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NHS FIFE Appendix A BALANCED SCORECARD UPDATE APRIL 2008 Status Assessment Completed Objective on track to complete by agreed date. Objective still likely to be achieved but likely to be delayed. Objective will not be met or is unlikely to be met. Performance direction since last update: Note - Colour of arrow depicts the target status given at last update ↑ target status has improved since last update ↓ target status has slipped since last update ↔ no change in target status since last update December 2007 - Performance at a glance: HEALTH IMPROVEMENT/PROTECTION PARTNERSHIP WORKING 1 2 3 4 5 6 19 20 21 22 23 24 7 8 9 10 11 12 25 26 27 28 29 30 13 14 15 16 17 18 31 32 33 34 35 36 37 38 39 40 41 42 64 65 66 67 68 69 43 44 45 46 47 48 70 71 72 73 74 - 49 50 51 52 53 54 - - - - - - 55 56 57 58 59 60 - - - - - - 61 62 63 - - - - - - - - - PATIENT EXPERIENCE EFFICIENCY April 2008 - Performance at a glance: HEALTH IMPROVEMENT/PROTECTION PARTNERSHIP WORKING 1 2 3 4 5 6 19 20 21 22 23 24 7 8 9 10 11 12 25 26 27 28 29 30 13 14 15 16 17 18 31 32 33 34 35 36 37 38 39 40 41 42 64 65 66 67 68 69 43 44 45 46 47 48 70 71 72 73 74 - 49 50 51 52 53 54 - - - - - - 55 56 57 58 59 60 - - - - - - 61 62 63 - - - - - - - - - PATIENT EXPERIENCE EFFICIENCY Note: - No corresponding targets in this quadrant. V1.0 - Board Version (180408) HEALTH IMPROVEMENT/PROTECTION No. Target Update Board Version (April 2008) Performance Responsible Direction Executive 1 Increase the percentage of children being In Sept 2006 the combined HibMenC booster (given at around 12 months of age) G Radford/ S immunised. along with a booster dose of PCV (given at around 13 months of age with the MMR) Manion was introduced with a catch-up programme for all children under the age of 24 PHG/DWF months. During 2007 another campaign was launched to ensure all preschool children receive a booster dose of HiB. NHS Fife has continued to show improvement in the overall uptake figures for childhood immunisations. 2007 uptake immunisation rates for primary courses of diptheria, tetanus, pertussis, polio, HiB, MenC and PCV by 12 months of age remain above 95% and have remained relatively stable at ↔ around 98% by 24 months of age. Uptake of one dose of MMR by 24 months for 2007 is 92.2% compared to 92.1% in 2006. Uptake of one dose of MMR by 5 year olds is 95.1%, slightly above the World Health organisation (WHO) target of 95%. Uptake of the second dose of MMR by 6 year olds was 88% for 2007 compared to 88.2% in 2006. 2 Reduce teenage pregnancies. On track to complete by agreed date. G Radford/ ↔ CHP GMs HWBA/PHG/ CHPs 3 Implement Local Aspects of the Child On track to complete by agreed date. S Manion/ Health Action Framework. ↔ A Buchanan SR 4 Implement key worker model for children ISSACCS has been reviewed and evaluated. Future development of a Joint S Manion/ with complex needs at local level. Assessment Framework for children will be progressed through IT solutions which A Buchanan are currently being discussed but will rely on the ability to link sytems such as SWIFT DWF and OASIS. Joint documentation is used widely within the pre-school teams, school liaison groups and Joint Action Teams. Our ability to share is supported by a ↔ structured meeting process to agree assessment and care plans for children. 5 Reduce the number of low birth weight Assigned to the Health for All 4 delivery group. Input via the Family Health Midwife A Buchanan/ babies. Project and funding secured for period April-Sept 2008 from the Fairer Scotland Fund CHP GMs to incorporate this approach into the work of the Community Midwives. Awaiting further development across Fife re Visible, Accessible and Integrated Care (Review ↓ HWBA/PHG/ CHPs of Nursing in the Community) which will impact on this agenda. ↔ 6 Develop robust Flu Pandemic Plan. On track to complete by agreed date. G Radford PHG/HWBA ↔ 7 Develop and implement the annual local Local action plans exist for most of the areas in NHS Fife but not all. Each area is R Webster Action Plans for Health & Safety. now able to produce and is developing Action Plans for 2008/09. HS 8 Continue to support a reduction in the There has still not been a definitive set of recommended actions from the national G Radford/G number of people abusing drugs. review. The DAAT is however continuing a series of development events to consider the wider aspects of the report. ↔ Cunningham /V Irons FP 9 Continue to support a reduction in the On track to complete by agreed date. G Radford number of young people who binge drink. ↔ /V Irons FP ↔ 10 Deliver outcomes set out in JHIP. On track to complete by agreed date. G Radford HWBA 11 Implementation of local elements of On track to complete by agreed date. A Buchanan/ ↔ Emergency Care Framework. J Wilson /S Manion SR/OD 12 Review age appropriate care provision. On track to complete by agreed date. A Buchanan/ ↔ J Wilson/ S Manion SR/OD 13 Reduce the prevalence of smoking in adults This target is now obsolete, having been replaced in 2008 by another LDP smoking N/A G Radford/ in Fife. target based on smoking cessation activity. In the absence of any further tracking CHP GMs information from SGHD it is not possible to provide any further information on PHG/HWBA performance against this target. /CHPs 14 Tackle inequality ratios by health On track to complete by agreed date. G Radford/ improvement measures i.e. CHD, cancer, smoking, dental decay, obesity, exercise. ↔ CHP GMs PHG/HWBA /CHPs 15 Implement Sexual Health Strategy Action Vasectomy waiting times have improved from 2005 to 2006, with 62% waiting more G Radford/ Plan. than 3 months as opposed to 80%. Fife performs 70% of terminations of pregnancy CHP GMs within <10 weeks gestation, above the Scottish average. PHG/HWBA Long Acting Reversible Contraception (LARC) - Fife has the second lowest rate in Scotland with a rate of 53/1000 women aged 15-49. Improvement will require a ↓ /CHPs significant shift in practice. The cost to Fife of meeting the QIS standard for LARC (60/1000) has been estimated at £100K for the first year. 16 Increase Breastfeeding rates. Implement Current mixed breastfeeding rate 35% in Fife which is below target. Breastfeeding J Wilson/ Board's Breastfeeding Strategy. Awareness Week - national multi-agency conference organised, radio ads and all A Buchanan CHPs holding local events. Publicity packs being sent to all practices. Community OD support being increased via Family Health project and the Peer Support project is continuing in Lochgelly and Glenrothes and outreach support being offered via Forth Park Infant Feeding Co-ordinator. Forth Park completed UNICEF site visit and ↓ maintained Baby Friendly status. CHPs are being asked to consider working towards UNICEF Baby Friendly in the Community 7 Point Plan as specified in the Breastfeeding Strategy. 17 Continue to support mental health On track to complete by agreed date. G Radford/G improvement and wellbeing as part of the Cunningham Mental Health Delivery Plan. ↔ /CHP GMs PHG/HWBA/ CHPs 18 Maintain cervical screening target of 80%. Data for Quarter Oct-Dec 2007 shows that uptake rate has dipped to just below G Radford target level to 79%. Fife Cervical Screening Committee is addressing this issue by: PHG feeding back uptake rates to individual practices; ensuring women know about option of attending a Contraception and Sexual Health clinic for screening; producing lists to defaulters for GP practices to work through; and planning local press publicity. ↓ National group has been set up to addres this national phenomenon. PARTNERSHIP WORKING No. Target Update Board Version (April 2008) Performance Responsible Direction Executive 19 Clearly demonstrate improved patient On track to complete by agreed date. Dr F Elliot/ benefits due to pay modernisation - (a) R Webster Consultant Productivity (FME) and (b) All Staffing Productivity (RMW) in line with ↔ SG Benefits Realisation Plan. 20 Undertake and complete all individual All submissions now received for reviews at end of March 2008. R Webster reviews in Agenda for Change. Timetable has been completed detailing stages and end date for all reviews by end of Sept 2008. Reviews have now begun to take place. ↔ SG 21 Review development and implementation of Completed. R Webster annual Workforce Modernisation and Development Strategic Action Plan. ↑ SG ↔ 22 Introduce specialty training for MMC. Completed. Dr F M Elliot SR ↔ 23 Implement Staff Governance standard. On track to complete by agreed date. R Webster SG 24 Develop and implement a Healthy Working Draft Strategy has been completed and is now being further developed in R Webster/ Lives Strategy for NHS Fife employees. partnership with Fife Council. It is intended to explore taking Healthy Working Lives forward in 2008/09 as a joint venture with Fife Council. ↓ G Radford SG 25 Develop and implement the NHS Fife NHS Fife Development Plan 2006-08 in place. 2008-10 Iteration being D Christie Development Plan, including leadership developed. Continuing good progress in the development and delivery of SG capacity. Leadership programmes e.g. 5th cohort of Fife Partnership Leading and Learning Programme, Frontline Leadership Programme commenced September 2007. Personal Effectiveness Development programme for ↔ frontline leaders, Fife Public Sector MBA programme developed and established. 26 Implement the Knowledge and Skills Monitoring arrangements confirm corrected management action being D Christie Framework of Agenda for Change. taken to embed KSF PDP arrangements. Returns to date indicate 78% SG compliance rate with managers confirming plans in place to ensure full compliance. The HEAT target requires all staff covered by Agenda for ↑ Change to have a KSF PDP in place by March 2009. 27 Develop hospital and community based Completed. S Manion models for learning disability services following phase IV Lynebank Discharge ↑ HSCP/SR Programme. 28 Work closely with Fife Council to deliver Staff/public consultation on the QMH plan has been undertaken. Leaflet D O'Keeffe travel planning for all major hospital sites. now prepared to market the QMH Travel Plan along with a range of other FP marketing ideas such as banners and presentations. St Andrews Travel Planning group now established. Plans in hand to set up a group for VHK ↔ by the summer of 2008. 29 Fife-wide action plans for managing long Completed. CHP GMs/ V term conditions (incorporating plans for Irons/F Elliot concluding the self assessment and introducing case management for complex ↔ SR/HSCP/ CHPs cases. 30 Develop collaborative budgets across Completed. V Irons/ Primary and Secondary Care, linking where appropriate with Managed Clinical Networks. ↑ F Elliot OD/CHPs/ F&R 31 Produce an Action Plan to extend local care Completed. V Irons/ through e.g. enhanced Primary Care Medical Services and Community Pharmacy. ↑ F Elliot CHPs/OD 32 Develop Fife's Balance of Care Strategy. Completed. V Irons/ S ↑ Manion/ F Elliot SR 33 Monitor implementation plans for Fife's Completed. CHP GMs community hospital/community resource centre plans. ↑ CHPs 34 Develop plan considering new national On track to complete by agreed date. G outcome measures of Health and Social Care Partnership (Joint Future) ensuring ↔ Cunningham HSCP LMUs and SIGs align work accordingly. 35 Ensure 4 identified community planning On track to complete by agreed date. C Adamson levers for Fife's future are embedded in NHS Fife's plans and operational delivery ↑ FP processes. 36 Work with other Boards to develop further On track to complete by agreed date. G J Brechin planning and commissioning of services on a regional basis, as appropriate. ↔ SR PATIENT EXPERIENCE No. Target Update Board Verson (April 2008) Performance Responsible Direction Executive ↑ 37 Detail ongoing targets for the Champions Completed Dr G Birnie Programme. CG ↔ 38 Reduce all staphylococcus aureus bacteraemia On track to complete by agreed date. Dr G Birnie (including MRSA) by 30%. CG 39 Continue progress on managing the dental On track to complete by agreed date. J Wilson decontamination process and progress actions resulting from the P-Cat audits. ↔ CG 40 NHS Fife, with key partners, will continue to Completed G implement the Mental Health Act 2003 and clarify fully the future service pattern. ↑ Cunningham KL 41 Continue implementation of agreed schemes for The first project is now nearly two months behind schedule due to delays in agreeing the G Mental Health inpatient services reconfiguration. guaranteed maximum price. ↓ Cunningham KL 42 Development of Local Action Plans based on First iteration of local Action Plan considered and approved by Mental Health Strategy G Delivering for Mental Health. Group/Partnership. Locality Mental Health Partnership developments based on Action Plan commitments. Action Plan due for further review and improved detail. ↔ Cunningham KL 43 Develop and implement local integrated care On track to complete by agreed date. G pathways for the 5 national clinical conditions in preparation for accreditation. ↔ Cunningham KL 44 Improve mental health services being offered to On track to complete by agreed date. G children and young people. ↔ Cunningham HSCP 45 Reduce number of readmissions within one year for On track to complete by agreed date. G those that have had a psychiatric hospital admission of over 7 days by 10%. ↔ Cunningham HSCP 46 Implement the new Care Programme Approach for On track to complete by agreed date. G all restricted patients. ↔ Cunningham HSCP 47 Ensure that anyone contacting their GP surgery On track to complete by agreed date. Dr F Elliot/ has guaranteed access to a GP, nurse or other health care professional within 48 hours from April ↔ CHP GMs SG 2004. 48 Maintain appropriate use of Availability Status Completed J Wilson Codes and implement plans for phasing them out by 2007. ↑ OD 49 Achieve and maintain all waiting time guarantees. On track to complete by agreed date. J Wilson ↑ /CHP GMs OD/CHPs 50 Implement 5 (simple) changes in Planned Care and Out of the 9 procedure targets set under the Planned Care Improvement Programme, 5 J Wilson achieve agreed performance targets. have seen a very positive move towards day case or procedure room procedures. OD/CHPs Waiting times targets were achieved as at December 2007. Work is in hand to pilot a system of reminding patients of hospital appointments in an attempt to reduce DNA rates. Cancellations by hospital for the 3 Planned Care Specialties remain fairly low (1% for ↓ new appointments, 2% for review appointments and 6% for admissions, most of which are for non-clinical reasons) although as part of the 18 Weeks Programme work will continue in an effort to ensure this is further reduced. 51 Establish Referral Management Centres to extend Completed J Wilson referral options and facilitate patients choice at the point of contact. ↔ OD/CHPs 52 Implement minimum National Standards for surgery Data not collected to this level of detail and NHS Fife does not have a theatre system J Wilson time and throughput for all surgical staff. which would give this level of detail. National Theatre Implementation Group is still working with incomplete data sets and until these issues are resolved this objective will ↔ OD be delayed. 53 Reduce Delayed Discharges in line with National The Joint Improvement Team visited Fife in January and their recommendations are J Wilson/ targets. being actioned. Over the last few months, there has been a significant reduction in the G number of delayed discharges and regular reports on performance against the target are Cunningham widely distributed on a monthly basis. Close joint working has and will continue to take place in order to progress towards achieving and maintaining the target set for April ↑ OD/CHPs 2008. Fortnightly meetings have also been introduced to closely monitor the position and allow any issues relating to potential tippers to be addressed at the earliest possible opportunity. 54 Reduce the proportion of older people admitted as On track to complete by agreed date. J Wilson an Emergency In-Patient, 2 or more times in a single year and reduce emergency inpatiend bed ↔ OD/CHPs days for people over 65. 55 Implement local aspects of adolescent care and National guidance on general surgery as developed at national workshop which took A Buchanan children's surgery review. place in September 2007 awaited. Rotation of staff to ensure surgical skills are maintained within the nursing workforce continues. Plans ongoing to allow a member of ↔ A Dickson SR the clinical team to operate at VHK on a day case basis. 56 Develop and progress local collaboratives for Completed J Wilson Unscheduled Care, Diagnostics and Planned Care. ↑ OD/CHPs 57 Keep Childbirth Natural and Dynamic. On track to complete by agreed date. J Wilson/ ↔ A Buchanan OD/SR 58 Ensure co-ordination of NHS 24 with Primary Care Completed. J Wilson Out-of-Hours arrangements, especially with regard to Winter Plan. ↔ OD ↔ 59 Establish a Diversity and Equality Strategy. The Gender Equality Scheme was agreed in June, 2007. Strategy has been drafted and S Manion will be presented to the Board in June, 2008 for approval. PFPI 60 Enhance the availability and use of patient On track to complete by agreed date. A Buchanan experience information in line with new National Patient Experience Programme. ↔ PFPI 61 Reduce the annual rate of increase of defined daily Work commenced in Kirkcaldy and Levenmouth CHP to review repeat prescribing for Dr F Elliot/G dose per capita of anti-depressants to zero. those on anti-depressants. Care pathway work carried out by psychology to identify Cunnningham alternative therapies for referral from Primary Care. The Mental Health Collaborative will be tackling this issue as part of the work on developing and implementing an integrated ↓ SR care pathway for depression. 62 Service Redesign - support implementation of On track to complete by agreed date. Dr F Delivering for Health. ↔ Elliot/CHP GMs/J Wilson SR 63 Ensure patient flows between NHS Fife and NHS On track to complete by agreed date. F Elliot/V Irons Tayside (and vice versa) are delivered in sustainable ways, fitting into care pathways, agreed ↑ SR between the two systems. EFFICIENCY No. Target Update Board Verson (April 2008) Performance Responsible Direction Executive 64 Continue implementation and change Completed Dr S Clark of practice in line with Fife-wide NHS Risk Management Strategy. ↔ CG/All Committees 65 Develop and implement NHS Fife Completed. C Adamson Business Continuity Plan. ↑ CG/All Committees 66 Progress the General Hospitals & General Hospital & Maternity Services Project: the current target date J Wilson Maternity and St Andrews Hospitals for reaching Financial Close remains unchanged (i.e. between July F&R Projects within planned timetables and budgets. 2008 to October 2008). St Andrews Project: Financial Close was attained on 21 November, ↔ 2007. The target date for construction completion is June 2009. 67 Reduce staff sickness absence rate to The Director of HR and Director of Nursing, Attendance Management R Webster 4%. Champions, continue to liaise with the Operational Division and CHPs SG in respect of their performance against the national target. The January 2008 figure for sickness absence increased to 6.37% compared to 5.36% for December 2007, due mainly to the high level ↔ of flu and winter vomiting. The national target has been reviewed and is now 4% by end of March 2009. 68 Continue the implementation of Local On track to complete by agreed date. Dr S Clark and National eHealth Strategies in support of service change and ↑ CG efficiency. 69 Rollout expansion of Nurse Bank to Nurse agency expenditure within NHS Fife in 2006/07 was J Wilson/ cover all aspects of CHPs/AHPs - bank £1,423,835 (a reduction of £1,394,102) against 2005/06. Apr 07 - Feb A Buchanan to be utilised rather than agency 08 is indicating an expenditure of £816,211 reducing expenditure this A/F&R reducing costs to organisation. year by approximately £500,000. NHS Fife Nurse Bank now fully supports Queen Margaret Hospital, Victoria Hospital, Forth Park Hospital, Lynebank Hospital, Glenrothes Hospital, Cameron Hospital Wards 1,2,3,4, QMH, Complex Paediatric Care and the Evening Nurse Service. St Andrews, Adamson, Stratheden and Whyteman's Brae will be fully integrated in June (on average 18 members of staff in each hospital will be transferred to NHS Fife Bank). These areas can currently ↔ access bank staff through the bank office. A number of ODPs already work on the Bank. Integration meetings have been completed with AHPs who will become part of the system when nursing and midwifery are fully integrated and when deliberations around the National AHP Bank are concluded. The expansion of the Nurse Bank to cover other staff groups was not part of the original brief and will require additional resource. 70 Universal utilisation of CHI. The overall target is 97% by March 2008 and this is monitored Dr S Clark centrally on a monthly basis. The February 2008 figure was 95% and CG slightly below the trajectory of 97%. The details of measure for this target change after we have achieved two months consecutively for a particular service. Performance is monitored monthly by the ECCI ↓ Programme Manager and appropriate action taken. 71 Develop and establish category B Negotiations continue with the national PACS team. The costs Dr S Clark PACS. associated with, and the details of this proposed contract have CG changed significantly in the past month. Central team now considering only allowing one year of images to be available. Local PACS group aware of the potential issues and seeking to resolve ↔ these. Chair of the national PACS Board is aware of the issues. 72 Review the equipment status and Completed J Wilson requirements of all Imaging, Pathology OD and Laboratory Departments and identify a suitable rolling capital budget ↔ for equipment purchase and renewal, 73 Achieve financial balance in 2007/08 On track to complete by agreed date. R Pettigrew and through a forward plan demonstrate how financial balance will ↔ A/F&R be maintained. 74 Achieve Efficient Government cash- On track to complete by agreed date. R Pettigrew ↔ releasing savings target for A/F&R reinvestment in services; includes joint projects through Fife Partnership.
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