Programación del plan de apoyo - Análisis del rendimiento académico en los/as estudiantes de oc

Reshaping Older People’s Services (Including: Integrating Health and Social Care)

To meet the needs of the older population now and in the coming years, all Health and Social Care Services should have a primary aim of maintaining and supporting independent living and maintaining quality of life. The resources of local people and communities will be at the centre of social care provision.

Within the context of ‘Getting Better in Fife’ we aim to:

Ensure that older people with complex needs are well supported by all parts of the care system. Develop care settings, with partners that will help older people to remain at home; or in a homely

setting; and developing community capacity to enable older people and their communities to develop local systems of self-care.

Reduce the length of stay for older people in hospital, and avoid any unnecessary transfers in care. Reduce falls-related admissions to hospital in the over 65s by 20% through the implementation of

integrated falls and fracture care pathways.

Build relationships with the voluntary sector and private providers to develop community capacity models, and new models of care.

Develop and invest in support for Carers. And in particular to:

Develop a new Integrated Assessment and Community Support Service (ICASS) which provides hospital at home, intermediate care and home re-ablement services that are responsive to need and will prevent admission to hospital as well as supporting early discharge.

Review the community bed resource, in line with our intention to move to more care at home and agree a plan of reduced inpatient based care and treatment.

Why will this improve the patient experience and reduce harm, waste and variation?

Hospitals have generally been viewed as the source of expert care and the public have become accustomed to receiving inpatient care as the first option when faced with a crisis or emergency. Hospitals do not always provide the most appropriate environment in which to provide care that is not of a specialist nature. This is particularly so for elderly frail patients and other vulnerable groups.

Importantly patients have also expressed the preference to remain in their own homes and to be treated there if possible.

Smooth transition for patients between health and social care sectors in Fife will reduce the opportunity for duplication and improve the patient experience

A patient safety approach to developing a “transfer bundle” will improve communication, and ensure transfers in care are undertaken efficiently and without harm.

The ICASS model currently being implemented across Fife plans to deliver a fully integrated service for frail older people who would have otherwise been admitted to hospital for common conditions.

The re-ablement and Home Care Change Programme will enable patients to maintain their skills and independence for longer periods.

Developing the use of technology for example using mobile telecare devices can support people beyond the confines of their own home allowing them to remain in the community.

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Building on our programme of falls and fracture prevention has significant potential to improve the patient experience and reduce harm waste and variation

Mental Health

A focus on modernising current day services and day hospital models will promote independence and re- ablement, and avoid unnecessary admissions to institutionalised based care.

The provision of therapeutic facilities and environments which offer privacy and maintain dignity is an essential aspect of good patient care. We will continue to seek improvements in the quality of the

mental health estate with the initial focus on developing a proposal for the re-provision of the Intensive Psychiatric Care Unit.

We will develop and provide a Forensic Low Secure inpatient unit on the Stratheden Hospital site. This development will ensure NHS Fife better meets its responsibilities for the care and supervision of patients with forensic mental health needs. It will enable Fife patients to be cared for in a local facility, improving the patient experience and service efficiency, and will eliminate the need to purchase services from outside Fife and so realise expenditure savings. The following provides a brief resume of the clinical developments planned at Stratheden hospital and the resulting changes to the use of the estate.

Forensic Low Secure Unit

This new service is due to become operational on or around 1 April 2013. The service will be provided in Radernie ward (ward 21) following redesign and refurbishment.

The current patient group in this ward (old age psychiatry) will transfer to Cairnie House following its refurbishment.

Current Use Planned Use

Cairnie House Vacant Old Age Psychiatry

Radernie ward (21) Old Age Psychiatry Forensic Low secure

Rehabilitation Redesign

The rehabilitation redesign programme is a collaborative programme with Fife Council Social Work Department, which will result in the discharge of up to 45 patients from the adult rehabilitation and long stay wards over the next 2 years. This should result in the closure of two wards.

To date, a sufficient number of patients have been discharged to enable the closure of one ward (Falkland – ward 2) within the next few months.

Current Use Planned Use

Lindores ward (1) Rehabilitation/Longstay Rehabilitation/Longstay

Falkland ward (2) Rehabilitation Closure

Dunino ward (14) Rehabilitation/Longstay Rehabilitation/Longstay

Edenview ward (26) Rehabilitation/Longstay Probable future closure

Intensive Psychiatric Care Unit (IPCU)

The IPCU (ward 4) at Stratheden is increasingly falling behind appropriate standards for the healthcare provision delivered and NHS Fife has identified its replacement as a priority. An options paper has been submitted to the Strategic Management Team (SMT) for consideration and proposals are currently being developed for a new eight bed IPCU on the Stratheden site. The timescale for the new build will be as soon as practically possible; anticipated within the next two years, given the necessary permissions and approvals. The clinical preference for the location of the new build is on the north eastern part of the Stratheden campus, to the north of the East Wing (K block) adjacent to the planned Forensic Low Secure Unit.

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Current Use Planned Use

IPCU (4) Intensive Care Future closure

New build IPCU N/A Intensive Care

As a result of these planned and proposed developments, there would be only two inpatient wards remaining in the Victorian buildings – Lindores (1) and Dunino (14). Plans for the future of these facilities will be included in the master planning for the site.

Mental Health East

The East psychiatry team is based in no. 6 Stratheden Court and deal with Community Old Age Services. Alternative accommodation has been identified in the redeveloped Adamson hospital, and the team will be relocating shortly. This will leave no.6 Stratheden Court empty.NHS Fife Board has declared no. 6 Stratheden Court as ‘surplus to requirement’ and the property will be sold in early course. There are, currently, no other developed plans or proposals for developments or changes on the Stratheden Hospital site.

Asset Targets

The asset related targets within the Local Development Plan (LDP) are listed within the current NHS Fife Balance Scorecard listed under the headings of Patient Experience, Planning Service Improvement and Delivery and Efficiency and they are:

Patient Experience

HAI – we will aim to reduce the rate of staphylococcus aureus bacteraemia (including MRSA). Health & Safety – we will develop and implement the annual local action plan for Health and Safety.

Planning Service Improvement

Reduction in Emergency Bed Day Rates for Patients Aged 75+.

Scottish Patient Safety Programme (SPSP) – we will aim to deliver the aims of the Scottish Patient

Safety Programme.

SEAT (South East and TAYSIDE) – we will contribute to the SEAT Regional Work Plan and linked

activity.

Service Alignment – we will aim to ensure that planning and delivery of services in NHS Fife and NHS TAYSIDE are aligned in such a way that would improve patient flows.

Resilience Planning – we will continually review and refine our emergency planning arrangements for

Business Continuity and Pandemic Flu.

Stroke Services – To improve stroke care.

Clinical Redesign – Agree an approach and framework for strategic planning and redesign for NHS

Fife, which identifies redesign priorities for the Board and which results in an outcomes-driven redesign programme with performance measures in place to monitor progress.

Integrating Health & Social Care - 2013 onwards

Reshaping Older Peoples Care: Hospital at Home ICASS 2013 onwards

Delivery and Efficiency.

Health – We will identify and implement solutions to support improved and safer patient care.

Financial performance – NHS boards to operate within their agreed revenue resource limit; operate

within their capital resource limit; meet their cash requirement.

Cash Efficiencies – In 2013/14 NHS Fife Board to deliver a £5.3 m Efficiency Savings Target.

Rate of Attendance at Accident and Emergency – 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.

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A&E Waiting Time – NHS Fife Board will aim to have 98% of attendees seen within 4 hours.

Cancer Waiting Times – From the quarter ending December 2011, 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.

18 Weeks Referral to Treatment - We will aim to deliver a maximum 18 weeks referral to treatment timescale.

Drug and Alcohol Waiting Times – By March 2013, 90% of clients will wait no longer than 3 weeks

from referral received to appropriate drug or alcohol treatment that supports their recovery.

Faster Access to Mental Health Services - 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 and 18 weeks referral to treatment for specialist Psychological Therapies by December 2014.

The main aims within the General Hospitals and Maternity Services Project, the main thrust in achieving the acute services related objectives within the ‘Right for Fife’ and ‘Getting better in Fife’ initiatives, are as follows:

To Improve Waiting Times for Services

National standards for waiting times must be met or exceeded.

To Improve the Physical Environment in which some Service are Provided

To provide all patients and staff with accommodation that provides the best possible environment for healthcare, all accommodation being to a minimum Physical Condition category ‘B’ (Satisfactory).

To Provide Services that are Sustainable

To meet the demands of the projected increase in the elderly population.

To retain training accreditation for junior doctors thus sustaining the supply of same.

To continue to recruit and retain consultants. To retain all current specialist services within Fife.

To Provide Services that have the Appropriate Clinical Links and Support

Continue with the single-site in-patient provision for smaller specialties. Provide all appropriate services as locally as possible.

Provide Fife-wide maternity provision from Kirkcaldy.

Physical Condition

It is vitally important to understand the risk around continued deterioration and/or failure of estate assets. As the Property Asset Management Strategy moves forward it will be important for the Board to take investment decisions based upon the risk areas in relation to the physical condition of the estate and to develop risk prioritised investment plans which address any shortfalls.

The aim for NHS Fife, will as per current objectives, be to bring all retained properties to a minimum condition ‘B’ (Satisfactory), within a timescale determined through risk analysis and projected available

funding or disposal. This will therefore involve targeting of the remaining 6% of our properties which fall

within the ‘Unsatisfactory’ condition category. Current actions in relation to the acquisition and disposal of property will have a positive impact on the condition assessment and these will therefore be taken into account in the proposals for investment in relation to the physical condition of our properties.

Functional Suitability

The aim of the functional suitability assessment is to determine how well the available accommodation supports the delivery of healthcare and is assessed on the basis of three elements: internal space relationships; support facilities and location. NHS Fife currently have 18.7% of properties to be classified

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as either Not Acceptable or Unacceptable. The aim of NHS Fife is to bring the functional suitability of all the properties in use to either Satisfactory or Very Satisfactory assessment level. This will be achieved through the acquisition and disposal of properties and implementation of the current investment plan. In those areas requiring improvement the aim will be to ensure:

the layout of the accommodation allows safe and effective service delivery;

the available accommodation is sufficient for the department to function appropriately; critical rooms are adequately sized;

good observation of patients is possible.

adequate toilet and bathrooms facilities are available; adequate storage space is available;

adequate seating and waiting space is available; Public areas are accessible for all.

location close to inter-dependant departments;

access via vertical or horizontal circulation is good (lifts, stairs etc);

Quality

The aim of the quality assessment is to determine how well the available accommodation provides a comfortable, modern, pleasing environment in which healthcare services can be provided. It is assessed on the basis of three elements: amenity; comfort engineering; and design. The current report shows

26% of NHS Fife property being not satisfactory. The NHS Fife objective in relation to the quality of our

properties will be to ensure that all properties fall within the Satisfactory or Very Satisfactory categories. In those areas presently not within those categories the aim will be to provide:

an attractive and pleasing area for patients and staff (for example in terms of privacy, dignity,

comfort, working conditions, signposting)

an acceptable environment (for example is it well lit, adequately heated and cooled, noise and odor

free)

An internal/external environment attractively designed (for example in terms of good color schemes,

well decorated, well furnished, enhanced by art, plants, landscaping, views etc)

Space Utilisation

The NHS Fife aim with regards to space utilisation will be to bring all properties within the Fully Utilised category. This will ensure, that in those retained spaces which are currently underutilised will be used intensively and that:

Usage is maximised over time i.e. on a working day and/or on a working week. Space usage will compare favourably with national guidance.

This approach will assist in ensuring that all remaining space in use is productive and essential to the provision of healthcare.

Environmental Management

An ongoing objective of NHS SCOTLAND is 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.

In accordance with this implementation of the NHS Fife Sustainability Strategy (which will incorporate the existing Environment Strategy) will be extended into 2013/14 and will incorporate elements of climate change, energy management, waste management, transport and travel planning, sustainable procurement, sustainable construction and carbon management. Many of the objectives contained within the Sustainability Strategy will directly and indirectly influence the outcomes of the Property and Asset Management Strategy and will also ensure that the operations of NHS Fife do not have a detrimental effect on the health of the general population of Fife. Current environmental aims of NHS Fife are:

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For a structured investment plan to be in place which will assist in enabling compliance with the Scottish Government targets for energy and carbon consumption reduction

NHS Fife Sustainability Strategy has been approved and shall be implemented in 2013 /14 NHS Fife Environment Action Plan targets achieved i.e.

o Implementation of Greencode Environmental Management System.

o Monitor energy, water and waste consumptions using eMART (Energy Monitoring and Reporting Tool) software.

o Review carbon emissions performance and inventory of facilities.

o Review estates management policies and operations to ensure compliance with the biodiversity duty.

o Engage with partners to initiate or review local/ regional transport strategies.

o Review current waste management practices and develop monitoring policies for all types of waste.

We will aim to reduce:

o CO² emissions, from the consumption of fossil fuels, by 3% per year.

o Energy consumption by 1% per year.

Statutory Compliance

NHS Fife will achieve the required improvement on Statutory Compliance and other facets by ensuring that the identified actions are controlled and co-ordinated with responsibility being allocated to staff accountable for the ongoing management and effectiveness of the asset management system. In addition, NHS Fife will integrate the use of the asset management system into the roles and responsibilities of all NHS Fife Estates and Facilities staff in order that the data within the system is appropriately updated, accurate and reliable.

The current aims and performance summary for Statutory Compliance are as shown in Table 5.1

SCART Statutory Compliance Summary Assessment Date: 8th March 2013 Item

No Item Response Notes

Percentage of Properties that have

been Assessed

98%

Increase of 6% since last year. There are 9 properties which have been assessed but have not been entered on system.

Average Percentage Compliance - NHS

Fife

81.40% Drop of 1.7% on last year’s figure due to inclusion of

individual CHP sites. National average is 72.1%

SCART Master Summary - Number of

Very High risks