NHSScotland Local Delivery Plan Guidance 2013/14

4 Local Delivery Plans

Local Delivery Plans

Local Delivery Plans will record agreement on NHS Boards' planned progress towards meeting key national targets. They will cover a period of three years, with the opportunity to review and adjust future years' plans each year.

The 2013/14 LDP Methods and Sources describes the performance measures used to monitor performance.

NHS Board Contribution to Community Planning Partnership

The Statement of Ambition issued following the recent Review of Community Planning and Single Outcome Agreements makes clear that effective community planning arrangements will be key strategic building blocks at the core of public service reform. It highlights the importance of removing barriers to effective partnership working and the need to ensure that leadership and cultures, systems and structures, and accountability arrangements across the public sector fully enable the delivery of better outcomes for communities. Work is now in hand to deliver on that Statement of Ambition, including the establishment of a National Group on Community Planning which will provide strategic oversight for how this overarching vision for community planning and Single Outcome Agreements develops.

NHS Boards are key partners within Community Planning Partnerships and have a crucial role to play in delivering improvements on a local and national basis. There is widespread agreement that Community Planning Partnerships focus on a small number of key priorities: economic recovery and growth; employment; early years and early intervention; safer and stronger communities, and offending; health inequalities and physical activity; and older people. Like all public bodies, there is an expectation that NHS Boards as CPP partners have evidence based understanding of local needs and opportunities which is translated in to prioritised plans and delivery of improved outcomes.

In this LDP NHS Boards are expected to indicate how they will improve their partnership approach during 2013/14, specifically focusing on how they will contribute to better outcomes through collaborative gain.

Building on the "critical issue" approach in last year's LDP, this year LDPs are expected to include a concise summary of the key tangible contributions that the NHS Board will make during 2013/14 towards improved outcomes in economic recovery and growth; employment; early years and early intervention; safer and stronger communities, and offending; health inequalities and physical activity; and older people. Clearly national improvements through HEAT and other programmes play an important role, however, this part of the LDP is expected to focus on locally developed improvements with a strong emphasis on changes to NHS services which reduce future demand by preventing problems arising or dealing with them early on. Helping people understand why this is the right thing to do, the choices it implies as well as the benefits it can bring will be crucial. These contributions are expected to be developed through the SOA and NHS Boards will be developing the planned contributions through local Community Planning Partnership and NHS Board structures. Where appropriate current performance and planned improvements in performance should be included.

The Scottish Government will discuss progress against these commitments at mid year stock takes and Annual Reviews.

LDP Risk Management Plans & Delivery Trajectories

Boards should, as in previous years, include LDP Risk Management Plans to provide contextual information on key risks to the delivery of each target and how the risks are being managed. Cross-reference to local plans should be made where necessary.

• Delivery and improvement: briefly highlight local issues and risks that may impact on the achievement of targets and/or the planned performance trajectories towards targets and how these risks will be managed.
• Workforce: provide a brief narrative on the workforce implications of each of the HEAT targets where appropriate and relevant. This should include an assessment of staff availability to deliver the target, the need for any training and development to ensure staff have the competency levels required, and consideration of affordability cross referenced to the Financial Plan.
• Finance: Where applicable boards should identify and explain any specific issues, e.g. cost pressures or financial dependencies specifically related to achieving the target. There is no need to repeat generic financial risks that apply to all targets.
• Equalities: Where applicable, boards should outline any risks that the delivery of the target could create unequal health outcomes for people with protected characteristics, and/or for people living in socio-economic disadvantage; and how these risks are being managed.

NHS Boards are expected to have processes in place to ensure that equality impact assessments for the three new HEAT targets are easily accessible to the public and demonstrate the actions that NHS Boards take following these equality impact assessments.

Setting out planned performance against key measures will enable NHS Boards and DG Health & Social Care to track actual operational performance against Boards' plans. The delivery trajectiories therefore provide an objective, factual basis to discuss with Boards any operational performance issues that may arise during the plan period and to offer support to achieve improvement if that is needed.

In order to minimize delivery risks, it is expected that delivery trajectories will generally see uniform improvements over time, avoiding reliance on significant improvements in the final stages of delivery. The Directorate for Health Workforce & Performance will continue to support Boards in benchmarking their performance, and will work on spreading good practice associated with improving performance.

This quantified and measured approach to performance planning and monitoring does not imply any reduction in the importance of the qualitative aspects of performance. Providing assurance to the Board, its Clinical Governance Committee (or equivalent) and the public about the quality of healthcare services continues to be a vital task for each Board. Local monitoring of quality will continue to be augmented at the national level by Healthcare Improvement Scotland and their Healthcare Scrutiny Model. This model will provide a framework for scrutiny activity, including inspections, peer review and accreditation and these reports will continue to be monitored by DG Health & Social Care.

Trajectory Change Control Process

Once an LDP has been agreed and signed off by DG Health & Social Care and the NHS Board, any mid‑year alterations to trajectories need to be agreed between the Directorate of Health Workforce & Performance and the NHS Board. The trajectory change control process to alter trajectories will be operated by the performance management teams in the Directorate of Health Workforce & Performance.

LDP Financial Plans

The Draft Budget 2013-14 can be found at http://www.scotland.gov.uk/Publications/2012/09/7829. Final NHS Board allocations will be agreed through the Scottish Budget.

Financial planning is an integral component of LDPs. To ensure that Boards plan over the longer term, financial plans are generally required for a three year period. However, a five year plan is required where any of the following apply: major infrastructure development, brokerage arrangements are in place, underlying deficit of over 1% of baseline resource funding, major service redesign. In terms of capital, a five year plan is required from all Boards. Boards are notified individually regarding the period of their financial plan.

NHS Boards should include draft financial plans as part of their LDP submission, in line with the timetable presented. In particular, NHS Boards are asked to complete the financial templates. Particular emphasis should be placed on workforce planning and NHS Boards should provide assurances that their proposed workforce requirements are driven by and reflect service change and are affordable. The detailed financial information included in the templates will be used to assess each Board's financial projections, including key risks/assumptions, to ensure achievement of financial targets.

The Scottish Government is supporting NHS Boards to improve the quality of services, and to eliminate waste and variation. The NHSScotland Efficiency and Productivity Framework for SR10 published in February 2011 identify priority areas to improve quality and efficiency. The Framework underpins NHS Boards' Efficiency Savings Plans. As part of the Financial Plans efficiency savings are required to be categorised by seven themes: Service Productivity, Drugs and Prescribing, Procurement, Workforce, Shared Services, Support Services, and Estates and Facilities.

Monthly performance assessment of the agreed financial plan / trajectories will continue to be based on the monthly Financial Performance Returns (previously called the Monthly Monitoring Returns, MMRs).

Workforce Planning

Ensuring the correct workforce is available to deliver the required clinical and supporting services is central to the delivery of key polices and targets, and the Quality Strategy. The three central workstreams within our Workforce 20:20 Vision - Governance & Engagement; Leadership & Capability; Capacity & Modernisation will help to describe our future workforce needs. Development and implementation of the NHSScotland workforce are also being taken forward through a number of workstreams including those linked to efficiency and productivity.

The Scottish Government set a target 25% reduction in NHSScotland senior management posts by the end of the next Parliament (2014/15). Guidance has been issued to enable NHS Boards to contribute towards the delivery of this target in ways that reflect individual Boards circumstances and their wider service plans.

Workforce planning is a key factor in enabling NHS Boards to deliver quality frontline services. It is important to ensure that changes to the NHS workforce are driven by patient safety, patient need and service demand. Service & workforce change should be designed to maintain and enhance the quality of care for patients while increasing efficiency. Staff should be empowered to use their local knowledge and professional judgment to do 'the right thing'. They should be supported to develop the skills both to work in partnership with other professionals and to actively engage with patients to co-produce care. The workforce narrative in the LDP Risk Management Plans therefore helps to ensure that the workforce capacity & capability implications of key HEAT targets are fully taken into account in NHS Boards' LDPs, and further reflected in Board Annual Workforce Plans and Projections. It is acknowledged that HEAT targets and LDPs do not represent the complete range of NHS Board services which rely on a multi-professional workforce mix for successful delivery but they contribute to an assessment of the total required capacity and skill requirements.

CEL 32(2011) Revised Workforce Planning Guidance 2011, this guidance reflects the 6 Step Methodology to Integrated Workforce Planning and is applied across the whole NHSScotland Workforce. The guidance and six steps methodology makes reference to workforce projections as part of the wider workforce planning process, NHS Boards are required to submit projections annually. The Scottish Government template for these projections, includes specific guidance on coverage and completion, and requires detailed projections for most staff groups for a 3 year period. This timeframe aligns the projections exercise with the normal Spending Review period, but consideration of longer term future workforce planning continues to be important to support decisions on undergraduate training numbers for the "controlled" staff groups of medical, dental and nursing and midwifery, and the wider education agenda across all staff groups to allow for preparation time and effective succession planning.

NHS Boards will be required to publish their wider workforce plan during 2013. Further guidance on the timings and process for submitting these, and workforce projections to the Scottish Government will follow in due course. Nursing & Midwifery have developed a series of Workload & Workforce Planning Tools, the application of these tools is mandatory to support evidence based decisions in relation to Nursing & Midwifery establishments. The tools use rigorous statistical analysis to calculate the whole time equivalent for current workload. These tools should form part of a triangulated approach to incorporate professional judgement and quality measures which will enable flexibility in decision making on staffing needs at local level. The Workload Tools available on the IT Platform via SSTS. The Scottish Government will work closely with Boards to refresh and continue to develop these workload tools to ensure they capture and reflect the changing case mix and modes of health care delivery.

NHS Boards are required to include in their LDPs, a brief summary of the anticipated workforce requirements, based around the following five headlines:

• describe existing and planned new service areas with particular workforce pressures and risks, which could affect the delivery of quality services, and the management of these risks;
• advise on significant changes in skill mix across the career framework and the plans to take this redesign forward;
• describe other significant workforce challenges that the Scottish Government should be aware of that may require a national focus to support resolution;
• how the workforce is contributing to efficiency savings; and
• describe the processes in place to ensure workforce capacity and capability risk assessments are undertaken in accordance with LDP Risk Management Plans around the delivery of HEAT targets

NHS Island Boards and mainland NHS Boards Partnerships

The Scottish Government is committed to retaining and ensuring the long term sustainability of Scotland's three island Boards (NHS Orkney, NHS Shetland and NHS Western Isles). The independence of these Boards allows them to develop and deliver services that meet the needs of their local population in ways that reflect the challenges of providing high quality services for island communities.

Each island Board has, over many years, played a full and active part within the regional planning process under which Boards agree to collaborate in order to develop and sustain healthcare services. It has been agreed to provide the support funding to enable NHS Boards to extend the concept of collaborative working to non clinical as well as clinical issues. Additional funding has been allocated to each island Board to enable them to enter into arrangements with their respective partners to strengthen their capability in areas such as: Human resources; Finance / Payroll; Governance; and Planning. It will enable Boards to set out an agreement that describes joint programmes of work between:

• NHS Orkney and NHS Grampian;
• NHS Shetland and NHS Grampian; and
• NHS Western Isles and NHS Highland

The three island Boards will remain independent and the precise shape and form of these partnership arrangements will be a matter for the members of the partnership themselves. They will be developed as a partnership of equals and it is anticipated that a Non Executive Director from each partner will attend the Board meeting of the other partner in order to ensure effective and ongoing liaison at the very highest level. The annual service agreement will form an addendum to the 2013/14 Local Delivery Plan of each partner. There may be some exceptional circumstances in which partners agree that the identified mainland partner Board is unable to provide a particular service, and in such cases, the island Board will be able to source this requirement from an alternative partner. Boards have formal arrangements in place to keep these arrangements under regular review.

HEAT Standards

The Scottish Government will continue to monitor the HEAT standards, NHS Boards are not required to provide delivery trajectories and risk narratives. Performance against HEAT standards is reported through Scotland Performs.

For 2013/14 there is one new HEAT standard on drug and alcohol misuse treatment waiting times. NHS Boards are on track to deliver the HEAT target to ensure that 90% of all patients admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013. Statistics will continue to be published on admission to stroke units and NHS Boards will continue to monitor performance locally. The former HEAT standard on early diagnosis of dementia is now included within the new HEAT target on dementia support.

NHS Board Planning

NHS Boards should ensure robust and clear planning arrangements at local level, engaging appropriately with local partners across the full range of health and social care policy, planning, service redesign and delivery issues.

Boards should consider the Review of Regional Planning in NHS Scotland Report 2012 collectively within regions and agree how best to consolidate and improve the benefits to date derived from regional approaches.

A number of HEAT targets cannot be delivered by NHS Boards alone. The Reshaping Care for Older People Programme and the introduction of the Change Fund are driving radical reforms to improve outcomes for individuals. The principles have been embraced by local government, the third sector and the independent sector and they should continue to be fully involved as partners in the delivery of relevant HEAT targets. These principles involve releasing resources tied up in institutional care, to support preventative and upstream interventions and to provide more appropriate support for older people. These are all issues that will be addressed by the integration of adult health and social care and should immediately be tackled though joint work on developing strategic commissioning plans. NHS Boards, along with their local authority and third and independent sector partners, are expected to have in place joint strategic commissioning plans by March 2013. Guidance on developing commissioning plans for older people issued in November 2012. The Change Fund should continue to be used as bridging finance to make better use of the overall combined resources for older people, investing in more preventative interventions and enabling partners to disinvest in institutional care. Partners will then jointly decide on how best to use the total resource envelop for older people. Joint strategic commissioning will be a key component of the Scottish Government's proposals to integrate adult health and social care. NHS Boards should consider how to embed future LDPs within the broader partnership agenda.

In terms of Early Years, NHS Boards should continue to play an active role in developing their local Integrated Children's Services plan along with other relevant members of the Community Planning Partnership. The Integrated Children's Services Planning process centres on understanding local needs, taking forward actions to address these and to improve outcomes for children. The Early Years Change Fund is a combination of existing funds currently committed and new funds yet to be allocated. The Scottish Government have always been clear that the monies in the Change Fund are a starting point and the partners should collectively consider how to increase the impact of the totality of spend. Given that the work of the Taskforce is now a year in, the Taskforce has signalled its intention to review how the Change Fund is currently operating and, consider how consistency and coherence across the country is accelerated.

NHS Boards working with Community Planning partners have a key role to play in implementing the Getting it right for every child (GIRFEC) approach. The GIRFEC approach requires services to work together to co-ordinate the design, planning and delivery of support for the child, when and where it is needed. The formal consultation on proposed provisions for key components of the approach in the Children and Young People Bill has just finished. NHS Boards should continue to work with partners in taking forward implementation in anticipation of legislation.

Boards' planning for healthcare should meet the needs of prisoners and prisons and ensure that agreed standards are delivered.

Boards should ensure that all of these activities and their LDPs are consistent with the quality ambitions outlined in The Healthcare Quality Strategy for NHSScotland and the direction set in Better Health, Better Care.

Boards should ensure that they continue to fulfil their statutory obligations on co operation and public involvement and are encouraged - in line with the public service reform approach - to go beyond this, actively engaging individuals and communities in the co-production of services. Boards should also ensure that local and regional planning supports their performance agreement with Scottish Government set out in the LDP, and that focus and alignment is maintained across the full range of local service planning and delivery to ensure achievement of planned progress towards meeting the key targets in the LDP.

Clearly the efforts and performance of CHPs will continue to be vital in shifting the balance of care and improving outcomes for local people and communities. NHS Boards need to ensure that CHPs play their full part in helping to meet the targets as planned and support the delivery of broader health improvement strategies. NHS Boards need to ensure that CHPs are able to develop effective, integrated community based services that have been robustly tested through the Integrated Resource Framework. CHPs should draw together health, social care and third sector partners, and seek to evidence the impact on targets and quality improvement which is an essential part of this process. NHS Boards should be mindful of Ministers' plans to further integrate adult health and social care and the development of joint strategic commissioning.

The achievement of targets set out in LDPs is also underpinned by service delivery and improvement work across NHSScotland, including QuEST and JIT. This detailed underpinning work will continue to play a vital role in supporting Boards to meet the targets set out in the LDP.

Special Health Boards (SHBs)

SHB LDPs should include a section describing how their objectives support National Outcomes, Quality Ambitions and quality outcomes.

SHBs are required to complete the Financial Templates and workforce summaries.

The State Hospital and National Waiting-Times Centre will also be required to complete risk management plans and delivery trajectories for the target to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009. The remaining SHBs will be required to develop local targets to reduce carbon and energy consumption.

The National Waiting-Times Centre Board will also be required to complete risk management plans and delivery trajectories for the relevant HEAT targets.

Health Directorate lead sponsors will provide guidance and advice on LDP content. It is anticipated that for 2013/14 this is likely to focus on delivery of key priorities and the support provided to territorial Boards in achieving key HEAT targets across Scotland measured through SMART targets and performance measures.

Publishing Local Delivery Plans

NHS Boards should ensure that the final Local Delivery Plans are published on their local websites by end of June 2013.

Mid-Year Stock-Take and Annual Reviews

The Annual Review will continue to focus on progress made on key priorities, performance against HEAT targets, and the contribution towards delivery of the outcomes.

NHS Board Chief Executive and senior management team mid-year stock-takes with the Scottish Government Health & Social Care Directors will provide the opportunity to take stock of 2012/13 performance, and also to look ahead to 2013/14.

We plan to continue to report progress against HEAT targets through the Scottish Government's Scotland Performs website.

The HEAT Performance Management IT system will be updated with HEAT 2013/14 targets (www.bic.scot.nhs.uk).

2013/14 Development Targets

This year three developmental HEAT targets will be taken forward.

• Workforce - Engagement is underway with a range of stakeholders including HR Directors, Deputy HR Directors and Employee Directors to develop proposals for a HEAT target to support implementation of the Staff Governance Standard. A developmental HEAT target will be tested during 2013/14. It is expected to take account of the range of Workforce transactional measures such as attendance rates, PDP review uptake, turnover rates, grievance and disciplinary process measures; and Workforce transformational measures such as vision, values, behaviours, staff experience/engagement, wellness/wellbeing.
• Musculoskeletal AHP Waiting times - During 2013/14, the Scottish Government will work with NHS Boards on a developmental HEAT target to reduce Musculoskeletal AHP waiting times - with detailed target definitions agreed in year. MSK is a high volume speciality with conditions that are most commonly reported type of work-related illnesses. There is significant variation in referral rates and waiting times across Scotland. A new MSK pathway has been designed, which has the potential to release significant efficiency savings for reinvestment in frontline services.
• Carbon Reduction - The introduction of the Public Sector Sustainability Reporting (PSSR) Guidance for Public Bodies in January 2012 provides the opportunity to align HEAT target measurement with the rest of the public sector. Scottish Government and Health Facilities Scotland will engage with NHS Boards to develop baseline data, measurement systems, and definitions for a new target during 2013/14. The existing targets for reductions of 3% per annum in carbon and 1% per annum in energy consumption will continue to be in place for 2013/14.