NHS Board November 2019 Item 6

CHIEF EXECUTIVE AND DIRECTORS REPORT – EMERGING ISSUES AND UPDATES Report by Iain Stewart, Chief Executive

The Board is asked to:

• Note the updates provided in the report.

Introduction from CEO

The engagement strategy which is helping to shape the ‘Culture Fit for the Future’ has been moving ahead. Fiona Hogg will be giving a detailed update on our progress with our Culture Programme later in the agenda. I am pleased with the progress which is being made, it’s a long-term piece of work which needs careful research and planning to make sure we understand the problems we need to address. There are some key milestones being achieved and presented at this Board meeting. A governance structure is in place and our revised plans are ready to be agreed and rolled out.

Many of the actions planned have been shaped by our ongoing engagement with the Board and with our colleagues across North Highland and Argyll & Bute and I’m delighted that our impending review in Argyll & Bute is going to provide further valuable insights and information.

In terms of the cost improvement programme, we continue to make good progress, with the current level of identified opportunities valued at £29M which when adjusted for the likelihood of delivery reduces to £22M. Of particular note is that 80% of the forecast savings are recurrent so the savings gain will benefit future financial years. Workstreams are ensuring the remaining plans in this financial year are approved, that ideas are progressed to plans and that changes already implemented go on to deliver the expected savings. Additionally, there is a need to consider ideas that slow down spend.

Board Appointments Ms. Ann Clark has been appointed as Vice Chair of the NHS Highland Board. Ms Clark was appointed as a non-executive director of the board in April 2017, bringing with her an extensive background in researching, developing and implementing health and social care policy in the Highlands. She is currently Chair of the Mid Ross Community Partnership and Chair of the Highland Health and Social Care Committee.

Ms Clark has a life-long interest in community empowerment and user involvement in the design and delivery of public service and she has wide ranging experience as a member of committees and boards at national and Highland level, including eight years with the Scottish Consumer Council and several years with Highland Brook Advisory Service and Partnerships for Wellbeing, a Highland-wide charity providing health and social care services to vulnerable adults. The position of Director of Finance is currently being recruited for with a closing date of 15th November 2019.

Hot Topics and Issues Mid-Year Review The Chair and I recently attended our Mid-Year Review chaired by Jeane Freeman, the Cabinet Secretary for Health and Sport. The review considered:

• Funding and Sustainability • Performance • Integration • Strategy • Service Redesign • Culture

NHS Highland will continue to work closely with the in achieving sustainability as we move in to the future.

The 2018/19 audit of NHS Highland The Auditor General for has published the report on the 2018/19 audit of NHS Highland under Section 22 of the Public Finance and Accountability (Scotland) Act 2000. The report noted the challenges we face in a number of issues including overspends on drugs, adult social care, locum staffing and other organisational challenges such as leadership changes, recruitment difficulties and incidents of bullying. It is likely that NHS Highland will attend a future Public Audit and Post-Legislative Scrutiny Committee to discuss the report findings.

Risk Management Progress is been made to improve the Board’s risk management arrangements. A risk manager has been appointed and is working with our Internal Auditors to ensure that a detailed action plan is prepared to ensure improvement in the Board’s risk management systems and processes. Information has been shared by other boards and best practice will be adopted by NHS Highland. Discussions have taken place with all corporate risk owners to discuss their risks and start to populate the new corporate risk template; this includes suggested assurance arrangements, controls and risk assessments. In preparation for the next Risk Management Steering Groups the following work is being progressed:

• Overall project plan with timescales • Risk hierarchy plan • Escalation guidance and checklists • Risk Register checklist • Training plan • Revised strategy

Elmgrove Care Home Following concerns relating to the quality of care and residents safety at Elmgrove Care Home 24 residents were moved to alternative accommodation. NHS Highland actively supported the care home with the provision of supplementary staff to ensure resident safety during the transition.

Staff flu vaccination programme The staff flu vaccination programme has started well and with only a few weeks into the programme already over 2,000 staff have been vaccinated which is an increase compared to the same time last year.

Flu champions across the organisation are co-ordinating the vaccination programme in their own areas with trolley and/or peer vaccination services; drop-in clinics have also been arranged by Occupational Health at agreed sites.

Clinical Care Strategy A detailed programme which will culminate in the creation of NHS Highland’s first Clinical & Care Strategy is underway. This programme of work will transform the way health & social care is delivered taking into account the unique factors that geographically make NHS Highland the largest health board in Scotland.

The programme covers the most appropriate healthcare settings to create a modern healthcare service which is sustainable and fit for the future. This will involve a number of workstreams to maximise participation from those providing the care to enable the strategy to be inclusive and effective. This is a critical piece of work which will shape our service and influence our future investment decisions.

A designated programme manager has been appointed. Chris Morgan has joined us from NHS24 and will be working with Deborah Jones, our Director of Strategic Commissioning Planning and Performance, who will act as Senior Responsible Officer for this project.

A&B Staff Excellence Awards In October I was delighted to attend the annual Staff Excellence Awards where the Health and Social Care Partnership (HSCP) recognised the outstanding health and social care staff who performed over and above expectations. Recognising the hard work and dedication our staff provide to patients and service users is important in building engagement and a positive working culture and I was thrilled to have the opportunity to celebrate these awards with the winners and congratulate them on their enthusiasm and commitment.

Nominations were received from members of the public and also colleagues with the winners as follows:

Nurse/Midwife of the Year - Katherine Henderson, Senior Midwife, Therapist of the Year - Gemma Bruce – Physiotherapist, Oban Social Care Worker of the Year - Julie Cameron, Social Worker, Admin Secretarial Worker of the Year - Community Hospital Receptionists, Admin Support Officers, Dunoon Support Worker of the Year - Willie Gemmell, Porter, Lorn and Islands Hospital, Oban Chief Officers Outstanding Contribution to Health Social Care - Kathy Graham, Clinical Services Manager, , Dunoon Outstanding Individual - Alistair Craig, Finance Department, Lochgilhead Outstanding Team - Campbeltown Dialysis Unit, Patient/Service User Choice Award - Gortonvogie Care Staff, Islay Mentor of the Year - Linda Pate, Staff Nurse, Islay

Allied Health Professions at Work During September, 13 secondary school students from Highland participated in a week-long work placement across a variety of Allied Health Professional (AHP) services in the area.

This was part of the “AHPs at Work” pilot programme aimed to attract, educate and support 5th and 6th year students who aspire to study towards a career in the AHPs. The pilot was designed to enable students to make informed applications towards studying for a career as an AHP. The week long placement followed a successful open day in June which was attended by over 30 pupils from across Highland.

Feedback from the students was very positive indicating they gained rich insights and value from their work placement.

A meeting early in November will consider the future of the “AHPs at Work” model for supporting work placement experience for senior High School students who aspire to study towards a career in AHP services. AHPs will also continue supporting events for students in earlier years of school including the annual “Careers in Health” event.

Recovery Walk Scotland The Highland Alcohol and Drugs Partnership (HADP) were pleased to present this year’s national Recovery Walk in September. This is the largest recovery event in Scotland and it was the first time it has been held in Inverness.

The event celebrates recovery from drug, alcohol and mental health problems and is designed to make recovery visible, be understood as a positive force for change in Scotland and make recovery accessible to more people across our country.

The walk helped draw attention to the innovative work being done in Inverness and Highland to prevent and reduce drug and alcohol-related harm to our communities. I joined people and families with lived experience of recovery alongside communities and partner organisations from across Highland and Scotland. I was delighted to be part of what was an extremely positive event that focused on supporting people on their journey to recovery.

Opportunity to return to nursing at Nurses with lapsed registration are being offered an opportunity to work at the Belford Hospital in Fort William while they complete a return to practice course.

Under the Scottish Government's Return to Practice Funding Scheme, returnees will be able to apply to have their university programme fees (£1500) at the four Scottish providers fully paid. In return, course participants must take up employment as a first level Registered Nurse in Scotland within three months of completing the course, or provide evidence that demonstrates they are actively seeking employment.

HQA award for Highland Children’s Unit In September staff at the Highland Children’s Unit were recognised with a Highland Quality Approach award.

As the only paediatric centre for the Highlands, the unit has been described as a ‘mini hospital within a hospital’ which continually adapts and changes to the needs of their patients ensuring teams are able to deliver care in the most efficient, high quality manner.

Using Value Management, a quality improvement initiative which looks at maximising value while achieving the best health outcomes based on a patient’s condition, the team have been able to make changes to the service and processes and systems that they use to help in delivering a high standard of quality care.

NHS Highland first for ‘tattooless’ radiotherapy NHS Highland is the first NHS centre in the UK to take forward ‘tattooless’ radiotherapy for breast cancer patients. Before radiotherapy treatment can begin, breast patients have a CT scan which allows treatment to be planned, they are then tattooed with small dots to allow accurate positioning for that treatment to begin. For some patients a tattoo can be quite negative, leaving them with a constant reminder of their treatment. A relatively new optical monitoring system (AlignRT) can now provide a different method of positioning the patient which does not rely on tattoos.

Friends of software donation Thanks to a £14,750 software donation from the Friends of Raigmore, the liver specialists at can now measure the amount of fat in a patient’s liver using a simple non-invasive test.

Specialists use a Fibroscan™ machine to check for scarring caused by a number of conditions including non-alcoholic fatty liver disease, chronic viral hepatitis and excess alcohol intake.

This software allows early detection of steatosis, also known as fatty liver, which would never be detected on ultrasound. The controlled attenuation parameter (CAP) reading isn't influenced by liver inflammation whereas fibroscan results are. CAP allows us to identify patients who are high risk and enables us to assess patients post hepatitis C treatment, offering valuable information regarding the type of surveillance they require.

Mental Health Conference I was delighted to attend NHS Highland’s ninth mental health conference earlier this month. The Compassion through the Years event was held in partnership with Birchwood Highland and it was a fantastic networking event for colleagues from NHS Highland, UHI, The Highland Council and a host of third sector and voluntary organisations.

The conference covered a wide range of topics including the importance of compassion to all patients, family, carers and staff as well as all aspects of NHS Scotland’s values and underlined the importance of sharing good practice for mental health services across Highland and Argyll and Bute.

There were over 250 people who attended on the day and the feedback has been extremely positive.