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Appendix A - Homepage - NHS Fife


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									                                          NHS FIFE                                           Appendix A

                      BALANCED SCORECARD UPDATE

                                         APRIL 2008

Status Assessment


            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:
  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      -    -      -     -     -   -   -            -       -

April 2008 - Performance at a glance:

  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     -      -       -     -       -     -    -     -       -
  - No corresponding targets in this quadrant.
                                                                              V1.0 - Board Version (180408)
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
3    Implement Local Aspects of the Child         On track to complete by agreed date.                                                                     S Manion/
     Health Action Framework.
                                                                                                                                               ↔          A Buchanan
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/
                                                  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

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
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

10   Deliver outcomes set out in JHIP.            On track to complete by agreed date.                                                                     G Radford
11   Implementation of local elements of          On track to complete by agreed date.                                                                    A Buchanan/

     Emergency Care Framework.                                                                                                                              J Wilson
                                                                                                                                                           /S Manion
12   Review age appropriate care provision.       On track to complete by agreed date.                                                                    A Buchanan/

                                                                                                                                                            J Wilson/
                                                                                                                                                            S Manion
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
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
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.
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

23   Implement Staff Governance standard.            On track to complete by agreed date.                                                     R Webster
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

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
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

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/
30   Develop collaborative budgets across        Completed.                                                                                    V Irons/
     Primary and Secondary Care, linking where
     appropriate with Managed Clinical Networks.                                                                                   ↑           F Elliot
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

32   Develop Fife's Balance of Care Strategy.        Completed.                                                                               V Irons/ S

                                                                                                                                   ↑           Manion/
                                                                                                                                               F Elliot
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
     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

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
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
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
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

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
44   Improve mental health services being offered to       On track to complete by agreed date.                                                                              G
     children and young people.
                                                                                                                                                           ↔           Cunningham
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
46   Implement the new Care Programme Approach for On track to complete by agreed date.                                                                                      G
     all restricted patients.
                                                                                                                                                           ↔           Cunningham
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
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
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
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
                                                            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
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
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.
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
65   Develop and implement NHS Fife           Completed.                                                                           C Adamson
     Business Continuity Plan.
                                                                                                                           ↑         CG/All
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
                                              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

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
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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