Scottish Government

CHAPTER TWENTY-ONE: PERFORMANCE MANAGEMENT - QUALITY IMPROVEMENT

This section of the Action Framework identified 10 existing targets for Children and Young People taken from the "core set" of Ministerial objectives (Health, Efficiency, Access and Treatment - HEAT) as well as other existing policy or legislation. In addition, 2 key milestones were suggested.

Five actions were proposed to be developed between now and 2008.

21.1 TARGETS AND MILESTONES

Relevance of targets

The Progress Measures targets identified deal with waiting and response times and the consultation document asked whether these targets remain relevant for 21 ^st Century Scotland. As shown in table 21.1 below, 77% of those who answered this question felt that they do.

Table 21.1
58: Whether existing targets for performance management remain relevant for 21 ^st Century Scotland

Base: All those responding in each category

The key comment to emerge, from 11 consultees, was that the targets need to be reviewed specifically for children as, in many cases, the target times are too long. These responses suggested an indication of a lack of awareness of current waiting times and procedures and these have been highlighted to the Scottish Executive.

In addition, 6 consultees also expressed the opinion that the targets should focus more on children and on the quality of their care. One Local Authority commented "Targets need to be more child-specific. Targets and milestones should be about quality of care, not just waiting times", while an NHS Service Provider felt that "The HEAT targets are relevant for adults".

One target time, however, was identified by 2 consultees as being too short. As an Individual (Professional) commented "the response time of 10 weeks for ASL may be hard to achieve. 12-16 more realistic".

The need to ensure that sufficient staff and other resources were in place to meet targets or implement milestones was mentioned by 6 consultees: For example, one

"Implementation of the milestones will have resource implications. If new monies are not available services will need to disinvest to implement the new milestones and targets."
NHS Service Provider

Three consultees commented on the importance of clinical priorities remaining key and this included one Professional Body who stressed "We support the concept of maximum waiting times for access to services provided that they do not lead to any distortion of clinical priorities".

Three consultees felt that waiting times are poor indicators of service performance.

Child and adolescent mental health services

The consultation document then asked whether consultees agreed with the development of specific indicators for child and adolescent mental health services by 2007. As table 21.1 shows, a large majority, 90%, were in agreement.

Table 21.2
59: Development of specific indicators for child and adolescent mental health services by 2007

Base: All those responding in each category

Three consultees commented specifically on the need to focus on mental health services for Children and Young people, including one Local Authority:

"Child and adolescent mental health services are a chronically under-served area and should be seen as a priority in the development of services for children's health."

Specific community based indicators

The last question of the consultation asked whether consultees agreed with the development of specific community based indicators by 2007 and table 21.3 shows that, once again, consultees were in favour.

Table 21.3
60: Development of specific community based indicators for example waiting times for therapy and other primary care services by 2007

Base: All those responding in each category

Two consultees commented on data collection, including one NHS Service Provider who felt "Only by capturing data on community waiting times can we determine the most need."

Comments on the need for more detail in relation to waiting times were included in 2 responses with a Professional Body commenting specifically on question 60; "there can be waiting for initial assessment, and then further waiting for therapy."

21.2 ACTIONS

The consultation invited further comments on the 5 actions tabled in relation to performance management and 20 consultees took the opportunity to comment on some or all of these actions.

Four consultees stressed the need to include therapy waiting times in the actions. The opportunity to focus on outcomes, in terms of differences being made both currently and in the long term, was identified by another 4 consultees.

The need to ensure that Children and Young People are at the heart of performance management and are involved in planning and implementation was mentioned by 3 consultees.

Joined-up working and thinking, removing any duplication of effort and the relationships with existing inspections were commented on by 3 consultees with one NHS Service Provider stressing the "need to ensure the inspection / quality improvement programmes are joined up otherwise we could end up duplicating work for service providers."

Two consultees welcomed action 97 in particular as, they felt, "Current waiting list times do not recognise any locally defined priority bandings, and do not acknowledge the volume of children who are being seen well within targets".( NHS Clinical Group)

Other comments, mentioned by one consultee each, included:

• that the timescales are extremely demanding;
• the need to include Health improvement for Children and Young People in and leaving care;
• query on funding for the Private Sector to implement initiatives and on joint private and public sector working;
• concern over patient confidentiality.