyone in the system? 1 Aim Is there an agreed aim that is understood by everyone in the system? 2 Correct Changes Are we using our full knowledge to identify the right changes and prioritising those that are likely to have the biggest impact? 2 Correct Changes Are we using our full knowledge to identify the right changes and prioritising those that are likely to have the biggest impact? 3 Clear change method Does everyone know and understand the method(s) we will use to involve? 3 Clear change method Does everyone know and understand the method(s) we will use to involve? 4 Measurement Can we measure and report progress on our improvement aim? 4 Measurement Can we measure and report progress on our improvement aim? 5 Capacity and capability Are people and other resources deployed and being developed in the best way to enable improvement? 5 Capacity and capability Are people and other resources deployed and being developed in the best way to enable improvement? 6 Spread plan Have we set out our plans for innovating, testing, implementing and sharing new learning to spread the improvement everywhere? 6 Spread plan Have we set out our plans for innovating, testing, implementing and sharing new learning to spread the improvement everywhere?

15. By what method? W. Edwards Deming

16. The Typical Approach : Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). Cambridge, Massachusetts: Institute for Healthcare Improvement; 2008. Available: www.ihi.org p26www.ihi.org

17. The Quality Improvement Approach:

18. Our change theory A clear and stretch goal A method Predictive, iterative testing

21. Hospital Standardised Mortality Ratios (Seasonally Adjusted) Scotland: Oct-Dec 2002 to Jan-Mar 2012 average yearly reduction 4.2% (Apr 2010 to Mar 2012) 1.4% average yearly reduction (Oct 2002 to Jan 2010)

22. Breakthrough Series Collaborative

23. This model is not magic, but it is probably the most useful single framework I have encountered in twenty years of my own work on quality improvement Dr Donald M. Berwick Former Administrator of the Centres for Medicare & Medicaid Services Professor of Paediatrics and Health Care Policy at the Harvard Medical School The Model for Improvement

25. Reducing offending/reoffending Can you manage stressful situations? How well can you manage your daily life? Do you have access to external resources which can support you in times of difficulty? What gives you a sense of meaning and purpose in life?

26. How has the frontline done it? Get goals Get bold Get together Get a model (and stick with it) Get patients and families Get the facts Get to the field Get a clock Get the numbers Get the stories

27. What do you mean, its a bit muddy?

30. Do one brave thing today….then run like hell!