1. Overview of Performance
Overview
This Annual Report provides the opportunity to report on progress on 2007/08 key priorities across NHSScotland. It presents a detailed assessment of progress against the key targets for NHSScotland for 2007/08, a summary of the financial performance of NHSScotland in 2007/08, the contribution of the NHSScotland workforce, and a summary of the key achievements of each of the Special Health Boards. More detail on the NHSScotland Annual Accounts is published as part of the wider Scottish Government accounts, and an independent assessment of these will be published by Audit Scotland in December 2008.
This report also provides information on significant policy and strategic developments, most significantly Better Health, Better Care published in December 2007 which set out an Action Plan for NHSScotland for the next five years.
This Action Plan sets the agenda for NHSScotland around four key themes:
- Health and wellbeing - a comprehensive cross-Government approach to promoting and sustaining health and wellbeing;
- Inequality - targeted action to reduce health inequality;
- Quality - an acceleration of progress towards an NHS that is of the highest quality; and
- Public participation and integration - a new era for public participation and integration in NHSScotland.
Progress in each of these themes during 2007/08 is described, not only by the progress against the key targets, but also through a number of significant achievements in both policy change and delivery of services. The Chief Medical Officer's Annual Report, which will be published at the begining of December 2008 will set out his assessment of progress against the key health and inequality challenges.
The key priorities identified for NHSScotland, defined in terms of the key targets, describe the main actions that will underpin the contribution that health services make to the achievement of the Government's main Purpose and related National Outcomes.
The key targets for NHSScotland fall in to four areas, described as HEAT:
H - Health of the population;
E - Efficiency and productivity, resources and workforce;
A - Access to services and waiting times; and
T - Treatment and quality of services.
Progress towards the Government's Purpose and National Outcomes is now publicly available through the new Scotland Performs website. Appendix A provides more detail on how the priorities of NHSScotland are determined in order to support progress towards these.
Summary
NHSScotland made significant progress in 2007/08 with the early achievement of a number of key targets to improve access to healthcare services, to enhance the quality of services for patients; and to support improved health. It did so whilst meeting its financial targets, and being on track to exceed targets for efficiency savings. A range of significant policy and strategy developments were also achieved, particularly the publication of Better Health, Better Care which set out an Action Plan for NHSScotland for the next five years.
Performance Against Key Targets in 2007/08
NHSScotland achieved or exceeded expected levels of progress towards most of the key national targets agreed for 2007/08. While significant progress was made during the year, three targets have not been met.
In particular, a number of very challenging targets for reducing waiting times were met in December 2007, after which time no-one should expect to wait more than 18 weeks for a first outpatient consultation or for inpatient or day case treatment. The former Availability Status Codes ( ASCs) approach, under which many thousands of patients were excluded from national waiting times targets, and often experienced very lengthy waits, was abolished on 1 January 2008. It has now been replaced with a new system of defining and measuring waiting times, which is clear, consistent and balances the responsibility of NHSScotland to provide care and treatment quickly with patients' responsibility to attend appointments.
On 31 December 2007, the target that no patient should wait more than 9 weeks for the 8 key diagnostic tests was met.
NHSScotland ensured that 98 per cent of patients were admitted transferred or discharged within 4 hours of arrival at Accident and Emergency (A&E) during December 2007.
NHSScotland achieved financial balance in both capital and recurrent expenditure, with 21 Health Boards achieving all their financial targets, and an overall slight underspend of 0.24 per cent on a total budget (Departmental Expenditure Limit or DEL) of £10.12 billion.
A total of £610 million in efficiency savings have been reported to date against a target of £531 million for the three-year programme that ended in March 2008, an over achievement of £79 million.
Major Policy Developments
Sustaining Health and Wellbeing
Considerable work was undertaken to develop and prepare a wide-ranging set of proposals for tackling alcohol misuse in Scotland. In 2007, as part of the Government's overall approach to this issue, a record investment of an additional £85.3 million over the next three years was announced to tackle alcohol misuse. Additional financial investment in tackling alcohol misuse will provide a significant step change in the level of screening for and diagnosis of alcohol misuse, and, where appropriate, effective and timely treatment.
In 2007/08 work was undertaken to plan and prepare for implementation of the new Human Papilloma Virus ( HPV) immunisation programme. This aims to help protect girls aged from 12 to under 18 years from the two high risk HPV types that cause 70 per cent of cervical cancers. HPV immunisation is one of the largest and most complex immunisation programmes to be undertaken in Scotland. A public communications campaign was developed to raise awareness of HPV and links to cervical cancer.
Work in developing tobacco policy in 2007/08 led to the publication of the smoking prevention action plan Scotland's Future is Smoke Freein May 2008 and to proposed legislation. Due to be enacted in 2009 the legislation will prevent tobacco displays in retail outlets and will introduce a registration scheme for all tobacco retailers. We want to do everything we can to de-normalise smoking within society in Scotland to help our young people in particular to choose not to smoke. Raising the age of sale, as part of the range of measures set out in the action plan, sends a clear message that tobacco is a highly dangerous substance with the intention of preventing young people from starting smoking in the first place.
Reducing Inequalities
A Ministerial Task Force on Health Inequalities led by the Minister for Public Health was established to identify and prioritise practical actions, shared across Scotland's public bodies, to reduce the most significant and widening health inequalities. Wave 2 of Keep Well, the programme aimed at reducing health inequalities in 45-64 year olds in Scotland's most deprived communities, was rolled-out during 2007/08. Managed by NHS Health Scotland, Keep Well aims to address the risk factors that contribute to poor health outcomes by engaging with those who do not typically make full use of the services available to them. It provides GP health checks and referrals to appropriate support services such as smoking cessation or weight management.
An NHSScotland that is of the Highest Quality
The Healthcare Associated Infection ( HAI) Task Force was formed in 2003 to instil strong infection-control procedures and practices across all healthcare settings. The end of 2007/08 saw the completion of the second HAI Task Force Delivery Plan at a cost of £5 million, which included funding for a range of front line HAI-related posts in Health Boards, establishing a Clostridium difficile reference laboratory in Scotland to speed up treatment for patients and the addition of a range of new quarterly monitoring reports on Clostridium difficile Associated Disease ( CDAD), Staphylococcus aureus bacteraemias, and audits of staff compliance with hand hygiene. The recent expansion of this important programme, with sustainable new funding of £54 million, signals our continued determination to tackle and reduce all avoidable infections across NHSScotland. The new Delivery Plan can be viewed on the Scottish Government's website.
In February 2008, the Cabinet Secretary for Health and Wellbeing accepted the recommendation of the Neurosciences Implementation Group that a Managed Service Network for Neurosurgery in Scotland should be established to ensure the future sustainability of neurosurgical services on all four sites and to strengthen collaborative working between them. It will enable a nationally planned and coordinated approach to the development of Scotland's neurosurgical service, ensuring that each unit is able to safely provide core elective neurosurgery and emergency care.
The Scottish Patient Safety Alliance was formed to bring together the Scottish Government, NHSScotland, professional bodies, patient representatives and the Institute for Healthcare Improvement to build on the already high levels of safety for patients across Scotland and to significantly reduce adverse events. All acute hospitals in Scotland are now involved in applying the interventions in different clinical areas - with the learning being shared to embed a culture of safety improvement into the daily work of NHSScotland staff. There is strong evidence of engagement by strategic leaders and frontline clinical staff in applying measures to improve quality and safety. This is the first time a patient safety programme will have been implemented across a whole healthcare system and signals our absolute determination to secure improvements for those using the NHS, and for those who work in it.
Better Health, Better Care recognised the integral part that palliative and end-of-life care has in delivering care by health and social care professionals, across a number of sectors, to those living with, and dying from, any advanced, progressive or incurable disease. It contained a commitment to develop an action plan to ensure the delivery of high-quality care based on clinical need and on the principles of equity and personal dignity. The action plan will strengthen the collaborative and integrated approach to service improvement described in Better Health, Better Care in working towards a mutual NHS.
Better Together - the patient experience programme - was launched, and will collect new national information and work in partnership to improve the experience patients have when receiving services from NHSScotland. The overall aim of the programme is to use patient experience to drive improvement in the quality of care delivered in Scotland by working in partnership with the national improvement programmes and NHSScotland staff. The programme is shared with Health Boards, and will produce evidence that will, for the first time, support comparison and benchmarking across NHSScotland. The work of the programme will feed in to a range of existing improvement programmes including patient safety, long term conditions, mental health and faster access, leading to sustainable improvements in patient experiences across Scotland.
Integration and Participation
An integrated and responsive health service needs to put the patient at the centre of the delivery of services. A commitment was given to consulting on the possible content of a Patients' Rights Bill, seeking views on issues ranging from equity of access and dignity in healthcare, to a legally binding waiting-time guarantee. This consultation is currently under way. The Patients' Rights Bill will clarify and strengthen patients' rights and ensure the provision of high-quality services which are responsive to the needs of patients. There will be a clear assurance for patients that should a Health Board be unable to meet the proposed waiting-time guarantee themselves, then the Board would be required to take urgent steps to ensure swift treatment is provided elsewhere - such as in another Health Board or at the Golden Jubilee National Hospital.
The public and local communities need to be fully engaged and involved in NHS service change. Proposals were developed and consultation took place during 2007/08 on independent scrutiny of proposals by Health Boards for service change. Independent scrutiny is designed to ensure that there is robust evidence to support proposed service change, and that there is public confidence that proposals have been fully scrutinised. Proposals on directly elected Health Board members were also consulted on and legislation has since been introduced in Parliament.
The Delivering for Remote and Rural Healthcare report was produced by a group of stakeholders from across NHSScotland and set out a vision for the development of a sustainable health system for remote and rural Scotland. This will maximise the amount of care provided locally by shifting the balance of care, supported by effective electronic health systems, working links with specialist centres and an effective emergency transport system for those occasions where patients need more specialist help.
A Review Group was set up in October 2007 to review existing guidance on car parking and arrangements for car park charging. The Review Group issued its final report in November 2007 and in December 2007 the Cabinet Secretary announced, as an interim measure, that the daily maximum charge at hospital sites should be capped at £3 a day. A further announcement by the Cabinet Secretary in September 2008 marked the abolition of car parking charges from December 2008 in the majority of hospitals, with the exception of three hospitals provided under Private Finance Initiatives ( PFI). In these cases, the Cabinet Secretary has indicated that she expects Health Boards to work with contractors to limit and reduce charges until the contracts come to an end.
The Minor Ailment Service ( MAS) which was first rolled out in July 2006, allows patients who are exempt from prescription charges to register with the community pharmacy of their choice for the treatment of common health conditions on the NHS without the need for a GP appointment. The pharmacist advises, treats or refers the individual according to their needs. To date, over 700,000 patients have registered for the service and pharmacists are now providing over 70,000 consultations a month. This provides an example of how the balance of care is being shifted within NHSScotland to improve the quality of health services.
The following section reviews the performance of NHSScotland in 2007/08 against the 2007/08 HEAT targets. Where appropriate, future related changes in HEAT targets are reflected and will be reported on in future Annual Reports. The evidence used to assess performance is drawn from the most up-to-date and validated information sources available at the time of writing, and is based on the related performance measures used to manage NHSScotland performance throughout the year. These performance measures are usually a direct measure of the relevant target, but in some cases, a proxy measure for the target is used - these are clearly noted in the performance narrative.