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Highland Health & Social Care Committee 1 March 2018 Item 3.5 NORTH HIGHLAND OPERATIONAL UNIT – Chief Officer's REPORT 1

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Highland Health & Social Care Committee 1 March 2018 Item 3.5 NORTH HIGHLAND OPERATIONAL UNIT – Chief Officer's REPORT 1 Highland Health & Social Care Committee 1 March 2018 Item 3.5 NORTH HIGHLAND OPERATIONAL UNIT – Chief Officer’s REPORT 1. Introduction This report will provide an overview of activity in North Highland and will highlight areas of focus as well as areas of further opportunity. South & Mid Division 2. People 2.1 Recruitment We continue to be challenged by recruitment to mental health services, in particular medical and registered nursing posts and are looking at new workforce models that are sustainable in the future. 2.2 Sickness Absence Sickness absence in the division was 5.66% in December 2017 with an annual trend of 5.31%. There is an improving position in East Ross with monitoring system implemented from the recent RPIW. 3. Quality Safety 3.1 Improvement Activity SPSP in Community Hospitals Leadership meetings are now taking place quarterly to provide a leadership system that supports the improvement of safety and quality in all Community Hospitals across NHS Highland. Priorities include falls reduction, Catheter Associated Urinary Tract Infection (CAUTI) prevention, early recognition of deteriorating patient, prevention of hospital acquired pressure ulcers, promotion of improvement culture and use of Quality Improvement (QI) methodology. Value Management New Craigs and the Royal Northern Infirmary (RNI) are participating in value management. They report out weekly on their box score which contains a mix of financial, performance and capacity measures. Improving systems and process Neighbourhood Teams The Inverness Neighbourhood teams have completed extensive mapping to refine processes in preparation for introduction of Morse IT system. 1 Rapid Process Improvement Workshop (RPIW) A discharge planning RPIW will New Craigs Hospital taking place 26th February – 2nd March. 3.2 Redesign Initiatives Prescribing Budget Position Data from PRISMS to end November 2017 shows the following budget positions: Area Allocation Expenditure Difference Percentage year-to-date year-to-date difference EastRoss £2,803,535 £3,103,272 +£299,737 +10.69 InvernessEast £5,696,469 £6,107,354 +£410,885 +7.21 InvernessWest £3,782,748 £3,885,960 +£103,212 +2.73 MidRoss £2,825,761 £2,911,127 +£85,366 +3.02 Nairn, Badenoch & £3,419,711 £3,493,439 +£73,728 +2.16 Strathspey South & Mid Division £18,528,224 £19,501,152 +£972,928 +5.25 Totals In the above table a negative value in the "Value YTD" and the "Percentage YTD (%)" columns denotes an underspend against allocation, whereas a positive value in these columns denotes an overspend against allocation A significant number of medicines are currently in short supply and, as a result, their price has increased. We are tracking the impact of the top 13 of these and, comparing the first eight months of 2017/18 to the first eight months of 2016/17, we have seen an increase in expenditure for these 13 medicines of over £854,300. 3.2.1 Psychology Waiting list improvement work continues with no waiting times for people with personality disorder in the Inverness area awaiting Systems Training for Emotional Predictability and Problem solving in Borderline Personality Disorder (STEPPS). A planning day for introducing the Computerised Cognitive Behavioural Therapy (cCBT) for Highland is scheduled for end of February. 3.2.2 Drug & Alcohol Recovery Service NHS Highland continue to have challenges in meeting the HEAT A11 Standard. However, improvement work carried out in June 2017 has resulted a test of a new service model within Osprey House (the biggest service with highest referral rate). In the 6 months since this has been implemented, Osprey are consistently meeting the HEAT A11 standard with over 90% of clients on treatment within 3 weeks of referral being received. This model is only just being rolled out to community services in Inner Moray Firth. Wider issues have impacted on the NHS Highland achievement, particular long waits in Caithness and Lochaber as a result of staff vacancies. Caithness is now back at full capacity and waits will reduce as a result. The Lochaber area is seeking to reappoint a senior practitioner as a result of a recent change to the team. 2 3.3 Health Improvement South & Mid Health Improvement Team has secured premises in Merkinch area of Inverness to deliver Health Improvement Services and it is anticipated that this local premises will provide a local hub for other health care services. The Vaccination Transformation Programme at Highland level has started scoping the process for various different vaccination schedules to inform the development of service models for delivering a cradle to grave vaccination service in the Inner Moray Firth. 3.4 Control of Infection The South & Mid division has seen a number of different flu outbreaks in both hospital and Care Home settings from the middle of December to date. Compliance with standard infection control precautions continues to achieve above 95% in all Hospital and Care Home settings. 4. Care Service and Delivery 4.1 Care at Home (including commissioning) One provider has started piloted involvement in one of the seven Inverness Neighbourhood Teams with further discussions having taken place regarding the next phase of this project. The Inverness Overnight Service is coming towards the end of its first year and discussions are due to commence on how this can be taken forward. Development work is also ongoing on creating standard care packages for Step Up, Step Down and Transfers to Daytime Providers are also being developed. The transformational change programme is not yet completed with the organisational change process ongoing for some staff. For both community divisions, discussions are ongoing regarding achievable efficiency savings and the development of proposals that encompasses additional capacity planning across the whole of the North Highland Area within a collaborative tariff structure. 3 4.2 Care Homes Care Homes (Including Commissioning) Work continues to progress to develop an internal position regarding a place of care strategy to determine what model of care is required into the future, where it is required, how much of it is needed and how it will be delivered. Three internal sessions have now taken place with operational directors, clinicians, public health, finance and commissioning staff, to review available data, understand the current position, flow and current projections into the future. A briefing was provided to a board development session in October 2017 in order to facilitate a shared understanding by Board Members of the issues and challenges. Following on from the second session, a short and accessible summary of the key points from the data wall is in preparation, to assist communicate the messages of and challenges around this work with wider stakeholders. The third session took place on 12 February 2018, which looked to articulate the Board’s proposed strategy and delivery plan. Following this, it is intended to engage with the sector during March 2018. 4.3 Falls Prevention South & Mid Operational Unit has established a short life working group to test a revised approach to the implementation of the new NHSH Policy for the prevention and management of falls in inpatient settings, including Community Hospitals and New Craig’s Hospital. This group will oversee the implementation of key measures which have demonstrated success in preventing falls in hospital settings. The success of the Multi- Disciplinary Team (MDT) working together to implement measures to reduce falls has been evidenced in the reduction of falls in both the RNI and County Community Hospital Invergordon (CCHI). 4.4 Mental Health and Learning Disabilities The redesign of the rehabilitation service has been completed. The first phase of the bed re- configuration on the New Craigs site will commence at end of February. 4.5 Support for People with Dementia and their Families The planning team preparing the Dementia Strategy Implementation Plan led by M Wyllie from the 3rd Sector interface has commenced. 5. Finance 2017-18 has been a challenging year for the South & Mid division given the significantly higher savings targets than allocated in previous years (£3.1m 2016-17 and £8.6m 2017-18) and as such this has been reflected in our year end out-turn of £4.8m as at Month 10. £3.2m of unachieved savings accounts for the majority of this overspend with adult social care pressures of £2.6m also being a factor. Whilst £4.832m of savings were achieved in 17/18, £3.2m of this was made non recurrently and South & Mid are now in the process of identifying what can be converted recurrently from 18/19. Prescribing pressures due to short supply and demand accounts for £1.3m of the year end out-turn with non-recurring benefits in Pay/Non Pay offsetting this. Prescribing initiatives in 4 17/18 has released £360k of savings from 1819 and work is ongoing to quantity the remainder of the schemes previously identified. For the remaining two months of the financial year it is imperative that the division contains its expenditure in order to retain the current year end out-turn. 5 North & West Operational Unit 2. PEOPLE AND STAFF MORALE 2.1 Recruitment There are recruitment challenges across the Unit and across all disciplines, the following are examples of this:- North: Nurse staffing in Dunbar Hospital and Town & County Hospital continues to be challenging with long and short term sick leave. Advanced Nurse Practitioner development posts for the Caithness Out of Hours service are being re-advertised. Patient safety remains paramount at Town & County Hospital, therefore the reduced bed numbers remain in place, retaining 6 beds within the hospital. Both sites form part of the Caithness Redesign consultation. West: Domestic staffing in Portree remains fragile although it is hoped this will improve over the next month. Every possible avenue is being followed, however there is a high level of concern around sustainability of services in Skye.
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