MID COMMUNITY HEALTH PARTNERSHIP COMMITTEE

OUT OF HOURS REPORT

Date: November 2011

MANAGEMENT REPORT

1.0 OVERVIEW • Work continues to facilitate call handling for Social work OOH calls, currently delayed as a result of technical issues. • An decrease in complaints and significant events has been recorded during the reporting period. • Activity in the 17 to 45 year age bracket remains the highest. • 1 hour response times for both Home Visits and Appointments remain a challenge with the highest percentage of breaches. • Home Visit 2 hours are also a problematic area in terms of response times. • A Highland wide OOH Clinical Governance Meeting took place during September – response times were discussed and local areas expressed a wish to explore in more detail each of the breaches. • The Healthcare Improvement (HIS) draft OOH quality indicators are being piloted by NHS Highland and NHS Greater Glasgow & Clyde and current work is focussing on the appropriateness of the response priorities from NHS24.

2.0 ACTIVITY

Activity data provided by NHS24 and the Highland Hub covering the period 01.09.11 – 31.10.11 is shown below.

Overall activity

September 2011

Month Highland Skye Hospital Daytime NHS24 Self Walk-ins % from Total OOH – included in OOH Care NHS24 Activity totals Sept 2011 5660 281 1971 1269 (23%) 64% Oct 2011 5894 384 2005 1254 (21%) 63%

Activity split by Aug % of Sept % of Oct % of CHP 2011 total 2011 total 2011 total North 367 7% 523 9% 564 10% Mid 1871 33% 1897 34% 2131 36% South East 1060 18% 1810 32% 1795 30% & Bute 537 9% 618 11% 683 12% Dental 228 4% 177 3% 204 3%

Age Profile of patients September/October 2011

total Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Age <5 8253 1091 901 871 969 867 800 796 580 672 706 Age 6- 16 5583 764 567 510 652 554 561 649 475 410 441 Age 17- 45 19259 2721 1793 1628 2196 2043 1941 2314 1898 864 1861 Age 46- 60 10002 1298 809 786 1059 1004 1031 1144 925 921 1025 Age 61- 75 9324 1106 795 721 1045 1034 1000 1083 847 843 850 Age >75 11033 1466 1055 944 1250 1123 1111 1164 959 950 1011

Age Profile 2011

25000

20000

15000

Series1

10000

5000

0 Age Age Age Age Age Age <5 6-16 17-45 46-60 61-75 >75

The charts below illustrate overall OOH activity across NHS Highland by month.

September 2011 by Call Type

Location Count of Case Number (blank) 3000 Wick PCEC Wick Car (TB1) Ullapool 2500 Tongue/Armadale Tighnabruich Thurso, Dunbar Hospital 2000 Scourie/KLB Rothesay PCEC Raigmore PCEC 1500 Raigmore Car (TB5) PORTREE PCEC Port 1000 Oban PCEC Nairn PCEC Mull 500 Muasdale Lochgilphead PCEC Lochcarron/Torridon 0 PCEC Invergordon PCEC

A&E Inveraray Advice (blank) Highland Hub ASAP Home Visit Home CPN Advice CPN

Appointment Golspie PCEC District Nurse District Untriaged Call Untriaged

Dual Response Dual Golspie Car (TB3) Information Only Information MIU Appointment MIU Glenelg NHS24 Advice Only Advice NHS24 GAIRLOCH/ Case Type FORT WILLIAM PCEC

October 2011 by Case Type

Location Count of Case Number (blank) 3000 Wick PCEC Wick Car (TB1) Ullapool 2500 Tongue/Armadale Tighnabruich Thurso, Dunbar Hospital 2000 Rothesay PCEC Raigmore PCEC Raigmore Car (TB5) 1500 PORTREE PCEC Own GP Practice Oban PCEC 1000 Nairn PCEC Mull Muasdale 500 Morven GP, Loch Aline Lochgilphead PCEC Lochcarron/Torridon 0 Islay PCEC Invergordon PCEC Inveraray Advice (blank) Highland Hub ASAP Home Visit Home CPN Advice CPN

Appointment Golspie PCEC District Nurse District Untriaged Call Untriaged

Dual Response Dual Glenelg Information Only Information MIU Appointment MIU GAIRLOCH/AULTBEA NHS24 Advice Only Advice NHS24 FORT WILLIAM PCEC Case Type Dunoon PCEC

September 2011 by Hour of Day Count of Case Number 700

600

Case Type

500 (blank) Untriaged Call ASAP NHS24 Advice Only MIU Appointment 400 Information Only Home Visit Dual Response 300 District Nurse CPN Advice Appointment 200 Advice A&E

100

0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (blank) Hour of call

October 2011 by Hour of Day

Count of Case Number 700

600

Case Type 500 (blank) Untriaged Call ASAP NHS24 Advice Only 400 MIU Appointment Information Only Home Visit 300 Dual Response District Nurse CPN Advice 200 Appointment Advice

100

0 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 (blank) Hour of call

September 2011 by Day of Week Count of Case Number 2000

1800

1600 Case Type (blank) 1400 Untriaged Call ASAP NHS24 Advice Only 1200 MIU Appointment Information Only 1000 Home Visit Dual Response District Nurse 800 CPN Advice Appointment 600 Advice A&E 400

200

0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday (blank) Day of call

October 2011 by Day of Week

Count of Case Number 2500

2000

Case Type (blank) Untriaged Call ASAP 1500 NHS24 Advice Only MIU Appointment Information Only Home Visit Dual Response 1000 District Nurse CPN Advice Appointment Advice

500

0 Monday Tuesday Wednesday Thursday Friday Saturday Sunday (blank) Day of call 2.1 NHS24 Satellite Report

The table below shows the volume of NHS24 calls answered by the Highland NHS24 Satellite and the distribution of Highland calls to other centres.

3.0 PERFORMANCE

Response time target % for 1,2 & 4 hours

Sept 2011 Oct 2011 Case Type Priority Breeched Breeched Home Visit 1 hour 36% 37% Appointment 1 hour 21% 22% Home Visit 2 hour 25% 22% Appointment 2 hour 10% 10% Home Visit 4 hour 11% 8% Appointment 4 hour 3% 3%

Argyll & Bute – September 2011 1 hour total – 40 2 hour total – 42 4 hour total – 50 Home Visit Breeched Breeched Breeched Oban 7 Oban 2 Oban 1 Dunoon 1 Muasdale 1 Dunoon 2 Tighnabruaich 1 Lochgilphead 6 Rothesay 2 Dunoon 6 Lochgilphead 1 Rothesay 3 1 hour total – 40 2 hour total – 59 4 hour total – 131 Appointment Breeched Breeched Breeched Dunoon 5 Dunoon 3 Oban 4 Oban 8 Oban 4 Lochgilphead 1 Lochgilphead 4 Islay 1 Rothesay 4 Rothesay 2 Tighnabraich 1 Campbeltown 6 Tighnabruaich 1 Campbeltown 1 Dunoon 2 Islay 1 Dental 1

Badenoch & Strathspey – September 2011 1 hour total – 10 2 hour total – 26 4 hour total – 24 Home Visit Breeched Breeched Breeched Aviemore 4 Aviemore 6 Aviemore 1 1 hour total – 17 2 hour total – 42 4 hour total – 96 Appointment Breeched Breeched Breeched Aviemore 10 Aviemore 6 Aviemore 4

Caithness – September 2011 1 hour total – 10 2 hour total – 21 4 hour total – 21 Home Visit Breeched Breeched Breeched Wick 1 Wick 3 Wick 2 Thurso 2 Thurso 4 Thurso 1 1 hour total – 27 2 hour total – 30 4 hour total – 47 Appointment Breeched Breeched Breeched Wick 7 Wick 5 Wick 2 Thurso 4 Thurso 3 Thurso 3

East Highland – September 2011 1 hour total – 31 2 hour total – 47 4 hour total – 55 Home Visit Breeched Breeched Breeched Dingwall 13 Dingwall 14 Dingwall 1 Invergordon 4 Invergordon 7 Invergordon 7 1 hour total – 84 2 hour total – 70 4 hour total – 219 Appointment Breeched Breeched Breeched Dingwall 16 Dingwall 5 Dingwall 6 Invergordon 16 Invergordon 11 Invergordon 11

Wester Ross – September 2011 1 hour total – 12 2 hour total – 16 4 hour total – 30 Home Visit Breeched Breeched Breeched Lochcarron 1 Gairloch 1 Lochcarron 1 Ullapool 3 1 hour total – 2 hour total – 4 hour total – Appointment Breeched Breeched Breeched Gairloch Gairloch Gairloch Lochcarron Lochcarron Lochcarron Ullapool Ullapool Ullapool

Sutherland – September 2011 1 hour total – 45 2 hour total – 33 4 hour total – 47 Home Visit Breeched Breeched Breeched Golspie 4 Golspie 8 Golspie 1 1 hour total – 2 hour total – 4 hour total – Appointment Breeched Breeched Breeched Golspie 10 Golspie 3 Golspie 3

North West – September 2011 1 hour total – 2 2 hour total – 2 4 hour total – 1 Home Visit Breeched Breeched Breeched 1 hour total – 2 hour total – 4 hour total – Appointment Breeched Breeched Breeched Tongue/Armadale 1 Tongue/Armadale 1 Tongue/Armadale 1

Skye & – September 2011 1 hour total – 29 2 hour total – 46 4 hour total – 405 Home Visit Breeched Breeched Breeched Broadford 3 Broadford 1 1 hour total – 2 hour total – 4 hour total – Appointment Breeched Breeched Breeched Broadford 1 Portree 1 Portree 1 Broadford 2 Broadford 4

Lochaber – September 2011 1 hour total – 34 2 hour total – 25 4 hour total – 117 Home Visit Breeched Breeched Breeched Fort William 5 Fort William 8 Fort William 7 1 hour total – 2 hour total – 4 hour total – Appointment Breeched Breeched Breeched Fort William 10 Fort William 4 Fort William 1

Inverness– September 2011 1 hour total – 118 2 hour total – 183 4 hour total – 427 Home Visit Breeched Breeched Breeched Raigmore 14 Raigmore 14 Raigmore 23 1 hour total – 2 hour total – 4 hour total – Appointment Breeched Breeched Breeched Raigmore 35 Raigmore 14 Raigmore 18

Argyll & Bute – October 2011 1 hour total – 36 2 hour total – 44 4 hour total – 66 Home Visit Breeched Breeched Breeched Oban 10 Oban 12 Oban 2 Campbeltown 0 Tighnabruaich 1 Dunoon 1 Dunoon 4 Dunoon 3 Rothesay 1 Rothesay 3 Rothesay 2 Islay 1 Mull 1 Lochgilphead 1 Campbeltown 1 Islay 1 1 hour total – 41 2 hour total – 66 4 hour total – 138 Appointment Breeched Breeched Breeched Dunoon 4 Dunoon 4 Oban 10 Oban 13 Lochgilphead 2 Dunoon 3 Lochgilphead 9 Oban 10 Inverary 1 Rothesay 1 Mull 1 Lochgilphead 4 Campbeltown 2 Rothesay 5 Rothesay 6 Inverary 1 Campbeltown 2

Badenoch & Strathspey – October 2011 1 hour total – 6 2 hour total – 26 4 hour total – 28 Home Visit Breeched Breeched Breeched Aviemore 3 Aviemore 9 Aviemore 0 1 hour total – 13 2 hour total – 22 4 hour total – 94 Appointment Breeched Breeched Breeched Aviemore 7 Aviemore 5 Aviemore 6

Caithness – October 2011 1 hour total – 21 2 hour total – 35 4 hour total – 59 Home Visit Breeched Breeched Breeched Wick 5 Wick 5 Wick 2 Thurso 2 Thurso 2 Thurso 5 1 hour total –31 2 hour total – 34 4 hour total – 77 Appointment Breeched Breeched Breeched Wick 10 Wick 6 Wick 4 Thurso 3 Thurso 2 Thurso 7

East Highland – October 2011 1 hour total – 30 2 hour total – 62 4 hour total – 66 Home Visit Breeched Breeched Breeched Dingwall 8 Dingwall 20 Dingwall 12 Invergordon 3 Invergordon 6 Invergordon 5 1 hour total –76 2 hour total – 100 4 hour total – 291 Appointment Breeched Breeched Breeched Dingwall 17 Dingwall 13 Dingwall 10 Invergordon 26 Invergordon 19 Invergordon 26

Wester Ross – October 2011 1 hour total – 16 2 hour total – 9 4 hour total – 15 Home Visit Breeched Breeched Breeched Gairloch 3 Gairloch 0 Gairloch 0 Lochcarron 0 Lochcarron 0 Lochcarron0 Ullapool 0 Ullapool 0 Ullapool 0 1 hour total –1 2 hour total – 3 4 hour total – 20 Appointment Breeched Breeched Breeched Gairloch 0 Gairloch 0 Gairloch 0 Lochcarron 0 Lochcarron 0 Lochcarron 0 Ullapool 0 Ullapool 0 Ullapool 3

Sutherland – October 2011 1 hour total – 18 2 hour total – 13 4 hour total – 9 Home Visit Breeched Breeched Breeched Golspie 8 Golspie 2 Golspie 0 1 hour total – 34 2 hour total – 12 4 hour total – 21 Appointment Breeched Breeched Breeched Golspie 5 Golspie 4 Golspie 1

Skye & Lochalsh – October 2011 1 hour total – 4 2 hour total – 3 4 hour total – 8 Home Visit Breeched Breeched Breeched Portree 1 Portree 0 Portree 0 Broadford 2 Broadford 0 Broadford 0 1 hour total –42 2 hour total – 69 4 hour total – 372 Appointment Breeched Breeched Breeched Portree 1 Portree 1 Portree 2 Broadford 2 Broadford 1 Broadford 1

Lochaber – October 2011 1 hour total – 20 2 hour total – 27 4 hour total – 30 Home Visit Breeched Breeched Breeched Fort William 11 Fort William 16 Fort William 3 1 hour total – 20 2 hour total – 25 4 hour total – 89 Appointment Breeched Breeched Breeched Fort William 7 Fort William 7 Fort William 4

Inverness– October 2011 1 hour total – 49 2 hour total – 87 4 hour total – 118 Home Visit Breeched Breeched Breeched Raigmore 11 Raigmore 17 Raigmore 14 1 hour total –57 2 hour total – 134 4 hour total – 311 Appointment Breeched Breeched Breeched Raigmore 4 Raigmore 14 Raigmore 15

Special Notes Usage

Notes used in Clinical Consultations: September October

Anticipatory Care Plans (ACPs) 545 523 Palliative Care notes 64 72 DNAR 51 54 High Risk Adult notes 1 1 Child At Risk notes 0 2

New ACPs 165 141 Reviewed ACPs 380 382

GP Provision

September October GP Provision 2011 2011 Total hours booked through Highland Hub 4827 4690 Total hours covered by Agency GPs 237 384 Uncovered GP shifts Total cancelled shifts 290.5 285

Cancelled shifts comprise of:

September October GP Provision 2011 2011 Hours Hours Sick leave 13 0 Maternity leave 22 17 Annual leave 133.5 191.5 Study Leave 25 0 No Reason Given 65 56.5 Sept Oct Dingwall 38 0 Dunoon 85 9 Fort William 14 0 Inverness 30 27.5 Oban 123.5 20

4.0 FINANCE

OOH budget devolved to CHP/Locality level. Locality level reports available in CHPs as part of overall financial management.

5.0 CLINICAL GOVERNANCE

5.1 DATIX/Complaints

• 1 new complaint received in second quarter of the year and closed within a period of 33 days.

OUT OF HOURS INCIDENTS – Quarter 2 2011/12

During the period of 1 July to 30 September 2011.

Grade of Incidents Per Quarter

Quarter 2 2010/11 Quarter 3 2010/11 Quarter 1 2011/12 Quarter 2 2011/12 Grade July to Sept Oct to Dec Apr to Jun Jul to Sept LOW 6 (46.15%) 8 (61.54%) 14 (51.85%) 6 (36.29%)

MEDIUM 7 (53.85%) 5 (38.46%) 11 (40.74%) 9 (52.94%)

HIGH 1 (5.88%)

VHIGH

Not yet graded 2 (7.41%) 1 (5.88%)

Total 13 13 27 17

Category of Incidents

The following table shows the category of incidents and grade Quarter 2 NOT YET Category LOW MEDIUM HIGH 2011/12 GRADED Jul - Sept Absconder/Missing Patient Access/Admission 1 (11.11%) 1 (5.88%) Clinical Assessment 2 (33.3%) 1 (100%) 3 (17.65%) Communication and confidentiality 2 (33.33%) 1 (11.11%) 3 (17.65%) Disruptive, Violent, Aggressive 1 (11.11%) 1 (100%) 2 (11.76%) Behaviour Medication (including vaccines) 1 (16.67%) 1 (5.88%) Security 3 (33.33%) 3 (17.65%) Test Results & Reports 1 (11.11%) 1 (5.88%) Transfer / Discharge 1 (11.11%) 1 (5.88%) Treatment / Procedure 1 (16.67%) 1 (11.11%) 2 (11.76%) Total Count of Category 6 9 1 1 17

6.0 PARTNER FEEDBACK (NHS24)

7 issues were reported back to NHS 24 by our partners in NHS Highland during April, May and June 2011. 4 issues were upheld and 3 not upheld. NHS 24 triaged 99,488 calls during April 2011, 91,421 calls during May 2011 and 78,984 calls during June 2011 for the out of hour’s period. NHS Highland accounted for 4,543 or 5% of the total in April, 3,694 or 4% in May and 3,730 calls or 5% of the total in June 2011. No further update at present.

Report prepared by Aly Roberts on behalf of Tracy Ligema September 2011