Scottish Government

NEW COMPETITION DETAILS

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You can download the programme from our website: www.cci.scot.nhs.uk

Why not play it on your CD player at home or in your car?

welcome
to the second issue of the Centre for Change and Innovation newsletter.

This issue includes:

• Our audio programme number 2 - CD attached!

• Updates from our national programmes

• Report on the National Convention of Workforce Design

• Feedback about our television programmes

• Competition to win a week in a self-catering holiday cottage

The PFB

Patient Focused Booking (or PFB as we like to call it) is now being introduced by all mainland NHS Health Boards as well as NHS Shetland. This new method of booking outpatient appointments for patients at all 30 of the major outpatient booking sites across Scotland is quickly demonstrating its potential. Already hospitals are beginning to see the impact on Did Not Attends (DNAs), Can Not Attends (CNAs), clinic cancellations and importantly waiting times.

At The Royal Alexandra Hospital in Paisley the waiting time for General Surgery has fallen from 34 weeks in January to 24 weeks in June.

At Aberdeen Royal Infirmary the Orthodontic waiting time has fallen from 82 weeks in January to 18 weeks in July.

At Stobhill Hospital in Glasgow the General Surgery waiting times have fallen from 93 weeks to 31 weeks.

At Edinburgh Dental Institute waiting times for Oral Surgery have fallen from 65 weeks to 12 weeks.

The process works on the basis that appointments are booked only six weeks in advance and ensures six weeks notice of all planned consultant absences. Best of all it enables hospitals, for the first time, to provide choice to patients, of date and time of appointment.

These results are the green shoots resulting from the amazing efforts of staff taking part in the national PFB project all across Scotland and a score of local initiatives by each NHS Board. Well done.

Making it happen

The Cancer Service Improvement Programme (CSIP) Conference will take place on Friday 5th November 2004 at the Edinburgh Corn Exchange. This essential conference will review the current programme and future plans and will be opened by a speech from Mr Andy Kerr, Minister for Health and Community Care. The day will combine workshops, plenary sessions and guest speakers such as Dr Rashad Massoud from the USA who will share his thoughts from an international perspective and Dr Eddie Obeng, Founder, Pentacle, The Virtual Business School, UK. There is also an opportunity to hear about different views from three clinical leads across Scotland and from a Macmillan Lead Cancer GP in Aberdeen.

This is your chance to get involved, hear about improvements, the speed at which they can be implemented, and learn how to improve communication and promote multidisciplinary team working.

If you are involved in planning and/or delivering cancer services in Scotland then you should attend.

Book your place by calling 0131-623 2514 or emailing: makingithappen@conventionmanagement.co.uk

Dr Eddie Obeng

Pilot of the Airwaves

Two half-hour television programmes have been made for the CCI by Scottish Television called Changing For A Healthier Scotland.

The programmes illustrate what is being done to improve care of patients and features staff and patients talking about their experiences. Both programmes have been screened on a new digital channel called Information TV. At present Information TV is only available on Sky TV so we asked 100 NHS staff with access to Sky to watch the programmes and give us their feedback by filling in a simple questionnaire.

The reaction we received to the programmes was overwhelming. Results from Programme 1:

96% agreed that the programme was interesting

83% agreed that the programme was relevant to their job

90% agreed that the programme was generally very useful

90% would watch this type of programme again.

We are aware that not everyone has Sky TV and so we had VHS copies of the programmes made up and sent out to all NHS Boards in Scotland. Copies of the programmes are still available and if you would like to obtain one or both to show to staff then please contact us at cci@scotland.gsi.gov.uk These programmes were made as a pilot project for the Scottish Executive. We would like to hear your feedback to find out whether they work.

Practice Nurse Catherine Partridge Church St Practice, Dunoon.

Howyoudoin'?

At Doing Well By People With Depression we are looking at how we can manage and provide better treatment and care for those people who present with signs and symptoms of mild to moderate depression.

Depression is one of the most common conditions that a GP will see on a day to day basis.

It is estimated that by 2010 depression will be a global chronic condition.

It is important to look at what alternatives could be offered to better manage this condition - we need to defeat depression. Currently, anti-depressants are the first line of treatment. We know that for a lot of people they work but equally we know that for others they are making little difference and that they would benefit more from psychological interventions such as

• Cognitive Behaviour Therapy

• Counselling

• Self-help materials

The emphasis is on patient choice and clinical need. However, we have to make sure that before we offer these alternatives we actually have the staff and the resources in place first. This is part of the work that we are doing. We are also looking at who is best to deliver this care. It does not always have to be in the statutory sector. It could be through the voluntary sector, who have expertise and knowledge about the condition and what sorts of things work well for individuals.

To keep the momentum in Scotland one of the next pieces of work that we are about to embark upon is the development of a care pathway for people with mild through to severe depression, involving the National Depression Alliance (Scotland) and NHS Quality Improvement Scotland. For more information on this programme contact: alex.mcmahon@scotland.gsi.gov.uk

AdmitToDecide

Unscheduled Care is a new national programme to help identify the problems faced by NHSScotland and how to reduce them.

The definition of unscheduled care is any contact with the NHS which does not actually have an appointment, calling out a doctor in the middle of the night or at the weekend or going to accident and emergency.

We know that for some people they could:

• probably have waited until the morning

• phoned their GP for an appointment or

• asked their local pharmacist for advice

The incidence of unscheduled care is increasing. In fact it is now one of the greatest sources of pressure on the NHS. If beds are filled by emergency admissions, it can lead to cancelled operations, longer waiting times and increased dissatisfaction with the performance of the NHS.

We need to look at what it is we can do to support this, as the NHS has to manage this work. Over 100 front line staff identified this problem when the CCI held a one day conference in October 2003. A report entitled ' Decide to Admit v Admit to Decide' with outcomes of that day was produced. Since then a Good Practice Conference was held in February 2004 and a Programme Manager has been appointed to take this work forward. This project will run for three years until 2007 with a budget of 4.7m.

Information on the programme can be found on the CCI website by logging on to www.cci.scot.nhs.uk and clicking onto the National Programmes button.

How do we make change happen?

CCI use a number of different ways to implement changes - Process Mapping and PDSA are just two methods:

PROCESS MAPPING

To improve patient care we need to understand the patient journey, from initial GP contact to hospital treatment through to the final outcome. Process mapping is a simple exercise that involves getting all NHS staff together to write down that journey, in detail. It is one of the most powerful ways for multi-disciplinary teams to understand the real problems from the patients' perspective. By reviewing the existing process we can identify opportunities for improvement. Process mapping has been widely used within our national programmes and has been instrumental in reducing waiting times across all disciplines.

PDSA

PDSA stands for PLAN, DO, STUDY, ACT and is a way of testing an idea by putting a change into effect on a temporary basis and learning from its potential impact. One PDSA invariably leads on to another. Because they are so small, they reduce the anxiety about change. In this way any member of the team can be involved and take ownership of the changes being implemented, thus leading to more sustainable improvements. The model can be condensed to:

Model for Improvement PDSA

We have a wealth of knowledge and experience at CCI to help you get started on your own initiatives; you can find more detailed information on our website along with guidelines and templates.

Don't forget that on our website you can also find:

• diagnostic tools and techniques to help Manage Your Team

• ideas and solutions for training needs to help Develop Your Organisation

People who need People

The National Workforce Committee has membership of key stakeholders and experts in healthcare workforce issues, including the Scottish Partnership Forum. The Scottish Executive Health Department has established a national strategy for NHS workforce including issues of recruitment and retention. As part of that work they set up the National Convention on Workforce Design on 9th September 2004 where the issue of future workforce design was examined. Scotland needs to design the workforce that is needed to secure delivery of healthcare in a changing NHS.

A post-convention report, which has been shared in draft form to about 300 delegates and other interested parties, will now be presented to the National Workforce Committee for consideration, and creation of an action plan. The convention categorised five themes for action planning.

These are:

• New ways of working

• Maximising capacity

• Redesign of roles

• Employment issues

• Strategic issues.

The full report of convention outputs ; ' Revolution or Evolution? Modernising the NHS Workforce' is available on the CCI website www.cci.scot.nhs.uk

For more information about the forthcoming Action Plan, please contact Audrey Cowie on Audrey.cowie@scotland.gsi.gov.uk

Referral Information Services

Lothian and Greater Glasgow NHS Boards have been invited to pilot Referral Information Services in Scotland. The projects will run from October 2004 until March 2006 and evaluation of these pilots will help to inform future CCI plans in relation to managing waiting times. A Referral Information Service can be a physical or a virtual centre. Its purpose is to receive all referrals from primary care and, through numerical analysis, generate useful information for referring and receiving clinicians. It aims to improve communication between local family doctors and hospitals and can lead to improved patient access and the development of new services. The RIS may incorporate one or more specialties, depending on local circumstances. However it is most effective when it covers referrals to all high volume specialties. For more information about the three levels of RIS and the benefits of the system log on to www.cci.scot.nhs.uk and click on to the Outpatients National Programme section.

Competition Get into the Craobh!

WIN A WEEK IN A LUXURY HOLIDAY HOME NEAR OBAN

We are offering one lucky winner a week in a self-catering holiday cottage right beside the sea on the coast of Argyll, Scotland. Craobh Haven Cottages (Craobh is pronounced 'croove', after the Gaelic for a small tree or shrub) are situated in the historical heart of Scotland just south of Oban, a great place for a romantic break, exploring history, touring, walking, riding, golfing, sailing, fishing, wildlife watching or just relaxing! The holiday is for one week in the two-bedroom Islay Cottage (maximum occupancy is up to 4 people) and must be taken before March 2005 (excluding Christmas and New Year). For more details about the cottage and the surrounding area log on to: www.craobhcottages.co.uk

TO ENTER our competition all you have to do is visit the Centre for Change and Innovation website atwww.cci.scot.nhs.ukand send us an email stating your name and address. Entries must be received by 30th November 2004.

Guy Rotherham Award

During the SPCC's second Wave 2 Learning Workshop in September Dr Sommerville and Sister May Carfrae accepted the Silver Guy Rotherham Award on behalf of the Dr Pugh & Partners Practice in Kilmarnock. The Guy Rotherham Award was created to celebrate best practice in Primary Care Organisations. The prizes are awarded to GP practices that demonstrate the best use of Primary Care Collaborative improvement methods to improve the quality of service and outcomes for their patients in an area (or areas) of their choosing.

Dr Pugh & Partners joined the Scottish Primary Care Collaborative in 2003 which provided them with the incentive & methodology to improve patient access and the care provided for patients with diabetes. The judges were impressed by the way the practice had systematically worked through the principles of Advanced Access, testing changes using the improvement model and successfully reduce waiting times for patients from 8 days to 0 days in 7 months. Working from a high baseline the practice also managed to make important improvements to the service offered to patients with diabetes. But they didn't stop there. The practice used the learning they had gained from the Collaborative to spread improvements to direct local practices and even established LHCC-wide group - education sessions for recently diagnosed type 2 diabetics. This practice's improvement journey is continuing as they apply the improvement method to other challenges within the practice.