1. NHS FIFE CLINICAL STRATEGY 2016 – 2021 Developing a Routemap for Healthcare in Fife

2. CREATING THE ROUTEMAP FOR FIFE Developing a Model for Future Healthcare Delivery in Fife

3. DRIVERS FOR CHANGE

4. Fife Population Projections Source: NRS

5. The Case for Change in NHS Fife – increase demand The population of Fife is expected to increase over the next twenty years 2012 366,220 2015 369,879 2025 384,812 2035 396,300 8% The proportion of Fife residents aged 65 and over is expected to grow from 1 in 5 of the population in 2012 to one in four of the population by 2035 The number aged 75 and over is expected to rise from 29,632 (one in 12 of the population) in 2012 to 39,6300 (one in seven of the population) by 2035 2035 Aged 65 and over 2035 Aged 75 and over The Clinical Strategy – Care delivered closer to home 2035 2015 ‘ Transforming Health in Fife’

6. Fife Population Structure as a % of total population; SIMD12 Quintiles 2013 Source: KnowFife Dataset

7.  The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions  More people have 2 or more conditions than only have 1 Multimorbidity is common in Scotland

8. SIMD 12 Deprivation Most and Least Quintiles; Fife Source: Information Services (NHS Fife)

9. People living in more deprived areas in Scotland develop multimorbidity 10 years before those living in the most affluent areas

10. Mental health problems are strongly associated with the number of physical conditions that people have, particularly in deprived areas in Scotland

11. Cancer Projections Fife Source: ISD 13,000

12. NHS FIFE STRATEGIC FRAMEWORK Outline

13. Safety First Dignity & RespectCare & CompassionExcellence Fairness & Transparency Through Innovation The people of Fife live long and healthy lives Transforming health and care in Fife to be the best Person-Centred We will...  listen to what matters to you and treat you as an individual;  design services in partnership with service users, carers and communities;  give you choices and information;  create environments that encourage caring and positive outcomes for all;  develop and redesign services that put patients first, supporting independent living and self-management of health through the integration of health and social care. Clinically Excellent We will...  work with you to ensure you receive the best possible care;  ensure there is no avoidable harm;  achieve and maintain recognised quality standards;  ensure that NHS Fife’s environment is clean, tidy, well maintained, safe and something to be proud of;  embed patient safety consistently across all aspects of healthcare provision;  support research, innovation and quality improvement which will see NHS Fife as a centre of excellence. An Exemplar Employer We will...  create time and space for continuous learning;  listen to and involve staff at all levels of the organisation;  give staff the skills, resources and equipment needed to do their jobs;  encourage and expect all staff to take appropriate decisions;  encourage staff to be ambassadors for health and social care in Fife;  create high performing multi-professional clinical teams through clinical education and development;  Equip people to be the best leaders. Sustainable We will...  ensure the maximum impact of our resources in the promotion of health and wellbeing;  increase efficiency and reduce waste;  ensure that our activities are cost effective and within budget;  ensure that all service redesign and development makes the most effective use of resources and avoids waste and unwarranted variation;  develop, in collaboration with our partners,our property and assets to meet the changing needs of health and social care provision. Our Mission Our Values We aspire to be Through Quality Improvement Our objectives NHS Fife Strategic Framework Our Vision Quantitative Assurance Qualitative Assurance BOARD PERFORMANCE REPORT LOCAL ACTION PLANS WITH AGREED METRICS How we will know

14. What is the Process? Timeline : December 2015 – June 2016  Our Compass  2020 Vision  National Clinical Strategy  Health & Social Care Changes & the H&SC Strategic Plan for Fife  NHS Fife Strategic Framework  Drivers – demographics, national, regional & local policy and planning  Development Phase  Wide Engagement  Workstreams – Service Review  Recommendations and core themes  Clinical Strategy  Principles  Layers of Detail

15. What do we see in the Future? Digital Solutions Patient Experience Access to Diagnostics Co- Production

16. COOL END HOT END Aim: To help people to remain well at home and when additional need arises seek to support them with the lowest level of intervention possible at the coolest point in the spectrum which will effectively address their needs. SPECTRUM OF SERVICES Overarching Principle

17. Care Circle Core Community Services Enhanced Community Based Services Rapid Assessment/ Ambulatory Options Intermediate Care Re-ablement Step Up Step Down Beds Hospital at Home Currently Outreach from hospital Future Model Community In-reach Locality Support Access to 24/7 Telephone Support to match service to needs Potential Future Model : To help people remain well at home and where necessary match lowest level of interventional support to address needs

18. Clinical Governance Committee NHS Fife Board PMO Urgent & 24/7 Care Scheduled Care Chronic Conditions/ Frailty Cancer Palliative End of Life Care Women & Children’s Care Mental Health & Learning Disabilities Support Services eHealth/Estates Clinical Strategy Steering Group Estates and Facilities Management Critical Parallel Work Redesign Community Provision Enhanced Community Services Hospital at Home Community Hosp Beds NHS Fife Clinical Strategy Workforce Planning Financial Planning Acute Services Planning Health & Social Care Strategic Plan Structure

19. Urgent & 24/7 Care Mental Health & Learning Disabilities eHealth, Estates, Support Chronic Conditions Scheduled Care Cancer, Palliative & End of Life care Women and Children Services & Frailty How Pieces Fit Together

20. Workstream Approach  Chair/Clinical Lead  Vice Chair  Senior Lead  Key Stakeholders  Medical, Nursing, Managers  AHP’s, Pharmacy, Labs, Radiology  Staff Side, 3 rd Sector

21. Workstream Approach  5 Meetings  Outline Plan & Monitoring  Data  Current & Future State – Develop Mary & John  Good Models & Drivers  ‘Go See’  Workstream Report end April 2016

22. Workstream Meeting 1 W/C Jan Outline Purpose Data Workstream Meeting 2 W/C Jan Current State Models Workstream Meeting 3 W/C Feb Transition ‘Go See’ Stretch Workstream Meeting 4 W/C Mar Future State Models Work steam Meeting 5 W/C Apr Draft Checks Finalise Workforce Strategy Estates Strategy Steering Group Meeting 1 Date Steering Group Meeting 2 Date Steering Group Meeting 3 Date Steering Group Meeting 4 Date Steering Group Meeting 5 Date OTHER WORKSTREAMS

23. Current StateTransitionFuture State Efficiency, Productivity, Value & Affordability Safety & QualityResilience & SustainabilityPerson CentredClinical Governance Measures & Sensitivity in System for reliable feedback Efficiency, Productivity, Value & Affordability Safety & QualityResilience & SustainabilityPerson CentredClinical Governance Measures & Sensitivity in System for reliable feedback Framework to consider Mary & John’s pathways CURRENT & FUTURE STATE

24. Workstream Report by end of April  Executive Summary  Introduction/Scope  Context  Patient, Public & Staff Engagement  Data & Evidence  Strategic Recommendations & Priorities  Appendices

25. Clinical Strategy Steering Group  6 meetings  Chairs/Senior Leads from 7 workstreams  Executive Directors  Objective – Draft Clinical Strategy June 2016  Pull key themes  Develop a list of other key work on-going  Commission key pieces of work e.g. Enhanced Community Services H@H, Community Hosp beds, STAR beds, Enhanced Teams

26. Opportunities & Challenges  Challenge - Ambitious Timescale & Scope  Positive – ‘Stand on the shoulders of Giants’  DATA  CLINICAL STRATEGIES  LITERATURE REVIEW  NATIONAL CLINICAL STRATEGY  Opportunity – Stretch Thinking – Believe in Better  Opportunity – shape where we go and what we do

27. RULES OF ENGAGEMENT

28. Themes for Development include Place of Care (best/appropriate) Person Centred Care/Good Quality Outcomes/Safe Communication (effective) Optimise use of technology Service efficiency Provision of 24/7 or 7/7 services Effective joined up working Simple access points for lowest level of intervention Reduce health inequalities

29. Terms of Engagement All workstream members: Are equal members on the workstream group Should be fully engaged in the process Should contribute to the discussions Will come to the meetings with 1.Ideas and thoughts to help inform endpoint recommendations for the workstream 2.Have completed any actions assigned to them Should respect others during the meeting including listening and not talking over each other

30. QUESTIONS?