Policy responses and statements

Name of organisation:

Academy of Medical Royal Colleges and Faculties in Scotland

Name of policy document:

Consultation from the Scottish Government's Directorate for Health and Workforce Planning on 'Developing Proposals for New Heat Targets for 2012/13'

Deadline for response:

9 August 2011

Background: The Scottish Government has written to the Scottish Academy to seek views on the development of the 2012/13 HEAT targets for NHSScotland and the contribution they make to the wider outcomes we are all pursuing. This letter is extended, for the first time, to colleagues in the wider public sector, and therefore provides a narrative on the developments in NHSScotland’s outcomes approach to performance management, including the development of quality outcomes and indicators and how HEAT targets will be aligned to maximise their contribution to the delivery of the quality outcomes and quality strategy.

In setting the context for the new HEAT targets for 2012/13 it should be noted that the Healthcare Quality Strategy builds upon existing foundations and aims to ensure that going forward all work is integrated and aligned to deliver the highest quality healthcare services to people in Scotland and in doing so provide recognised world leading quality healthcare services. It sets out 3 Quality Ambitions which provide a single and shared description of quality for NHSScotland. Work is underway to streamline and align all work programmes with these Ambitions. They will act as the focus for priority action for all services. The 3 quality Ambitions are:

• Person centred: Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

• Safe: There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate clean and safe environment will be provided for the delivery of healthcare services at all times.

• Effective: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit and wasteful or harmful variation will be eradicated.

Following extensive consideration, consultation and developmental work, the Cabinet Secretary has agreed six healthcare Quality Outcomes which provide a more comprehensive description of the priority areas for improvement in support of the Quality Ambitions. It is intended that these Quality Outcomes should provide a context for partnership discussions about local and national priority areas for action. They will also provide the basis for the future development of an aligned set of HEAT targets. The 6 healthcare Quality Outcomes are:

• Quality Outcome 1 - Everyone gets the best start in life, and is able to live a longer, healthier life: NHS Scotland works effectively in partnership with the public and other organisations to encourage healthier lifestyles and to enable self care, therefore preventing illness and improving quality of life.

• Quality Outcome 2 - People are able to live well at home or in the community: NHSScotland plans proactively with patients and with other partners, working across primary, community and secondary care, so that the need for hospital admission is minimised. This is therefore reflected in the outcome indicators on emergency admissions and end of life care.

• Quality Outcome 3 - Healthcare is safe for every person, every time: Healthcare services are safe for all users, across the whole system.

• Quality Outcome 4 - Everyone has a positive experience of healthcare: Patients and their carers have a positive experience of the health and care system every time, which leads them to have the best possible outcomes. This should be demonstrable across all equalities groups.

• Quality Outcome 5 - Staff feel supported and engaged: Staff throughout NHSScotland, and by extension, their public and third sector partners, feel supported and engaged, enabling them to provide high quality care to all patients, and to improve and innovate.

• Quality Outcome 6 - The best use is made of available resources: NHSScotland works efficiently and effectively, making the best possible use of available resources.

An initial set of 12 Quality Outcome Indicators for national reporting on longer term progress towards the Quality Ambitions and the Quality Outcomes has been developed. This set is intended to provide indicators of quality, and will not have associated targets. It is expected that most Quality Outcome Indicators (QOIs) will be disaggregated geographically, and by equality groups, where possible, and appropriate. The initial set of 12 Quality Outcome Indicators will be reviewed by the Quality Alliance Board after one year. A detailed document setting out the process through which these Quality Outcomes and related Indicators have been developed, along with technical information about the sources, definitions etc of the individual indicators is available at www.scotland.gov.uk/nhsscotlandquality.

The HEAT performance targets will set out the accelerated improvements that will be delivered specifically by NHSScotland in support of the quality outcomes and quality indicators. It is therefore essential that we have a shared agreement on these key areas for HEAT target setting, and an understanding of how these targets will contribute to the Quality Outcomes.

After considering the alignment of the HEAT targets which are still to be delivered in 2012/13 or later (See Annex), 5 areas for further accelerated improvement to support progress towards the Quality Outcomes have been identified. As a result, work is underway to develop proposals for new HEAT targets in 2012/13 as follows:

• Early Access to Antenatal Care for all women focusing on women under 20 and those living in the poorest SIMD quintiles (Quality Outcome 1);
• Timely and accurate communication at the interface between Primary and Secondary Care to support the delivery of safe and effective care (Quality Outcomes 2, 3 and 4)
• Detecting Cancer Early to support cancer survival rates (Quality Outcomes 1 and 2);
• Supporting Reshaping Care for older people and better integration (Quality Outcomes 2 and 3); and
• Cash Efficiency savings (Quality Outcome 6).

The Scottish Government is interested in receiving views on the proposed targets for development together with the existing HEAT targets that are due for delivery in 2012/13 onwards and how these targets support the wider outcomes we are all pursuing.

COMMENTS ON
ACADEMY OF MEDICAL ROYAL COLLEGES AND FACULTIES IN SCOTLAND
CONSULTATION FROM THE SCOTTISH GOVERNMENT’S DIRECTORATE FOR HEALTH AND WORKFORCE PLANNING ON DEVELOPING PROPOSALS FOR NEW HEAT TARGETS FOR 2012/13

The Royal College of Physicians of Edinburgh welcomes the opportunity to comment on the proposed HEAT targets and would hope to have an earlier opportunity to contribute to this and related work streams on quality in the future.

In terms of the HEAT targets to drive accelerated improvements against the 6 Quality Outcomes and 12 Quality Indicators, the College has the following brief comments:

• The target areas are uncontroversial, but it is difficult to comment on the feasibility of measuring performance against HEAT targets in the absence of clear indicators.
• The College strongly supports efforts to improve communication on medicines and  prescribing between secondary and primary care
• The College agrees that older people should be kept out of hospital whenever possible and improvements to anticipatory and planned care should be supported.  However, the College has some concerns about the effectiveness of the indicators offered to monitor this target; reducing emergency admissions and/or lengths of stay following emergency admissions can be attributed to many factors and it will be difficult to account for the particular contribution of anticipatory and planned care.
• Emergency admissions to the medical specialties are the drivers of much activity within secondary care, and the apparent reduction in emergency admissions in ISD statistics does not reflect reality for practicing physicians.  Also, the College would strongly challenge any perception that current emergency admissions to medicine are avoidable; most patients have good clinical reasons for admission, albeit that it can then be difficult to arrange a timely discharge.  Resources must not be transferred from acute medicine until preventive strategies are well established and demonstrated to be working effectively.  The College is undertaking an in-depth study of the staffing and service pressures in acute medical units across Scotland and will be happy to share the results which will be relevant to several quality initiatives, including those designed to prevent admission to hospital and protect standards of care.
• It would be useful to understand better the role and remit of the Quality Alliance Board.

Copies of this response are available from:

Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.

Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939

[9 August 2011]