NHSScotland Local Delivery Plan Guidance 2013/14

This document sets out for NHS Boards the Guidance underpinning the production of their Local Delivery Plans for 2013/14

3 HEAT targets & standards

There has been wide engagement on HEAT target development with proposals considered on the basis of strategy, delivery and measurement.

For 2013/14 there are 15 targets which set out the 'performance contract' between Scottish Government and NHS Boards - these include three new targets:

  • Dementia - a minimum of one year's post diagnostic support, through a link worker, for people newly diagnosed with dementia including person-centred support plan. This target will be due for delivery by 2015/16. This supports sustained independence within context of strong family and community support and promotes early decision making on future care options as part of person-centred care.
  • Healthcare Associated Infection - to further reduce the levels of staphylococcus aureus bacteraemia (including MRSA) and Clostridium difficile. Reducing preventable HAI directly supports healthcare that is free from avoidable harm.
  • IVF - eligible patients will commence IVF treatment within 12 months by March 2015. This will ensure equitable access to IVF services across Scotland.

For 2013/14 there is one new HEAT standard on drug and alcohol misuse treatment waiting times. The former HEAT standard on early diagnosis of dementia is now included within the new HEAT target on dementia support.

HEAT 2013/14 Target Policy Aim
To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25% by 2014/2015. To improve Scottish cancer survival outcomes. Late-stage diagnosis accounts for most of the European variation in survival and elderly people and less affluent groups are particularly affected by late diagnosis and a survival deficit. The high rate of avoidable deaths from cancer is due to people being diagnosed with cancer when their tumour is at a stage when life saving treatment will not contain its impact and spread. There is a cancer treatment waiting times HEAT standard.
At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours. To improve early access to antenatal services to support mothers-to-be to breastfeed, improving maternal and infant nutrition, reduce harm from smoking, alcohol and drugs, and improve healthy birth weight. These health behaviours will be monitored through the Maternity care quality indicators.
At least 60% of 3 and 4 year olds in each SIMD quintile to have fluoride varnishing twice a year by March 2014. To increase the number of children who are decay free at age 5 years, particularly addressing inequalities. Dental decay is almost totally preventable but is the most common reason to admit children to hospital and accounts for significant pain and discomfort to the child and to absence from school.
To achieve 14,910 completed child healthy weight interventions over the three years ending March 2014. Maintaining a healthy weight during childhood is important for both physical health and mental wellbeing. The best start in maintaining a healthy weight is through breastfeeding. Being overweight or obese during childhood is a health concern in itself, but when it continues into adulthood it can lead to physical and mental health problems, such as heart disease, diabetes, osteoarthritis, increased risk of certain cancers, low self-esteem and depression.
NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014. The Scottish Government remains committed to driving down smoking levels further. NHS Boards will continue to deliver a universal smoking cessation service, and there is an emphasis on helping people in deprived areas and pregnant mothers to stop smoking. All pregnant women will have smoking status recorded on attendance at antenatal clinic and will be offered smoking cessation support.
Reduce suicide rate between 2002 and 2013 by 20% Evidence indicates that open discussion about suicide reduces its risk. Therefore, the more people who feel confident and willing to explore possible signs of suicide risk and provide support and help, the more lives could be saved.
NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement. NHS Boards have an obligation to operate within their allocated funds and ensure value for money.
NHSScotland 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. Both the carbon emissions reduction target and efficiency target are designed to not only achieve the Climate Change (Scotland) Act 2009 target, but also ensure that NHSScotland continues to lead by example within the Public sector. This will secure NHSScotland contribution to the Scottish Government's national Outcome to "reduce the local and global environmental impact of our consumption and production".
Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013, reducing to 18 weeks from December 2014; and 18 weeks referral to treatment for Psychological Therapies from December 2014. Timely access to healthcare is a key measure of quality in mental health and other services. Early action is more likely to result in full recovery and in the case of children and young people will also minimise the impact on other aspects of their development such as their education, so improving their wider social development outcomes. Psychological therapies have an important role in helping people with mental health problems, who should have access to effective treatment, both physical and psychological. These therapies can have demonstrable benefit in reducing distress, risk of harm to self or others, health related quality of life and return to work.
Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between 2009/10 and 2014/15. NHS Boards and their Local Authority and Third Sector partners' change fund is helping to address avoidable hospital admissions and bed days in older age groups, primarily through the provision of upstream support. Over 75s have longer hospital stays and a higher risk of Hospital Acquired Infections, delayed discharge and institutional care.
No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013; followed by a 14 day maximum wait from April 2015. To enable and support people to remain in their own home, as independently as possible, for as long as possible. When this is not possible then people should be cared for in as homely a setting as possible. This will seldom be a hospital bed. The norm should be to discharge in hours and days.
To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14. A&E attendances across all age groups should decrease with better provision and use of primary care services, better preventative and continuous care in the home, and improved self care.
To deliver expected rates of dementia diagnosis and by 2015/16, all people newly diagnosed with dementia will have a minimum of a year's worth of post-diagnostic support coordinated by a link worker, including the building of a person-centred support plan This supports sustained independence within context of strong family and community support and promotes early decision making on future care options as part of person-centred care. This will be aligned with Alzheimer Scotland's 5 pillar of support.
Eligible patients will commence IVF treatment within 12 months by 31 March 2015. This will ensure equitable access to IVF services across Scotland.
Further reduce healthcare associated infections so that by March 2016 NHS Boards' staphylococcus aureus bacteraemia (including MRSA) cases are 0.24 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 15 and over is 0.25 cases or less per 1000 total occupied bed days. To provide professional and clinical leadership in reducing HAI in hospitals and other settings ensuring safe and effective care and systems as well as maximising healthcare outcomes for patients.

HEAT 2013/14 Standard Policy Aim
95% of all patients diagnosed with cancer to begin treatment within 31 days of decision to treat, and 95% of those referred urgently with a suspicion of cancer to begin treatment within 62 days of receipt of referral Timeliness and access are integral to a quality service and can contribute to improved survival outcomes.
90% of planned / elective patients to commence treatment within 18 weeks of referral Access is a key measure of quality and faster access to diagnosis and treatment services reduces patients' uncertainty and stress and improves their quality of life.
No patient will wait longer than 12 weeks from referral (all sources) to a first outpatient appointment (measured on month end Census)
Provide 48 hour access or advance booking to an appropriate member of the GP Practice Team Often a patient's first contact with the NHS is through their GP practice. It is vital, therefore, that every member of the public has fast and convenient access to their local primary medical services to ensure better outcomes and experiences for patients.
To respond to 75% of Category A calls within 8 minutes across mainland Scotland (Scottish Ambulance Service) Patients in situations categorised as potentially immediately life threatening need the ambulance service to respond as quickly and safely as possible in order to maximise the outcome for the patient.
98% of patients will wait less than 4 hours from arrival to admission, discharge or transfer for accident and emergency treatment Medical evidence shows that long waits impact on patient experience and the quality of care.
90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. To ensure more people recover from drug and alcohol problems so that they can live longer, healthier lives, realising their potential and making a positive contribution to society and the economy. The first stage in helping people to recover from drug and alcohol problems is to support action across the country to provide a wide range of services for individuals and their families that are recovery focused, good quality and that can be accessed where and when they are needed.
NHS Boards to achieve a sickness absence rate of 4% Sickness absence can result in cancelled appointments and procedures, increased pressure of staff, and increased cost.
NHS Boards and Alcohol and Drug Partnerships (ADPs) will sustain and embed alcohol brief interventions (ABI) in the three priority settings (primary care, A&E, antenatal). In addition, they will continue to develop delivery of alcohol brief interventions in wider settings. ABIs are a highly effective early intervention to help individuals to reduce hazardous or harmful alcohol use, thereby reducing their chances of developing more serious alcohol-related problems. The standard will ensure that NHS Boards and ADPs sustain and embed delivery of ABIs in the three established settings as well as enabling them to extend into wider settings, contributing to the developing evidence base. This will ensure that ABIs remain a core component of local strategies to reduce alcohol related harm.


Email: David Smith

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