5. Special NHS Boards
The role of the Special NHS Boards is to provide services that can be delivered more effectively and efficiently on a national basis, allowing the 14 Territorial NHS Boards to concentrate resources on frontline patient treatment and care. By operating at the national level, Special NHS Boards can take advantage of economies of scale, make the best use of available skills and ensure consistency of approach across Scotland. The eight Special NHS Boards account for around £1.3 billion of the total NHSScotland budget of around £10.5 billion.
This chapter briefly describes the role of each Special NHS Board and then summarises their achievements and progress in 2008/09.
NHS 24
NHS 24 provides information and guidance on health needs, appropriate treatment advice, and access to services for the people of Scotland. Its core role is providing patients with advice and triage during the out-of-hours period when GP surgeries are closed. In addition, NHS 24 offers a range of telephone and web-based support for the public.
Service Delivery Improvements
NHS 24 received a total of almost 1.5 million patient calls during 2008/09, 90 per cent of which were received in the out-of-hours period 11. Call handlers, nurse advisers and other members of the multi-disciplinary team consistently exceeded clinical and service targets, ensuring that patients were dealt with safely and within appropriate timescales. In addition, new frontline roles were introduced including mental health specialists and physiotherapists, increasing the range of skills available to patients.
www.nhs24.com continued to develop during 2008/09 with a continued focus on patient-friendly delivery of information about health and health services. The site also supported a number of national health campaigns, including meningitis awareness and cervical screening. The website received almost 950,000 visits during the year. In addition, NHS 24 led the development of the NHSScotland Winter and Easter advertising campaigns aimed at ensuring the public were prepared for the holiday periods when their GP practices would be closed.
NHS 24 continued to expand its local presence with the opening of remote centres in NHS Forth Valley and NHS Borders and the creation of a new centre in Cardonald, Glasgow, co-located with the Scottish Ambulance Service's West Emergency Dispatch Centre and the Greater Glasgow and Clyde out-of-hours centre.
The Board's Breathing Space service implemented a number of initiatives, including joint projects with Macmillan Cancer Care, and British Sign Language, and developed services to support Armed Forces personnel who have recently been discharged from active service. Living Life - a telephone-based cognitive behavioural therapy service was launched with clients referred by GPs from the five participating partner NHS Boards (Greater Glasgow and Clyde, Lothian, Borders, Western Isles and Shetland).
NHS 24 also continued to support the Scottish Emergency Dental Service as the first point of contact for patients requiring emergency dental services in the out-of-hours period, assessing symptoms and arranging face to face clinical treatment if needed.
NHS Education for Scotland
NHS Education for Scotland ( NES) is responsible for the education and development of the NHSScotland workforce. NES helps provide better patient care by designing, commissioning, quality assuring and, where appropriate, providing education, training and lifelong learning for the NHS workforce in Scotland.
NES delivers its role in close partnership with NHSScotland Boards, higher education institutions, Scotland's colleges, other relevant health and social care bodies and voluntary organisations.
Service Delivery Improvements
NES has completed the transition of postgraduate medical education and training to align with the new structures set out under Modernising Medical Careers, and to meet the regulatory requirements of the Postgraduate Medical Education and Training Board. NES supports the education and training of some 5,700 doctors, in 225 training programmes across the four Scottish postgraduate deaneries.
Dental outreach teaching facilitated by NES is now operational in Aberdeen, Glasgow (two centres), Arbroath, Kilmarnock, Kirkcaldy, Cupar, Inverness, Dumfries, Falkirk, Dundee, and Edinburgh. These help meet the student clinical capacity for dental and therapy students, and benefit patients through improved access to NHS dental services.
In 2009, 114 staff working in the frontline management of patient care and service delivery successfully graduated from the first postgraduate certificate in Frontline Leadership and Management.
NES took over the management of the pre-registration pharmacy scheme, enhanced the quality assurance of the scheme, and successfully managed to broker arrangements to allow all trainees experience in both community and primary care settings.
The first group of physician assistants in anaesthesia completed their training. All 12 have been employed in NHSScotland where they will provide a support role to anaesthetists, improving the efficiency and effectiveness of anaesthetic services, and care of patients in the peri-operative environment.
NES has strengthened its process of engagement with NHS Boards through the appointment of a senior named contact with each Territorial NHS Board to complement the pre-existing uni-professional links. NES has also strengthened links with other agencies; an example being the Scottish Funding Council with whom it has developed a joint action plan which has delivered 100 additional student places for healthcare subjects in remote and rural areas.
NHS Health Scotland
NHS Health Scotland's role is focused on improving the health of the people of Scotland and tackling inequalities in health.
It works with NHS Boards and health improvement partners to implement public health improvement and health inequalities programmes and other initiatives designed to achieve positive health outcomes. These focus on meeting public health HEAT targets, embedding equality and diversity and addressing local priorities, thereby supporting national outcomes.
Service Delivery Improvements
NHS Health Scotland made a major contribution to NHS Boards' delivery of Alcohol Brief Interventions ( ABI), providing high quality support for health practitioners. This included training 88 ABI trainers who have delivered courses to 1,000 practitioners and the production of support materials which have been well received and are now used in all local Boards.
Support for smoking cessation improved through the use of direct services such as online digital and TV marketing. The number of people contacting Smokeline and visiting the canstopsmoking.com website (up 15 per cent on 2007/08) increased as a result. At the same time,the Healthy Working Lives* smoking cessation campaign reached around 30,000 small and medium-size enterprises, and the Stop Smoking Roadshow held 35 events across Scotland.
NHS Health Scotland ran a media campaign for Breastfeeding Awareness Week 2008 and oversaw the development of new media and resources for the 2009 campaign, resulting in 17,000 posters and flyers being distributed.
NHS Health Scotland influenced the development of the new H8 HEAT target, together with its monitoring arrangements, and will be supporting its delivery through the programme management of Keep Well*. NHS Health Scotland is also leading the development of a Translation, Interpreting and Communications Support ( TICS) strategy. This involves working with stakeholders in communities and the NHS, to help achieve fairer access to health services.
NHS National Services Scotland
NHS National Services Scotland ( NSS) provides a range of national and specialist services which enable and support improvements in the health and wellbeing of Scotland's population.
Its services touch almost every area of healthcare and impact on the health of people across Scotland. NSS staff are involved in everything from health surveillance to health screening, from blood transfusion services to analysis, and the publication of health statistics. NSS delivers lifeline hospital supplies, and every day it provides the payments that support dentists and family doctors in local communities.
Service Delivery Improvements
Through its Scottish National Blood Transfusion Service division, NSS recruited 26 per cent more new and returning blood donors and increased the donor base by 6.2 per cent from December 2007 levels, to meet the transfusion needs of patients.
NSS co-ordinated national screening programmes for the Scottish population with over 1.5 million people invited for screening. Bowel screening is now available in 11 of the 14 NHS Board areas. Seven of the 14 NHS Boards have started to provide two views at every round of breast screening.
Working closely with Territorial Boards, NSS implemented the Human Papilloma Virus ( HPV) immunisation programme, with uptake rates of 93.5 per cent for the first dose, 92.4 per cent for the second dose and 87.7 per cent for the third dose in girls in the second, fifth and sixth years of secondary school.
NSS extended the Scottish Patients at Risk of Readmission and Admission risk-prediction algorithm from patients aged over 65 to patients of all ages. The new algorithm can be used by NHS Boards to assess a patient's risk of emergency inpatient admission. It trebles the number of patients for whom risk can be predicted. Information is used locally to identify and target patients with complex care needs who may benefit from additional case management or co-ordination. NSS also developed a similar predictive tool to assess a patient's risk of psychiatric admission.
The launch took place of phase two of Navigator, the web-based information intelligence system for senior healthcare staff. This provides enhanced functionality with additional indicators and features, including a GP profiler tool which allows comparison of GP practices by age or deprivation profile. The number of registered users has doubled in the last year and it is being used in eight NHS Boards.
Throughout the year, £2 billion of payments were made on behalf of NHS Boards to GPs, pharmacists, dentists and opticians, 98 per cent of which were accurate and on time.
NSS also achieved the waiting time target of 15 weeks for inpatient elective treatment in specialist services, with over 5,000 treatments provided for patients with rare conditions or requiring treatment of a highly specialist nature.
NSS met all the HEAT efficiency and financial targets included in its Local Delivery Plan and delivered £5.3 million of recurring local savings against a target of £4.9 million. Additionally, it contributed £33 million of savings towards the Efficient Government target in 2008/09. It also launched the Frameworks Scotland procurement initiative for the effective delivery of publicly funded capital projects, with over £800 million of projects registered within its first three months.
NHS Quality Improvement Scotland
NHS Quality Improvement Scotland ( NHSQIS) leads on improving the quality of healthcare for the people of Scotland and performs three key functions. It provides advice and guidance on effective clinical practice, including setting standards; drives and supports implementation of improvements in quality; and assesses the performance of the NHS and reports on and publishes its findings. NHSQIS has central responsibility for patient safety and clinical governance across NHSScotland.
Service Delivery Improvements
NHSQIS changed the way it developed and shaped its work programme, including extensive stakeholder consultation. This included implementation of a clinical engagement strategy, ensuring its activities reflect the views of frontline clinical staff. NHSQIS has developed integrated programmes of work, encompassing each of its functions in a cycle of continuous improvement. A Directorate of Implementation and Improvement support has been established to deliver this work.
In 2008/09 NHSQIS delivered a range of projects including work on: cancer; cardiovascular disease; clinical governance and patient safety; long-term conditions; maternal and child health; mental health; primary and community care; and vulnerable groups. One example of this work was the publication of a national overview of performance against the standards for asthma services for children and young people, which was accompanied by a report on patient experience.
NHSQIS has established a work plan for the Healthcare Environment Inspectorate, and issued NHS Boards with an online self-assessment based on Healthcare Associated Infection standards. This action represented one of our major responses to the events at the Vale of Leven Hospital in 2008 - which became the subject of an Independent Review and subsequently a Public Enquiry. NHSQIS continues to co-ordinate the Scottish Patient Safety Programme, including the establishment of clinical fellowships.
A number of clinical governance activities have been undertaken, including 'shared learning' visits to three NHS Boards following C. difficile outbreaks to promote improvement and provide support.
NHSQIS provided NHS Boards with a second surgical profile, consisting of data on surgical services which can identify areas of good practice and areas requiring attention. Work is continuing with the Scottish Health Council on the development and implementation of the participation standard for NHS Boards.
Other initiatives include a practice development toolkit to support the National Integrated Tissue Viability Programme. Around 500 healthcare practitioners across NHSScotland and in care homes have signed up to use this web-based resource. NHSQIS has also worked with NHS Education for Scotland in developing a nutritional care toolkit as part of the Scottish Government's Integrated Programme for Improving Nutritional Care.
National Waiting Times Centre Board
The National Waiting Times Centre Board manages and operates the Golden Jubilee National Hospital and the Beardmore Hotel and Conference Centre.
The Golden Jubilee is Scotland's flagship hospital for reducing patient waiting times, receiving referrals from across the country in the specialties and services they provide. The hospital is also home to the West of Scotland Heart and Lung Centre, a first-class facility that provides regional and national services.
The award-winning four-star Beardmore Hotel and Conference Centre is the national NHS and public sector conference and training facility.
Service Delivery Improvements
The National Waiting Times Centre Board effectively met its delivery target by carrying out 24,675 procedures during the year - this excludes heart and lung patients.
Just under half (40 per cent) of all hip and knee replacements undertaken by West of Scotland hospitals were carried out at the Golden Jubilee National Hospital in Clydebank in 2008/09. The hospital carried out just under a fifth (18 per cent) of all hip and knee replacements in Scotland.
One year after successfully implementing the West of Scotland Heart and Lung Centre, cardiac surgery waiting times are less than ten weeks, with most patients waiting under eight weeks.
The development of an Optimal Reperfusion service for the West of Scotland is seen as the gold standard in the care and treatment of cardiac patients suffering from a ST Elevation Myocardial Infarction ( STEMI). All patients suffering from a STEMI will be transferred to either the Golden Jubilee or Hairmyres Hospital in East Kilbride, based on their location at the time of diagnosis.
Patient satisfaction remained high at approximately 90 per cent, and complaints equated to 0.15 per cent of the patients who were treated at the hospital.
High standards of cleaning and hygiene were continually maintained. Quarterly auditing of clinical areas using the National Cleaning Services Monitoring Tool continues with scores above 90 per cent since its introduction in 2006. The hospital also maintained its good record of infection control and introduced a zero tolerance approach to non compliance of hand hygiene.
The Board continues to promote the involvement of patients in services and recently received an access award from West Dunbartonshire Disabilities Access Panel.
Scottish Ambulance Service
The Scottish Ambulance Service provides comprehensive accident and emergency ambulance services for the whole of Scotland, including a dedicated air ambulance service. In addition, it operates a non-emergency patient transport service and an inter-hospital transfer service for those patients who have a clinical need for care when accessing treatments and appointments.
Service Delivery Improvements
The Scottish Ambulance Service responded to nearly 600,000 accident and emergency incidents, undertook 1.6 million patient transport service journeys and carried out 3,797 air ambulance missions in 2008/09.
By March 2009, the service responded to 77.4 per cent of Category A (life threatening) incidents within 8 minutes exceeding the target of 75 per cent. This reflected improvement throughout the year and resulted in a full year performance of 70.7 per cent compared to 62 per cent in 2007/08. This equates to over 106,000 life-threatening incidents responded to within target, compared with over 92,000 in 2007/08.
The service responded to 94.4 per cent of Category B (serious but not life-threatening) calls within appropriate timescales, up from 91.4 per cent in the previous year. This equates to over 228,000 serious but not life-threatening incidents responded to within target, compared with just under 218,000 in 2007/08.
More effective patient triage and treatment at scene resulted in 50,000 callers to the emergency ambulance service (some 9.7 per cent of all callers) receiving a level of care that, in many cases, avoided an unnecessary hospital attendance. The vast majority of these were dealt with by paramedics and technicians at scene using 'see and treat' protocols. The Scottish Ambulance Service estimates that this represents a wider saving to the health service of £12 million.
20% of cardiac arrest patients were alive on arrival at hospital as a direct result of emergency pre-hospital treatment provided by ambulance staff.
Air ambulance performance remained at a high level - 96 per cent of emergency incidents were reached within 60 minutes and 98 per cent of planned cases arrived within the time agreed with the clinician. A significant proportion of the 16 per cent increase in demand on the service in 2008/09 is due to more specialist retrievals. Clinical audits of the air ambulance service show improved effectiveness and patient care.
The State Hospital Board
The State Hospital is one of four high security hospitals in the UK. It is a national service for Scotland and Northern Ireland and provides assessment, treatment and care for up to 140 male patients with mental disorder who, because of their dangerous, violent or criminal propensities, cannot be cared for in any other setting.
Service Delivery Improvements
In line with the request from the Cabinet Secretary for Health and Wellbeing, that people are not detained in conditions of excess security, more appropriate care settings have been arranged in NHS Greater Glasgow & Clyde and Lothian for those female patients who were, until March 2009, detained in the State Hospital.
The redevelopment of the hospital, together with the establishment of new medium secure units now available in east and west Scotland, has seen the number of patients reduce from 240 to 143 as at 30 June 2009.
The hospital is introducing a robust health improvement plan with the appointment of a nutritional champion and the roll out of the Counterweight Programme. A smoking cessation target of 65 per cent has been achieved as part of a continuing effort to become a smoke-free hospital.