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BUILDING ON SUCCESSCreating a Modern Health System for Grampian
Annual Report of the performance of NHS Grampian 2003/04
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If you would like: • additional copies of Building on Success
• this information in large print, Braille, audiotape or in another language
• more information on issues and initiatives which are mentioned
• to give us your views on this publication or other aspects of the work of NHS Grampian
please contact:
Corporate CommunicationsAshgrove HouseForesterhillAberdeen AB25 2ZATel: 01224 554400email: [email protected]
Building on Success is also available online at www.nhsgrampian.org (go to publications)
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CONTENTS
A vision of health 5
Foreword from the Chairman 6
1 Helping health happen 8
2 Help for healthy minds 11
3 Dentistry: biting on the challenge 12
4 Pharmacy: the ‘right medicine’ 13
5 Cancer: early detection, co-ordinated care 14
6 Hearts needing help: beating the target 15
7 Partnerships for care 16
8 Healthcare-Associated Infection: a challenge for us all 19
9 Preparing for the unexpected 20
10 Working on waiting times 21
11 Developing our team 23
12 Modern facilities for modern care 25
13 Summary of Accounts 28
Grampian NHS Board 32
NHS Grampian Community Forum 34
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The performance of NHS Grampian is continually assessed, both by ourselves, and by the Scottish Executive Health Department. This process identifies where we have improved, stayed the same, or worsened, when compared to national targets and how other areas of Scotland are performing. An annual Accountability Review takes place in the summer which looks at the previous year. This is followed by a formal letter from the Chief Executive of NHSScotland, extracts of which are contained in this report.
We also monitor our own performance as part of our commitment to ongoing improvement, and we are keen to involve our public more closely in this. NHS Grampian’s Clinical Effectiveness team are exploring new ways to keep everyone up-to-date with their programme of audits and other work which helps to further improve the high standard of care which patients in Grampian receive.
“At the Accountability Review meeting on 26 July 2004, I noted that the performance of NHS Grampian had improved substantially over the last three years. I commended the Board on key successes in 2003/04, particularly your excellent record in partnership-working and your plans to establish a Partnership Support Department. You had also achieved your delayed discharge target and secured reductions in waiting times in line with targets. You have made good progress to single system working and shadow Community Health Partnerships continue to develop. Of particular note was the opening of the Children’s Hospital in January. This facility not only provides the base for the Grampian Combined Child Health Service, but also secondary and tertiary services to the children of Orkney and Shetland, and links with Highland and Tayside.
“A central issue, underpinning your ability to make and sustain progress on service issues, is the need to restore the financial balance of the Board. We have discussed this on a number of occasions and you agree and are clear about the overall aim and the steps that have to be taken.
“In summary, the Board has a difficult period ahead in settling its financial base. It has made very good progress and I am confident it will continue to do well in developing as a public health organisation and providing services to the people of Grampian.”
TREVOR JONES Head of Department and Chief Executive, NHSScotland
A vision of health
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Our vision in NHS Grampian is two-fold, to:
• improve the health of people in Grampian, by increasing the rate at which the health of our population improves, and, at the same time, narrowing the gap in health between our most disadvantaged and our most affluent communities...
• provide services that have patients at the heart of the service, receiving safe, high-quality treatment according to their clinical need, when they need it, and within comfortable surroundings.
Our script: the Grampian Health Plan
Every NHS Board in Scotland has the responsibility to draw up a local health plan for its population. The aim of this plan is to give leadership and direction to local NHS and wider health systems.The plan also seeks to raise awareness and understanding of important health issues, and achieve a partnership approach to taking action and getting results.
The Grampian Health Plan is the ‘script’ for NHS Grampian. It must also complement the wider Community Plans drawn up for each local authority area. NHS Grampian is an active partner in the community planning process in each of our council areas.
You can view the Grampian Health Plan for 2004/05 on www.nhsgrampian.org(go to publications).
A vision of health
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People in the north-east of Scotland have always had a health service dedicated to serving our diverse population – in town and country – with skilled and committed staff. We have an excellent track record in promoting health and preventing illness, and for the ‘joined-up’ way in which we work with our partner organisations. These include our three local authorities in improving the health of local communities, our universities and research institutes to keep Grampian at the forefront of new advances in medicine and technology, and of course, the many people who work in local voluntary organisations.
Today, we face many challenges. Our geography, the growing expectation and changing needs of our population, and the need to attract into our communities specialist skills, are just a few. All require us to build on our strengths and successes to date, engage with the population we serve, and together embrace new ideas and solutions that we can afford and sustain.
It can be all too easy to concentrate on areas where things are not as good as they could be and overlook our many successes. On the opposite page we list just a few of the successes suggested by members of our staff. There are many more than we can do justice to in this brief report.
In summary, over 2003/04 we have:
• met the national targets for inpatient waiting times and reducing delayed discharges
• continued to develop as an organisation which has improving the public’s health at the heart of its operation
• made significant progress in working in partnership with local authority colleagues, staff, and with the people of Grampian
• created a single health system - saving over £1.2 million a year in administrative costs
• increased our efficiency.
This would not have been possible without the efforts of our staff, the teamwork and shared goals of our partners, and the involvement of our patients and wider public. On behalf of my fellow Board members I want to thank you all for what we have achieved together over the past year.
I am confident that such a team is well up to the task of taking on the challenge of continuing to improve health and deliver modern healthcare services for people in Grampian, and I look forward to presenting another list of successes in next year’s annual report.
JIM ROYANChairman NHS Grampian
FOREWORD FROM THE CHAIRMAN
Celebrating success, recognising challenge
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Celebrating success
Here are just a few of last year’s achievements nominated by staff...
• The first young patients moved into the new Children’s Hospital on 25 January 2004
• Continued progress in taking forward the Joint Future agenda to care for the most vulnerable people in our communities
• Surpassed national targets for reducing delayed discharges
• Achieved the national waiting times targets
• The first NHS Board in Scotland to have a registered Champion in Infection Control
• Members of the public throughout Grampian took up new opportunities to get involved
• Developed specialist skills for GPs and nurses
• Opened the Elmwood facility as part of improving services for people with learning disabilities
• Met the target of 70% of GP practices delivering structured care for people with diabetes
• Became recognised nationally for our work in protecting our staff from violence and aggression
• Secured funding from the New Opportunities Fund for many projects in coronary heart disease, cancer and palliative care
• Approved plans for a new hospital in Banff to serve the community of north Aberdeenshire
• Introduced a new role for a specialist community psychiatric nurse to work with nursing homes
• Hosted the first Scotland’s Health at Work national conference and exhibition
• Launched HI-Net (Grampian Health Improvement Network) website, quickly attracting hundreds of users across many agencies
• Won a national award for pharmacy-led immunisation services
• Commended by Scottish Accident Prevention Council for first aid/home safety training course
• Many NHS Grampian staff gained professional awards or fellowships.
It is impossible in this brief report to detail all the work of last year. So, over the following pages, we have picked out just a few examples of what we are doing well, where we are improving, and where we still face challenges. For fuller information on any of these issues or initiatives, or to read our full self-assessment report, contact the Corporate Communications team (see page 2).
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Grampian has an excellent track record in bringing together organisations, groups and communities to put health improvement on everyone’s agenda. National priorities such as the growing level of obesity are of concern here as elsewhere. Increasing the number of children who benefit from breastfeeding and childhood immunisations, helping pregnant mums stop smoking, and tackling binge drinking are also among the biggest challenges facing us all today.
“We noted Grampian’s sound performance on health improvement and that you were continuing to develop as a public health organisation, with health improvement being integrated into the operational agenda.”
Health Department Accountability Review for 2003/04
What are we doing well?
• Last winter over three-quarters of local people who were eligible took advantage of a free flu jab. This exceeded both the national target of 70% and the Scottish average of 72.5%. Demand in Grampian for the pneumococcal vaccination offered at the same time was so great that supplies of vaccine ran out temporarily.
• We plan to recruit GP practices to the national ‘flu spotter’ scheme so that we have a better picture of flu locally. Grampian has so far been the only NHS area which has not been part of this scheme which began in 1972.
• Over half of five-year-olds in Grampian have no dental disease, and we are aiming to reach the target of 60% by the year 2010.
• Grampian has the second lowest rate in Scotland for girls aged 13-15 years who become pregnant, exceeding the national target. However, there is still wide variation across Grampian, and we cannot be complacent about this.
• An increasing number of drug users are in contact with drug services, though tackling the harm caused by drugs, and increasingly alcohol, remains very challenging (see page 10).
Helping healthhappen
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! What do we need to do better?
Childhood immunisation
Although we are slowly increasing the number of young children receiving childhood vaccinations, we still need to do better if we are to prevent serious childhood diseases returning with a vengeance.
For example, nearly 88% of Grampian’s two-year-olds had received the MMR vaccination by March 2004, but this is well below the national target of 95%.
We achieved about 94% for other childhood diseases, which is also below both the target of 95%, and the rate which other areas are achieving.
We are directing a lot of effort into improving this, including:
• checking our recording systems
• focusing on the high rate of immigrant children – especially in Aberdeen City and Moray – whose immunisation records may be incomplete
• educational sessions to keep health visitors updated
• reminders on good immunisation practice sent regularly to all GP practices
• a telephone helpline for all health staff involved in immunisation, and for concerned parents
• plans to introduce ‘scheduling of immunisation’, which is a centralised, computerised database for inviting children for vaccination, recording, and identifying children who are unvaccinated.
“The Board’s performance on MMR immunisation is disappointing. You shared this view and agreed that further action was now required based on the considerable analysis of the local issues which had been undertaken. You agreed to keep the MMR programme under close scrutiny and monitor performance regularly.”
Health Department Accountability Review for 2003/04
Smoking in pregnancy
While the Grampian rate of just over 24% of mums-to-be who smoke is better the Scottish average of 26%, we are concerned, as our rate appears to be increasing. Activities over last year included:
• specialist training for midwives from a recognised expert in stopping smoking in pregnancy
• a midwife providing individual support to pregnant smokers
• a research project at University of Aberdeen looking at the needs and views of pregnant women and those who care for them, in relation to stopping smoking
• developing a policy for providing NRT (nicotine replacement therapy) in pregnancy.
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Breastfeeding
Breastfeeding has proven benefits for both babies and mothers. The national target is that at six weeks old, half of all babies should still be being breastfed. Although we have the second highest level of breastfeeding in Scotland, we still fall short of the target, with overall 45% of six-week-old babies being breastfed. Projects underway to improve this include training mothers who are experienced in breastfeeding to provide ongoing support to those starting out.
Drugs and alcohol
Drug use and the growing consumption of alcohol particularly by women and young people remains a concern here, as elsewhere. Within Grampian, the main challenge relates to women and alcohol, with 18% of women drinking more that the recommended levels. This is higher than the Scottish average and certainly higher than the national target for 2005 which is 12%. Working closely with partners in the three Drug and Alcohol Action Teams, NHS Grampian continues to develop genuinely integrated services which focus on both prevention and treatment of the harm caused by both drugs and alcohol.
Here are just a few recent developments:
• A new Integrated Community Drug Service, funded by the National Lottery and Aberdeen City Council, involves a range of voluntary sector partners and is led by Aberdeen Cyrenians.
• Getting drug users into treatment as quickly as possible remains a high priority. Additional nursing staff were appointed specifically to help shorten the waiting time for assessment and treatment.
• Specialist expertise was boosted with the appointment of an additional consultant to support those working in the drug field in Aberdeen, Aberdeenshire and Moray. In Aberdeen specialist GP sessions have been increased.
• A new service to support people with problems due to stimulant drugs (such as crack cocaine) began in April 2004, managed by Drugs Action and with funding from the Scottish Executive.
The announcement in summer 2004 of around £650,000 of new annual funding for drug services is most welcome and will be used to continue to improve access to treatment and rehabilitation services, bringing about further reductions in waiting times.
A further piece of good news in summer 2004 was the allocation of around £1 million from the Scottish Executive to develop a one-stop shop facility for drug users in Aberdeen City.
Help for healthyminds
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Promoting mental health and providing good services for people suffering mental health problems is a national and local priority. This is an area in which our well-developed partnerships between specialist and community services, local authorities, voluntary organisations, and with carers and people using services, will stand us in good stead for the new Mental Health Act.
Help to choose life
Profiles of our communities, which were published in spring 2004, suggest wide variations in health status across Grampian. Examples of this are suicide and self-harm. More people living in the centre of Aberdeen are likely to be admitted to hospital because they have harmed themselves than elsewhere in Grampian and Scotland. We know that deaths due to suicide have been falling over the last few years in Grampian, and are lower than the Scottish average, so we need to investigate these new findings carefully.
Meanwhile, we now have several initiatives which focus particularly on children and young people, such as student counselling and young people helping each other, such as through ‘buddy’ systems in schools. Funding from the national ‘Choose Life’ programme to prevent suicide and self harm has been allocated to organisations in Grampian’s Community Planning partnerships to take forward a co-ordinated and integrated approach to the mental health and wellbeing of children and young people at a crucial stage in their development.
Patients and carers on the team A major success story last year was work by Grampian Local Health Council to introduce guidelines for staff involved in mental health services for how best to involve the people using these services, and their carers.
The vast majority of organisations within the mental health community in Grampian have signed upto the guidelines. As part of the process, the views and experiences of over 150 users, carers and professionals were gathered. The Scottish Executive Mental Health Division has congratulated Grampian on this initiative, and we are discussing how this could be shared with other areas of Scotland. Other opportunities for people using mental health services and carers to be directly involved in the planning of services included three patient representatives being appointed to the Clinical Management Board of Grampian’s mental health service, and another patient representative gathering views as part of the re-design process following the closure of Craigievar Ward.
The ongoing challenge is how best to routinely involve people using these services, and their carers, at all levels of mental health services from individual patient care to long-term planning.
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The shortage of NHS dentists is a national problem, which is felt acutely here in Grampian where just 43% of adults and 63% of children are now registered with an NHS dentist. The good news is that we are now beginning to move forward more positively, but need long-term investment in planning and workforce.
Dental Outreach Centre
We are making good progress on this new educational facility to help recruit and keep dentists in Grampian. In June 2004 we asked the Scottish Executive Health Department and NHS Education Scotland to approve an undergraduate education facility in Aberdeen as part of an ambitious development programme for dental services in Grampian as a whole. The proposals are part of the creation of a ‘hub and satellite’ approach, with the first stage being the ‘hub’ or integrated dental centre. The plans were approved, and £2 million has been given to NHS Grampian to progress this centre at the east end of Aberdeen Royal Infirmary, to be opened by September 2006.
Dental developments include:
• Half-a-million pounds for a new dental unit in Banff, complete with a hygienists’ unit and dedicated x-ray facility – this will provide 17,000 new appointments for the area each year.
• A busy year for GDENS the Aberdeen-based central out-of-hours dental emergency service, with 532 three-hour dental sessions undertaken and around 6,000 unregistered patients being seen. Thirty-four dentists work regularly in this voluntary scheme with a further eleven also involved.
• More ‘salaried dentists’ who are specially employed by NHS Grampian to provide NHS services in areas where this has previously been difficult to obtain. We now have eleven salaried NHS dentists working at five locations, and a further three are expected to be in post by March 2005 to cover the Fraserburgh/Peterhead area, Peterculter, and the homeless population.
• The maximum waiting time for a first appointment for an orthodontic appointment came down last year from 132 weeks in Aberdeen to 27 weeks, and in Elgin from 131 weeks to 84 weeks. Waiting times for treatment to begin are still long, but we have made inroads by re-designing the service, having one common waiting list, and appointing a third locum consultant. We are also trying to fill a new post of specialist practitioner in orthodontics.
Grampian, together with Dumfries and Galloway, has been chosen by the Scottish Executive to pilot a project which we hope will provide a template for a new model for dental premises. This will emphasise holistic care and have salaried, independent and community dentists all working together under one roof with hygienists and therapists.
Dentistry: biting onthe challenge
3Pharmacy: the ‘right medicine’
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Pharmacists are key members of the NHS team, and community pharmacies provide expert healthcare advice ‘on the high street’. The national strategy for pharmaceutical care is aptly called ‘The Right Medicine’. It aims to help patients get the maximum benefit from their medicines, and involves co-operative working within pharmacy, with other healthcare professions and with patients and the public.
Innovations in pharmacy
• Pharmacists are part of the Grampian smoking cessation service. They are based in the heart of our communities, providing support and supplying medicines to those wishing to stop smoking.
• Selected trained pharmacists with suitable facilities are giving private flu immunisations. This initiative has been introduced to complement the NHS service provided by GPs for those considered to be at higher risk. This service is currently offered by ten pharmacies across Grampian.
• With the agreement of patients and doctors, pharmacists are beginning to prescribe medicines once a doctor has made a diagnosis. This is called supplementary prescribing and is being introduced in the hospital, practice and community settings.
• The pharmaceutical care model schemes involves community pharmacists providing additional support to older patients on four or more medications, and to patients with long-term conditions such as epilepsy, asthma and mental health problems. Patients report benefits from being able to talk to a different healthcare professional about their medicines, and research tells us that pharmacists complement the relationships patients have with their doctors.
Bugs ‘n drugs
Antibiotics are a modern miracle, but growing resistance is a concern internationally as well as locally.
Initiatives to reduce people’s expectation of receiving a prescription for an antibiotic for a minor viral infection have been ongoing for some years in Grampian, together with promoting self-help and advice from pharmacists.
We also have the benefit of a 24-hour ABLE (Accelerated Bacterial Laboratory Evaluation) service at Foresterhill, which can rapidly test patient samples and guide GPs on whether an antibiotic should beprescribed, and if so which one. Early findings suggest that this is having a positive benefit on the prescribing of antibiotics.
Pharmacy: the ‘right medicine’
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Fewer people die of cancer in Grampian than any other part of the Scottish mainland, although we still have a way to go to meet the targets set nationally for the year 2010.
What are we doing well?
• Networks of specialists are coming together across the north of Scotland to provide care tailored around the needs of each individual patient (see page 17).
• We continue to be consistently well above the Scottish average for the percentage of people who survive five years or more after a diagnosis of lung, breast or bowel cancer.
• Reports published last year by NHS Quality Improvement Scotland (QIS) recognised the quality of the screening programmes provided for women in Grampian, and the hard work of our dedicated teams of specialist staff and primary care colleagues working out in our communities.
• Our uptake for breast screening in women over 50 years is the highest in Scotland at over 82% compared to a Scottish average of 74%. Grampian was the only breast screening centre which met the target of issuing results within 15 working days. Our uptake for cervical smear tests of almost 89% is also above the Scottish average of 86%. We met the majority of the targets for cervical screening, and work is ongoing to address specific issues that were noted in the QIS report.
• As an example of co-ordination, Grampian, Orkney and Shetland lung cancer patients are benefiting from streamlined and highly co-ordinated care which involves tests being scheduled in succession, and the specialist team coming together weekly to discuss results, plan care, review outcomes and communicate quickly with patients and their GP practices.
Cancer: early detection,co-ordinated care
5Hearts needing help: beating the target
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For heart disease the picture is even better, with fewer people dying of heart disease in Grampian than any other part of Scotland. We expect to meet the national target set for 2010, although there are still too many people living in deprived circumstances who suffer heart disease.
We are also on course to meet the target for reducing the number of people who die of strokes.
What are we doing well?
• We have expanded heart surgery and other procedures at Aberdeen Royal Infirmary to cut the length of time that people need to wait or have to travel to Glasgow for treatment.
• We secured Lottery funding from the New Opportunities Fund to boost rehabilitation programmes for patients who have suffered heart attacks, including special exercise classes starting up across Grampian.
• The new local service for implanting and monitoring ICDs (implantable cardio-verter defibrillators) is proving popular with Grampian patients who need this and previously had to travel to Glasgow.
Hearts needing help: beating the target
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Health is everybody’s business. Never have partnerships been more critical than they are today:
• partnerships across neighbouring NHS areas across the north of Scotland
• between local hospitals and specialist centres dealing with state-of-the-art treatment and care for particular conditions
• with local authorities, to care for the most vulnerable people in our communities through the Joint Future programme
• with local public sector and other organisations and groups – including the voluntary sector through Community Planning and joint alcohol and drug action teams
• health professions working together across hospital and community settings, taking on new skills and roles
• partnerships with Grampian’s two universities, helping to train the doctors, nurses and other health professionals of the future
• ...and perhaps most importantly the growing partnership between the NHS and the people it serves.
Grampian has always had a great track record for partnerships. On these pages we give just a few examples of what we achieved last year:
Developing a Joint Future
The concept of Joint Future is well advanced in Grampian. Throughout 2003/04 this teamwork continued in each local authority area and included:
• formal agreements between NHS Grampian and each local authority, called Extended Local Partnership Agreements (ELPAs)
• a Single Shared Assessment (SSA) process to be used by all organisations in assessing the needs of an individual person
• joint health and social care teams located together and managed as one team, with closer funding arrangements, and a joint equipment service
• a joint management structure, and all partners agreeing how to report and measure progress
• arrangements in each local authority area to increase the involvement and influence of people using services, and their carers, in planning and developing services.
Children are a particular group for which the benefits of joined-up services are obvious. Partnership working along similar lines is now aiming to deliver a single system for children’s services locally, in line with the national strategy For Scotland’s Children.
Partnerships for care7
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Reducing delayed discharges
Helping people to leave hospital as soon as they are able needs close partnership between community and hospital services, with local authority social work departments, and with private care homes. Over the last four years we have steadily reduced the number of people who are ready to be discharged from hospital but who remain there because they cannot get the care they need at home, or there is no place available in a care home. However, this remains challenging.
We successfully met our targets for April 2004, exceeding by 40 the target we had been set by the Health Department to discharge 275 people to more appropriate accommodation. This was made possible by a whole range of measures including:
• making best use of existing vacancies in care homes
• funding for social work departments to obtain more care home places
• further investing in rehabilitation facilities
• continuing the successful rapid response teams to help prevent people being admitted to hospital wherever possible
• investing in more community geriatricians
• investing in old age psychiatry teams to better support patients and community staff
• investing in more equipment to enable people to live at home
• further strengthening the integration and teamwork between community health and social work teams.
“We recognised your achievement in exceeding the national target in the number of delayed discharges in April 2004. We agreed that continued effort was now required to achieve the more challenging April 2005 targets.”
Health Department Accountability Review for 2003/04
Cancer patients at centre of networks
Cancer care presents many examples of the progress we are making in surrounding the patient with a network of care:
For example, with funding from the North of Scotland Cancer Network (NOSCAN), the ‘managed clinical network’ (MCN) which focuses on gynaecological cancers has appointed a team of surgeon, manager, data manager and secretary to improve the co-ordination and standard of care for these patients. The MCN has agreed protocols for standardising high-quality care across all the NHS areas in the north of Scotland, and clinicians are operating and running clinics in both Grampian and Highland. NOSCAN aims to roll out the successful model of MCN support to other cancer teams to support their improvement efforts. This drive to deliver equitable care is also being taken up by MCN teams covering bowel, blood, lung and gastric cancers.
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Creative partnerships for children
The highly-specialised nature of children’s medicine combined with the relatively small populations of the north of Scotland stimulated innovative solutions last year, with Grampian, Highland, Tayside and the Islands joining forces to create two specialist paediatric networks.
One network for paediatric neurology has NHS Grampian participating in delivering the service and NHS Tayside taking the lead in developing this further. Meanwhile NHS Grampian has the lead for planning and delivering a paediatric gastroenterology and nutrition network.
Partnering patients, carers and the wider public
None of the successes outlined in this report would be possible without the growing partnership between the NHS and the people it serves. Although it might seem obvious, this partnership brings its own challenges, and requires the NHS not just to ‘listen’ but to actively engage with patients, carers and the general public as equals. We received very positive feedback from the Scottish Executive on our progress to date in taking forward the national Patient Focus, Public Involvement agenda to build a culture of true involvement across NHS Grampian.
Highlights of the year include:
• NHS Grampian’s Community Forum continued to grow, and members became increasingly involved in working with clinical staff and managers to plan, re-design and improve.
• We introduced a policy for spiritual care, steered by a Board committee chaired by the Board Chairman.
• Work began internally to agree quality standards for information and educational materials, and how to make it easier for people to have the right information, in the right place, in the right way, and at the right time.
• We introduced a new approach to public consultations, emphasising listening, informing, involving, and feeding back.
• Patient representatives featured strongly in networks and groups working to improve services for people with cancer, diabetes, and for other conditions.
• Staff training came under the spotlight, as we explored new ways to share experience and expertise in involving the public across NHS Grampian.
Responding to complaints
We are determined that NHS Grampian be a ‘listening’ organisation. We welcome all comments on our services, whether that be compliments for staff, practical suggestions, or, sometimes, concerns that we need to respond to.
In general we are managing to respond more quickly to complaints, despite an increase in the number of people who choose to make a complaint. We are currently meeting the national target of responding within 20 working days in just over half the complaints we receive.
As well as working towards this target, we are also exploring how as an organisation we can learn from every comment and complaint that we receive.
Healthcare-Associated Infection: a challengefor us all
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Healthcare Associated Infection (HAI) is a term we are all becoming increasingly familiar with. Preventing it is a priority nationally and locally, and requires a ‘package’ of decontamination and infection control to be in place.
In 2003/04 we have:
• doubled the size of the infection control team across NHS Grampian
• revitalised the Area Infection Control Committee to drive this work and report regularly to the Board
• implemented a pilot programme for screening patients being admitted to Aberdeen Royal Infirmary and Dr Gray’s for MRSA
• introduced an education and training programme for infection control
• forty-three staff registered with NHS Education for Scotland to become ‘Champions of Infection Control’, with Grampian having the first champion in Scotland.
The national Watt Report made 47 recommendations to prevent HAI. Of these, we have locally agreed the following priorities:
• to meet the requirements for decontamination of equipment in both hospitals and primary care
• to further develop our HAI core team, so that we can monitor our position in accordance with national requirements, and keep our excellent record of comparatively low MRSA
• to increase our domestic staff to deal with high risk areas and purchase items such as bed screens
• to identify individuals responsible for setting cleaning schedules and specifications in each ward area or department
• to examine our current practices in infection control and routine surveillance
• to ensure all staff who are required to handle food have completed food hygiene training.
MRSA – a community problemGrampian has among the lowest rates of recorded MRSA bloodborne infection in Scotland.
We hear much about the so-called superbug Methicillin-Resistant Staphylococcus Aureus. Reports in the media would suggest that this is a problem for hospitals alone to deal with. In reality, it’s a problem for us all.
People are now carrying this bug within the community, and can bring it into hospitals, either as patients, staff or visitors. In hospitals it is easily spread to other patients, many of whom may be very vulnerable to such an infection.
Hospitals in Grampian are working hard to prevent MRSA infections through a wide range of procedures. Visitors also have a responsibility to ensure they wash their hands and avoid introducing any possible infections onto wards.
Healthcare-Associated Infection: a challengefor us all
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Accidents and emergencies can happen at any time. The NHS works 24 hours a day, seven days a week, 365 days a year, to be ready to provide ‘unscheduled’ care when it’s needed.
The geography of Grampian clearly poses lots of challenges – for example in getting people with suspected heart attacks diagnosed and treated quickly.
Over 2003/04 work continued on increasing the chances of survival for heart attack victims by training paramedics to carry out ECG tests on the patient, relay the results to Accident and Emergency consultants at ARI and Dr Gray’s, and then, if advised by the consultant, to give life-saving clot-busting drugs well before the patient reaches hospital.
Other important developments included preparing for new arrangements for out-of-hours care. Throughout the UK, changes are being introduced to the arrangements for patients when their GP surgery is not open. As part of the new national employment contract which GPs are working to, they are able to transfer responsibility for providing out-of-hours cover to their local NHS Board. The aim of this is to encourage more young doctors to become GPs, by removing the burden of 24-hour responsibility for their patients.
Most Grampian GPs have decided that they wish to transfer this responsibility. So, during the spring of 2004 a team led by NHS Grampian’s Director of Primary Care developed a proposal for how this cover could be provided from a network of special out-of-hours centres across Grampian, staffed by doctors, nurses and paramedics.
Over the summer of 2004, communities throughout Grampian were asked their views on the proposal, and, as a result of their suggestions, the Grampian NHS Board approved a modified proposal in September 2004, so that the new arrangements could be in place by 1 November.
The important elements of the new out-of-hours system are these:
• There is no change to emergency services such as Accident and Emergency and ‘blue light’ ambulances, and patients should always call 999 if the situation is an emergency, such as a serious accident or someone with severe chest pain.
• If patients need advice or are not sure if they need an ambulance they should call NHS 24 on 08454 24 24 24.
• An NHS 24 nurse will offer advice over the phone, or pass the call to a doctor.
• If the doctor thinks that the patient needs to be seen, a home visit will be arranged, or the patient will be asked to go to an out-of-hours centre, with free transport provided if necessary.
Preparing for the unexpected
9 Working on waiting times
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a
“You had done well in meeting targets for outpatient and inpatient waits but you indicated that the six-month target by end of 2005 would be very challenging. In particular, you were concerned that outpatient waits were currently increasing. A concentrated programme of focused service redesign was required in order that outpatients services were to meet the December 2005 target.
“On inpatient targets, there were particular challenges around key specialities such as orthopaedics. You had achieved the nine-month targets through additional work locally and utilisation of independent sector capacity.”
Health Department Accountability Review for 2003/04
What are we doing well?
We were successful last year in achieving the national targets for inpatient waiting times. This is the length of time a patient waits from being put on a waiting list to actually having their operation or treatment. We are now working towards meeting the national target time of patients waiting no longer than six months by December 2005. To achieve this we are creating more capacity in our operating theatres.
Heart surgery
The planned expansion of heart surgery at Aberdeen Royal Infirmary resulted in targets for waiting times for heart procedures being met in full by the local service.
Waiting in Accident and Emergency
The length of time that patients wait from arriving in A&E to completing their treatment has traditionally compared poorly with the rest of Scotland. However this has improved recently. One reason for this is our team of Emergency Nurse Practitioners who are able to deal with a variety of patients who would previously have had to wait until a doctor was free.
Working on waiting times
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! What do we need to do better?
Outpatient waiting times
Outpatient waiting times (the time between being referred by a GP and attending a first outpatient clinic) present us with considerable challenges. We have now agreed targets for 2004/05 with the National Waiting Times Unit and we have an action plan in place.
As part of our Change and Innovation Programme (which every NHS Board must have), we have started a project which aims to manage and match the demand for what we call ‘planned health care’ with our capacity to deliver it. To achieve this match, we need to radically re-design our outpatient, diagnostic, treatment, inpatient and day case services, so that we:
• make best use of all our resources, skills and facilities
• deliver a system which we can sustain
• work in a more integrated way across primary and hospital care, and with all relevant partner organisations
• achieve national and local waiting time targets.
An example is the Ear, Nose and Throat (ENT) service, where local ENT clinics are being introduced at several locations in Grampian, removing the need for all patients to come into Aberdeen. In addition to giving patients choice and shortening waiting times, these clinics also make more use of the skills of other members of the team, such as ENT nurses.
Day cases
We have done much work over last year with the National Information Services Division of the Scottish Executive to better understand why fewer patients in Grampian are classed as being treated as ‘day cases’ compared to the rest of Scotland, and to see how we might increase this. Our statistics can be partly explained by people being classed as ‘outpatients’ in Grampian when they have their treatment, but who would be described as ‘day cases’ in other parts of Scotland. However we are working on an action plan to increase our number of day cases, so that we match the highest rate in Scotland.
Breast clinic
For some time we have been working to re-design our busy breast service, which would bring many benefits to patients. This has been hampered unfortunately by the national shortage of the specialist staff on which this service depends. Much effort is going into finding ways to improve the situation, and we are optimistic that our action plan will bring improvements as we move through 2004.
Developing our team11
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We know that having a highly-motivated, skilled and well-supported workforce results in better care for patients. We need both short-term and longer-term plans for developing our staff team, particularly in an environment of continuous change.
To help achieve this, staff and managers work in partnership. The Area Partnership Forum (a joint staff/management group) and the Staff Governance Committee (a committee of the Board) play a major role in planning and monitoring our progress and performance.
Our workforce plans are founded on:
• capacity - the right number and mix of staff in place
• capability - staff having the necessary knowledge, skills and attitude, and
• commitment - staff being motivated, supported and looked-after
Here’s what we have achieved over 2003/04:
Working in partnership Staff and staff partnership groups were fully involved in organisational changes such as the coming-together to form one single NHS system in Grampian, and also in the re-design of services.
Modernising pay and conditions
Three important new national employment contracts are being introduced, all of which have needed much complex and time-consuming preparation locally:
These are:
• The new national contract for consultants
• The new General Medical Services (GMS) contract for GPs
• Agenda for Change which will introduce new pay and conditions
of service for all other NHS staff.
Planning a Joint Future workforce
We have worked hard to form single integrated teams of community health staff employed by the NHS, and social work care staff employed by local authorities.
We have also improved our links with our local universities and colleges and other partner organisations who are training the workforce of the future.
Developing our team11
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Learning and development We are investing in developing the capability and skills of all staff groups, including gaining the Investors in People award in parts of the organisation.
Employee relations Working in partnership with staff has become the accepted way to achieve any changes in services or in the organisation.
Staff governance We had a positive audit of our progress in taking forward our action plan to ensure that staff are:
• well informed
• appropriately trained
• involved in decisions that affect them
• treated fairly and consistently
• have a safe working environment
Looking after the health and safety of our staff
Examples include policies for Dignity at Work, Management of Stress, and Zero Tolerance to Violence and Aggression.
Policies for a single system We developed and introduced over 20 new or harmonised staff policies.
“Looking ahead, changes in the way services are delivered and pay modernisation will make additional demands on your staff. I was very interested to hear about the stress toolkit you have developed.”
Health Department Accountability Review for 2003/04
A great place to nurse!
Grampian is being increasingly recognised as an attractive employer by nurses. Re-designing our development programme, offering flexibility, schemes to attract mature nurses back to work, more opportunities to widen experience, and the chance to earn extra money while a student, have all helped us to recruit and retain our nurses.
Other developments in 2003/04 include:
• efforts to reduce our dependence on expensive agency nurses by creating permanent posts suitable for newly-qualified nurses
• increasing opportunities for new nurses to gain experience, especially in the community
• recruiting experienced nurses from overseas to fill senior vacancies in areas which are traditionally hard to recruit to – such as care of the elderly
• three nurses working in Grampian being honoured in the Queen’s Honours for their contribution to the NHS in Grampian.
Modern facilities for modern care
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Designed and produced byCorporate Communications, © NHS Grampian 2003.
Photography courtesy ofCorporate Communications, NHS GrampianMedical Illustration, NHS GrampianAberdeen Journals Ltd.
As medicine marches on, and it becomes possible to provide more services in our communities closer to home, the buildings of yesteryear no longer meet the requirements of a modern NHS...
2003/04 saw several important new developments bring the benefits of state-of-the-art purpose-designed facilities for several groups in our population:
...for children and families
A major highlight of this year has been the opening of the new Royal Aberdeen Children’s Hospital. The creation of this dedicated child and family-centred environment was the culmination of a ground-breaking partnership between designers and planners, clinical experts, artists, parents and children, and the whole community of Grampian through the ARCHIE fundraising campaign. This raised over £5 million to make possible the many ‘extras’ which make such a difference to children and parents at what can be an anxious time.
The new hospital opened on the Foresterhill site in January 2004 on time and on budget with world-class facilities for its young patients and their families in Grampian, and increasingly for the north of Scotland and the islands.
It combines separate, child-centred facilities with both a physical link to adult Accident and Emergency, (so that families involved in serious accidents can be cared for together), and a link bridge to ARI for speedy access to high-tech facilities such as MRI and CT scanning.
The huge benefits of the new facility include:
• much more flexibility to deliver many different types of service, including having many more single rooms
• greatly improved facilities for parents to remain in hospital with their ill child
• bringing together traditional hospital services with academic and community teams under one roof
• providing a focus for research, teaching, education and networking which will benefit children and families across the whole of the north of Scotland.
Modern facilities for modern care
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...for people with learning disabilities
The opening of Elmwood in August 2003, a purpose-built unit on the Cornhill site next to Ashgrove Road West, was a major step forward in our long-term plans to modernise care for people with learning disabilities. These plans also saw the closure last year of Woodlands Hospital, west of Aberdeen, with former residents given the opportunity to live in supported accommodation in local communities.
...for people needing palliative care
The Oaks Palliative Day Care Centre opened just outside Elgin during 2003, to provide a non-residential centre and focus for palliative care for people living in the Moray area with cancer and other diseases.
Meanwhile work continued on the new purpose-built Roxburghe House which opened in summer 2004 in a peaceful corner of the Cornhill site, conveniently close to Foresterhill, and replacing the previous building at Milltimber.
...for older people needing rehabilitation
With patients who would formerly have gone to Tor-na-Dee Hospital in Milltimber now receiving modern rehabilitation at Woodend and in the community, work continued in partnership with interested parties and with the public, to explore options for creating a development on the hospital site which would provide a range of services for frail, elderly people.
...for the communities of Moray and north Aberdeenshire
In spring 2004 the communities of Moray were asked their views on an ambitious package of projects designed to ensure that they have access to a modern health service designed to meet their 21st century needs. The overall plan, which was subsequently approved by the Grampian NHS Board, comprises three linked components to:
• re-design inpatient services across Dr Gray’s Hospital and linked community hospitals, with the closure of Spynie hospital in Elgin
• modernise primary care and community services, including new premises for five GP practices in Elgin, Forres and Lossiemouth, and eventual closure of Leanchoil Hospital in Forres
• create an emergency care centre at Dr Gray’s Hospital.
Meanwhile plans to develop a new hospital in Banff to serve the community of north Aberdeenshire were approved by the Grampian NHS Board, and work continues involving local interest groups and the public to explore options for how this could be taken forward.
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Torry Neighbourhood Centre
Torry Neighbourhood Centre opened its doors to the community of Torry in May 2003, and was officially opened by HRH The Princess Royal in February 2004.
The project team of NHS Grampian in partnership with Aberdeen City Council, Grampian Police, and Torry Community Council had secured £1.6 million from the Scottish Executive to build a local, accessible Neighbourhood Centre to serve the community of Torry.
The aim was to bring health services closer together with community policing, social work and housing services, to work towards greater integration and a speedier and more ‘joined-up’ response to people’s problems.
NHS services in the centre include three GP practices, nurse practitioner, community nursing, health visitors, podiatry, physiotherapy, dietetics and occupational therapists. Occupants also include the Substance Misuse Service, Social Work, Housing, and Neighbourhood Police Services. All these services are now available to Torry residents for the first time ever under one roof.
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The three legal entities within NHS Grampian, being Grampian Health Board, Grampian University Hospitals NHS Trust and Grampian Primary Care NHS Trust, are required to provide a full set of accounts for the financial year, which are adopted by their respective organisations.
A consolidated extract of the NHS Grampian Operating Cost Statement along with a summary of resource outurn and Balance Sheet for the year ending 31 March 2004 are presented here.
Independent Auditor’s Review Report on the unified financial statements included in the Grampian Board Annual Report
I have reviewed the unified financial statements on pages 30 and 31 of Grampian NHS Board’s annual report.
This report is made solely to the parties to whom it is addressed in accordance with guidance issued by the Scottish Executive Health Department and the Code of Audit Practice approved by the Auditor General for Scotland and for no other purpose, as set out in paragraph 43 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by Audit Scotland, dated July 2001.
Respective responsibilities of the Board and Auditor
The Grampian NHS Board is responsible for preparing the unified financial statements. My responsibility is to report to you my opinion on any apparent mistatements or inconsistencies with the audited financial statements of the NHS bodies within Grampian NHS Board’s area.
Basis of review
The unified financial statements have been prepared by the Board on the basis of the individual audited financial statements of each local NHS body within Grampian NHS Board’s area and in accordance with guidance issued by the Scottish Executive Health Department. The Auditor’s Reports on the financial statements of each local NHS body describe the basis of the audit opinion and report the auditor’s opinions on the individual financial statements. A review consists principally of making enquiries of management, applying analytical procedures to the unified financial statements, assessing whether accounting policies and presentation have been consistently applied, unless otherwise disclosed, and checking on a sample basis the process of the preparation of the unified financial statements by agreeing the amounts used for local NHS bodies back to their individual audited financial statements. A review excludes audit procedures such as tests of control and verification of assets and liabilities and is substantially less in scope than an audit performed in accordance with Auditing Standards. Accordingly I do not express an audit opinion on the unified financial statements.
Summary of Accounts13
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Review conclusion
On the basis of my review, the financial information presented in the unified financial statements for Grampian NHS Board for the year ended 31 March 2004 has been properly prepared from the original audited financial statements of each local NHS body within Grampian NHS Board’s area.
However, in giving this review opinion I have not considered the effects of any events between the dates on which the auditor gave his audit opinions on the individual audited financial statements of each local NHS body within Grampian NHS Board’s area and the date of this statement.
Peter Johnston CA CPFAChief AuditorAudit ScotlandBallantyne House84 Academy StreetINVERNESS
21 October 2004
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Consolidated Balance Sheet as at 31 March 2004
2002/03 2003/04
£000 £000
FIXED ASSETS
0 Intangible Assets 8
341,007 Tangible Assets 348,606
341,007 348,614
934 Debtors falling due after more than one year 977
CURRENT ASSETS
4,368 Stocks and work in progress 4,506
17,423 Debtors 24,881
0 Investments 0
6,302 Cash at bank & PGO Account Balance 1,454
28,093 30,841
CREDITORS
-69,383 Amounts falling due within one year -73,910
-41,290 Net Current Assets/(Liabilities) -43,069
300,651 Total Assets Less Current Liabilities 306,522
-2,315 Provisions For Liabilities And Charges -2,549
298,336 TOTAL 303,973
FINANCED BY:
250,330 General Fund (note 1) 240,869
7,738 Donation Reserve 10,869
40,268 Revaluation Reserve 52,235
298,336 TOTAL 303,973
Note 1 - Includes Inter Board/Trust adjustments relating to the RRL.
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Consolidated Operating Cost Statement for the year ended 31 March 2004
2002/03 2003/04
£’000 £’000
Clinical Services Costs
307,083 HCH 343,150
145,495 FHS 156,799
452,578 Total Clinical Services Costs 499,949
155,960 Non Clinical Costs 154,345
7,278 Effect of valuation of properties 652
-2,137 (Profit)/loss on disposal of Fixed Asset -3,496
0 Interest Payable 0
613,679 Gross Operating Costs 651,450
-48,308 Less: Miscellaneous Income -49,799
-420 Less Interest Receivable -221
564,951 Net Operating Costs 601,430
Summary of Resource Outturn
564,951 Net Operating Cost 601,430
-50,927 Less FHS Non Discretionary Allocation -53,414
-161 Less Local Health Council Allocation/Expenditure -178
0 Less Other Allocations 0
0 Other 0
1,302 Brought Forward Income & Expenditure Balance 0
515,165 Net Resource Outurn 547,838
510,336 Revenue Resource Limit 542,361
-4,829 Saving/(Excess) against Revenue Resource Limit -5,477
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Grampian NHS BoardThe overall purpose of the single Grampian NHS Board is to ensure the efficient, effective and accountable governance of the local NHS system, and to provide strategic leadership and direction for the system as a whole.
The Board does this through:
• developing strategy
• allocating resources
• implementing the Grampian Health Plan
• having overall responsibility for managing performance
Members of the Board are selected on the basis of their position, or their particular expertise which enables them to contribute to the decision-making process at a strategic level.
The Board has collective responsibility for the performance of the local NHS system as a whole, and reflects the partnership approach which is essential to improving health and health care.
Membership for the year 2003/04 was as follows:
Non-Executive Members
Mr Jim Royan, ChairmanMrs Anne Campbell, Deputy Chair Ms Margaret BurnsCouncillor Eddie Aldridge, (The Moray Council)Councillor Raymond Bisset, (Aberdeenshire Council)Councillor Len Ironside, (Aberdeen City Council) (resigned 31 July 2003)Councillor Kate Dean, (Aberdeen City Council) (appointed 1 August 2003)Mr Angus Gordon (employee director)Professor Neva Haites (university representative)Dr Stuart Watson, (Chair of the LHCC Professional Advisory Committee)(appointed 1 October 2003)Professor Jamie Weir, (Chair of the Area Clinical Forum)
Executive Members
Dr Eric Baijal, Director of Public HealthMr David Benton, Nurse DirectorMr Neil Campbell, Chief Executive (resigned 31 August 2003)Mr Alec Cumming, Chief Executive, Grampian University Hospitals Trust Mr Ewan Robertson, Acting Chief Executive, Grampian Primary Care TrustMr Alex Smith, Acting Chief Executive to 31 July 2003, thereafter Interim Chief Executive
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The following representatives also attend Board meetings:
• chair of Grampian Local Health Council
• representative of the Grampian Partnership Forum (to support the close involvement of staff)
• chairs of the local clinical forums representing doctors, nurses, pharmacists, dentists, ophthalmologists, and allied health professions such as physiotherapy and occupational therapy
A new Grampian NHS Board came into being formally on 1 April 2004, following the dissolution of Grampian’s two NHS Trusts and the formal creation of the one organisation NHS Grampian.
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NHS Grampian Community ForumThe Community Forum is one of a number of ways in which NHS Grampian is involving the people of Grampian in its work.
The Community Forum is a group of members of the public who act - together and individually - in partnership with NHS Grampian. Members of the Forum debate and discuss issues alongside clinical staff and managers, with the aim of informing and influencing the future of health and healthcare in Grampian. The focus is on the planning of future services as well as changing, modernising and developing existing services.
Most of the Forum’s work is concerned with issues that have an effect on the whole of Grampian, rather than on specific issues relating to the day-to-day running of services.
Who can be a member of the Forum?
• We welcome anyone with an interest in hospital, community and other issues that affect the health of people in Grampian.
• We are keen to recruit members from all communities in Grampian.
• The Forum operates in such a way that no-one will be excluded because of where they live, their ethnic background, age, gender, religion or other reason.
• The Forum includes members with particular interests or experiences (for example, patients and carers) as well as members of the public with no direct experience of the NHS.
What does the Forum do?
• The Forum is used for a variety of purposes, for example, as a method of consultation, for two-way communication, and as a ‘sounding-board’ for ideas. Individual members can also have the chance to contribute to particular pieces of work about specific health services.
• Members of the Forum may take part in working groups, discussion groups, project teams and other similar groups. They may also participate in surveys, questionnaires and structured interviews and other methods that seek a patient and public perspective.
Would you like to join the Community Forum?
• We are looking for new members, all sorts of people, from all parts of Grampian
• You do not need any special skills, knowledge or experience
• You may have a lot of time to give or just a little
• We just ask that you have an interest in health and health services
• To find out more contact: Corporate Communications
tel: 01224 554400
email:[email protected]
www.nhsgrampian.org
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Designed and produced byCorporate Graphic DesignCorporate Communications, © NHS Grampian 2004.
Photography Corporate Communications, NHS GrampianDepartment of Medical Illustration, University of Aberdeen
NHS GrampianSummerfield House2 Eday RoadAberdeenAB15 6RE
www.nhsgrampian.org
Healthline 0500 20 20 30