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Appendix A
The Scottish Government's Purpose
In September 2007, the Scottish Government introduced a National Performance Framework which set out, for the first time, an ultimate Purpose of Government, supported by seven high-level purpose targets, and 15 National Outcomes.
National Performance Framework for Scotland
The Government has set a single, over-arching Purpose:
To focus the Government and public services on creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth.
Progress towards this Purpose will be supported by the achievement of seven high-level Purpose Targets:
Purpose Targets
1. Economic Growth: by 2011, raise our GDP growth rate to the UK level, and by 2017, match rate of small independent EU countries
2. Productivity: by 2017, rank in the top quartile of OECD countries
3. Participation: by 2017, maintain position as the top performing UK nation for labour market participation, and close gap with top five OECD countries
4. Population: by 2017, match average EU-15 population growth, and increase healthy life expectancy
5. Solidarity: by 2017, increase overall income and the share of income earned by the lowest 30 per cent as a group
6. Cohesion: by 2017, narrow the gap in participation between our best/worst performing regions
7. Sustainability: by 2011, reduce emissions and by 2050, reduce emissions by 80 per cent
Achievement of these Purpose Targets and the ultimate Purpose will be underpinned by progress towards 15 National Outcomes:
National Outcomes
1. We are better educated, more skilled and more successful, renowned for our research and innovation
2. We live in a Scotland that is the most attractive place for doing business in Europe
3. Our young people are successful learners, confident individuals, effective contributors and responsible citizens
4. Our children have the best start in life and are ready to succeed
5. We live our lives safe from crime, disorder and danger
6. We have improved the life chances for children, young people and families at risk
7. We live longer, healthier lives
8. We have strong, resilient and supportive communities where people take responsibility for their own actions and how they affect others
9. We have tackled the significant inequalities in Scottish society
10. We realise our full economic potential with more and better employment opportunities for our people
11. We live in well-designed, sustainable places where we are able to access the amenities and services we need
12. We value and enjoy our built and natural environment and protect it and enhance it for future generations
13. We reduce the local and global environmental impact of our consumption and production
14. We take pride in a strong, fair and inclusive national identity
15. Our public services are high quality, continually improving, efficient and responsive to local people's needs
This framework provides the context for all public sector organisations to develop outcome-focused approaches to identifying their key contributions to these national goals, and to put in place agreements, performance management systems and processes which will support them in delivering their highest quality services, and making the biggest contributions they can. A new website - Scotland Performs has been launched to allow the public to access regularly-updated information and statistics, which describe progress towards the National Performance Framework's Purpose Targets and National Outcomes using a basket of 45 National Indicators.
In parallel, public bodies will be expected to report publicly on the progress they are making towards achieving their specific commitments in support of these national priorities. The section below describes the NHSScotland approach, which will continue to develop throughout 2008/09 and 2009/10, in line with the discussions Health Boards are engaged in with local authorities through their Community Planning Partnerships ( CPPs) in order to develop new Single Outcome Agreements.
Single Outcome Agreements ( SOAs)
A new single outcome approach and related Concordat have been introduced for 2008/09. Their purpose is to establish a set of shared priority local outcomes and related indicators which each local authority agrees with its community planning partners. These local priorities will reflect the National Outcomes and Purpose, but also provide an opportunity for local areas/partnerships to emphasise their specific challenges and priorities. In some cases these priorities will be shorter-term outcomes, or will be targeted at particular groups or geographies.
The SOAs have provided an opportunity for CPPs to set out how they will contribute toward the Care Outcomes - a small set of national priority outcomes for community care which have been agreed across Health Boards and local authorities.
Through CPPs, Health Boards, local authorities and other public services will agree how they will work, individually and together, towards the shared priority Local Outcomes. This will require each organisation to be clear about their contributions. Each organisation will ensure that they have appropriate local performance management systems in place to ensure the delivery of their particular responsibilities.
NHSScotland's Priorities for 2007/08
A new approach to identifying, and pursuing a small set of core priorities for Health Boards was introduced for the first time in 2006/07. These priorities were described by a set of targets which were closely related to the key health strategies. They also set out the key actions and outputs NHSScotland will deliver in order to support national progress towards achieving the high-level, long term outcomes and targets set out in the Scottish Government's National Performance Framework. This NHS Performance Management system has been reviewed and updated annually following significant consultation with NHSScotland, and reflecting the new context of the National Performance Framework, and the new Single Outcome Agreements with local authorities and Community Planning Partnerships. A strict principle, in order to retain focus and priority, is that the number of targets should remain very close to 30. The targets fall into four areas, described as HEAT:
H - Health of population;
E - Efficiency and productivity, resources and workforce;
A - Access to services and waiting times;
T - Treatment and quality of services.
The introduction of this new and focused approach to agreeing levels of performance across Health Boards in terms of their progress towards a small number of high priority national targets has been widely accepted across NHSScotland as a significant improvement.
There is widespread awareness of the HEAT targets across NHSScotland which has helped all staff understand the priorities of the Cabinet Secretary for Health & Wellbeing, and their role in improving services and the health of the people of Scotland.
Through their annual Local Delivery Plans ( LDPs) Health Boards set out how they will be judged in terms of their performance on the HEAT targets, which have been developed to support delivery of the Government's purpose.
Through the Cabinet Secretary's Annual Reviews with Health Boards, there is a regular opportunity to discuss and scrutinise progress towards the plans set out in the Boards' LDPs in public (based on Boards' self assessments of their performance). The complimentary development of an NHSIT system to report regular and timely updates of performance against plans for each Board has also been seen as a very helpful resource, allowing Boards to see the Health Directorates interpretation of their performance, and to assess their own position relative to other Boards. This resource is also used by the Scottish Government Health Delivery Directorate in its ongoing performance discussions with Boards. This system is also used as the basis for the analysis and performance reports presented in this Annual Report, and in a new public reporting website currently being developed.
Through the annual process of reviewing and refreshing the HEAT targets, there has been a specific aim to re-balance the range of targets across the four HEAT areas to ensure a better alignment with the Scottish Government's high-level National Outcomes and Purpose and a better reflection of priorities across the system. There also continues to be a particular focus on identifying priorities/targets which reflect the key health strategies,as set out in Better Health, Better Care.
Appendix B sets out the current set of 2008/09 HEAT targets, and the 2009/10 HEAT targets can be found in Appendix C. These later sets of targets reflect the developing role and position of HEAT as described above.
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