Risk Management Plan NHS Grampian

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Risk Management Plan NHS Grampian Powered By Docstoc
					Final 16th March 2012

LDP Risk Management Plan

Health Board: NHS Grampian

Use of Risk Management Plan

Boards should, as in previous years, use the LDP Risk Management Plan to provide
contextual information on key risks to delivery of each target and how risks are being
managed. Within the template, the description of the key risk should be provided in the
first column and detail on how the risk is being managed should be provided in the
second column. Cross-reference to local plans should be made where necessary.

   o Delivery and Improvement: briefly highlight local issues and risks that may
     impact on the achievement of targets and/or the planned performance
     trajectories towards targets and how these risks will be managed.

   o Workforce: brief narrative on the workforce implications of each of the HEAT
     targets where appropriate and relevant. This should include an assessment of
     staff availability to deliver the target, the need for any training and development
     to ensure staff have the competency levels required, and consideration of
     affordability cross referenced to the Financial Plan.

   o Finance: Where applicable boards should identify and explain any specific
     issues, e.g. cost pressures or financial dependencies specifically related to
     achieving the target. There is no need to repeat generic financial risks that
     apply to all targets.

   o Equalities: Where applicable, boards should outline any risks that the delivery
     of the target could create unequal health outcomes for the six equalities groups,
     and/or for people living in socio-economic disadvantage; and how these risks are
     being managed.




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HEATS TARGETS FOR 2012/13


To increase the proportion of people diagnosed and treated in the first stage of breast,
colorectal and lung cancer by 25%, by 2014/15

At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by
the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates
and other important health behaviours

Reduce suicide rate between 2002 and 2013 by 20%

To achieve 14,910 completed child health weight interventions over the three years ending
March 2014

NHSScotland to deliver universal smoking cessation services to achieve at least 80,000
successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-
Board SIMD areas over the three years ending March 2014

At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two
applications of fluoride varnish (FV) per year by March 2014

NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy
consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate
Change (Scotland) Act 2009

By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to
appropriate drug or alcohol treatment that supports their recovery

Deliver faster access to mental health services by delivering 26 weeks referral to treatment for
specialist Child and Adolescent Mental Health Services (CAMHS) from March 2013; reducing
to 18 weeks by December 2014; and 18 weeks referral to treatment for Psychological
Therapies from December 2014

Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000
population, by at least 12% between 2009/10 and 2014/15

No people will wait more than 28 days to be discharged from hospital into a more appropriate
care setting, once treatment is complete from April 2013, followed by a 14 day maximum wait
from April 2015

To improve stroke care, 90% of all patient admitted with a diagnosis of stroke will be admitted
to a stroke unit on the day of admission, or the day following presentation by March 2013

Further reduce healthcare associated infections so that by 2012/13 NHS Boards’
staphylococcus aureus bacteriamia (including MRSA) cases are 0.26 or less per 1,000 acute
occupied bed days; and the rate of Clostridium difficile infections in patients aged 65 and over
is 0.39 cases or less per 1,000 total occupied bed days

To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates
of attendance at A&E between 2009/10 and 2013/14




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To increase the proportion of people diagnosed and treated in the first stage of
breast, colorectal and lung cancer by 25%, by 2014/15

Executive Lead:         Sir Lewis Ritchie: Director of Public Health
Board Lead:             Dr William Moore: Consultant in Public Health Medicine

Delivery and Improvement
Risk                                    Management of Risk
Target Uncertainties and
Unknowns:
 Detect Cancer Early (DCE)               There will be effective communication links
 baseline estimates and individual       with the DCE Scottish Government
 NHS Board performance targets           Performance Team.
 are not finalised - revisions are       The NHS Grampian implementation plan for
 planned within next 12 months.          DCE will have sufficient flexibility to adapt to a
 Limited evidence for the                different planning context. It is anticipated that
 effectiveness of specific local         the current baseline estimate for Grampian (
 interventions or pathway redesign       12.6% ) will change.
 to achieve the target.                  Agreed NHS Grampian actions will be
 Stochastic health outcome events        reviewed and revised based on local
 - probabilistic random variation in     monitoring and evaluation, emerging evidence,
 frequency of occurrence                 and reported learning from early diagnosis and
 (denominators) for calendar             treatment initiatives elsewhere.
 years.
 Biological variation - differences
 in rate of progression for
 individual tumours (numerators).
Planning and Delivery:
 Non-adoption of an integrated           A time-limited steering group is responsible for
 cross-boundary and whole                co-ordination, development and
 system approach across                  implementation of the DCE programme within
 Grampian.                               Grampian. This function will transfer to the
 Non-representative processes            NHS Grampian Cancer Services Managed
 with insufficient engagement by         Clinical Network (MCN) before summer 2012
 clinicians and other key                NHS Grampian DCE working groups are
 stakeholders.                           aligned to discrete steps within the cancer care
                                         pathway :
                                                  Community Engagement (Public
                                                   Awareness and Influencing Behaviour)
                                                  Primary Care (Symptom Management
                                                   and Referral)
                                                  Diagnostics (Capacity and Managing
                                                   Demand)

 Duplication at national, North of       There will be effective communication links
 Scotland Cancer Network                 with the DCE Scottish Government Team,
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 (NOSCAN) and NHS Grampian             Regional Cancer Networks and other NHS
 levels.                               Scotland Boards.
Public Awareness & Individual
Decisions:
 No increase in ‘positive view’ of     Appropriate secondary prevention
 cancer treatment and prognosis.       communications and targeted social marketing
 No increase in individual             will be developed and implemented within
 awareness and identification of       Grampian - ‘empowerment’, tumour-specific,
 symptoms and signs that may be        and participation in screening programmes.
 related to breast, colorectal or      There will be consistency with the national-
 lung cancer.                          level campaign content and timetable.
 No reduction in individual delay to   Population profiling will be used to identify high
 seek medical advice.                  priority groups.
                                       There will be integration with existing local
                                       primary prevention activities, and utilisation of
 No increase ( or reduction ) in       existing links to organisations and
 screening programme                   communities.
 participation - it is expected that
 most ‘early stage’ breast and         A cross-sectoral approach will be adopted in
 colorectal cancer cases will be       partnership with cancer charities, local
 detected by the Screening             authorities, voluntary organisations / services,
 Programmes.                           and ‘Healthy Working Lives’ employers.
  NHSG Bowel Screening                It will be ensured that information on screening
    Uptake - 59.1% (May 2011           benefits and potential harms is readily
    KPIs)                              available within Grampian. NHSG DCE
                                       working groups will further examine specific
  NHSG Breast Screening               options, such as General Practitioner
    Uptake - 81.1% (2007-10            involvement in the bowel screening
    KC62)                              programme.
Patient Care Pathway:
 Non-specific clinical features        There are conflicts between certain identified
 which have a low positive             risks.
 predictive value (probability of      As a principle, NHS Grampian DCE working
 disease given clinical features).     groups will focus on ‘clinically appropriate’
 Increased ‘false positive’ patient    thresholds for further investigation and / or
 flows through the diagnostic          referral. Diagnostic pathways will be reviewed
 pathway - potential harm for these    and redesign options further examined in
 ‘true negative disease’ patients      terms of:
 and inefficient use of scare                   structure and process barriers
 resources.
                                                optimal productivity
 Delay due to process barriers for
 referral or direct access                      reducible variation and waste
 investigations.                                referral guidance and clinical guidelines
 Inequity of access to cancer                   support for GP clinical suspicion and
 diagnostics due to                              clinical judgement
 misclassification of clinical need
                                                models for risk categorisation and ‘risk
 for Urgent Suspected Cancer
                                                 sharing’ between primary and secondary

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 Referral.                                        care for individual patients and patient
 Increased identification of breast,              sub groups
 colorectal or lung cancer at all                open access imaging and direct referral
 stages of disease.                               for diagnostics
 Minimal increase in proportion of               alternative diagnostic modalities
 colorectal cancer cases
                                                 alternative models for diagnostic clinics
 diagnosed and treated in first
 stage - improvement expected to
 compensate for smaller potential
 gains for Breast and Lung
 Cancer.
 Demand and capacity mismatch           NHS Grampian DCE working groups will
 due to increased patient numbers       review diagnostic capacity provision (imaging,
 and patient flows.                     endoscopy and pathology services ) and
 Performance against cancer             treatment capacity provision ( surgery and
 access standards not sustained.        oncology services ).

Data Collection and Reporting:
 Non-standardised data fields.         DCE ‘Data and Reporting’ working group will
                                       review current cancer audit data process, MDT
 Insufficient validation checks.       data collection, data storage, data validation, and
 Incomplete dataset collection.        data extraction.
 Separate information systems          NHS Scotland standardised definitions and
 with no direct communication          measures will be applied for all DCE processes
 links.                                in Grampian.
 Delays in report generation.

Workforce
Risk                                   Management of Risk
 Optimal diagnostic and treatment       Predicted necessary changes will be
 pathways in the Grampian context       incorporated into workforce planning
 that require changes to workforce      processes.
 capacity, processes and patterns       Targeted training support will be provided.
 of working to meet clinical needs -
 anticipated high impact for            Processes for benchmarking and
 imaging, endoscopy and                 dissemination of learning will be supported
                                        within Grampian, such as practice referral
 pathology diagnostic services.
                                        profiling.


Finance
Risk                                   Management of Risk
 Unpredictable peaks or patterns        Notification of national-level and local
 in service use.                        marketing campaign phases will be widely
 Level of DCE funding available         disseminated within Grampian.
 insufficient to meet net resources     Available DCE funding, and other resources to
 requirement.                           support cancer services modernisation, will be
                                        subject to a prioritisation process by the NHS
                                        Grampian Cancer Services MCN.
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Equalities
Risk                                Management of Risk
 Poor impact for individuals and     A proportionate and whole population
 communities in relative and         approach will be adopted. Communication
 absolute deprivation or             and marketing resources will be prioritised
 disadvantage.                       towards local high-risk target groups.
 Poor impact for the Grampian        An asset-based approach will be adopted -
 population who reside in            working with individuals and communities to
 accessible or remote rural areas    identify and strengthen skills, knowledge,
 (> 30% ).                           resources, and networks - to build resilience
                                     and a sense of coherence to effect positive
                                     change.
                                     Specific actions to mitigate the identified risks
                                     are included within the previous Public
                                     Awareness & Individual Decisions section.




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At least 80% of pregnant women in each SIMD quintile will have
booked for antenatal care by the 12th week of gestation by March
2015 so as to ensure improvements in breast feeding rates and other
important health behaviours

Executive Lead:               Dr Pauline Strachan: Chief Operating Officer
Board Lead:                   Mr Andrew Fowlie: General Manager Moray CHP

Delivery and Improvement
Risk                                    Management of Risk
High midwifery caseloads and            A Grampian review has been conducted and a
workload may diminish ability to        new workforce plan proposed.
attain target fully.
Our full understanding of the needs     Public Health will analyse available data to
of the target group is at an early      identify priority groups so that interventions can
stage.                                  be shaped appropriately.

Workforce
Risk                                    Management of Risk
The spread of midwifery services is     We will work to re-allocate resources based on
historical rather than planned on a     need. Our Maternity Review has been
needs-based service approach.           comprehensive.
The social context of antenatal care    We will take forward a training and development
delivery is not fully integrated into   plan with NHS Education Scotland and other
our model of delivery.                  stakeholders. We have expressed an interest to
                                        take part in the Family Nurse Partnership
                                        programme.

Finance
Risk                                    Management of Risk
The redistribution of resources to      The NHS Grampian Maternity Review is in
areas of greatest need will take        process and will guide resource allocation.
time.

Equalities
Risk                                    Management of Risk
Our approach may be based on            The full analysis will be completed in 2012. We
incomplete needs assessment and         have involved local ethnic and diversity
data analysis.                          communities in the Maternity Review and impact
                                        assessed the consultation document.
                                        We have appointed 3 bi/tri-lingual Health Link
                                        Workers to reach out to non-English speaking
                                        communities and feed back on healthcare
                                        needs.




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Reduce suicide rate between 2002 and 2013 by 20%

Executive Lead:            Sir Lewis Ritchie: Director of Public Health
Board Lead:                Mr Bill Harrison: General Manager Mental Health

Delivery and Improvement
Risk                                      Management of Risk
Achievement of the target is              We will continue to influence and encourage
affected by demographic changes           each Choose Life Steering Group (aligned to
and by NHS Grampian’s lack of             local authority areas), and their newly revised
influence on other stakeholder            and agreed local Choose Life action plans which
agencies and the general public.          also take account of self harm aspects.
                                          We will ensure effective links between our
                                          Grampian Mental Health Collaborative and
                                          Towards a Mentally Flourishing Scotland Group,
                                          Mental Health Improvement Group and the
                                          Choose Life groups. There will be close
                                          monitoring of impact of those action plans.
The reduction in the suicide rate         We will ensure detailed analysis of available data
continues to fluctuate due to small       to ensure comprehensive understanding of the
numbers and demographic factors.          number and rate and will work with partners on
                                          developing an overarching implementation plan
                                          for the Mental Health Strategy for Scotland.

Workforce
Risk                                      Management of Risk
Training time for suicide prevention      We will continue to deliver Suicide Prevention
may be seen as excessive beyond           Training to front-line staff and will offer Protected
the immediate needs of staff. In          Learning Time sessions for primary care staff.
particular staff in primary care might    Community and Primary Care staff will be
not be released for this.                 supported in such training.

Finance
Risk                                      Management of Risk
No high or very high risks.

Equalities
Risk                                      Management of Risk
There is variation in suicide rates       This has been defined within local Choose Life
within different local authority areas.   Action Plans and is regularly reported to the
                                          Grampian Mental Health Collaborative for
                                          appropriate action to be agreed.




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To achieve 1,556 completed child health weight interventions (CHW)
over the three years ending March 2014

Executive Lead:         Sir Lewis Ritchie: Director of Public Health
Board Lead:             Mrs Caroline Comerford: Nutrition Co-ordinator

Delivery and Improvement
Risk                                     Management of Risk
There is a lower number of eligible      We will monitor emerging prevalence rates and,
completions (above the 91st centile)     if necessary, increase coverage of school based
due to lower rates of children           intervention and manage resource implications
overweight compared to national          accordingly.
average which increases challenge
of target.
Failure to meet the requirement for      We will use available local intelligence and
40% completions in two most              learning from the implementation of other
deprived SIMD quintiles, 1 and 2, by     programmes and work with Community Planning
local SIMD datazone in more              Partners to target the programme and monitor
remote and rural areas.                  progress through existing performance
                                         mechanisms.
Delivery of Child Healthy Weight         We will continue to embed the Child Healthy
services is currently dependent on       Weight Pathway into routine practice. There will
ring-fenced, time limited resource.      be strong Nursing, Allied Health Profession
This factor, combined with service       leadership to encourage delivery.
capacity limitations, poses a            We will work with Education partners to discuss
challenge for mainstreaming              the viability of the long term sustainability of the
targeted interventions within clinical   school-based intervention.
services and the school based
intervention into school settings.
We will be reporting through the         Systems and key staff will be put in place to
national database for all                input and quality assure monitoring data.
interventions from April 2012. This
is a new system that will inevitably
need time to bed in and could
present challenges with reporting as
it does so. We do not have a local
database for our school-based
programme.
The collection of accurate and           We will monitor the data collection processes
verifiable data, provided in a timely    and tools continuously through statistical
fashion is critical to the success of    analysis and by revisiting the quality and
our CHW programme. Data will be          completeness of data received. This will be done
collected via the Child Health           through a regular contact with all data providers
Surveillance Programme and the           in Grampian by the public health intelligence
worthiness of the collected data will    unit. Similarly all data received will be tested to
be dependent on the performance          determine the amount of variation induced by the
of data providers. Potential risks       measurement system.
include; inaccurate data entry
errors, incomplete data and data
corruption during translation. The
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data collected for the programme
must also relate to the correct time
period and be available when
required, in a form that can be
subsequently analysed.



Workforce
Risk                                    Management of Risk
Development of pre-school               Senior nursing support of the strategic planning
intervention will require additional    of the programme will ensure competing
capacity and skills development of      demands are taken into account in determining
Health Visiting and other relevant      contribution to the programme.
professionals, e.g. Speech and          We will support staff through the continued
Language Therapy and Dietetic           development and implementation of a training
Services.                               programme.
There may be staff retention            Posts will be extended when national funding is
challenges -given the short term        fully confirmed.
nature of the CHW funding and           Peer support and training is being provided to
consequent appointment to               increase motivation and maintain job
temporary posts, especially             satisfaction.
Community Health Partnership
based Health Coaches.

Finance
Risk                                    Management of Risk
The budget is not yet fully confirmed We will develop a project plan based on
for 2012/14.                          assumptions and review this as national
                                      guidance/funding is confirmed.

Equalities
Risk                                    Management of Risk
Existing materials/approaches have      We have carried out an Equality Impact
the potential to exclude minority       Assessment (EQUIA) for our overall CHW
ethnic groups and those with            framework and action plan and will EQUIA our
literacy problems.                      individual interventions also. This will be carried
                                        out with NHS Grampian Equality and Diversity
                                        Specialist support.
Ensuring 40% completions in two         We will work with families in this target group to
most deprived SIMD quintiles for        ensure that approaches meet their needs.
our targeted intervention, is a         We will better identify the needs of this target
challenge, given the sensitivities of   group through our planned Social Marketing
this issue, combined with reaching      insight gathering
this hard to reach group.




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NHSScotland to deliver universal smoking cessation services to
achieve at least 80,000 successful quits (at one month post quit)
including 48,000 in the 40% most-deprived within-Board SIMD areas
over the three years ending March 2014

Executive Lead:         Sir Lewis Ritchie: Director of Public Health
Board Lead:             Mr Derek Petrie: Tobacco Co-ordinator

Delivery and Improvement
Risk                                   Management of Risk
There is a risk that one or both        A HEAT Target Plan 2011-14 has been
elements of the target are not met in developed to ensure that we deliver the Target.
full.                                   Performance Management will continue to be
                                        carried out through our Board performance
                                        management structure.
                                        We have set this Plan in the context of a wider
                                        Tobacco Control Strategy for Grampian and will
                                        establish a Tobacco Control Strategy Group to
                                        work with partners to reduce smoking prevalence
                                        in Grampian.
Focusing exclusively on the HEAT        We will address smoking cessation in its widest
target may be to the detriment and      sense by developing an operational Smoking
exclusion of other smoking related      Cessation Plan. This will incorporate our HEAT
health impacts. There is a risk that it Target Plan and will also address wider smoking
might not address the relatively low cessation issues including Smoking in
uptake of smoking cessation             Pregnancy.
services by pregnant women in
Grampian


Workforce
Risk                                   Management of Risk
There is a lack of defined training    We will put resource in place and develop a plan
process and resource for Tobacco       for Tobacco related training.
related training which can impact on
training capacity.

Finance
Risk                                   Management of Risk
Budget for 2012/13 is indicative only We will develop a project plan based on
although target continues through to assumptions and review this as national
2014.                                 guidance/funding is confirmed.
                                      We will allocate funds through a formal Resource
                                      Allocation Framework so that the resulting output
                                      meets national and strategic objectives and
                                      outcomes are monitored.




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Equalities
Risk                               Management of Risk
Programme delivery may result in   We will base our Tobacco Control Strategy,
unequal outcomes.                  Smoking Cessation Plan and HEAT H6 Plan on
                                   a Tobacco Profile to ensure that our
                                   interventions are based on an understanding of
                                   the available population data.

                                   Smoking Cessation booklets are available in the
                                   main local ethnic community languages and
                                   accessible formats.

                                   We have appointed three bi/tri-lingual Health
                                   Link Workers to reach out to non-English
                                   speaking communities and feed back on
                                   healthcare needs.




NHS Grampian February 2012             12
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At least 60% of 3 and 4 year old children in each SIMD quintile to
receive at least two applications of fluoride varnish (FV) per year by
March 2014

Executive Lead:            Sir Lewis Ritchie: Director of Public Health
Board Lead:                Mr Ray Watkins: Consultant in Dental Public Health

Delivery and Improvement
Risk                                    Management of Risk
Continued issues relating to data       We will continue to liaise with ISD on data quality
linkage and completeness make           and in the meantime use robust local monitoring
accurate performance reporting and      to track improvement in performance against
planning difficult.                     target supplemented by oral health outcomes.
                                        We will ensure data collection is comprehensive.
There may be difficulties associated    We will continue to undertake practice visits to
with recruiting and engaging            encourage recruitment and participation in the
independent and NHS practices in        programme and provide support where required.
the programme.
Failure to deliver the 80% target for   There are currently no waiting lists for
3-5 year old registrations may          registration of children although the target has
impact on performance.                  not been delivered in full. We will engage with
                                        parents to encourage registration and ensure all
                                        registrations with community dentists are
                                        included.
There may be insufficient focus on      This will be monitored closely and action taken
the target population by Childsmile.    as required.

Workforce
Risk                                    Management of Risk
There may be a delay or slowdown In co-operation with NHS Education Scotland we
in recruitment and training of will establish the capacity to train staff from over
practice staff.                  100 practices over the next year.


Finance
Risk                                    Management of Risk
There may be pressure on the            Expansion in participation will be monitored
budget as more practices                closely in order to match total allocation to
participate.                            service delivery requirements.

Equalities
Risk                                    Management of Risk
Inability to reach hard to reach        There will be close monitoring and performance
groups e.g. rural, disadvantaged        management of services to identify gaps in
and special needs.                      service provision. We will continue to work with
                                        Community Planning Partners to identify
                                        problems and develop solutions including the
                                        utilisation of technology.


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NHSScotland to reduce energy-based carbon emissions and to
continue a reduction in energy consumption to contribute to the
greenhouse gas emissions reduction targets set in the Climate
Change (Scotland) Act 2009

Executive Lead: Dr Pauline Strachan: Chief Operating Officer
Board Lead:     Mr Gary Mortimer: General Manager Facilities & Estates

Delivery and Improvement
Risk                                  Management of Risk
We do not deliver targets due to        We will continue to promote prudent
poor housekeeping, technical            housekeeping by staff including the proper
failures or fluctuations in the         management of simple measures such as
weather. We continue to use fossil      control of windows, doors, heating, cooling and
fuels through the lack of a Board-      lighting with respect to time and temperature.
wide sustainable development plan       Building Energy Management System (BEMS)
to map out site specific migration      controls will continue to be managed according
from fossil fuel to non-carbon          to NHS Encode standards.
alternatives and energy                 Energy consumption and emissions are
conservation measures.                  monitored by an Environmental Manager on an
                                        ongoing basis with any deviations to
                                        performance brought to the attention of
                                        functional users and estates staff.
                                        Use and changes to fossil fuels are a function
                                        of availability and sustainable investment
                                        strategy.
                                        To compensate for weather variations, energy
                                        consumption is benchmarked against national
                                        Degree Day targets.
The quantity of CO2 produced by       NHS Grampian has a Carbon Management
NHS Grampian will vary according      Implementation Plan (CMIP) with targets and
to the type of fuel used and its      objectives to address changing energy use and
carbon content. Although              the resulting carbon emissions.
consumption may increase as sites     A new Energy Centre at the Foresterhill Campus
develop, migrating to a fuel with a   is now constructed and is in the course of
lower carbon impact will reduce       commission and hand over. The design
carbon emissions.                     incorporates Combined Heat and Power,
                                      Biomass steam plant and conventional energy
                                      sources. The revised design is expected to
                                      contribute to CO2 estimated savings of 9570
                                      Tonnes per annum, for an anticipated reduction
                                      of at least 4% on the current CMIP for 2011/12
                                      and 15% on the first full years use in 2012/13.
                                      The Emergency Care Centre at Foresterhill
                                      Campus is under construction and has an
                                      indicative energy performance of 46 GJ/100m3.
                                      We are taking steps to review the NHS
                                      Grampian wide Carbon Management
                                      Implementation Plan (CMIP) to map out site
NHS Grampian February 2012                14
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                                        specific migration from fossil fuel to non-carbon
                                        alternatives and further energy conservation
                                        measures to meet E 8 Phase 2 Targets and
                                        Climate Change Act.
The NHS Grampian property               NHS Grampian property performance standards
portfolio contains a high number of     and new construction procurement standards
at risk, aged and poor performing       (including for energy efficiency certification and
stock (with high and unnecessary        carbon management to BREEAM Healthcare)
heated volumes and inefficient and      are identified in the annual Property Strategy
poorly controlled energy systems)       updates and this influences decision making on
which, without major changes to         disposal, refurbishment and provision of new
construction or infrastructure, limit   buildings to NHS standards.
scope for achieving Phase 2             To address the identified Delivery and Finance
Targets at local site level.            Risks, we are taking steps to develop a Board-
                                        wide sustainable asset and investment strategy
                                        to review the Carbon Management
                                        Implementation Plan (CMIP), and to map out site
                                        specific migration from fossil fuel to non-carbon
                                        alternatives, on-site renewables, new
                                        technologies and energy conservation measures
                                        to meet E 8 Phase 2 Targets and Climate
                                        Change Act.

Workforce
Risk                                    Management of Risk
Maintaining management                  Through the Board’s Safe Affordable Workforce
awareness and resource capacity         initiative, we are continuing to review
on managing the Phase 2 Targets         arrangements for dedicated technical and
across the whole estate, through        clerical support.
lack of sufficient appropriate          Currently E 8 Phase 2 energy data for returns
technical and support staff to          are subject to unplanned work due to errors and
address the Climate Change Act.         estimating of the energy data – and resource
                                        issues are monitored monthly.

Finance
Risk                                    Management of Risk
Capital funding allocations may be      NHS Grampian promotes risk reduction through
used to deliver Buildings and Assets    using its approved Building and Asset
to budget and timeline, but             performance standards for all new and
disregard a sustainable life cycle      refurbishment procurement projects. This
approach to Phase 2 Targets,            includes for energy efficiency certification and
Climate Change Act, energy              carbon rating by Simplified Building Energy
efficiency and specification to NHS     Model (SBEM) calculation and carbon
standards.                              management specifically to Building Research
                                        Establishment - Environmental Assessment
                                        Method (BREEAM) Healthcare – excellent rating
                                        for new projects and very good rating for
                                        refurbishment projects.
NHS Grampian may be unable to           NHS Grampian energy efficiency projects aimed
continue to participate in the          at reducing emissions have been identified to
Scottish Government revolving           secure funding. To reduce the potential risk, a
NHS Grampian February 2012                  15
Final 16th March 2012


Central Energy Efficiency Fund    local revolving finance mechanism will be
(CEEF) which provides a           devised. Fluctuating fuel costs distort the
mechanism to implement energy     mechanism.
efficiency and carbon reduction
across the public sector.
NHS Grampian may be               An application to install a Biomass Facility at
unsuccessful in NHS Scotland      Royal Cornhill Hospital has been lodged and is
CO2 Reduction Grant Scheme        ranked 11th by Investment Ratio for potential
applications.                     approval and identified likely to proceed in
                                  2012/13. Further future applications may be
                                  lodged where the Board-wide sustainable asset
                                  and investment strategy identifies a need and as
                                  applicable national grant schemes become
                                  available.

Equalities
Risk                              Management of Risk
Not Applicable




NHS Grampian February 2012            16
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By March 2013, 90% of clients will wait no longer than 3 weeks from
referral received to appropriate drug or alcohol treatment that
supports their recovery

Executive Lead:                 Sir Lewis Ritchie: Director of Public Health
Board Lead:                     Mr Bill Harrison: General Manager Mental Health

Delivery and Improvement
Risk                                     Management of Risk
Compliance with target may not be        Good progress has been made in Aberdeenshire
delivered equitably across               and Moray towards the 2012 target. Work
Grampian. Aberdeenshire and              continues to manage the numbers of people
Moray are at particular risk of not      waiting. Redesign work will continue across all
delivering in full.                      areas to improve patient pathways. Alcohol and
                                         Drug Partnerships will continue to be closely
                                         involved in performance management to support
                                         services in identifying and managing risks to
                                         delivery.
There may be data quality issues.        There has been focused support to identify and
                                         resolve data quality issues by providing training
                                         and ensuring processes for data collection are
                                         robust. We will continue to monitor data to
                                         ensure this level of quality is maintained.

Workforce
Risk                                     Management of Risk
Recruitment and vacancy                  Vacancy control is managed locally and action
management processes may lead            will continue to be taken timeously once approval
to delay in filling key posts.           to recruit is given. A review of processes to
                                         ensure key posts are not delayed has taken
                                         place.
The required culture change and          New management arrangements have been put
capacity building to deliver in full     in place in Moray. Additional nursing posts have
and on time may be a challenge.          been recruited to in Aberdeenshire. The overall
                                         position will be kept under review.

Finance
Risk                                     Management of Risk
No high or very high risks

Equalities
Risk                                     Management of Risk
There is a risk of inequitable service   Action will focus on ensuring geographic equity.
accessibility if targets not met.        Work is underway with partners to raise
                                         awareness of services available to hard to reach
                                         groups such as those from ethnic population and
                                         sex industry workers.
                                         We have appointed 3 bi/tri-lingual Health Link
                                         Workers to reach out to non-English speaking
                                         communities and feed back on healthcare
NHS Grampian February 2012                   17
Final 16th March 2012


                             needs. Language Line is available and drug and
                             alcohol booklets are available in the main local
                             ethnic community languages.




NHS Grampian February 2012       18
Final 16th March 2012


Deliver faster access to mental health services by delivering 26
weeks referral to treatment for specialist Child and Adolescent
Mental Health Services (CAMHS) from March 2013; reducing to 18
weeks by December 2014; and 18 weeks referral to treatment for
Psychological Therapies from December 2014

Executive Lead:              Dr Pauline Strachan: Chief Operating Officer
Board Lead:                  Mr Bill Harrison: General Manager Mental Health

Delivery and Improvement
Risk                                   Management of Risk
There is a risk that the access       A waiting time steering group has been
target for CAMHS is not delivered in  established and made accountable for
full.                                 compliance. Current issues have been explored
                                      and an action plan is being developed to address
                                      them.
The mental health Patient             Workarounds and manual data collection will be
Management System (PMS) will be used from April 2012 to provide priority data.
implemented in May 2012 but is        This will be agreed with ISD and Scottish
unlikely to be fully functional until Government Mental Health Division. A
towards the end of 2012.              standalone IT reporting system will be piloted
Comprehensive data on CAMHS           from May 2012 then rolled out. Performance will
from this source will be unavailable be closely monitored to ensure improvement.
until then.                           There will be continued close working with the
                                      Patient Management System project team to
                                      minimise adverse impact.
Capturing the data required to        We have identified a stand alone IT reporting
demonstrate delivery of the           system which will be piloted in adult community
Psychological Therapies target will   mental health teams during April/May 2012 with
be a considerable challenge.          reports available May/June 2012.
There may be insufficient dedicated We have funded alternatives to Mental Health
continuous service improvement        Collaborative resource for Continuous Service
resource to support clinical services Improvement provision, clinical leadership and
to deliver the required improvement. project management.

Workforce
Risk                                   Management of Risk
There may be inadequate staff We will continue to ensure all vacancies in
available to deliver the improvement CAMHs are approved for appointment by
required in CAMHS.                   vacancy management procedures. New
                                     resource has been allocated to increase staffing
                                     where required. An appraisal of all services
                                     offered by CAMHs took place in 2011 and a
                                     redesign of services is underway.
There may be Inadequate staff NHS Grampian’s Psychological Therapies
available to meet the demands of Steering Group (PTSG) has undertaken work to
the Psychological Therapies target. record workforce data across mental health
                                     services, relating to staff groups, the modalities
                                     of psychological therapies delivered and
                                     supervision/training arrangements for those
NHS Grampian February 2012                 19
Final 16th March 2012


                                       practitioners involved. Information on accredited
                                       practitioners in Psychological Therapies and
                                       those staff members who are currently working
                                       towards accreditation has been collected.
                                       We are reviewing the skill mix of Community
                                       Mental Health Teams and the provision of
                                       varying Psychological Therapies across all areas
                                       of our service in line with locally developed
                                       guidance.
                                       Integrated Care Pathways (ICP) work has been
                                       focused towards IT infrastructure and the
                                       recording of information for the ICP Generic
                                       Pathway. This work has been inclusive of data
                                       recording for each standard and in particular
                                       standard 15 for Psychological Therapies. There
                                       is an ongoing training package which is
                                       underway to allow clinical staff to record the
                                       required information and planning has
                                       commenced in relation to our future Patient
                                       Management System (PMS) to be implemented
                                       by May 2012.

Finance
Risk                                   Management of Risk
New resource is being invested in      We will develop initiatives to deliver efficiencies
CAMHs at the same time as the          overall to ensure resource is utilised efficiently
service must contribute to meeting     and effectively. The position will be performance
NHS Grampian’s efficiency              managed closely by the CAMHs Clinical
requirements.                          Management Group.
The      requirement      for   cost   We will seek support with development work
efficiencies will impact on resource   from Scottish Government and we will engage
required for development work.         with the Scottish Government on proposals for
(Psychological Therapies)              national improvement support.

Equalities
Risk                                   Management of Risk
There may be under-provision of We will ensure increased focus on older people.
psychological therapies for older In first instance a psychological therapies group
people.                           has been established to lead on this within the
                                  Old Age Psychiatry Directorate.




NHS Grampian February 2012                 20
Final 16th March 2012



Reduce the rate of emergency inpatient bed days for people aged 75
and over per 1,000 population, by at least 12% between 2009/10 and
2014/15


Executive Lead:         Dr Pauline Strachan: Chief Operating Officer
Board Lead:             Ms Heather Kelman: General Manager Change Fund

Delivery and Improvement
Risk                                     Management of Risk
Uncertainty in the independent           Independent care providers will be involved in
residential care setting may lead to     the development of Strategic Joint
increase in length of stay for clients   Commissioning Plans to estimate required
returning to or being admitted to a      capacity in this sector and to provide some
care home.                               certainty. The situation will be monitored by local
                                         partnership management teams and action taken
                                         as necessary.
The current trend of reducing bed        The Grampian Integrated Strategic Monitoring
days may not continue.                   Performance Group (ISMPG), which has both
                                         local authority and health representation, will
                                         performance manage closely using local health
                                         Intelligence data. Action will be initiated where
                                         required.
                                         Change Plans and Strategic Joint
                                         Commissioning Plans will have a significant
                                         focus on this issue, and implementation will be
                                         monitored by the integrated health and care
                                         management teams in each area.
Continued growth in the number of        Transformation work in progress with continued
emergency admissions (2.9%               focus on the contributions of health (primary and
growth in 2011) as a consequence         secondary care), local authorities and
of the planned increase in               independent sector partners to improve the
anticipatory care failing to create      delivery of care with the aim of reducing
sufficient reduction in unscheduled      unnecessary admissions and length of stay,
need.                                    alongside supporting self management and
                                         independence.
                                         The ISPMG will also monitor progress on this
                                         work, alongside local CHP joint planning and
                                         management structures.
                                         Aberdeen City has highest level of growth (3.6%)
                                         and GP Cluster Teams have been asked to give
                                         this issue specific attention.
Uncertainty in independent               Independent care providers will be involved in
residential care setting may lead to     development of Strategic Joint Commissioning
increase in length of stay for clients   Plans to estimate required capacity in this sector
returning to or being admitted to a      and provide some certainty.
care home.                               Situation to be monitored by local partnership
                                         management teams and action taken as
                                         necessary.
NHS Grampian February 2012                   21
Final 16th March 2012


Ensuring consistency and support        Within the GMS Quality and Outcomes
to embed continuous service             Framework for 2011/12 all GP practices were
improvement approaches in existing      required to participate in an external review to
practice                                compare data on emergency admissions with
                                        peer practices. The external review requires
                                        each practice to undertake a Significant Event
                                        Review on a sample of patients (maximum of 5)
                                        admitted to hospital as part of the Frail Elderly
                                        Pathway and consider whether or not the
                                        admission was potentially avoidable or whether
                                        alternative management of the patient could
                                        have been taken to avoid the admission. This
                                        reflective practice will enable the multi-
                                        disciplinary team to reduce variation and
                                        increase understanding and use of alternative
                                        pathways of care.
                                        Action Learning Sets have also been established
                                        in both Aberdeen and Aberdeenshire.

Workforce
Risk                                    Management of Risk
Increasing demand for home based        Partnership working with local authorities to
care not matched by increase in         develop Strategic Joint Commissioning Plans to
availability of home care/community     inform workforce planning.
health staff.                           We will seek new markets for recruitment.
                                        Workforce plans continue to be developed using
                                        the 6 steps model.
                                        The Releasing Time To Care approach locally
                                        has implemented a workload analysis tool and a
                                        caseload management tool which will assist in
                                        organising workload and being clearer about the
                                        resource required and competency levels.

Finance
Risk                                    Management of Risk
Budget constraints may                  Change fund is providing additional capacity to
compromise the quality of care.         support modernisation in this area.

Equalities
Risk                                    Management of Risk
Insufficient awareness of the           The change fund is enabling a specific focus on
specific needs of each individual       promoting active ageing/wellbeing and tackling
and their personal ability to           social isolation.
contribute to their own health and      We will use risk prediction tools alongside local
wellbeing, leading to less ability to   intelligence to identify those at risk and actively
prevent deterioration and               facilitate management plans, including other
management of their ailments or         options for support e.g. peer support, local self
conditions.                             help mechanisms
                                        Managing equalities is a key objective across
                                        Grampian and there will be a continuing focus on
                                        raising awareness.

NHS Grampian February 2012                  22
Final 16th March 2012


No people will wait more than 28 days to be discharged from hospital
into a more appropriate care setting, once treatment is complete from
April 2013, followed by a 14 day maximum wait from April 2015

Executive Lead: Dr Pauline Strachan: Chief Operating Officer
Board Lead:     Mr Sandy Dustan: Acting General Manager
                Aberdeenshire CHP

Delivery and Improvement
Risk                                      Management of Risk
Uncertainty in independent                Independent care providers will be involved in
residential care setting, particularly    development of Strategic Joint Commissioning
in Aberdeen, may lead to increase         Plans to estimate required capacity in this sector
in length of stay for clients returning   and to provide some certainty.
to or being admitted to a care home.
Availability and distribution of Care     We will ensure the Choice policy is introduced
Home Places may introduce delays          sensitively and as early as possible. The
in the choice process.                    situation will be monitored by local partnership
The introduction of the                   management teams and action taken as
                                          necessary.
Rehabilitation and Enablement             Rehabilitation and enablement, along with
Service in Aberdeenshire may not          anticipatory care and the expansion of out of
be completed to fully influence           hours services should be prioritised within the
length of stay.                           Change Plan. This will be managed and
                                          monitored by the Older Peoples Strategic
                                          Outcomes Group.
Effectiveness of multi agency             We will continue to integrate services around
working across whole system.              treatment and care pathways into, through and
                                          out of hospital. We will ensure Estimated Date of
                                          Discharge focused discharge planning and
                                          embed continuous service improvement
                                          approach into existing practice.
                                          Progress through pathways will be monitored by
                                          local partnership management teams and action
                                          taken as necessary.

Workforce
Risk                                      Management of Risk
Increasing demand for home based          Partnership working with local authorities to
care not matched by increase in           develop Strategic Joint Commissioning Plans to
availability of home care/community       inform workforce planning.
health staff.                             We will seek new markets for recruitment
                                          The Releasing Time To Care approach locally
                                          has implemented a workload analysis tool and a
                                          caseload management tool which will assist in
                                          organising workload and being clearer about the
                                          resource required and competency levels.




NHS Grampian February 2012                    23
Final 16th March 2012

Finance
Risk                                    Management of Risk
Budget constraints may                  Change fund is providing additional short term
compromise the ability to place         capacity to support modernisation in this area.
patients into resource intensive
packages of care.

Equalities
Risk                                    Management of Risk
Patient and Family reluctance to        We will ensure link to anticipatory care planning
make, or who experience great           and begin discussions re future care
difficulty making, life changing        requirements as early as possible.
decisions within increasingly shorter   We will ensure choice policy is introduced
periods of time.                        sensitively and as early as possible.
                                        The situation will be monitored by local
                                        partnership management teams and action taken
                                        as necessary.




NHS Grampian February 2012                  24
Final 16th March 2012


To improve stroke care, 90% of all patient admitted with a diagnosis
of stroke will be admitted to a stroke unit on the day of admission, or
the day following presentation by March 2013

Executive Lead:         Dr Pauline Strachan: Chief Operating Officer
Board Lead:             Mr Vincent Shields: General Manager Acute Services

Delivery and Improvement
Risk                                    Management of Risk
Patients ready for discharge cannot     We will identify beds outwith the stroke unit for
leave the stroke unit because the       the post stroke palliative and interim care
care they require is not available at   required by c10% of patients.
the required time. This then            We will ensure facilities such as community
impacts on the admission of new         hospitals and community rehabilitation teams are
patients to the unit.                   available and appropriately integrated for
                                        rehabilitation post stroke.
                                        The system will focus on patient flow (not just
                                        bed numbers) to ensure that facilities are
                                        available for patients as their care can be
                                        appropriately provided outwith the stroke unit.
Post stroke palliative and interim      These beds will be managed by the stroke
care beds are not protected and are     physicians and their use will be closely
utilised for other patients.            monitored. We will ensure that Rehabilitation
                                        Teams are integrated and working across the
                                        system to ensure timely and appropriate
                                        discharge.
Length of stay in stroke unit and       Within the limitations of multi site working we will
specialist rehabilitation beds is       encourage early supported discharge to reduce
longer than required which impacts      length of stay and will work with key
on availability for others.             stakeholders to make this happen. Rehabilitation
                                        teams will play a key role in ensuring a seamless
                                        patient journey through Stroke Unit.
Performance may be understated,         Discussions underway through MCN National
with the exclusion of our unit in Dr    Framework to explore its inclusion.
Gray’s Hospital, Elgin.
The development of the different        We will apply consistent improvement
approach is not supported by            methodologies to ensure success. We will
behavioural change.                     ensure that there is a clear communication
                                        strategy keeping stakeholders updated on
                                        progress towards attainment of target.

Workforce
Risk                                    Management of Risk
Expertise and confidence of             We will ensure staff are supported across the
community hospital staff to care for    system with their training needs met as
stroke patients may require further     appropriate. This will be facilitated through E-
development.                            KSF and PDP activity and will encompass
                                        support from external partners (CHSS) and
                                        national competency frameworks. The Stroke
                                        Training Co-ordinator will be tasked with

NHS Grampian February 2012                  25
Final 16th March 2012


                                           ensuring staff are at a competency level
                                           appropriate for the demand on their
                                           locality/unit/service.

Finance
Risk                                       Management of Risk
Budget constraints may prevent the         We will continue to progress service redesign
required changes taking place.             which delivers improved efficiency and through
                                           this facilitate change within available resources.

Equalities
Risk                                       Management of Risk
Different facilities will be provided in   We will ensure a cross system approach and
different locations across Grampian        monitor service provision closely to minimise
                                           differences. We will ensure that there are
                                           appropriate pathways and protocols so that flow
                                           is sustained but also that the patient is being
                                           treated in the most appropriate
                                           location/site/facility.




NHS Grampian February 2012                     26
Final 16th March 2012


Further reduce healthcare associated infections so that by 2012/13
NHS Boards’ staphylococcus aureus bacteriamia (including MRSA)
cases are 0.26 or less per 1,000 acute occupied bed days; and the
rate of Clostridium difficile infections in patients aged 65 and over is
0.39 cases or less per 1,000 total occupied bed days

Executive Lead:              Dr Roelf Dijkhuizen: Medical Director
Board Lead:                  Ms Pamela Harrison: Infection Control Manager

Delivery and Improvement
Risk                                   Management of Risk
Effective measurement of               Plans are in place to ensure that the system of
compliance with infection prevention   Healthcare Environmental Inspection (HEI)
and control policy may not take        audits taking place across NHS Grampian raise
place                                  awareness of infection prevention and control
                                       policy and procedures and monitor their
                                       implementation. Quality assurance of this
                                       system is now in place
Risk assessment of patients in         A risk assessment tool incorporating both MRSA
terms of risk of cross transmission    clinical risk assessment and general infection
should take place on admission and     risk assessment has been developed and is in
be documented.                         the implementation phase.
Clear allocation of cleaning duties    A new system for allocation and sign off of
with a sign-off system at ward level   domestic cleaning duties was successfully
                                       implemented in several sites and we will
                                       continue to roll this out to other sites.
There may be misunderstanding of       A standard operating procedure for the
the correct method for cleaning        decontamination of patient equipment has been
patient equipment                      developed with assistance from Health
                                       Improvement Scotland and Health Protection
                                       Scotland. This has been implemented but will be
                                       closely monitored. We will participate in the
                                       development of a national A-Z of equipment
                                       cleaning.
Ward staff are unable to make the      We will continue to provide support from the
necessary changes to their practice    Infection Protection and Control Team (IPCT),
to reduce SABs.                        Scottish Patient Safety Programme and
                                       executive leads for Healthcare Associated
                                       Infection and Patient Safety. This support will
                                       take the form of education around cannulation
                                       and blood sampling, invasive device care
                                       bundles and implementation of the Scottish
                                       Antimicrobial Prescribing Group S. aureus
                                       guidance.

Workforce
Risk                                   Management of Risk
The potential annual HAI point         We will engage in discussions with Health
prevalence survey may again result     Protection Scotland and explore with them
in criticism from the Healthcare       possible reductions in dataset, reduction in
NHS Grampian February 2012                 27
Final 16th March 2012


Environment Inspectorate around          frequency and resources around data collection
lack of visibility of the Infection      and training of staff outwith the Infection
Prevention and Control Team.             Prevention and Control Team.
Ensuring effective communication         The IPCT will continue to use a range of
flows                                    communication methods including global emails,
                                         newsletters, team brief, awareness sessions,
                                         teaching sessions, the intranet and posters to
                                         communicate key infection prevention and
                                         control messages. The IPCT continues to
                                         regularly review its communication strategy.
Service pressures may impact on          We will continue to reinforce the importance of
delivery of the mandatory                supporting the release of staff for mandatory and
programme of HAI education               statutory training. The IPCT will continue to
                                         develop alternative training packages that do not
                                         require staff to be away from the clinical setting
                                         for long periods.

Finance
Risk                                     Management of Risk
Current funds for parts of the           Current practice is under constant review and
service are “ring-fenced” and non-       redesign of services will take place to ensure
recurring.                               continuity once funding comes to an end.

Equalities
Risk                                     Management of Risk
Staff, patients and visitors will have   We have Language Line telephone interpretation
different levels of literacy and         service live in over 700 locations across NHS
English may not be their first           Grampian. We also have available BSL
language.                                interpreters and Portable Induction Loops and
                                         produce material in a wide range of accessible
                                         formats. This ensures that we meet the individual
                                         communication needs of both patients, visitors
                                         and staff




NHS Grampian February 2012                   28
Final 16th March 2012



To support shifting the balance of care, NHS Boards will achieve
agreed reductions in the rates of attendance at A&E between 2009/10
and 2013/14

Executive Lead:         Dr Pauline Strachan: Chief Operating Officer
Board Lead:             Mr Andrew Fowlie: General Manager Moray CHSP

Delivery and Improvement
Risk                                    Management of Risk
There may be a lack of public           We will continue to promote and develop our
understanding about unscheduled         Know Who to Turn To campaign
care choices.
Lack of knowledge and                   We will ensure information is available to GPs
understanding across NHS system         and others on A&E attendances in a format that
about A&E attendances.                  is relevant to them. As per 2012/13 Quality and
                                        Outcomes Framework.
Current trends may not be               We will ensure ongoing reminders to the public
maintained and more members of          about when they should and shouldn’t use A&E.
the public may self present to          The ‘Know Who To Turn To’ campaign
Accident and Emergency (A&E)            continues.
Financial position of Local             We will continue to discuss changes with our
Authorities may result in the           partners to mitigate any risks.
reduction or withdrawal of services
with impact on A&E attendance
Rate of attendance may reach a          We will review performance regularly and ensure
lower limit below which it cannot be    realistic target setting.
further reduced
Access to day time Primary Care –       We will process map all capacity and demand
GP / Optometry / Pharmacy may be        and put in place improvement plans.
constrained due to increased
demand.

Workforce
Risk                                    Management of Risk
Training to ensure required skill set   We will identify required skills and agree
is available in community may not       prioritisation or alternative provision
be achieved within current funding
levels.

Finance
Risk                                    Management of Risk
Provision or access may need to be      We will be focus on redirection, de-escalation of
increased beyond that which is          current activity and on ensuring that patients are
currently funded. An example would      accessing the most appropriate level of
be for increases in access to GP        unscheduled care currently available, rather than
appointments.                           looking to increase capacity.




NHS Grampian February 2012                  29
Final 16th March 2012

Equalities
Risk                                    Management of Risk
We are an area of both urban and        The recent Know Who To Turn To campaign
rural geography with the main A&E       highlighted unscheduled care services available
department based within Aberdeen.       across the Grampian area including at Dr Gray’s
As we encourage the public to use       in Elgin (with telehealth links to Aberdeen and
lower level services, there may be a    communications with Raigmore Hospital in
perceived risk that only those living   Inverness) and the minor injuries units at 14
in the city centre have access to       Community Hospitals.
unscheduled care.
Shifting demand away from Level 1,      We will ensure better promotion of pharmacist
2 emergency care departments            services through the Pharmore pilot and through
includes the promotion of lower         Know Who To Turn To. Also better promotion of
level minor injury units in community   extended hours availability at general practices.
hospitals, which are available only
in Aberdeenshire and Moray. In          Since 2007, NHS Grampian has mounted an
Aberdeen City the minor injury          education campaign with recent migrant workers
service is run from the main A&E        and their families to encourage them to register
department with fewer options for       with their local GP. This is designed to help
residents to ‘de-escalate’ their        reduce inappropriate attendances at A&E by
choice of care.                         members of our local ethnic communities. This
                                        campaign will continue.

                                        Our Bi-Tri-Lingual health Link Workers are also
                                        an important part of this work.




NHS Grampian February 2012                  30

				
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