1. PERSON CENTRED, SAFE AND EFFECTIVE HEALTHCARE A QUALITY STRATEGY FOR NHSSCOTLAND

2. Purpose To inform you of the development of the quality strategy To work with you, sharing thinking and ideas To consider the ways in which the quality strategy will affect NHS Scotland and services To hear your thoughts on how to make it happen

3. PROPOSED AIMS FOR QUALITY STRATEGY? 1.To make NHS Scotland a world leader in healthcare quality. 2.To do so in a way that is meaningful to all.

4. KEY MESSAGES Not ‘just another strategy’ Not top down imposition Integrated rather than additional A development of Better Health Better Care – not a replacement Built on shared values For the whole of the NHS, our partners and for the public

5. WHAT PEOPLE SEE AS HIGH QUALITY HEALTHCARE? caring and compassionate health services; collaborating effectively with clinicians, patients and others; confidence and trust in health services; providing a clean and safe care environment; improving the access to care and continuity of care; delivering clinical excellence

6. The aim is to get out in front; Some foundations

7. Work to do…

8. Ageing Population Health inequalities Economic position Changing expectations THE CONTEXT

9. The Right Time? Everyone working in or with NHSScotland is already committed to providing high quality healthcare Demographic, resource and cultural context combine to create clear drivers and a unique challenge/opportunity We know that marginal changes will not create the scale of change required NHSScotland particularly well placed, through its structures, values and through the foundations already in place to take action and achieve these aims, positioning it amongst the best in the world.

10. The perfect storm? Where values and expectations align

11. THE QUALITY STRATEGY What people have said… A unique and important opportunity for all of us to work together to make our NHS even better, for everyone. We all need to understand what our respective expectations, roles and responsibilities are, and make a shared commitment to take the action required of each of us to make the changes needed to ensure that our NHS delivers the very best quality healthcare for us all, now and into the future.

12. How will we do it?

13. PROPOSED APPROACH Person-centred : beyond shared decision making – i.e. relationship-based care in the very fabric of every interaction (Every Person Every Time). Clinically effective : with a focus on reducing unnecessary variation in delivering care and treatment, and in support for managing long term conditions Safety : throughout primary, mental and acute services achieving significant reductions in adverse events Efficient, timely and equitable integrated

14. Aim Key Drivers Priority Areas For Action Scotland is a World leader in Healthcare Quality Person Centred Safe Effective 1. Improve and embed patient reported outcomes and experience across all NHS services 2. Support staff, patients and carers to create partnerships which result in shared decision making 3, Inform and support people to manage and maintain their health, and to manage ill health 1. Ensure continuity in all care pathways through implementation of long term conditions action plan and other key opportunities 2. Apply information from quality data to drive consistently better care across NHS 3. Promote culture of improvement in NHS at all levels 1. Establish appropriate governance arrangements 2. Develop information to provide rapid feedback to identify and tackle risk 3. Develop outcome measures to drive and monitor progress 4. Develop data for improvement Quality infrastructure 1. Secure the improvements which have been delivered through the success of the Patient Safety Programme, and 2. Roll out across other areas of NHS activity support integrated programme of action to reduce occurrence of HAI

15. IMPLEMENTATION - APPROACH Overarching and integrating approach – NOT additional Bottom up – will be achieved through the accumulation of ‘excellent’ interactions, every person every time

16. IMPLEMENTATION - ROLES Patients, their families and carers and the public Mobilising and supporting public by Communicating expectations, responsibilities – building on mutuality Everyone delivering healthcare services for NHS Mobilising and supporting Staff through development, KSF, revalidation, assessment reshaping etc NHS management and Scottish Government Making whole system changes – alignment in governance, measurement/performance targets, and policy development etc

17. Key Drivers Priority Areas For Action Specific Improvement Interventions Person Centred Safe Effective 1. Improve and embed patient reported outcomes and experience across all NHS services 2. Support staff, patients and carers to create partnerships which result in shared decision making 3, Inform and support people to manage and maintain their health, and to manage ill health 1. Ensure continuity in all care pathways through implementation of long term conditions action plan and other key opportunities 2. Apply information from quality data to drive consistently better care across NHS 3. Promote culture of improvement in NHS at all levels 1. Secure the improvements which have been delivered through the success of the Patient Safety Programme, and 2. Roll out across other areas of NHS activity support integrated programme of action to reduce occurrence of HAI 1. Establish appropriate governance arrangements 2. Develop information to provide rapid feedback to identify and tackle risk 3. Develop outcome measures to drive and monitor progress 4. Develop data for improvement 1. Develop and introduce patient reported experience and outcome measures 2. Establish CARE measures in all clinical appraisal and In revalidation 3. Develop and introduce collaborative decision-making through relationship-based care reflecting individual circumstance Quality infrastructure 1. Ensure Anticipatory Care Plan in place of the 5% population most at risk (SPARRA) 2. Shift the balance of care and reduce variation 3. Reduce re-admission 4. Implement long term condition action plan 5. Ensure alignment of GP enhanced services 1.Accelerate spread of Scottish Patient Safety Programme (SPSP) throughout acute care 2. Develop approaches to improve patient safety in Primary Care and Mental Health 3. Make the Electronic Care Summary widely available 4. Integrate the work of the HAI taskforce with the SPSP 1. Establish Quality Alliance 2. Develop ‘Quality Dashboard’ 3. Develop Quality Measures and align with HEAT 4. NHS: QIS and NHS;NSS;ISD to establish appropriate data to support continuous improvement

18. 3-TIERS OF MEASURES? High level outcomes Intermediate Outputs Local/short term actions/outputs and at each level – appropriate measures/targets/indicators…

19. POTENTIAL AREAS FOR MEASUREMENT ? PatientStaffSystem Person- centred experiencesatisfactionAnticipatory care Effective outcomecapability and capacity Re-admission Safe cleanliness adverse events HAI HSMR

20. It can be done… “ NHS Scotland has undertaken a bold, comprehensive, and scientifically grounded programme to improve patient safety. The dedication of NHS leadership at all levels to this endeavor is apparent to me, and bodes well for success. In its scale and ambition, the Scottish Patient Safety Programme marks Scotland as leader – second to no nation on earth – in its commitment to reducing harm to patients dramatically and continually.” Don Berwick June 2008 Will people say the same about our Quality Strategy?

21. NEXT STEPS Launch draft Strategy Document – Oct ‘09 Engage in discussion/consultation - Oct/Nov ‘09 (NHS events 19/21) Launch Quality Strategy Jan’10 Detailed collaboration and consultation about ‘bottom-up’ implementation, building on successful local and national approaches – Jan’10 onwards Launch Communications Strategy – Jan ’10 Establish approach to ensuring alignment in workforce development, policy, governance, measurement etc

22. QUESTIONS Do you agree that this is the right thing to do - why? How would you describe high quality healthcare ? Do you think these are the right drivers to use and initial areas to focus on? What are the hurdles/risks, how do we mitigate against them and what do we need to stop doing? What do we need to do first? What do you think success would look like, and what measures should we pursue to report progress? Do we need to be explicit about the need to embed efficiency, equity and access, and how do we achieve this?

23. Questions for Quality measures What do you think about this general 3-tier approach to measures of quality (person-centred, safe, effective from patient, staff and system perspective)? What type of measures should we use to report progress at the high /outcome level? How should they relate to the National Outcomes/Government Purpose What type of measures are appropriate at the Intermediate /output level? For improvement? How should they relate to HEAT targets? Do we need to agree a core set of local/short term activity/output measures, or should these be for local determination? Do we have the information required to inform these measures/targets and indicators? If not – how do we establish it? Do we need to stop collecting other data? Do we need to be explicit about the need to embed efficiency, equity and access in the Quality Strategy by developing appropriate measures at each level? How do we achieve this?