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									                                                                          APPENDIX A

                                        NHS FIFE

                     BALANCED SCORECARD 2008/09

                               UPDATE - AUGUST 2008

Status Assessment to be used

           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.

August 2008 - Performance at a glance:
  1     2     3     4     5        6     11     12 13    14  15      16
  7     8     9     10    −        −     17     18 19    20  21      22
  −     −     −     −     −        −     23     24 25    −    −      −
  26   27     28    29    30      31     43     44 45    46  47      48
  32   33     34    35    36      37     49     50 51    52  53      54
  38   39     40    41    42       −     55     56 57    58  59      60
   - No corresponding targets in this quadrant.

No.                         Target                            Update on Target Achievement (Aug 2008) - Board Version               Accountable    Governance
                                                                                                                                     Executive     Committee
1     Reduce mortality from Coronary Heart Disease           On track to complete by agreed dates.                                   G Radford     CG/HWBA/
      among the under 75s in deprived areas.                                                                                                         CHPs

2     Achieve agreed number of screenings using the          On track to complete by agreed dates.                                  G Cunningham     CHPs
      setting-appropriate screening tool and
      appropriate alcohol brief intervention, in line with
      SIGN 74 guidelines.
3     Through smoking cessation services, support            As at June 2008 the cumulative number of quits from smoking             G Radford     CG/HWBA/
      8% of your Board's smoking population in               cessation services was 710 against a straight line trajectory of                        CHPs
      successfully quitting (at one month post quit)         1,028. The Tobacco Issues group has held two development days
      over the period 2008/9 - 2010/11.                      and agreed a local Action Plan to move towards achievement of
                                                             this target.
4     Increase and maintain uptake of cervical               This is a maintenance target requiring continuous achievement.          G Radford        CG
      screening programme.                                   Performance for quarter ending March 2008 was 79.4% which is
                                                             slightly below the 80% threshold. Local review of literature on
                                                             likely effectiveness of interventions completed. Work with St
                                                             Andrews University to promote cervical screening has begun and
                                                             on schedule. Actions planned for the coming academic year:
                                                             information for students to be included in this year's induction
                                                             booklet; regular e-mails to students; information to be placed in
                                                             local CASH/GUM clinics. Feedback to GP practices of defaulter
                                                             patients on course to start in October, 2008 as planned. Protocol
                                                             for screening long stay patients now in place for all relevant wards
                                                             as of July 2008, ahead of schedule.

5     80% of all 3-5 year old children to be registered      67.3% of 3-5 year old children were registered with an NHS dentist      G Radford     CG/HWBA/
      with an NHS dentist.                                   as at 31 March 2008, which is ahead of trajectory. This continues                       CHPs
                                                             positive progress since the baseline position. New dental access
                                                             centres projected to open in early autumn enabling transfer of
                                                             more children to full registration. Staff recruitment in progress.

6     Achieve agreed completion rates for child              Detailed proposal developed for achievement of HEAT target and          G Radford     CG/HWBA/
      healthy weight intervention programme.                 submitted to Scottish Government. Awaiting approval before new                          CHPs
                                                             service developed. The delay in approval will impact adversely on
                                                             timescales with the target unlikely to be met.

7     Increase the proportion of new-born children           Breastfeeding data collected at 6 weeks via child health now            A Buchanan    SR/H&WA/
      exclusively breastfed at 6-8 weeks from 26.6%          mandatory. 3 month and 6 month data is collected via local CHP                           CG
      in 2006/7 to 33.3% in 2010/11.                         audits. Breastfeeding resources available. Currently a Fife-wide
                                                             audit being undertaken with schools and public health nurses to
                                                             identify gaps. Breastfeeding and Returning to Work Policy
                                                             currently being reviewed and a research proposal being developed
                                                             by Public Health. Community support remains static. Board
                                                             advised to ask CHPs to review Baby Friendly approaches in the
                                                             community to maintain Baby Friendly status.

8     Reduce teenage pregnancies for 13-15 year       Data are subject to random variation due to small numbers. The                 G Radford     HWBA/CG/
      olds to 7.2 per 1,000 by Mar 2011.              Scottish average also rose from 7.1/1000 to 8.1/1000 from 2005-                                CHPs
                                                      2006. There are significant developments ongoing in Sex and
                                                      Relationships Education in schools. Training has been targeted at
                                                      workers in contact with vulnerable young people at high risk e.g.
                                                      looked after children. Services in each CHP are being developed
                                                      to meet the needs of young people and target areas of need. An
                                                      audit in relation to 'Healthy Respect' standards has been carried
9     Reduce preventable childhood infections through As at quarter ending March 08, immunisation (inc MMR) was 97%                  G Radford      CG/DWF
      the childhood immunisation programme.           for 2 year olds and 92% for 5 year olds. Slow progress is
                                                      continuing on uptake levels as cohort moves through.
10    Implement self management framework for long On track to complete by agreed dates.                                               V Irons     SR/HSCP/
      term conditions within CHPs.                                                                                                                   CHPs
No. Target                                                    Update on Target Achievement (Aug 2008) - Board Version                    Accountable   Governance
                                                                                                                                          Executive    Committee
11   Reduce delayed discharges to nil.                 Between April and June 2008 there has been 1 patient breaching the 6 week             G          OD/CHPs/
                                                       target and 4 patients in a Short Stay bed (1 in May and 3 in June 2008).          Cunningham      HSCP
                                                       Partnership working continues in order to maintain the target with fortnightly
                                                       meetings taking place to closely monitor the position and enable action to be
                                                       taken on potential tippers at the earliest opportunity. A Planning Workshop
                                                       was held on 30 April 2008 which was well attended. The EMPTAYDD system
                                                       has been rolled-out within Primary Care and Mental Health services.

12   Deliver commitments as set out in Delivering      On track to complete by agreed dates.                                           G                 HSCP
     for Mental Health.                                                                                                            Cunningham
13   Develop Equality and Diversity Strategy.          Completed.                                                                   S Manion             PFPI
14   To reduce all staphylococcus aureus               The number of SABs have increased in 2008 compared to the same period in      G Birnie            CG
     bacteraemia (including MRSA) by 30%.              2007. The Infection Control Team are working with clinicians and nursing
                                                       staff in the Renal Unit to reduce the number for haemodialysis line related
15   Work in partnership with staff, patients and      On track to complete by agreed dates.                                       A Buchanan            PFPI
     members of the public, to create a mutual
16   Improvement in the quality of healthcare          On track to complete by agreed dates.                                             A Buchanan      PFPI
17   Develop and implement the annual local            On track to complete by agreed dates.                                              R Webster       HS
     Action Plans for Health & Safety.
18   NHS Boards to achieve a sickness absence          NHS Fife reported a 5.24% sickness absence rate at May 2008 against a              R Webster       SG
     rate of 4%                                        trajectory of 5.5%. OD interventions at Lynebank and QMH Mental Health are
                                                       engaging with staff/line managers to inform further training and awareness
                                                       raising. Directorate of Estates and Facilities have undertaken a specific pilot
                                                       to focus on sickness absence. Since the introduction of appointment
                                                       information being supplied to Managers the OHSAS appointment DNA rate
                                                       has reduced from 33% to 12% in the first month and continues to decline.
                                                       This positively impacts upon appointment turnaround times. Workshop to be
                                                       arranged for managers, HR and staff representatives focussing on
                                                       attendance management.
19   Develop and implement 2008-10 NHS Fife            Draft Development Plan developed. Learning & Development Framework                 D Christie      SG
     Development Plan.                                 established.
20   Increase the use of Elearning by NHS Fife         On track to complete by agreed dates.                                              D Christie      SG
     staff by 20% per annum.
21   Review Workforce Modernisation and                On track to complete by agreed dates.                                              R Webster       SG
     Development Strategy.
22   50% of key frontline staff in mental health and   On track to complete by agreed dates.                                              D Christie   SG/HWBA
     substance misuse services, primary care and
     A&E being educated and trained in using
     suicide assessment tools/suicide prevention
     training programmes to support the reduction
     in the suicide rate between 2002 and 2013 by
23   NHS Boards to ensure that all employees           On track to complete by agreed dates.                                              D Christie      SG
     covered by Agenda for Change have an
     agreed KSF Personal Development Plan.
24   Develop, review and implement the Staff           On track to complete by agreed dates.                                              R Webster       SG
     Governance Action Plan using the Self
     Assessment Audit Tool.

25   Implement Healthy Working Lives Strategy for On track to complete by agreed dates.                                                   R Webster       SG
     NHS Fife employees.
No. Target                                                Update on Target Achievement (Aug 2008) - Board             Accountable    Governance
                                                                                 Version                               Executive     Committee
26  Develop capacity in community settings,             On track to complete by agreed dates.                           V Irons         F&R
    including community resource centres, for the
    provision of care closer to home.
27 By 2008-09, we will reduce the proportion of         Telecare project now fully established. SPARRA data being         G           OD/CHPs
    older people (aged 65+) who are admitted as         utilised. Data collection is retrospective and given          Cunningham
    an emergency patient 2 or more times in a           challenging targets it is prudent to suggest there may be a
    single year by 20% compared with 2004/05            delay in achieving targets.
    and reduce, by 10%, emergency inpatient bed
    days for people aged over 65.
 28 Increase the level of older people with complex     On track to complete by agreed dates.                             G          SR/HSCP/
    care needs receiving care at home.                                                                                Cunningham       CHPs

 29 To achieve agreed reductions in the rates of        On track to complete by agreed dates.                           V Irons         SR
    hospital admissions and bed days of patients
    with primary diagnosis of COPD, Asthma,
    Diabetes or CHD, from 2006/07 to 2010/11.

30  Ensure Service Redesign and Planning within         On track to complete by agreed dates.                          Dr F Elliot      SR
    NHS Fife is in line with Better Health Better
31 Review, develop and manage referral                  On track to complete by agreed dates.                           V Irons      SR/HSCP/
    pathways                                                                                                                         CHPs/OD
32 Reduce the number of readmissions (within 1yr        On track to complete by agreed dates.                             G           HSCP
    for those that have had a pyschiatric hospital                                                                    Cunningham
    admission of over 7 days by 10%).
 33 Reduce the annual rate of increase of defined       As at March 2008, there were 32.32 anti-depressant DDDs           G             SR
    daily dose per capita of anti-depressants to        per capita against a trajectory of 32.09. First phase of      Cunningham
    zero by 2009/10, and put in place the required      Integrated Care Pathway development plan completed and
    support framework to achieve a 10% reduction        audited for accreditation by NHS QIS. Each CHP confirming
    in future years.                                    at next Co-ordinating Group what is happening locally to
                                                        change prescribing patterns.

34   Each NHS Board will achieve agreed                 On track to complete by agreed dates.                             G            HSCP
     improvements in the early diagnosis and                                                                          Cunningham
     management of patients with a dementia.
35   Undertake a review of Out-of-Hours services.       On track to complete by agreed dates.                          S Manion        CHPs

36   Enhance the provision of care for patients with Progress Assessment and Treatment Unit: planning of the          S Manion       HSCP/SR
     learning disabilities.                           unit is ongoing. Technical difficulties in relation to
                                                      refurbishment have necessitated new build. Completion
                                                      date March 2010.
                                                      Service actively taking forward discussions on models of
                                                      Review of joint models of care for community based
                                                      learning disability services: LD Service are exploring options
                                                      for future joint/aligned organisational arrangements with
                                                      Social Work Service, statement of intention on joint working -
                                                      March 2009.
                                                      Joint Resourcing and Joint Management Group (Learning
                                                      Disability) established July 2007.
                                                      Progress Regional Learning Disability Unit: Planning for the
                                                      Regional LD Unit is ongoing. Completion date scheduled for
                                                      November 2009.
37   Provide services to support and reduce the       On track to complete by agreed dates.                               G             FP
     number of people abusing drugs.                                                                                 Cunningham
38   QIS clinical governance and risk management On track to complete by agreed dates.                                 G Birnie         CG
     standards improving.
39   Contribute to the SEAT Regional Work Plan        On track to complete by agreed dates.                          G J Brechin        SR
     and linked activity.
40   Ensure that planning and delivery of services in Regular meetings now in place and a work programme              Dr F Elliot       SR
     NHS Fife and NHS Tayside are aligned, taking being developed. Review of performance management of
     account of the impact on patient flows.          Service Level Agreement still in progress. Mapping exercise
                                                      on schedule for completion in September 2008. This will
                                                      guide the finalisation of an agreement demonstrating

41   Work closely with Fife Council to deliver travel   On track to complete by agreed dates.                          D O'Keeffe       FP
     planning for all major hospital sites.
42   Develop robust Flu Pandemic planning               On track to complete by agreed dates.                          G Radford     CG/HWBA
No.   Target                                                        Update on Target Achievement (Aug 2008) - Board Version                     Accountable   Governance
                                                                                                                                                 Executive    Committee
43    NHS Boards to deliver agreed improved           On track to complete by agreed dates.                                                       J Wilson     OD/CHPs
      efficiencies for 1st outpatient attendance DNA,
      non-routine inpatient average length of stay,
      review to new outpatient attendance ratio and
      day case rate.

44    To increase % of new GP outpatient referrals        On track to complete by agreed dates.                                                   J Wilson     OD/CHPs
      into consultant led secondary care services
      that are triaged online for clinical priority and
      appropriate recipient service to 90% from
      December 2010.
45    Rollout expansion of Nurse Bank to cover all        ● All preparatory work completed for transfer of staff (approx. 18 members of staff     J Wilson      A/F&R
      aspects of CHPs/AHPs - bank to be utilised          in Stratheden and Whytemans Brae). All Bank staff and Charge Nurses have been
      rather than agency reducing costs to                informed by letter and drop-in sessions held. Delay in complete transfer due to
      organisation.                                       payroll merge (from monthly to weekly). All sites are accessing Bank Office for
                                                          staff. Adamson, Netherlea and St Andrews are using service to advertise for
                                                          ● Review carried out - recruitment to bank continues as demand not fully met by
                                                          NHS Fife Bank. Small percentage still offered to agency or 'unfilled'. Situation
                                                          continues to be monitored.
                                                          ● Retention Strategy agreed. Stability in Bank Admin team.
46    Produce and implement in priority areas NHS         On track to complete by agreed dates.                                                 C Adamson       CG/All
      Fife Business Continuity Plan.                                                                                                                          Committees
47    Progress the completion of significant capital      On track to complete by agreed dates.                                                  D O'Keeffe     F&R
      building schemes within planned timetables
      and budgets.
48    Implement NHS Fife Child Action Plan                On track to complete by agreed dates.                                                 A Buchanan       SR
49    Progress the integration of Paediatric Services     On track to complete by agreed dates.                                                  S Manion      CHPs/OD
      within NHS Fife.
50    Universal utilisation of CHI                 Performance dipped below 97% during April and May 2008 - 93% as at May 2008.                   S Clark        CG
                                                   A number of measures have been taken to improve performance. Actions include
                                                   the wider distribution of label printers across hospital wards and an increase in the
                                                   number of results included in the monthly analysis to improve statistical reliability of
                                                   the results.
51    Implement targets within local eHealth       Information restructure nearing completion but still progressing with HR and staff             S Clark        CG
      Strategy Action Plan.                        side.
52    Operate within the agreed Revenue Resource On track to complete by agreed dates.                                                          R Pettigrew     A/F&R
      Limit (RRL) and Capital Resource Limit (CRL)
      and meet the Cash Requirement.

53    Meet the Cash Efficiency Target.             On track to complete by agreed dates.                                                        R Pettigrew     A/F&R
54    Achieve agreed reductions in the rates of    On track to complete by agreed dates.                                                          V Irons      CHPs/OD
      attendance at A & E from 2006/07 to 2010/11.

55    Ensure that anyone contacting their GP              48-Hour access ceased being a Directly Enhanced Service on 31 March 2008.                F Elliot      CG
      surgery has guaranteed access to a GP,              GPs can still claim points for 48-Hour access using the Quality and Outcomes
      Nurse or other Health Care Professional within      Framework (QOF) voluntarily. The QOF achievement for these indicators will be
      48 hours.                                           measured by a National Patient Survey which has yet to be carried out therefore
                                                          there is no data currently available.
56    Achieve and maintain all waiting time               On track to complete by agreed dates.                                                   J Wilson     OD/CHPs
57    Continue progress on managing the dental     P-Cat Audits - Directly managed: all completed. Independent: All 49 GDP and 73                 J Leiper       CG
      decontamination process and progress actions GMP areas have been completed but the actual number of audits undertaken have
      resulting from the P-Cat audits.             been much greater due to the number of treatment rooms in each area. 51
                                                   Optometrist areas still to be carried out. NHS Fife has no remaining P-Cat
                                                   auditors but arrangements are in place to complete optometrists areas before the
                                                   end of 2008.
                                                   Improvement in non-compliances - Organisational and procedural elements of
                                                   audits have been corrected in many areas but the physical change required to
                                                   buildings is taking time for a variety of reasons e.g. reviewing premises, consulting
                                                   stakeholders, working up and costing possible design solutions, Infection Control
                                                   interface etc.
                                                   LDU Plan - An Action Plan has been produced and an anticipated programme of
                                                   work and expenditure arising from the findings of the P-Cat Audits is to be
                                                   prepared. The improved design of 3 LDU's is currently in progress.
                                                   Funding - Funding has been allocated to the improvement of Decontamination
                                                   practice in NHS Fife and funds will be managed to be available when required.

                                                          Resources/Infrastructure to implement improvements - Decontamination structure
                                                          is in place and decontamination work being taken forward. A pilot of single use
                                                          instruments for Podiatry to conclude shortly advising the Decontamination Strategy
                                                          for this service and its influence/impact on decontamination as a whole in NHS
                                                          Fife. Testing and validation of washers currently being procured from an external
58    Implement annual programme of quality               On track to complete by agreed dates.                                                   F Elliot     D&TC/CG
      prescribing initiatives in Primary Care.
59    Reduce the impact of NHS Fife's consumption On track to complete by agreed dates.                                                           J Leiper       FP
      and production in relation to the local
60    Ensure NHS Fife's contribution to            On track to complete by agreed dates.                                                        C Adamson        FP
      implementation of revised Community
      Plan/Single Outcome Agreement is embedded
      in NHS Fife's plans and operational delivery

A-       Audit                                HSCP -   Health & Social Care Partnership
CG -     Clinical Governance                  HWBA -   Health & Wellbeing Alliance
CHPs -   Community Health Partnerships        KL -     Kirkcaldy & Levenmouth CHP
D&TC -   Drugs & Therapeutics Committee       OD -     Operational Division
DWF -    Dunfermline and West Fife CHP        PFPI -   Patient Focus/Public Involvement
FP -     Fife Partnership                     SG -     Staff Governance
F&R-     Finance & Resources                  SR -     Service Redesign
GNEF -   Glenrothes and North East Fife CHP
HS -     Health & Safety

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