Health and social care delivery plan: progress report

5 NHS Board Reform

5.1 The objective of the Board Reform activity is to review the functions of existing national NHS Boards, exploring the scope for more effective and consistent delivery of national services; and the support provided to local health and social care systems for delivering services at a regional basis. A further priority is to ensure current leaders are equipped to drive the changes required, and ensure sustainability of approach by identifying the next cohort of future NHS Scotland leaders.

What we have done

5.2 Territorial and Special NHS Boards are collaborating in a number of ways, including with Integrated Joint Boards (IJBs), to allow service reform on the basis of population needs as set out in the National Clinical Strategy. NHS Board Chief Executives, supported by programme teams, have been working to develop more standardised, harmonised approaches across Scotland to improve equity of care and access, improve the use of resources and improve the sustainability of services. Progress is now gaining traction with items including the development of Once for Scotland workforce policies and the commitment in Programme for Government 2019 to improve consistency in employee experience and workforce practices.

5.3 Work is also taking place to enhance workforce capacity, improve the employment experiences of staff, and make services more efficient and convenient through better use of digital technology.

5.4 Much of the work taken forward through regional collaboration is particularly focused on supporting actions to deliver the outcomes required by our Waiting Times Improvement Plan during the next 18 months, and in the longer term. Other activities support the drive to reduce demand (now and in the future) on services. Particular initiatives underway include:

• The East of Scotland Diabetes Partnership has been established as a whole system approach to tackle the prevention and reversal of Type 2 Diabetes (T2D) supported by the six Councils, six IJBs and three NHS Boards along with other agencies such as Diabetes Scotland and Health Scotland. The Partnership forms one of the Early Adopter sites implementing the T2D Prevention Framework (see Page 21).
• Enhancing workforce capacity in key specialties, for example, by developing a 'Once for Scotland' approach to NHS workforce policies across Boards, where appropriate.
• Patients seeing the right healthcare professional at the right time is one of the key aspects of primary care reform. Work is underway in East Lothian working with NHS 24 to triage GP patients to the most appropriate healthcare professional. Not only has this seen a reduction in GP workload, allowing them to focus on the most complex cases, but patients are seeing the most appropriate healthcare professional quicker, and referrals into secondary care have reduced.

5.5 One of the priority areas of the 2018 General Medical Services Contract Offer and associated Memorandum of Understanding was urgent care services within general practice being carried out by other healthcare professional than GPs. While this work is still in the development phase, some areas have seen the use of paramedics carrying out home visits to improve GP workload, and seeing great patient satisfaction rates. Evaluation of this work is currently underway to allow for learning to be shared.

5.6 The Practice Admin Staff Collaborative have piloted improved workflow optimisation for admin staff to improve their direction of patients to the most appropriate healthcare professional. This has worked successfully in four pilot areas, with work underway to roll out this approach.

5.7 We have developed a new approach to recruit, retain, develop and manage talent within Health and Social Care in Scotland to ensure the very best and most able leaders reach boardrooms. There are 4 key strands to the approach, launched under the banner of Project Lift^[33]: The project has progressed four main area as follows: Leadership Development; Talent Management; Performance Appraisals; and Values Based Recruitment.

5.8 The leadership development framework recognises that 'one size does not fit all' and promotes a more nuanced and meaningful approach, with a talent management database being used to match individuals to new/existing openings.

5.9 The new and bespoke Scottish Leadership Development offer for aspiring directors, Leadership^3,, has had a full cohort of 20 aspiring directors from all across Health and Social Care in Scotland in place since October 2018, and live collaborative projects are core to this initiative. A further cohort started in May 2019, with plans for a third cohort starting November 2019.

5.10 An inclusive approach has been designed to help identify and develop future leaders at all levels, by encouraging colleagues from all backgrounds and at all levels of seniority to participate, rather than relying on a traditional 'top down' approach. As at June 2019, over 2800 staff from across Health and Social Care have accessed the Talent Management process with more than 1,400 having completed the Self-Assessment Questionnaire.

5.11 A communities page has been added to the Project Lift website as one of many ways for individuals to engage in conversation. Several community events have already been held and others will follow throughout the year.

5.12 A national performance appraisal form for executives/senior managers in NHS Scotland was introduced in April 2018 to support consistency nationally, and was trialled throughout the year. We have actively sought feedback through 4 Remuneration Committee Roadshows which took place in April and May 2019.

5.13 In June 2018, we introduced recruitment processes for senior leaders in NHS Scotland using a Once for Scotland Values Based Recruitment approach. This means that the values of leaders, and how they relate to the values of NHS Scotland, are as important as their skills and experience. A significant number of recruitment processes have followed this approach, including the recruitment of 7 new NHS Board Chief Executives.

5.14 We are currently undertaking a pilot with Scottish Social Services Council to widen the scope of Project Lift further to include Social Care staff from Local Authorities.