Public Document Pack

25 January 2021

SUPPLEMENTARY PACK 1

ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) - VIA SKYPE on WEDNESDAY, 27 JANUARY 2021 at 1:00 PM

I enclose herewith the inspection report in relation to item 11 (HEALTHCARE IMPROVEMENT SCOTLAND - UNANNOUNCED INSPECTION: COWAL COMMUNITY HOSPITAL) which was marked to follow on the Agenda for the above meeting. I also enclose additional item 17 (BUDGET CONSULTATION 2021/22) which was not previously included on the Agenda for the above meeting.

ITEM TO FOLLOW / ADDITIONAL ITEM

11. HEALTHCARE IMPROVEMENT SCOTLAND - UNANNOUNCED INSPECTION: COWAL COMMUNITY HOSPITAL (Pages 3 - 30) Inspection Report

17. BUDGET CONSULTATION 2021/22 (Pages 31 - 48) Report by Head of Finance and Transformation

Argyll and Bute HSCP Integration Joint Board (IJB)

Contact: Hazel MacInnes Tel: 01546 604269 This page is intentionally left blank Page 3 Agenda Item 11

Unannounced Inspection Report

Hospital Inspection

Cowal Community Hospital NHS Highland

27 October 2020 Page 4 CONFIDENTIAL – DRAFT REPORT

Healthcare Improvement Scotland is committed to equality. We have assessed the inspection function for likely impact on equality protected characteristics as defined by age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation (Equality Act 2010). You can request a copy of the equality impact assessment report from the Healthcare Improvement Scotland Equality and Diversity Officer on 0141 225 6999 or email [email protected]

© Healthcare Improvement Scotland 2021 First published January 2021

This document is licensed under the Creative Commons Attribution- Noncommercial-NoDerivatives 4.0 International Licence. This allows for the copy and redistribution of this document as long as Healthcare Improvement Scotland is fully acknowledged and given credit. The material must not be remixed, transformed or built upon in any way. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc-nd/4.0/ www.healthcareimprovementscotland.org

Page 5

Contents

About our Hospital inspections 4

A summary of our inspection 6

What we found during this inspection 8

Appendix 1 – Areas of good practice 17

Appendix 2 – Requirements 18

Appendix 3 – List of national guidance 20 Appendix 4 – Inspection process flow chart 21

Page 6

About our Hospital inspections

Background 1. Prior to March 2020, Healthcare Improvement Scotland inspection activity included:  Safety and Cleanliness inspections carried out against Healthcare Associated Infection (HAI) standards, in both acute and community hospitals, and  Care of Older People in Acute Hospital (OPAH) inspections carried out in acute hospitals (inpatient ward areas) caring for older people.

2. During the COVID-19 pandemic, in March 2020, a letter was issued from Healthcare Improvement Scotland to all NHS Board Chief Executives and Integrated Joint Boards (IJB) Chief Officers to advise that the inspections of NHS facilities in Scotland would be paused until further notice. 3. In May 2020, Healthcare Improvement Scotland received a letter from the Chief Nursing Officer (CNO) Directorate of Scottish Government requesting that hospital inspections be reinstated due to the number of COVID-19 related outbreaks in hospital sites. As COVID-19 outbreaks appear to affect older people, our inspections will have a combined focus on Safety and Cleanliness and Care of Older People in Hospital. 4. We have adapted our current inspection methodology for safety and cleanliness and care of older people as a result of this combined focus. We will measure NHS boards against a range of standards, best practice statements, and other national documents, including the Care of Older People in Hospital Standards (2015) and Healthcare Associated Infection (HAI) standards (2015). A list of relevant national standards, guidance, and best practice can be found in Appendix 3. 5. During our inspection, we identify areas where NHS boards are to take actions and these are called requirements. 6. A requirement sets out what action is required from an NHS board to comply with national standards, other national guidance, and best practice in healthcare. A requirement means the hospital or service has not met the standards and we are concerned about the impact this has on patients using the hospital or service. We expect that all requirements are addressed and the necessary improvements are made.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 4

Page 7

Our focus 7. Given the impact of COVID-19, our inspections will focus on ensuring that older people in hospital receive care that:  meets their care needs in relation to food, fluid and nutrition, falls and the prevention and management of pressure ulcers  manages risks specifically for standard infection prevention and control precautions, falls, and the prevention and management of pressure ulcers, and  is safe and effective, and in line with current standards, best practice and delivered with local systems and policies in place to effectively manage the care provided. 8. The flow chart in Appendix 4 summarises our inspection process. 9. We will report our findings under three key outcomes:  people’s health and wellbeing are supported and safeguarded during the COVID-19 pandemic  infection control practices support a safe environment for both people experiencing care and staff, and  staffing arrangements are responsive to the changing needs of people experiencing care.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 5

Page 8

A summary of our inspection

About the hospital we inspected 10. Cowal Community Hospital, Dunoon provides healthcare services to the Argyll area. The hospital has a nine-bedded general ward, accident and emergency department, maternity unit and a dental surgery suite. About our inspection 11. We carried out an unannounced inspection to Cowal Community Hospital on Tuesday 27 October 2020, and we inspected the general ward. 12. During the inspection, we:  spoke with staff and used additional tools to gather more information. In both wards, we used a mealtime observation tool  observed infection control practice of staff at the point of care  observed interactions between staff and patients  inspected the ward environment and patient equipment, and  reviewed patient health records to check the care we observed was as described in the care plans. We reviewed all patient health records for infection prevention management and control, food, fluid and nutrition, falls, and pressure ulcer care.

13. We would like to thank NHS Highland and in particular all staff a Cowal Community Hospital for their assistance during the inspection. Key messages 14. We noted areas where NHS Highland is performing well and where they could do better, including the following.  Mealtimes were well managed and coordinated.  Very good standard of hospital environmental cleaning and patient equipment cleanliness.  Assessments for food, fluid, and nutrition should be accurately completed in line with national guidance.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 6

Page 9

What action we expect the NHS board to take after our inspection 15. This inspection resulted in three areas of good practice and four requirements. A full list of the areas of good practice and requirements can be found in Appendices 1 and 2, respectively on pages 17 and 18. 16. We expect NHS Highland to address the requirements. The NHS board must prioritise the requirements to meet a national standard. An improvement action plan has been developed by the NHS board and is available on the Healthcare Improvement Scotland website: www.healthcareimprovementscotland.org

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 7

Page 10

What we found during this inspection

People’s health and wellbeing are supported and safeguarded during the COVID-19 pandemic

Key areas include the extent to which:  people’s rights are respected, and they are treated with dignity and respect  people are enabled and supported to stay connected  people’s physical, mental and emotional health is promoted.

Treating older people with compassion, dignity and respect 17. We saw all patients were treated with dignity and respect, staff addressed patients in a respectful manner, and all interactions seen were positive. Patients appeared well cared for and the majority of patients’ had nurse call bells within reach. Call bells were not often heard, as staff were always nearby to respond to patients’ needs. 18. Patients were cared for in single rooms or single sex bays. The layout of the ward allowed for good bed spacing and the ability for physical distancing between patients. 19. We saw evidence of ward staff communicating with relatives to ensure that they were kept up-to-date with information. Patients were able to keep in touch with relatives by telephone. Immediately following our inspection, we were told an issue with connecting to the internet had been resolved, and the ward now had access to a web-based platform that offers video call access to patients. Screening and assessments 20. We reviewed patient health records and looked at assessments relating to infection control, food, fluid, and nutrition, falls and pressure area care. 21. Patients would either be admitted directly to the hospital or transferred from another NHS board. If transferred from another NHS board, then all documentation would be completed as a new admission. The majority of patient assessments are contained in the mandatory nursing assessment booklet with some additional loose-leaf assessments. The majority of assessments were accurately completed on admission for infection prevention and control, falls and pressure area care. However, these were not always accurately completed for food, fluid, and nutrition. We found the following:

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 8

Page 11

 None of the patient health records reviewed had it documented if they had any weight loss prior to admission. This information is required for an accurate completion of the Malnutrition Universal Screening Tool (MUST). Where the patient was unable to be weighed on admission, this was not always done at the earliest possible opportunity.  When patients were unable to be weighed on admission due to clinical reasons, the alternative measurement was not used to calculate the MUST score.  The nutritional assessment did not have a place to document the date or time of completion. It also did not contain all required information, such as food allergies or specific dietary requirements.  In two patient health records reviewed, the oral health assessment was blank.

22. Along with the Pressure Ulcer Risk Assessment (Waterlow), patients should have a foot assessment completed. This is a check, protect, and refer assessment ensuring patients have the correct equipment and are referred to appropriate service if required. We saw that for the majority of patients the foot assessment was not fully completed. 23. With the exception of MUST, the majority of reassessments were accurately completed within the required timeframes in line with NHS Highland’s policies. Where the MUST assessment did not document the patient’s weight loss on admission, this information was not updated on reassessment.

Care planning 24. NHS Highland care plans are contained within the About Me and My Long Term Plan of Care sections, are completed along with the patient, and should be specific to them. The care plan consists of the patient’s goals, date of evaluation and evaluation comments. 25. All patient health records reviewed had care plans in place, but they were not always well completed. We found the following.  Although the care plans had dates of evaluation, it was unclear what had changed with the patient’s care and they did not provide sufficient detail to guide patient care.  The MUST assessment stated a care plan should implemented and this was ticked for all patients. However, on discussion with staff there was no MUST care plan to complete.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 9

Page 12

26. We were told these care plans were introduced in April 2020. There was some virtual education sessions on the introduction of this document, but there was nothing else planned in the near future. The senior charge nurse is aware the care plans require some further work and will therefore address this issue. Food, fluid and nutrition (incl. mealtimes) 27. There was good provision of food, fluid, and nutrition for patients. We observed a mealtime on the ward and it was well managed. All patients remained within their rooms for their meal, as dining rooms were not in use in order to maintain safety measures during COVID-19. 28. There was an allocated mealtime co-ordinator who managed the mealtime service. Each course was served separately to ensure that the meal received was hot. If a patient did not want their ordered meal, we saw staff organising alternative food options. Patients were given sufficient time to eat each course and they were offered a choice of drinks with their meal. 29. Adaptive aids, such as cutlery and plate guards were available for those patients who required them. Where appropriate, patients were given encouragement or assistance with eating and drinking, and this was done in a dignified manner. 30. The ward had a nutritional board to communicate to staff information about patients requiring special or texture modified diets or any assistance required with eating and drinking. 31. The ward stocked a range of snacks to offer to patients throughout the day. Additional snacks, such as sandwiches and cakes could also be ordered from the kitchen for those patients who required them. 32. Patients had access to drinks such as water and juice that staff refreshed throughout the day. Hot drinks were offered at various times. 33. For one patient, on two previous occasions, the patient’s MUST score was scored incorrectly. The most recent assessment was scored correctly, and this should have prompted a referral to the dietician for further assessment, but this was not done. There was no documentation as to why the referral had not been done. We raised this with staff who were going to refer the patient to the dietitian for review. Prevention and management of falls 34. If a patient’s risk assessment considers them at risk of falls, then a falls bundle and falls safety bundle should be completed. 35. The falls bundle contains information such as appropriate footwear and aids provided, such as hearing aid or walking frame. The falls bundle also included

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 10

Page 13

interventions such as bedrail risk assessment, intensity of observation, such as care rounding or one to one observations. The majority of these were fully and accurately completed. 36. In the patient health records reviewed, no patients had fallen during their stay in hospital. We were told if patients required a review following a fall, staff would contact the ward doctor and if out of hours it would be the accident and emergency medic. 37. We saw good input from physiotherapy service during the inspection with good documentation of their input throughout the patient health records. Staff told us there is no falls nurse at present, but physiotherapists are available in the ward to give staff falls management advice. Pressure ulcer prevention and management 38. If a patient’s Pressure Ulcer Risk Assessment (Waterlow) considers them to be at risk of pressure ulcers, then a SSKIN Bundle (skin, surface, keep moving, incontinence, and nutrition) should be implemented. 39. The two patients who required a SSKIN Bundle had this in place. However, they were not accurately completed. We found the following:  The prescribed frequency of care delivery was not documented; therefore it was difficult to know how often this should happen.  There could be long gaps in care, for example between 7-23 hours with no explanation documented.  The patient could also be in the same position for a long period of time, with no documentation as to why, such as this was the patient choice.

40. One patient had a wound assessment chart in place for two wounds. The wound assessment in place was only a partial document. This meant it was unclear where the wounds were, what type of wounds they were, or what wound dressings were applied. There was some documentation within the patent health record regarding the wounds, but this did not correspond with the details on the wound assessment chart. We discussed this with staff, and the patient’s wounds were reassessed and a new wound assessment chart put in place. 41. We were told that pressure ulcers reported on the electronic system are discussed at the professional and practice standards meetings. We saw minutes of this meeting, which showed a report compiled by the tissue viability improvement group for sharing learning, and escalating concerns, which is completed quarterly.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 11

Page 14

Access to equipment 42. All wards inspected had access to different types of weighing scales such as sit on or hoist scales and all were calibrated. 43. A range of equipment for the management of falls and pressure ulcer care was available. This included high and low beds, pressure relieving mattresses and cushions, heel protectors and falls alarms.

Area of good practice ■ Mealtimes were well managed and coordinated and individual courses were served separately to ensure food remained hot.

Requirements 1. NHS Highland must ensure that all older people who are admitted to hospital are accurately assessed in line with the national standards. This includes nutritional assessment including MUST screening and oral health assessment. There must be evidence of reassessment, where required. 2. NHS Highland must ensure that patients have person-centred care plans in place for all identified care needs. These should be regularly evaluated and updated to reflect changes in the patient’s condition or needs. The care plans should also reflect that patients are involved in care and treatment decisions. 3. NHS Highland must ensure that the SKIN bundles are consistently and accurately completed to ensure that the frequency of repositioning is indicated and the results of skin inspection are documented.

Infection control practices support a safe environment for both people experiencing care and staff

Key areas include the extent to which:  people are protected as staff take all necessary precautions to prevent the spread of infection.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 12

Page 15

Physical distancing 44. All staff observed physical distancing where possible and staff in clinical areas wore surgical face masks at all times. There was a system in place to inform staff which patients were able to wear a face mask while moving around the ward. There was signage at the entrance to the hospital and throughout the ward advising staff and visitors on physical distancing and hand hygiene. Standard infection prevention and control precautions 45. Compliance with standard infection control precautions such as linen, waste and sharps management was good. 46. Hand hygiene facilities of clinical wash hand basins and alcohol-based hand rub were appropriately located and staff compliance with hand hygiene was good. We also saw staff offering patients hand wipes prior to mealtime. 47. We were told that there was a sufficient stock of personal protective equipment (PPE) for staff and visitors and this is maintained by monthly monitoring of stock levels. PPE dispensers were in appropriate locations. Gloves and aprons were generally worn appropriately. Any exceptions were raised at the time of inspection. 48. Staff told us that they have sufficient uniform and were aware of how to safely launder uniform at home. We were told that when there were COVID-19 positive patients in the hospital, staff wore scrubs which were laundered by the on-site laundry. Transmission based precautions 49. Due to COVID-19 restrictions in place at the time of inspection, patients had one designated visitor. We were told of the safe system that was in place to allow safe hospital visiting, such as taking contact details for the track and trace process and keeping an appointment booking system. The guidelines are displayed in the entrance corridor to inform visitors. 50. At the time of inspection, there were no patients with suspected or confirmed COVID-19 and no patients were isolated for other reasons. Staff were however able to describe the transmission based precautions that would be required. We saw that single rooms were set up in case they are needed for an isolated patient with dedicated patient equipment in the room. 51. In line with national guidance at the time of the inspection, patients over the age of 70 are tested for COVID-19 on admission. A patient would require two negative results within 48 hours before being transferred to Cowal Community Hospital or discharged out of the hospital to a care home. Admissions from the

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 13

Page 16

accident and emergency department and any patient with symptoms would be tested for COVID-19. Audits, policies, procedures, and guidelines 52. We saw evidence of audit activity at ward level and by the infection prevention and control team with resulting action plans which were complete or in progress. In line with NHS Highland’s policy, ward staff audit hand hygiene compliance and one other standard infection control precaution monthly on a rolling programme. Staff spoken with were aware of the audits that take place in their ward and told as that results are fed back during the safety brief and are displayed on the noticeboard. 53. The senior charge nurse produces a monthly report on audits that have taken place which is sent to the lead nurse. The audit information is collated with the other community hospitals within the Argyll and Bute area, and this data is reviewed for trends to identify where improvements can be made and learning shared. Patient equipment 54. We inspected a range of patient equipment. We found that all patient equipment was clean. Environment 55. The standard of environmental cleaning appeared very good. The environment was well organised and uncluttered to allow for effective cleaning. 56. Domestic staff confirmed that a chlorine-releasing disinfectant and detergent product is being used for twice daily cleaning of the environment including cleaning of sanitary fittings. We were told that frequently touched surfaces were being cleaned three times a day. Estates 57. We were told that estates issues are reported through an electronic estates reporting system. Staff told us response times from the estates team was good. 58. Although the ward environment was generally well maintained, there was some wear and tear of the fabric due to the age of the building. We saw that some estates issues had been identified on previous audits carried out by the infection prevention and control team, but that a recent facilities monitoring audit scored estates as 100%. We acknowledge that some works are on hold at present during COVID-19 and future restructuring of wards may be required.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 14

Page 17

However, the ward should be maintained to ensure that effective decontamination can be carried out.

Area of good practice ■ Very good standard of domestic cleaning and patient equipment cleanliness.

Requirement 4. NHS Highland must ensure that audit activity is robust and findings acted upon to provide assurance that the environment is being well managed.

Staffing arrangements are responsive to the changing needs of people experiencing care Key areas include the extent to which:  staffing arrangements are right and are responsive and flexible  staff are well supported and confident  staff knowledge and skills improve outcomes for people.

Staffing resource 59. Whilst current staffing levels were adequate, we were told that staffing was challenging at the height of COVID-19, as an additional ward was open. However, extra resource was provided by community staff and additional medical cover was put in place. 60. Staff told us that they were happy with the service provided by the domestic team and domestic resource was felt to be adequate with sufficient hours for tasks to be covered. Communication 61. There was good verbal communication between the ward teams to ensure safe delivery of care. Staff used handovers, safety briefs, and alert signs to communicate risks such as infection or falls risks. There was also good communication between ward staff and domestic staff to ensure safe management and decontamination of the environment.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 15

Page 18

62. Patient information boards were located in the nurses’ room, which displayed information such as mobility, diet, and fluids for each patient. 63. Within the patient health records reviewed, we saw some entries were not dated or signed. In addition, some loose-leaf documents did not have a place to record this information. 64. We were told referrals for advice and support dietician, speech, and language are made by paper referral but all services are in the process of changing to electronic referrals. Tissue viability referrals are already made electronically or by email. Staff are also able to contact by telephone for advice. Physiotherapists and occupational therapists are in the ward daily therefore staff are able to verbally refer patients. Leadership, education, and training 65. Wards appeared calm and organised with evidence of good team working. It was clear who was in charge of the ward. 66. We were told that compliance reports of mandatory staff education can be generated and we have seen evidence that these are discussed at the quality, professional and practice standards meetings. The compliance report is broken down into staff groups at the hospital, and the majority of which have good compliance rates. However, only one of the 10 medical staff at the hospital have completed the mandatory infection prevention and control education. Senior staff had already identified this as an area for improvement and discussions have started with the local clinical lead to improve compliance. We will follow this up at future inspections. 67. Nursing and domestic staff said they had been well supported during COVID- 19 by immediate line management and the infection control nurse who visits the ward monthly. As well as carrying out audits, the infection control nurse provides advice and face to face training, which can include updated COVID-19 guidance or any infection control issue that the staff request support with.

Area of good practice ■ Nursing and domestic staff felt supported during COVID-19 by senior staff and the infection control nurse.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 16

Page 19

Appendix 1 – Areas of good practice

People’s health and wellbeing are supported and safeguarded during the COVID-19 pandemic 1 Mealtimes were well managed and coordinated and individual courses were served separately to ensure food remained hot (see page 12).

Infection control practices support a safe environment for both people experiencing care and staff. 2 Very good standard of hospital environmental cleaning and patient equipment cleanliness (see page 14).

Staffing arrangements are responsive to the changing needs of people experiencing care. 3 Nursing and domestic staff felt supported during COVID-19 by hospital management and the infection control nurse (see page 16).

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 17

Page 20

Appendix 2 – Requirements

People’s health and wellbeing are supported and safeguarded during the COVID-19 pandemic 1 NHS Highland must ensure that all older people who are admitted to hospital are accurately assessed in line with the national standards. This includes nutritional assessment including MUST screening and oral health assessment. There must be evidence of reassessment, where required (see page 12).

This is to comply with Food, Fluid and Nutritional Care Standards (2014) criteria 2.1, 2.2 2.3 and 2.4.

2 NHS Highland must ensure that patients have person-centred care plans in place for all identified care needs. These should be regularly evaluated and updated to reflect changes in the patient’s condition or needs. The care plans should also reflect that patients are involved in care and treatment decisions (see page 12).

This is to comply with The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives (2015); Care of Older People in Hospital Standards (2015) criteria 1.1, 1.4, and 11.2a; Food, Fluid and Nutritional Care Standards (2014) Criterion 2.9a and Prevention and management of Pressure Ulcers standards (2020) Standard 6.

3 NHS Highland must ensure that the SKIN bundles are consistently and accurately completed to ensure that the frequency of repositioning (see page 12).

This is to comply with Prevention and management of Pressure Ulcers standards (2020) Standard 6.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 18

Page 21

Infection control practices support a safe environment for both people experiencing care and staff 4 NHS Highland must ensure that audit activity is robust and findings acted upon to provide assurance that the environment is being well managed (see page 15).

This is to comply with This is to comply with Healthcare Associated Infection (HAI) standards (2015) Criteria 6.4.

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 19

Page 22

Appendix 3 – List of national guidance

The following national standards, guidance and best practice are relevant to the inspection of the care of older people in acute hospitals.

 COVID-19: infection prevention and control guidance (Public Health England, June 2020)  Publication of COVID-19: Endorsed Guidance For NHS Scotland Staff and Managers on Coronavirus (Scottish Government, DL (2020)  Healthcare Associated Infection (HAI) standards (Healthcare Improvement Scotland, February 2015)  Best Practice Statement for Working with Dependent Older People to Achieve Good Oral Health (NHS Quality Improvement Scotland, May 2005)  Care of Older People in Hospital Standards (Healthcare Improvement Scotland, June 2015)  Prevention and Management of Pressure Ulcers Standards (Healthcare Improvement Scotland, October 2020)  Food, Fluid and Nutritional Care Standards (Healthcare Improvement Scotland, October 2014)  Complex Nutritional Care Standards (Healthcare Improvement Scotland, December 2015)  The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives (Nursing & Midwifery Council, January 2015)  Generic Medical Record Keeping Standards (Royal College of Physicians, November 2009)  Allied Health Professions (AHP) Standards (Health and Care Professionals Council Standards of Conduct, Performance and Ethics, January 2016)

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 20

Page 23

Appendix 4 – Inspection process flow chart

Healthcare Improvement Scotland Unannounced Inspection Report (Cowal Community Hospital, NHS Highland): 27 October 2020 21

Page 24

You can read and download this document from our website. We are happy to consider requests for other languages or formats. Please contact our Equality and Diversity Advisor on 0141 225 6999 or email [email protected]

Healthcare Improvement Scotland

Edinburgh Office Glasgow Office Gyle Square Delta House 1 South Gyle Crescent 50 West Nile Street Edinburgh Glasgow EH12 9EB G1 2NP

0131 623 4300 0141 225 6999 www.healthcareimprovementscotland.org

Improvement Action Plan

Healthcare Improvement Scotland: unannounced hospital inspection

Cowal Community Hospital, NHS Highland 27 October 2020

Page 25 Improvement Action Plan Declaration It is the responsibility of the NHS board Chief Executive and NHS board Chair to ensure the improvement action plan is accurate and complete and that the actions are measurable, timely and will deliver sustained improvement. Actions should be implemented across the NHS board, and not just at the hospital inspected. By signing this document, the NHS board Chief Executive and NHS board Chair are agreeing to the points above. A representative from Patient/Public Involvement within the NHS should be involved in developing the improvement action plan.

NHS board Chair NHS board Chief Executive

Signature Signature

Name Pamela Dudek

Name Professor Boyd Robertson Date 21st December 2020

Date 21st December 2020

File Name:2020102720201027 Impr action plan CCH NHSH V0.1 (1).docx (final).docx CCH NHS High V0.1 Version: 0.1 Date: 21/12/2020 Produced by: HIS //NHS Highland Page: Page 1 of 5 Review Date: - Circulation type (internal/external): Internal & External

Ref: Action Planned Timescale Responsibility for Progress Date to meet taking action Completed action 1 NHS Highland must ensure that all older people who are admitted to hospital are accurately assessed in

line with the national standards. This includes nutritional assessment including MUST screening and oral health assessment. There must be evidence

of reassessment, where required (see page 12). This Page 26 is to comply with Food, Fluid and Nutritional Care Standards (2014) criteria 2.1, 2.2 2.3 and 2.4.

 NHS Highland will continue to deliver 30/06/2021 Esther education on the revised patient Dickinson(Quality

documentation, including electronic nursing Improvement Projects records, which was introduced in May 2020. Lead NMAHP) This will include education on MUST and oral Supported by Lead and health assessment. The use of an electronic Associate Lead Nurses nursing document will aid with timely

assessment and reassessment and accuracy.

 Compliance will be monitored by Senior SCNs 30/06/2021 Charge Nurses (SCNs) by way of regular audit

of documentation and real-time feedback to staff in order to ensure continued quality improvement.

31/07/2021

Lead Nurse and  With the support of the Lead and Associate Associate Lead Nurses Lead Nurses, learning will be collated and

shared across the Board area.

2 NHS Highland must ensure that patients have person-centred care plans in place for all identified

care needs. These should be regularly evaluated and updated to reflect changes in the patient’s condition Page 27 or needs. The care plans should also reflect that

patients are involved in care and treatment decisions (see page 12). This is to comply with The Code: Professional Standards of Practice and

Behaviour for Nurses and Midwives (2015); Care of Older People in Hospital Standards (2015) criteria 1.1, 1.4, and 11.2a; Food, Fluid and Nutritional Care

Standards (2014) Criterion 2.9a and Prevention and management of Pressure Ulcers standards (2020) Standard 6.

 NHS Highland will continue to deliver 30/06/2021 Esther education on the revised in- patient Dickinson(Quality

documentation which was introduced in Improvement Projects May 2020 with an emphasis on all care plans being person centred and developed in Lead NMAHP) conjunction with the patient. Supported by Lead and Associate Lead Nurses

 Local support and education from Associate Lead Nurses to work alongside staff on 30/04/2021 Associate Lead Nurses person centred care planning in real time.

3 NHS Highland must ensure that the SKIN bundles Page 28 are consistently and accurately completed to ensure

the frequency of repositioning (see page 12). This is to comply with Prevention and management of Pressure Ulcers standards (2020) Standard 6

 Commission Tissue Viability Nurse to deliver 30/04/2021 Lead Nurse education sessions on wound assessment and completion of SSKIN

 A number of early implementer sites 30/06/2021 Lead Nurses currently testing revised Care Rounding tool which will be an aid to ensuring frequency of positional changes 4 NHS Highland must ensure that audit activity is robust and findings acted upon to provide assurance

that the environment is being well managed (see page 15). This is to comply with Healthcare Associated Infection (HAI) standards (2015) Criteria

6.4.

 Any finding from audits should be actioned as soon as is reasonably possible. 31/02/2021 SCNs

 Where this is not possible, the issue should 31/02/2021 SCNs be risk assessed, captured with the ward HEI Page 29 action plan and escalated to local management and Lead Nurse as infection control lead.

This page is intentionally left blank Page 31 Agenda Item 17

Integration Joint Board

Date of Meeting: 27 January 2021

Title of Report: Budget consultation 2021/22

Presented by: Judy Orr, Head of Finance and Transformation

The Integration Joint Board is asked to:  Note the budget consultation for 2021/22 went live on 22 January and runs until 19 February 2021

 Promote the consultation widely to maximise responses

1. EXECUTIVE SUMMARY

1.1 The Finance & Policy Committee has approved the public consultation on the budget for 2021/22 seeking views of our stakeholder priorities for our services and where they would prefer to see savings targeted. The consultation runs form 22 January till 19 February 2021 and can be accessed on the Council website. The intention is to seek responses so public views can influence the final savings proposals due to be considered by IJB on 31 March 2021.

2. INTRODUCTION

2.1 The Scottish budget announcement will be on 28 January 2021. We need to plan in advance of that date for next year’s budget. The current mid-range budget outlook scenario has been developed for this purpose and shows a need to develop savings proposals amounting to £7.2m. Savings of this level can only be achieved through a significant amount of transformation which will affect future services.

2.2 This paper presents the finalised public consultation on the budget for 2021/22 seeking views on our stakeholder priorities for our services and where they would prefer to see savings targeted. The consultation runs online until 19 February so public views can influence the final savings proposals due to be considered by IJB on 31 March 2021.

2.3 The IJB delegated authority to the Finance and Policy Committee to finalise the budget consultation at its meeting of 25 November 2020.

1 Page 32

3. DETAIL OF REPORT

3.1 Context

3.1.1 The Integration Joint Board (IJB) is legally required to set a balanced budget for the Health and Social Care Partnership (HSCP) 2021/22 at its meeting on 31 March 2021. Normally, by now the IJB would have a clear idea of our funding from Argyll and Bute Council and NHS Highland. This year the Scottish Government has announced that it will set out its budget on 28 January 2021. This means that there is still considerable uncertainty about our budget. However, as of December 2020 we are predicting that we need to reduce our spending by in the region of £7.2m next year.

3.1.2 There are previously agreed new savings for next year of £570k. There are also some as yet undelivered savings from the current financial year still to be delivered on a recurring basis. These effectively add to the challenge for next financial year, increasing the total savings to be delivered to £11.797m.

3.2 Budget Consultation

3.2.1 Attached at Appendix 1 is an updated draft budget consultation document which has been agreed by Finance and Policy Committee at its meeting of 22 January. It has been uploaded onto the Council’s website consultation pages and runs for a 4 week period, ending 19 February. It is accessible here: https://www.argyll-bute.gov.uk/forms/hscp-budget-consultation- survey-2021-22 It seeks views from the public on where savings should be targeted, along with views on the proposed policy savings areas and further suggestions. 3.2.2 This will be promoted via Community Planning Partnership and Council’s Keep in the Loop subscriber service and a range of fora including staff partnership forum, internal management team meetings, Strategic Planning Group, locality planning groups, ADP, CPP area groups. It will be promoted via posters where members of the public are likely to see these, but there will be no option this year to complete paper copies because of the difficulties in handling this whilst working remotely and in enforcing social distancing. Paper copies were offered last year across a wide range of locations. Despite this, just 19 paper responses were received out of a total of 563 responses. Many of these were from members of staff who should all have access to be able to complete this online. Managers will be asked to ensure that staff are supported to be able to do this. 3.2.3 Members of the IJB are asked to promote the consultation widely.

4. RELEVANT DATA AND INDICATORS

4.1 Information is derived from the financial systems of NHS Highland and Argyll and Bute Council.

5. CONTRIBUTION TO STRATEGIC PRIORITIES

5.1 The Integration Joint Board has a responsibility to set a budget which is aligned to the delivery of the Strategic Plan and to ensure the financial 2 Page 33

decisions are in line with priorities and promote quality service delivery. This needs to be considered when assessing the proposed budget savings options which are needed to deliver a balanced budget for 2021/22.

6. GOVERNANCE IMPLICATIONS

6.1 Financial Impact – The budget gap for 2021/22 on a mid-range scenario is estimated at £6.604m after previously agreed savings of £570k. This paper advises on the arrangements for consultation which are aimed at meeting that budget gap for consideration and comment.

6.2 Staff Governance – It is probable that some of the savings will require reductions in staffing. These have still to be fully identified along with assessments of whether these can be accommodated through vacancies and natural turnover, or would involve potential redeployments / redundancies.

6.3 Clinical Governance – Heads of Service have been asked to consider any potential impacts on clinical care and governance in putting forward savings proposals and ensure that proposals are acceptable. Equality and Socio- Economic Impact Assessments (EQIAs) are still to be produced for the Policy related savings. The proposed consultation will inform these.

7. PROFESSIONAL ADVISORY

7.1 Professional Leads have been involved in savings proposals and will assist in completion of the EQIAs.

8. EQUALITY AND DIVERSITY IMPLICATIONS

8.1 Proposals to address the estimated budget gap will need to consider equalities impacts. As yet, equality and socio economic impact assessments have still to be prepared. These will be prepared as savings proposals are more fully worked up.

9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE

9.1 None directly from this report.

10. RISK ASSESSMENT

10.1 The budget consultation will help inform an assessment of the risks associated with savings proposals.

11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT

11.1 Budget consultation is now underway. In addition, significant transformational savings will require local stakeholder and community engagement separate to this broad based consultation.

12. CONCLUSIONS

3 Page 34

12.1 The budget gap for 2021/22 on a mid-range scenario is estimated at £6.6m, and increases to £7.2m after excluding previously agreed new savings. This paper advises on the consultation now underway on the proposed savings and on bridging the remaining budget gap. The Board is asked to assist in promoting the consultation widely.

13. DIRECTIONS

Directions to: tick Directions No Directions required √ required to Council, NHS Argyll & Bute Council Board or NHS Highland Health Board both. Argyll & Bute Council and NHS Highland Health Board

REPORT AUTHOR AND CONTACT DETAILS

Author Name: Judy Orr Email: [email protected] Tel: 01586-555280

Appendices: 1 Budget Consultation Finalised Budget Consultation link: https://www.argyll-bute.gov.uk/forms/hscp- budget-consultation-survey-2021-22 Word version for information only

4 Page 35

PLANNING OUR FUTURE

CONSULTATION ON OUR BUDGET 2021/22

What are your priorities for HSCP services and how can we reduce our spending?

January - February 2021

1

Page 36

Budget Consultation 2021/22 Argyll and Bute Health & Social Care Partnership (HSCP) delivers a broad range of services to our communities, many of which are most used by very vulnerable people. Our vision is that people in Argyll and Bute will live longer, healthier, independent, happier lives and this underpins all that the HSCP does. Our population is ageing, and this is happening faster than elsewhere in Scotland, so this gives us particular pressures and demands for Older People services. We have other pressing demands with treating long term health conditions like cancer, heart disease and stroke, for example, obesity is driving up demand for diabetes related services which now cost 9% of the total NHS budget in Scotland. At the same time, the resources available to the HSCP are declining in real terms year on year. We cannot simply continue to provide the same services in the same ways. We have to find efficiencies, transform how we operate, and do less going forward. These are difficult choices, and there are no easy options left to reduce our spending. We would really value your views to help us make the best decisions that will affect all of our lives. This consultation is about high level budget decisions and how we prioritise our investment in local services, when it comes to the impacts on services being delivered, we will carry out further detailed community engagement. This will include working with people who will be affected by these changes including patients, carers, our staff and partners to ensure we listen to and take into account their ideas and worries. Thank you for taking the time to respond to this consultation. Councillor Kieron Green Chair, Integration Joint Board

2

Page 37

What is an HSCP? The Health and Social Care Partnership (HSCP) is an independent public body whose duties are laid out in Scottish law. It is a partnership between NHS Highland and Argyll and Bute Council who both contribute to its budget. In Argyll and Bute the HSCP is the organisation that plans the delivery of all of our health and social care services. How is the HSCP funded? HSCP receives money from both partners, NHS Highland and Argyll and Bute Council, each year. The amount that each partner pays is a decision taken by their own Boards. The HSCP then has to live within the amount of money it has been given. This budget must be “balanced”; in other words, the HSCP cannot plan to overspend in its finances. Setting the 2021/22 budget The Integration Joint Board (IJB) is required to set a balanced budget for the Health and Social Care Partnership (HSCP) 2021/22 at its meeting on 31 March 2021. Normally, by now, the IJB would have a clear idea of our funding from Argyll and Bute Council and NHS Highland. This year the Scottish Government has announced that it will set out its budget on 28 January 2021. This means that there is still considerable uncertainty about our budget because our partners do not yet know how much they will be receiving from Scottish Government. The funding from the Council is currently anticipated to reduce reflecting our agreement to payback some of previous overspends, to the extent of £1.2m. They could reduce funding by up to a further 2% but we are not currently planning for this. NHS Highland is expecting an increase in funding from the Scottish Government of between 2 to 3% and intends to pass this on in full to the HSCP using the nationally agreed formula (NRAC). We are planning for an increase of 2.5% as the mid-point. Given what we know already, as of December 2020, we are predicting that on a like- for-like basis, we need to reduce our spending by around seven million pounds (£7m) next year. Over recent years we have worked very hard to become more efficient. In the year 2020/21 alone we have reduced our spending by £6m. However, due to the Covid-19 pandemic, we have been on an emergency footing since March 2020, and that has meant that many transformational changes have not been made as fast as we originally anticipated, or have not been possible at all. We will carry forward in April to the new financial year £4.6m of previously agreed savings to be made next year. Together with the anticipated funding gap of £7.2m, this means that next year we must save 4% of our current annual budget, around £11.8m. The total shortfall in the HSCP’s budget for 2021/22 is approximately £11.8m. Changes which HSCP can, and cannot, make Many of the demands on HSCP’s budget are not wholly within its control. These include, for example:

3

Page 38

 Provision of services because the law requires them  Providing services in a specific way because this is laid down in national guidance and standards  Increased demand for healthcare because of demographic pressures, e.g. growing numbers of older people  People have increasingly complex needs, which increases the cost of some care packages  The cost of new drugs without these being fully funded  Costs for GP out-of-hours services increasing due to new GP contracts  Staff and supplier costs increasing on account of nationally agreed pay awards and the Scottish Living Wage  Costs for services contracted through NHS Greater Glasgow & Clyde  Services provided through nationally agreed GP, dentistry, pharmacy and optometry contracts This means that the HSCP has relatively limited ways in which it can make savings. There are 3 types of savings the HSCP can make: 1. Reducing overheads 2. Reducing or cutting services 3. Redesigning services to make them more efficient Reducing overheads For the past 2 years there has been a far-reaching drive to cut overheads within the HSCP. The senior leadership team has continued to identify areas of overhead savings, but the reality is that after such an extensive cost-cutting exercise, there is now little potential for further significant cuts. Reducing or cutting services This is where we are proposing to offer less services, such as through limiting support we provide directly or contracting for fewer hours from our providers. Changing how we work Having less money in our budget means that we cannot continue to deliver our services in the same way as we have previously and changes are needed. Some of these changes are already due to be implemented in 2021/22 including: • More technology used to support people at home, by allowing remote monitoring of conditions and consultations with trained staff, thus avoiding hospital visits and unnecessary admissions • More care delivered at home and more support for carers (especially family and friends), so nursing and care home beds will be used for people with higher care requirements.

4

Page 39

• Most hospital treatments will not require overnight stays, so that beds can be prioritised for those with continuous medical needs. However, more now needs to be done to ensure we can provide high quality care within a reduced budget. The HSCP’s Senior Leadership Team has carefully reviewed all budgets to identify any areas where efficiencies can be made without adversely affecting quality and/or safety. There has been an ongoing effort throughout 2020/21 to restrict non-essential expenditure, for example, in-depth scrutiny of all vacancies. We have identified new areas to stop spending of over £4.3m next financial year which will grow to £4.5m the following year. Some of these possible savings will potentially affect services you use and our staff. We want to know your views on these. We need to identify another £2.5m of savings and want your suggestions. We would like to know what matters most to you about HSCP services. The diagram below shows a breakdown of how this year’s budget of £278m is spent:

A&B HSCP Budget Summary 2020-21 £m

21.75, 7% Children & Families 1.81, 1% 21.43, 7% Older People social care

19.36, 7% Mental Health & Learning Disability & 35.81, 12% Physical Disability Commissioned services incl NHS GG&C 56.74, 19% GP services 34.49, 12%

Dentists, chemists & opticians

Hospital and Community Services 14.29, 5% 69.41, 24% Prescribing 19.34, 6%

Public Health

 The biggest area of spend is £65.6m on acute (specialist) services with NHS Greater Glasgow & Clyde. We also buy services worth £3.9m from other health boards.  The second biggest area of spending is £56.7m on hospital based services. This includes our hospital in Oban (£17.3m), and our community hospitals and services in Campbeltown, Dunoon, Lochgilphead, Mull and Iona, Islay, and

5

Page 40

Helensburgh. All community based services like community nursing and allied health professionals are included here.  The third biggest area of spend of £35.8m on older people social care which includes care at home and care home placements.  We spend £34.4m on Mental Health, Learning Disability and Physical Disability which includes both social care and NHS based services  Children and families services cost £21.7m include fostering and adoption, hostels and children’s houses, residential placements, child protection, children with disabilities, maternity services and school nurses, and justice social work.  GP services cost £19.2m and these are largely set nationally with little ability for the HSCP to make efficiencies. The same applies to £14.3m costs for dentists, chemists and opticians.  Management and corporate costs of £21.4m include services such as planning, finance, IT, estates, safety and quality and certain centrally held contingency budgets. After reductions to these budgets in recent years, there is little left to cut.

6

Page 41

CONSULTATION QUESTIONS Section 1: The role of the Health & Social Care Partnership in Argyll and Bute 1. What for you is the most important role for the HSCP (Please tick one option only) Deliver the services I use

Deliver services for the most vulnerable people in our communities

Help us all to live longer, healthier, independent, happier lives

Support local people to help others in our communities

Other (please tell us what)

2 Which of these general service categories do you use most (Please tick one option only) Children & Families Services

Older People Social Care

Mental Health, Learning Disability and Physical Disability Services

Greater Glasgow & Clyde hospitals and other services outside Argyll and Bute GP Services

Dentists, Chemists & Opticians

Argyll & Bute local hospital and community services

Public health (immunisation, health screening and other health improvement activities) Other (please tell us what)

3 What other services do you use (Please tick any that apply)) Children & Families

Older People Social Care

Mental Health, Learning Disability and Physical Disability Services

Greater Glasgow & Clyde Hospitals and other services outside Argyll and Bute GP Services

7

Page 42

Dentists, Chemists & Opticians

Argyll & Bute local hospital and community services

Public health (immunisation, health screening and other health improvement activities)

Other (please tell us what)

Section 2: Balancing our Budget We need to reduce our spending by £7.0m next year but the following costs are not available for savings:  GP, dentist and pharmacy contracts – set nationally  Contract costs for the Mid Argyll Hospital Plus some spending is very challenging to reduce:  Contract for acute hospital services with NHS Greater Glasgow & Clyde where we expect these to be based on an inflation based uplift, due to Covid affecting usage data

4 In which 3 categories would you most support reductions to spending? (Please label your top 3 options as 1, 2, 3) Children Services – fostering & adoption, looked after children Maternity, Health Visitor and School Nursing services Justice Social Work services Care at Home and other community social care support packages Residential care and nursing home placements Mental health services Disability support packages Community hospitals (offered at Campbeltown, Dunoon, Islay, Mid Argyll, Mull, Rothesay) Community services (Nursing, Occupational Therapy) Acute (hospital) Services offered from Oban Lorn & Isles Rural General Hospital Acute (hospital) services from NHS Greater Glasgow & Clyde GP practices Dentists, pharmacists and opticians Public health screening & immunisation and other health improvement programmes (this would not affect the COVID vaccine programme which will be implemented in full) Management & corporate including patient safety and quality of care Other (please tell us what)

8

Page 43

5 Please indicate your top 3 priorities from these service areas (Please label your top 3 options as 1, 2, 3) Children Services – fostering & adoption, looked after children Maternity, Health Visitor and School Nursing services Justice Social Work services Care at Home and other community social care support packages Residential care and nursing home placements Mental health services Disability support packages Community hospitals (Campbeltown, Dunoon, Islay, Mid Argyll, Mull, Rothesay) Community services (nursing, Occupational Therapy) Acute Services offered from Oban Lorn & Isles Rural General hospital Acute services from NHS Greater Glasgow & Clyde GP practices Dentists, pharmacists and opticians Public health screening & immunisation and other health improvement programmes (this would not affect the COVID vaccine programme which will be implemented in full) Management & corporate including patient safety and quality of care Other (please tell us what)

6 All of the HSCP’s funding comes from NHS Highland and Argyll and Bute Council. In turn, the bulk of their funding comes from the Scottish Government. We know this funding will not be enough to cover all our service costs in the coming year. We have identified a number of savings that may affect the services you are used to accessing. These are listed in the table in Appendix 1 and we would like to hear your views on these options. (In addition we have identified £3.5m of operational savings from vacancies, underspends across a range of budgets, reduction in travel, and other efficiencies.) If you have comments on the policy related savings options, please let us know

9

Page 44

7 We need to identify more ways to bridge our estimated funding gap. If you have any other ideas about where we could save money please let us know here:

8 We understand that people worry about changes to services and how this might affect them and their families, however the need for change is imperative due to our financial situation. We are interested in what changes might be acceptable to you. Please let us know your views on the following service changes: Option Acceptable Not Not sure acceptable More use of technology e.g. video facilities for appointments or electronic monitoring systems for people looked after at home – already used much more due to Covid social distancing requirements Reduce housing support services for learning disability clients ensuring this is based on level of need Shift from individual packages of care for Mental Health support to enabling model of group based care providing more peer support and social interaction Fewer local nursing home and care home facilities for older people in order to sustain and concentrate services in the remaining homes (occupancy levels are dropping) Fewer health visitors and school nurses

10

Page 45

Reduce community based day services for older people or people with learning disabilities and replace with a range of community based Third Sector services For clients who refuse a care home placement, Care at Home packages capped at £30k p.a. (equivalent to cost of residential care) with option for clients to cover costs above this level themselves More support for unpaid carers (family and friends) including short breaks / respite Improve utilisation of Oban hospital theatre capacity through patients travelling from North Highland or work transferred that is currently done from Glasgow hospitals (e.g. urology) Remove support for lunch clubs Reduce discretionary (non-contractual) support to voluntary organisations encouraging these to be self-funding Less support for patient travel escorts – stricter criteria to ensure we pay for escorts only when they are absolutely necessary

9 Please let us know if the impacts of these changes are acceptable or not: Impacts Acceptable Not Not sure acceptable More travel to specialist services

Less in person face to face time with specialists

Increased waiting times for care at home packages Care at home packages only for those with the highest level of care needs Family and friends doing more to support people living at home You taking more responsibility for your health and wellbeing and making healthy lifestyle choices to prevent health problems

Section 3: About You 10 Age Group Under 18 18-30 31-50 51-65 66-75

11

Page 46

76-85 Over 85

11 What is your gender Male Female Transgender Non-binary Other Prefer not to say

12 Which area do you live in? Helensburgh and Lomond Oban, Lorn, and the Isles Bute and Cowal Mid Argyll, Kintyre, and the Islands

13 Do you have dependents that you look after? No dependents Child or children under 18 Spouse or partner Older relative(s) Other adult(s)

14 Are you a young carer, or a person being cared for by others, or disabled? I am a Young Carer I am cared for by others I have a disability

Many thanks for taking the time to respond to our questions. Your views are very important to us and will be taken into account in our budget planning. We will report your responses and the findings in various ways including Argyll and Bute Council’s website and on social media.

Closing date for questionnaires: 19 February 2021

12

Page 47

Appendix 1: Proposed 2021/22 Savings with impact on services - for consultation

2021/22 2022/23 No. of staff Ref £k £k Savings descriptions impacted Children & Families & Justice

2122-01 100 100 Align business model for staffing for the 2 children's homes 2122-02 44 44 Carry out hostel review to achieve best value in admin and catering 2122-03 8 8 Do not replace independent chair of panel Community & Hospital services Bring back urology services from NHS Greater Glasgow & Clyde and offer from Oban 2122-04 110 221 Hospital instead 2122-05 35 35 Only pay for escort travel where it is essential Transfer current clients from in house run care home which is no longer fit for purpose 2122-06 190 380 to private sector home which has capacity within same locality 34

2122-07 Transfer current clients from in house run care home which is no longer fit for purpose 0 380 to private sector home which has capacity within same locality Pay for care home placements for older people in line with national contract with no 2122-08 70 140 added enhancements When a new client is assessed as requiring 24 hour care and refuses care home 2122-09 placement, offer to fund a package of care at home up to £30k, allowing the service 60 100 user to fund the additional hours of care if they chose to remain at home Redirect Oban Integrated Care Funding (used to pay grants to a range of voluntary 2122-10 74 74 sector organisations) to pay for day responder service as in other areas

2122-11 29 29 Remove funding for all lunch clubs 2122-12 60 60 Reduce payments to voluntary organisations for non-contracted services Mental Health and Learning Disability and Physical Disability End externally contracted day services for learning disability and replace with 2122-13 220 440 Endalternative Service provision Level Agreement for commssioned advocacy service and replace with signposting to carers groups, other advocacy services and national mental health 2122-14 0 41 organisations

2122-15 6 6 End grants paid to link clubs, some of which are no longer providing services 2122-16 12 12 Reduce befriender service following review of clients Encourage clients to have individual tenancies with housing association - they will 2122-17 qualify for benefits covering housing costs - rather than HSCP paying for rents and 9 9 council tax - encouraging fuller independence for clients Dental 2122-18 32 32 Reduce budget for Oral Health which would impair ability to deliver this service Totals 1059 2111 34 This page is intentionally left blank