Public Document Pack
20 May 2020
NOTICE OF MEETING
A meeting of the INTEGRATION JOINT BOARD (IJB) will be held VIA SKYPE on WEDNESDAY, 27 MAY 2020 at 1:00 PM, which you are requested to attend.
BUSINESS
1. APOLOGIES FOR ABSENCE
2. DECLARATIONS OF INTEREST
3. MINUTES (Pages 3 - 12) Integration Joint Board held on 25 March 2020
4. MINUTES OF COMMITTEES
(a) Clinical and Care Governance Committee held on 23 January 2020 (to follow)
(b) Finance and Policy Committee held on 6 March 2020 (Pages 13 - 16)
(c) Clinical and Care Governance Committee held on 26 March 2020 (to follow)
(d) Finance and Policy Committee held on 27 March 2020 (Pages 17 - 20)
5. CHIEF OFFICER'S REPORT (Pages 21 - 24) Report by Chief Officer
6. COVID-19 MOBILISATION READINESS UPDATE AND LOOK FORWARD TO LIVING AND OPERATING WITH COVID-19 (Pages 25 - 36) Report by Head of Strategic Planning and Performance
7. THE ROLE OF PUBLIC HEALTH TO DATE IN THE COVID -19 RESPONSE (Pages 37 - 54) Report by Associate Director of Public Health
8. UPDATE ON PROGRESS WITH THE STURROCK REVIEW ACTIONS INCLUDING A REPORT ON THE ARGYLL & BUTE CULTURE SURVEY AND PLANS FOR THE LAUNCH OF THE HEALING PROCESS (Pages 55 - 118) Report by Chief Officer and Director of Human Resources and Organisational Development NHS Highland 9. STAFF HEALTH AND WELLBEING
(a) Employee / Staff Wellbeing and Resilience / COVID-19 (Pages 119 - 144)
Report by Head of Customer Support Services
(b) HR Resourcing (Pages 145 - 156)
Report by Head of Customer Support Services
10. ENHANCED CARE HOME ASSURANCE (Pages 157 - 168) Report by Head of Adult Care
11. FINANCE
(a) Budget Monitoring as at 31 March 2020 (Pages 169 - 182)
Report by Head of Finance and Transformation
(b) Budget Outlook 2021-22 to 2023-24 (Pages 183 - 194)
Report by Head of Finance and Transformation
(c) Covid-19 Response and Financial Implications (Pages 195 - 206)
Report by Head of Finance and Transformation
12. DATE OF NEXT MEETING Wednesday 5 August 2020, 1.00pm
Contact: Hazel MacInnes Tel: 01546 604269 Page 3 Agenda Item 3
MINUTES of MEETING of INTEGRATION JOINT BOARD (IJB) held via SKYPE on WEDNESDAY, 25 MARCH 2020
Present: Councillor Kieron Green, Argyll and Bute Council (Chair) Sarah Compton-Bishop, NHS Highland Non-Executive Board Member (Vice Chair) Councillor Aileen Morton, Argyll and Bute Council Councillor Gary Mulvaney, Argyll and Bute Council Councillor Sandy Taylor, Argyll and Bute Council Jean Boardman, NHS Highland Non-Executive Board Member Professor Boyd Robertson, Interim Chair, NHS Highland Dr Gaener Rodger, NHS Highland Non-Executive Board Member Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Linda Currie, Lead AHP, NHS Highland Elizabeth Higgins, Lead Nurse, NHS Highland Joanna Macdonald, Chief Officer, Argyll and Bute HSCP Kevin McIntosh, Staffside Lead for Argyll and Bute HSCP (Council) George Morrison, Depute Chief Officer, Argyll and Bute HSCP Judy Orr, Head of Finance and Transformation, Argyll and Bute HSCP Elizabeth Rhodick, Public Representative Dr Nicola Schinaia, Associate Director of Public Health Alex Taylor, Chief Social Worker/Head of Children and Families, Argyll and Bute HSCP
Attending: Douglas Hendry, IJB Standards Officer/Executive Director, Argyll and Bute Council David Forshaw, Principal Accountant, Argyll and Bute Council Caroline Cherry, Head of Adult Services, HSCP Julie Lusk, Head of Adult Services, HSCP Jane Fowler, Head of Customer Support Services, Argyll and Bute Council Stephen Whiston, Head of Strategic Planning and Performance, HSCP Craig McNally, Senior Health Improvement Specialist, Alcohol and Drugs, Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Hazel MacInnes, Committee Services Officer, Argyll and Bute Council
The Chair made the following announcement at the start of the meeting –
Welcome to this meeting of the Argyll and Bute Integration Joint Board.
This meeting is being held remotely on an audio only basis following the announcement by the Prime Minister and the First Minister, and the associated guidance in relation to gatherings of more than two people.
Furthermore arrangements have been put in place to support audio recording of the meeting, which will subsequently be hosted on the IJB website as a Public Record. This is a previously untested arrangement so please do bear with us in the event of any technical issues. Page 4
I would remind all members that this is the first time we have convened a meeting under these conditions, and members should use the instant message function in the call to indicate if they wish speak, or if they are joining by phone then wait until they are invited to.
In the public interest and to fulfil our public obligation to ensure openness and transparency members of the press have also been invited to attend the meeting remotely and furthermore we have 2 councillors, Councillors Philand and Horn who have requested to listen in.
As this is an audio meeting for the purposes of the Sederunt we will read out the names of the members and officers invited to participate or support the meeting and ask them to confirm their attendance.
In the event of a vote, names will be called out and a roll call vote will be taken.
1. APOLOGIES FOR ABSENCE
Apologies for absence were received from Rebecca Helliwell, Angus MacTaggart, Kirsteen Murray and Fiona Thomson.
2. DECLARATIONS OF INTEREST
There were no declarations of interest.
3. MINUTES AND ACTION LOG
The Minutes of the meeting of the Integration Joint Board held on 29 January 2020 were approved as a correct record.
There were no matters arising from the action log.
The Chair referred to an email from Kirsteen Murray raising governance issues with the Minutes of the meeting of 27 November 2019. The Chair advised that these issues were similar to those raised previously and suggested that as this meeting was audio only, the Board defer this to another meeting. This was agreed by the Board.
4. MINUTES OF COMMITTEES
(a) Finance and Policy Committee held on 24 January 2020 The Minutes of the meeting of the Finance and Policy Committee held on 24 January 2020 were noted.
(b) Audit and Risk Committee 6 December 2019 The Minutes of the meeting of Audit and Risk Committee held on 6 December 2019 were noted.
The Chair proposed as the meeting was audio only and there was a need to prioritise the business considered, that the Board consider items 6 (Covid-19 Update), 7 (Delegated Authority for the Chief Officer), 8 (Culture Fit for the Future), 9 (Dementia Services Page 5
Redesign Update) and 16 (Finance) first and if time allowed then other items of the Agenda would be considered. This was agreed by the Board.
5. COVID-19 UPDATE
The Board gave consideration to a report that provided factual information on the Coronavirus that caused Covid-19 and advised that as it had been identified as a pandemic, partners were required to take the appropriate response and implement business continuity planning.
The Associate Director of Public Health provided a verbal update on Covid-19 advising that the position had moved forward considerably since the report had been published. He advised that the number of cases in Scotland had almost doubled in that time, with confirmed cases in the NHS Highland area rising to 13 from 5.
The Chief Officer advised that operationally they had stood up a Bronze meeting which met daily and which fed into Silver and Gold meetings. She advised that they were liaising closely with Argyll and Bute Council colleagues and that staff were working and planning for the worst case scenario.
The Head of Finance and Transformation advised that assurances had been given by the Scottish Government that additional costs in relation to Covid-19 would be reimbursed. She advised that all costs were being tracked and would be discussed at the Finance and Policy Committee.
Decision
The Integration Joint Board -
1. Noted the COVID-19 information and public health response in the context of Argyll and Bute contained within the submitted report.
2. Noted the verbal update from the Associate Director of Public Health and the Chief Officer of the Health and Social Care Partnership.
3. Thanked all local staff in Health and Social Care, including unpaid carers, commissioned and third sector colleagues, for their ongoing dedication and commitment.
(Reference: Report by Associate Director of Public Health dated March 2020, submitted)
6. DELEGATED AUTHORITY FOR THE CHIEF OFFICER
The Board gave consideration to a report that sought delegated authority for the Chief Officer to take operational decisions that would normally require Board approval in the light of the ongoing Covid-19 situation and the strong possibility that the Board would be unable to meet as normal.
Decision
The Integration Joint Board – Page 6
1. Agreed to grant the Chief Officer power in an emergency to instruct executive action on any matter for the duration of the Covid-19 emergency in consultation with the Chair or Vice Chair of the Board.
2. Agreed that the Chief Officer would consult with both the Chair and Vice-Chair before exercising but that an inability to consult either Chair or Vice Chair would not invalidate any actions taken.
3. Agreed that the delegation of powers to the Chief Officer would be the subject of ongoing review and normal Board meeting arrangements would be re-introduced as soon as practicable.
4. Noted that a record would be kept of all actions taken and reported to the Board when possible.
(Reference: Report by Chief Officer, Health and Social Care Partnership dated March 2020, submitted)
Alex Taylor left the meeting at this point.
7. CULTURE FIT FOR THE FUTURE UPDATE
A report providing an update on progress with the Culture Fit for the Future Programme plans and delivery was given consideration by the Board.
Decision
The Integration Joint Board noted the updates contained within the report.
(Reference: Report by Director of Human Resources and Organisational Development dated March 2020, submitted)
Alex Taylor re-joined the meeting, and Kevin McIntosh left the meeting, during the consideration of the following item of business.
8. DEMENTIA SERVICES REDESIGN UPDATE
Prior to consideration of the report, the Chief Officer read out the following statement advising of an operational decision to relocate patients within the Knapdale Ward, Mid Argyll and to designate the ward for potential Covid-19 patients in order that the decision could be separated from the policy decision of the IJB.
NHS Scotland has instructed Health Boards and Integration Joint Boards to reduce delayed discharges and increase bed capacity immediately.
This has been discussed at the Gold Command across the Health Board, which co- ordinates the response to COVID-19 and supports the need for immediate capacity and to delay the spread of COVID-19 amongst the population.
As a result, the Knapdale Ward within Mid Argyll hospital in Lochgilphead has been designated for potential COVID-19 patients. This ward is currently a dementia assessment ward and the patients who are being cared for within Knapdale will be provided with alternative care arrangements. Page 7
This decision has been taken in light of the demand for bed capacity as a result of the COVID-19 pandemic and we have been working with the families of the patients about the change to their care arrangements.
This operational decision is taken for clinical grounds and any permanent decision on the future of the ward remains with the IJB, which will be discussing the dementia services redesign at its meeting on the 25 March.
The Board gave consideration to a report that provided an update on the initial consultation, provided reassurance on the consultation process and outlined the next steps in relation to the dementia services redesign.
Decision
The Integration Joint Board –
1. Noted the operational decision to designate the Knapdale Ward, Mid Argyll for potential Covid-19 patients.
2. Approved the planned closure of Knapdale Ward, Mid Argyll in order to move to implementation planning of the Enhanced Community Dementia Model, noting that this process may take a year or more to implement.
3. Approved the development of detailed implementation plan by way of a Dementia Steering Group, giving the Board assurance that risks are managed as a result of the process of transition.
4. Noted the feedback from the consultation.
(Reference: Report by Head of Service, Older Adults and Community Hospitals dated March 2020, submitted)
The Chaired ruled and the Board agreed to take a 5 minute comfort break from 3.20pm.
The meeting resumed at 3.25pm.
9. FINANCE
(a) Budget Monitoring The Board have consideration to a report that provided a summary of the financial position of the Health and Social Care Partnership as at 31 January 2020.
Decision
The Integration Joint Board –
1. Noted the forecast outturn position for 2019-20 is a forecast overspend of £1.165m as at 31 January 2020 and that there is a year to date overspend of £1.365m as at the same date.
2. Noted the above position excludes any provision for the ongoing dispute with Page 8
NHS Greater Glasgow and Clyde.
3. Agreed further steps will be taken in relation to the ongoing dispute with NHS Greater Glasgow and Clyde by the Chief Officer in line with delegated powers.
(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)
(b) Budget Outlook The Board gave consideration to a report that summarised the budget outlook for the period 2020-21 to 2022-23 taking into consideration the budget decisions taken at the Integration Joint Board on 27 March 2019. A full update on the budget outlook was presented to the Board on 29 January 2020.
Decision
The Integration Joint Board noted -
1. The current estimated budget outlook report for the period 2020-21 to 2022-23.
2. That there was a separate report on the agenda detailing savings options to deliver a balanced budget on 2020-21.
(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)
(c) Financial Risk The Board gave consideration to a report that provided an update on the financial risks facing the organisation which had not been reflected in the forecast of the financial outturn.
Decision
The Integration Joint Board noted –
1. The updated financial risks identified for the Health and Social Care Partnership.
2. That financial risks will continue to be reviewed and monitored on a two monthly basis and reported to the Board.
(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)
(d) Budget Consultation Findings The Board gave consideration to a report that summarised the 563 budget consultation responses received when the consultation closed on 4 March 2020.
Decision Page 9
The Integration Joint Board –
1. Noted the findings from the budget consultation.
2. Agreed to consider the findings when discussing the separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21.
(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)
(e) Budget Savings 2020/21: Assessing Equality and Socio-Economic Impact The Board gave consideration to a report that outlined the work undertaken to ensure that due regard is given to equalities, islands and the Fairer Scotland Duty in the decision making process relating to budget savings. The report presented a strategic equality and socio-economic impact assessment for the savings programme to advise on overall impact.
Decision
The Integration Joint Board noted the findings from the summary Equality and Socio-Economic Impact Assessment and agreed to ensure that these were considered when discussing the separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21.
(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)
(f) Budget Proposals The Board gave consideration to a report that presented savings proposals identified by the Strategic Leadership Team in order to deliver a balanced budget in 2020-21.
Decision
The Integration Joint Board –
1. Noted the management/operational savings amounting to £4.157m approved by the IJB on 29 January 2020 in 2020-21.
2. Approved the changes to the Management & Operational savings set out at 3.2.4 to 3.2.5 amounting to £85k for 2020-21 and the revised list of savings now presented at Appendix 1 totalling £4.242m.
3. Approved the removal of previously agreed saving 1920-6 £25k relating to ferry ticketing as set out at 3.2.6.
4. Approved the policy savings at Appendix 2 amounting to £1.463m in 2020-21.
5. Approved the proposed investment in financial sustainability totalling £318k in 2020/21 and 2021/22 set at 3.3.8. Page 10
6. Noted that in endorsing the management/operational savings and approving the policy savings this will deliver a balanced budget in 2020-21.
7. Instructed the Chief Officer to accept the funding from NHS Highland and Argyll and Bute Council and issue formal Directions (see drafts at Appendix 3) delegating resources back to the Partners.
8. Noted the high level timetable for the budget preparation 2021-22 set out at 3.5.1.
9. Noted that there would be additional costs due to Covid-19, which should be recoverable from the Scottish Government, and that therefore the savings may need to be flexed accordingly.
(Reference: Report by Head of Finance and Transformation dated March 2020, submitted)
The Integration Joint Board agreed to give consideration to the following two items of business as they required action to be taken following consideration by the Board.
10. DRAFT ALCOHOL AND DRUG PARTNERSHIP STRATEGY
The Board gave consideration to a report that presented the Argyll and Bute Alcohol and Drug Partnership Strategy and Action Plan for approval. The Scottish Government requires every Health and Social Care Partnership to deliver a strategy for the reduction of harm from alcohol and drug use.
Decision
The Integration Joint Board approved the Alcohol and Drugs Partnership Strategy and Action Plan 2020-23 for Argyll and Bute.
(Reference: Report by Senior Health Improvement Specialist, Alcohol and Drugs dated March 2020, submitted)
11. REVIEW OF THE HEALTH AND SOCIAL CARE INTEGRATION SCHEME
The Board gave consideration to a report that provided a further update on progress with regard to the review of the Integration Scheme.
Decision
The Integration Joint Board –
1. Noted the outcome of the 6 week consultation process.
2. Noted that reports will be tabled at the NHS Highland Board on 31st March 2020 and the Council on 16th April 2020 to seek approval of the revised Scheme of Integration.
3. Noted that further to agreement the revised Scheme of Integration will be jointly submitted by the Chief Executives of the two parent bodies to the Scottish Government Page 11
by end April 2020 for their consideration and that a further update report will be provided to the IJB thereafter.
(Reference: Report by IJB Standards Officer dated March 2020, submitted)
The Chair thanked everyone for their attendance and thanked Governance Officers for their support in arranging the meeting.
The following items were not considered by the Integration Joint Board due to time constraints given that the meeting was held on an audio only basis.
12. CHIEF OFFICER'S REPORT
13. ARGYLL AND BUTE HSCP ADULT SERVICES STRATEGIC COMMISSIONING AND MARKET FACILITATION PLAN
14. HSCP PERFORMANCE EXCEPTION REPORT FQ3
15. STAFF GOVERNANCE REPORT Q3
16. CHIEF OFFICER RECRUITMENT
17. DATE OF NEXT MEETING This page is intentionally left blank Page 13 Agenda Item 4b
Argyll & Bute HSCP Finance & Policy Committee
Friday, 6 March 2020 at 1.30pm in Committee Room 1 Kilmory, Lochgilphead
Present Councillor Kieron Green (VC) IJB Chair Councillor Sandy Taylor IJB Member (from item 5) Sarah Compton Bishop (VC) Vice-Chair IJB Kevin McIntosh Staff Side Representative
In attendance Joanna MacDonald (Acting Chair) Chief Officer Jim Rundell Audit Scotland Judy Orr Head of Finance and Transformation George Morrison (VC) Head of Finance Alex Taylor (VC) Head of Children & Families Caroline Cherry (VC) Head of Adult Services Julie Lusk (VC) Head of Adult Services Charlotte Craig (VC) Business Improvement Manager Nicola Schinaia (VC) Associate Director of Public Health David Forshaw Principal Accountant Social Work Fiona Broderick(Phone) Staff Side Representative Irene Luke PA (minutes)
Apologies Councillor Gary Mulvaney IJB Member Prof Boyd Robertson IJB Member Liz Higgins Professional Advisory Group Rep Dr Angus MacTaggart Clinical Lead
Action by
1. Welcome and Apologies
As Cllr Green was joining the meeting via VC he asked the Chief Officer to Chair the meeting on his behalf. Members were welcomed to the meeting with introductions made around the room and VC sites. Apologies were noted as above.
2. Draft Minutes of 24 January 2020 The minute of meeting held on 24 January 2020 was agreed as an accurate record.
Matters Arising:
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Item 6 – Budget Setting 2020/21 Chief Finance Officer confirmed that, as agreed at the last meeting, budget codes have been removed.
3. Action Log
Updated Action Log was circulated and reviewed.
4. Budget Monitoring
Budget Monitoring Report as at January 2020 and appendices were presented. The report provided the Committee with a summary of the financial position of the Health and Social Care Partnership as at 31 January 2020. The forecast outturn position for 2019-20 is a forecast overspend of £1.165m which has improved by £145k from that forecasted at end of December.
Head of Adult Services (Mental Health, Learning Disabilities, Autism, Life Long Conditions) assured the Committee that, working alongside Finance, an action plan with identified timescales is being developed to complete the review high cost placements.
Head of Adult Services (Older Adults) reported Service Improvement support is now in place and work is taking progressing with Resource Team Leads and Procurement Officers to develop standard practice to ensure delivery of best practice and best value.
The Committee noted: The forecast outturn position for 2019-20 is a forecast overspend of £1.165m as at 31 January 2020 and that there is a year to date overspend of £1.365m as at the same date. The above position excludes any provision for the on-going dispute with NHS Greater Glasgow & Clyde
5. Budget Outlook 2020-21 to 2022-23
Budget Outlook 2020-21 to 2022-23 and appendix was circulated. The report indicated that in the mid-range scenario, the Health and Social
Care Partnership budget gap estimated over the three year period 2020- 21 to 2022-23 is £15.759 with a gap of £5.362m in 2020-21. This is a significant improvement of £2.9m from the gap indicated on 29 January 2020 of £8.289m following the Scottish Budget announcements on 6 February.
The Committee considered the current estimated budget outlook report for the period 2020-21 to 2022-23 and noted that there is a separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21.
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6 Financial Risks 2020-21
Financial Risks 2020-21 report was presented. The report summarises the key financial risks facing the Health and Social Care Partnership.
There are 34 risks identified in total with a potential adverse impact of £2.130m which is not included in the financial forecast. Only one risk is potentially exceeding £0.5m. The next largest risk is classed as potentially in the range of £300-500k and is considered likely to occur during 2020/21.
The Committee considered the updated financial risks identified for the Health and Social Care Partnership and noted that financial risks will continue to be reviewed and monitored on a two monthly basis and reported to the Board.
7 Budget Consultation Findings
Budget consultation launched on Wednesday 5 February for a 4 week period. As at 24 February, 424 responses had been received. The report presented summarises interim findings with attached appendices providing a full summary of responses and ideas for many savings.
The Committee agreed to note the findings from the Budget Consultation and ensure these are fed into considerations when discussing the separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21.
8 Budget Savings 2020/21: Assessing Equality and Socio-Economic Impact
This report and the accompanying combined EQIA report outlined the work undertaken to ensure that due regard is given to equalities, islands and the Fairer Scotland Duty in the decision-making process relating to budget savings, and presents a strategic EQIA for the savings programme to advise on overall impact.
The Committee agreed to note the findings from the summary Equality and Social-Economic Impact Assessment and ensure these are fed into considerations when discussing the separate report on the agenda detailing savings options to deliver a balanced budget in 2020-21. 9 Budget Proposals 2020-21
Budget Proposals 2020-21 report was presented. The report informed the Committee of savings proposals identified by the Strategic Leadership Team in order to deliver a balanced budget in 2020-21. A separate report on the agenda details the budget outlook over the period 2020-21 to 2022-23. The budget gap in 2020-21 amounts to £5.362m.
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The Committee discussed the proposals presented and Chief Finance Officer will take account of comment in preparing final reports for presentation to the Integration Joint Board.
9 NHS Greater Glasgow & Clyde Update
Head of Finance confirmed that, as proposed at the last meeting, a joint letter from the IJB Chair and Chair NHSH had been issued to NHS GG & C in an effort to bring about a speedy resolution.
It was noted there has been no response from NHSGG & C to date.
The Committee noted the verbal update and efforts made to engage with NHS GG & C. It was agreed to move to the next stage of KG escalation and propose a meeting with Chief Executive NHSH, Chair IJB, Chair NHSH and NHS GG & C. 10. Updated Finance & Policy Terms of Reference
The Committee noted the updated Finance & Policy Terms of Reference as presented. 11. AOB:
(a) Reporting
Cllr Taylor suggested as an appendage to the robust reporting from committees and governance groups to the Integration Joint Board a summary sheet updating on highlights/concerns and verbally reported by the Chair would be a useful communication.
Chief Finance Officer and Business Improvement Officer to explore JO/CC options.
Date of next Meeting
Friday, 27th March at 2020 at 1.30pm via Skype
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Page 17 Agenda Item 4d
Argyll & Bute HSCP Finance & Policy Committee
Friday, 27 March 2020 at 1.30pm Via Skype
Present Councillor Kieron Green IJB Chair Councillor Gary Mulvaney IJB Member Councillor Sandy Taylor IJB Member Sarah Compton Bishop Vice-Chair IJB Prof Boyd Robertson IJB Member
In attendance Joanna MacDonald (to item 5) Chief Officer Judy Orr Head of Finance and Transformation George Morrison Head of Finance Caroline Cherry Head of Adult Services Charlotte Craig Business Improvement Manager David Forshaw Principal Accountant Social Work Fiona Broderick Staff Side Representative Irene Luke PA (minutes)
Apologies Alex Taylor Head of Children & Families Julie Lusk Head of Adult Services Nicola Schinaia Associate Director of Public Health Liz Higgins Professional Advisory Group Rep Stephen Whiston Head of Planning & Performance
Action by
1. Welcome and Apologies
Chair welcomed members joining the Skype meeting. Apologies were noted as above.
2. Draft Minutes of 6 March 2020
The minute of meeting held on 6 March 2020 was agreed as an accurate record.
3. Action Log 2019-202 v5
Updated Action Log was circulated and noted.
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4. Budget Monitoring
Budget Monitoring Report as at 29 February 2020 and appendices were presented. The report provided the Committee with a summary of the financial position of the Health and Social Care Partnership as at 29 February 2020. The forecast outturn position for 2019-20 is a forecast overspend of £1.312m which has deteriorated by £147k from that forecast at end of January. This is now expected to change relatively little from now to the year end.
There is a year to date overspend of £0.991m as at 29 February 2020. This consists of an overspend of £1.019m within Social Work delivered services offset by a year to date underspend of £28k within Health. The position has improved by £374k in the month which relates mainly to Social Work.
The Committee requested further detail around actions being taken to address the continued Health overspend on locums and agency and the carry forward savings target assigned to Learning Disability Service.
Officers updated on the recently awarded GP contract for Mull and the project management approach to locum use which will have an impact on reducing dependency on locums. Within Learning Disability Services work is ongoing to look at core and cluster services. It is anticipated that through repatriation the savings identified can be achieved and the new SIO post will assist with this.
The Committee noted: Noted the forecast outturn position for 2019-20 is a forecast overspend of £1.312m as at 29 February 2020 and that there is a year to date overspend of £0.991m as at the same date. Noted the above position excludes any provision for the on- going dispute with NHS Greater Glasgow & Clyde
5. COVID-19 Cost Tracking
The Committee was provided with a verbal update on financial arrangements being put in place to support COVID-19 work and accounting processes. National procurement guidance is being followed with arrangements in place to ensure prompt payment of invoices to support suppliers and commissioned services. Workforce monitoring continues and will identify recruitment to COVID-19 specific posts. Covid specific cost centres have been created both for social work and Health and these will be used for equipment and PPE purchases. Additional care packages will be tracked on CareFirst. A new CareFirst interface for non-residential charges will be implemented faster than originally planned in order to reduce admin and speed up invoice payments. It is then planned to review self billing plans as this may assist further. All adverse variances will be reviewed to see if caused by any additional
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Covid costs to ensure that all additional hours are all picked up.
Boards are being funded on Board of Treatment basis for Covid so there will be no cross charging for any Covid related costs
The Committee noted the verbal update.
6 NHS Greater Glasgow & Clyde Update
Head of Finance advised that NHSGG&C's Director of Finance had responded to the points raised in his letter of 5 December 2019. However, NHSGG&C has only accepted one of the twenty points raised and has agreed to reduce the proposed SLA charge for 2019/20 by £210k in relation to urology charges. This leaves £1.324m still under dispute for 2019/20 and the matter therefore remains unresolved. Under accounting rules, we will have to accrue this at year end, but it will not be paid over
NHSH Chair proposed a conversation between Chairs for NHSH and NHSGG&C, and Chief Executives of NHSH and NHSGG&C to attempt to resolve the matter.
It was noted that we are not the only board in dispute over these charges and this may take some time to resolve fully.
The Committee noted the verbal update. 7. AOB:
No further business was raised.
Date of next Meeting
Friday, 24th April at 2020 at 1.30pm via Skype
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Integration Joint Board
Date of Meeting: 27 May 2020
Title of Report: Chief Officer Report
Presented by: Joanna Macdonald, Chief Officer
The Integration Joint Board is asked to: Note the following report from the Chief Officer
Mental Health Awareness Week
This year Mental Health Awareness Week is from the 18-24 May and the theme is promoting kindness. Across Argyll and Bute, people will be celebrating kindness in a range of digital and creative ways within social and physical distancing restrictions. The HSCP is helping to celebrate the campaign and is encouraging people to be kind to themselves and practice relaxation management using a self-management service “Time to Relax” provided by the HSCP’s Technology Enabled Care Team.
This is a digital service and helps people learn a relaxation technique to become more self-aware, less stressed and calmer and provides positive benefits to people’s overall physical and mental wellbeing. It is accompanied with audio guidance, soothing music and partnered with the Florence (Flo) text messaging self-management system which provides service users with a daily text message at an agreed time(s) to remind them to practice the technique.
International Nurses Day
International Nurses Day took place this year on the 12 May and we thank our nurses and midwives for all that they do each and every day and for the excellent service they provide for the people of Argyll and Bute.
It is always important that we celebrate and mark this event but it is even more important this year with the amazing work that our nursing staff are doing to deal with the ongoing COVID-19 challenges. We are very proud of them and they are a real credit to the organisation.
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Chief Social Work Officer
Alex Taylor has announced that he is planning to retire later this year as Chief Social Work Officer and we would like to thank him for his many years of outstanding dedication to social work services across Argyll and Bute and we wish him a healthy, long and happy retirement when it comes.
Julie Lusk has been appointed Chief Social Work Officer and she is a qualified social worker with over 20 years experience as a senior manager and Head of Service across social work, voluntary and the private sector.
Oral Health Improvement Team
The Oral Health Improvement Team is continuing to support children and families across Argyll and Bute during what is a difficult time for everyone: All children receiving free school meals from their local school hubs will receive a toothbrush and toothpaste pack along with their school meal delivery. Health Visitor/Nursing Staff will be giving out a toothbrush, toothpaste and free flow cup pack to 0-3yrs or toothbrush/toothpaste pack to 3-6yrs olds at routine immunisation clinics. They will also give out a 3-12yr old toothbrush/toothpaste pack to any siblings in the family that they think would benefit. They are also busy distributing 0-3yr, 3-12yr, 13-16yr and adult toothbrush/toothpaste packs to local foodbanks to help the most vulnerable people maintain good oral health routines.
Caring for People Tactical Partnership
The HSCP continues to be heavily involved in community support planning through the Caring for People Tactical Partnership which was set up to co- ordinate urgent community support during the COVID-19 outbreak. Membership of the Partnership consists of the HSCP, Argyll and Bute Council, and the Third Sector Interface.
A huge amount of work has taken place since the Partnership was set up including a webpage on the Council website with information and resources to support safe community responses to the current situation, including Volunteering Safely Guidance and contact details of local groups.
A helpline (01546 605524) has also been developed for people who are self- isolating/vulnerable and whose usual support network is no longer available. This will ensure they will have access to food, essential supplies and support. Over 2,300 people have requested support from the helpline since it went live on the 27 March.
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Midwives Pushing Delivery of Online Antenatal and Postnatal Classes HSCP midwives are delivering innovative digital Baby Massage, Parent Education and Hypnobirthing classes using Messenger App video chat tool to stay closely connected with clients and their partners during this unusual and challenging time. The midwives have been busy getting in touch with their clients to invite them to take part in the newly developed programme of digital classes being offered and are really pleased with the uptake and response from women across Argyll and Bute. Hypnobirthing uses self-hypnosis, relaxation and massage to take the fear and anxiety out of giving birth. While Parent Education Classes are really important to build upon parents existing skills, and really help to improve confidence for parents to be.
Staff Wellbeing Wednesday
The importance of self care and staff health and wellbeing and sustaining our resilience is even more important at the present time. The HSCP has therefore introduced Wellbeing Wednesday to bring a weekly focus to staff wellbeing and to share useful key messages/tips about looking after yourself and maintaining and building resilience with links/signposting to online resources and support as these become available and are developed.
An HSCP Wellbeing Group has also been established and is meeting weekly to ensure provision of the resources and support that staff need. This group links closely with NHS Highland and Argyll and Bute Council’s Wellbeing team so that resources can be shared.
A&B HSCP Staffside Update;
In response to Covid-19 the Staffside group are involved in the current Bronze/Silver Command meetings on a daily basis, the Care Homes Group and also to the daily huddles in the different areas. We have moved to holding a weekly Joint Partnership meeting so that issues can be raised timeously. A further step forward is we are linking with the Council Joint TU/HR meeting with the last half hour being dedicated to HSCP issues. This has been welcomed by all.
We have also welcomed the opportunity to comment early on the paper by Stephen Whiston on Covid-19 Looking Forward, comments have been collated and passed on. This is a great example of Partnership working.
The restrictions at the present time has led to further delays in Employee Relation cases and we are keen to work with HR on ways to make this work in a virtual world.
This crisis has brought out the very best in all staff going that “extra mile” and feeling valued, something we need to build on and recognise ensuring that their views and ideas are included for future planning.
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Our aim is to continue to strengthen our Partnership input as noted above. Although we do not always agree, we can usually find a way of moving things forward together.
Fiona Broderick Mary Watt Staffside Lead A&B Health Joint Chair of the A&B JPF. Joint Chair of the A&B JPF.
4 Page 25 Agenda Item 6
Integration Joint Board
Date of Meeting: 27 May 2020
Title of Report: COVID-19 mobilisation readiness update and look forward to living and operating with COVID-19
Presented by: Stephen Whiston, Head of Strategic Planning and Performance
The Integration Joint Board is asked to: Consider the COVID-19 escalation status update and projections to 31st August 2020 Review the look forward planning themes/implications to inform our resumption of “business as usual” living with COVID-19.
1. Executive summary
This paper reviews the current Public Health projections for the spread of COVID-19 in NHS Highland and how this information has been used to provide a modelling update of demand and an assessment of capacity. It highlights when and where the current and planned bed capacity does not meet expected demand. Additionally, this paper reflects considerations of the new normal arising out of the implications of COVID-19 for health and social care.
The material points are summarised below
Projected Demand Peak NHS demand in Argyll and Bute is projected to occur in the Week of the 31st May, with 21 beds required for critical care for COVID-19 in NHSGG&C and 42 other hospital beds required for COVID-19 in Argyll and Bute and 14 in NHSGG&C.
Critical Care NHS GG&C have modelled Argyll and Bute requirements and also have confirmed their peak week occurring at the beginning of June.
The SAS are in the process of assessing their resources to support the transfer activity into critical care. During peak week the model predicts there will be 13 critical care transfer to NHS GG&C
General Beds Argyll and Bute non-COVID Emergency Inpatient activity 1st April to 30th August 2019 was 1741 admissions with an average length of stay of 5.2 days. If we were to mirror this, then in May during peak week we could expect current bed capacity to just be sufficient to meet expected demand. However a number of contingency beds should be available.
COVID-19 Assessment Centres The current Community Assessment Centre (CAC) resource can see a maximum of 450 patients if all rooms utilised against an estimated peak demand of 95 to 100 patients in peak week.
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Social Care and Community The social care response to COVID-19 has focused on undertaking essential/emergency work only and responding to the impact of our revised social behaviour i.e. Social Distancing, Shielding and outbreak response in care homes and care at home and rehabilitation and reablement of patients recovering from COVID-19. Redesign of care at home services to respond to need and supporting care homes to support residents at this difficult time.
The setup of mental health assessment centres in line with Scottish Government guidelines have been implemented across Argyll and Bute to ensure quick assessment for those with mental health and/or addictions needs, keeping footfall from Accident and Emergency Departments
The limited testing capacity means the prevalence in the community is unknown although a 9% infection rate would indicate nearly 8,000 people will be infected
“Business as usual” living/working with COVID-19 This paper also provides an indication of what the HSCP need to consider as a thematic look forward for what our health and care services will require to consider and respond to through to 2020/21 in managing COVID-19 as our new normal.
2. Public Health Projections
A range of scenarios have been explored in order to plan for the expected demand associated with COVID-19. We have used a set of assumptions produced by the Scottish Government on 07/04/2020. They are based upon UK work led through the UK Scientific Advisory Group for Emergencies (SAGE), Imperial College epidemiological modelling, and modelling work from the four countries of the UK, applied to Scotland by the Scottish Government’s COVID Modelling and Analysis Division, and then applied to the NHSGGC population. The model provides information on estimated COVID-19 cases, their impact on hospital bed numbers and ITU bed numbers, and fatalities. These estimates are based on 40% compliance with social interventions. Social interventions applied include home isolation, household quarantine, lockdown for whole population, stopping mass gatherings, and closure of schools and universities. While this data is more optimistic than previous models used, NHSGGC continues to work towards maximum mobilization.
Our current best estimate is that we are around week 7 of the pandemic in Scotland, although different areas of Scotland are likely to be in different weeks.
The NHS Highland revised assumptions (14th April 2020) indicate the following impact of COVID-19
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Table 1 - NHS Highland COVID-19 disease model
Change variables: Select area: Argyll & Bute Infection (attack) rate 9% Symptomatic case rate 66% Hospitalisation rate 6.0% Hospitalised patients requiring ICU 33.9% Critical Care age threshold (≥ value) ICU deaths 25.0% Infection Fatality Rate (IFR) 1.5%
Population 86,260 Level 3 cohort 86,260
In the A&B context over the period April to End of August this equates to:
Around 8,000 infected people 5,300 who are symptomatic Around 1,200 requiring further assessment 316 additional hospital admissions, and within the number, almost 108 critical care admissions 120 excess deaths.
Over the coming weeks we will model our actual activity against projections to provide some assurance around the shape and length of the projected demand curve.
3. Critical Care
The table below shows a projection of the new admissions, and total COVID-19 patients in NHSGGC critical care beds during the 23 week pandemic phase peaking at 226 in week 19 (end of May/June). This also includes expected admissions from Argyll and Bute through their current critical care pathway with NHSGGC. This brings the GGC proportion of national ITU activity to 28.94%.
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NHSGG&C are carrying out further work to assess the expected non-COVID activity in ITUs, as this is likely to increase demand by around 14 beds in each week bringing the peak to
240.
NHSGG&C has committed to expand adult Intensive Care beds to 170. At that stage of expansion virtually all theatre staff will be supporting ICU and other surgical activity will be minimal. No expansion of NICU or PICU has been planned given low levels of activity.
4. Non-Critical Care
4.1 NHSGG&C
Across the NHS GGC estate, there are 3989 staffed adult inpatient beds. There are a further 144 unstaffed beds. If we assume 95% occupancy, there is a total of 3790 available beds for both COVID and non-COVID with additional surge capacity of 144. An additional 33 could be made available but has not been included in the NHSGG&C mobilisation plan. This excludes any capacity that could be made available from the Louisa Jordan Hospital established at the SEC in Glasgow.
Based on the projections above, the requirement for inpatient beds is expected to peak at 3435. This peak would occur in Week 18, currently expected to be at the beginning June, and NHSGGC has capacity to meet this demand.
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Non-COVID-19 admissions are based on experience in the last few weeks. It is possible that social distancing may have an impact in further reducing non-COVID-19 related morbidity as well as the spread of the virus e.g. less trauma admissions.
4.2 Argyll and Bute
The graph below shows the bed occupancy profile in Argyll and Bute over the period to September 2020. This modelling shows a requirement of 52 beds during peak week. Of which 14 beds are required in NHSGG&C to support Helensburgh and Lomond population and 38 beds are required in Argyll and Bute hospitals.
Argyll & Bute Acute Adjustment Beds (9.0% Attack Rate, 33.0% Critically Unwell, 25.0% Mortality Rate) 60
50
40
30
20
10
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 ------l l l l r r r r r r r r r t t y y y y y g g g g g n n n n b b b b p p p p c c u u u u a a a a a p p p p a a a a a u u u u u e e e e e e e e J J J J u u u u J J J J - - - - O O A A A A F F F F S S S S A A A A A M M M M M ------M M M M M ------5 2 9 6 ------7 4 1 8 4 1 5 2 9 6 2 9 6 3 6 3 0 7 0 1 1 2 2 9 6 3 0 1 8 5 2 9 3 0 7 4 1 0 1 2 2 0 1 0 1 1 2 0 0 1 2 0 1 2 2 0 0 1 2 3 0 0 1 2 2 0 1 1 2 3
Adj Acute Occupancy
4.3 Actual Activity to Modelled activity
The figure below shows the actual against model of COVID-19 Acute inpatient activity in NHS Highland hospitals as at 1st May 2020.
This shows the continuing impact of social distancing reducing the “r” number to below 1 and we are seeing a reduced COVID-19 demand in our hospitals.
Subject to the process and transition speed of relaxing the lock down arrangements it is “possible/probable/likely” that the demand will not exceed our capacity to cope.
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5. Community Assessment Centres
Community Assessment Centres (CACs) have been established to:
Maximise the numbers of symptomatic people who can be cared for in the community, reserving our hospitals for those with the most serious illness, and
Minimise the exposure of patients using GP practices to COVID-19.
There are eight CACs in Argyll and Bute, 7 of which operate 24/7 and Helensburgh day time hours Monday to Friday. In addition, they will be responsible for distribution of testing kits to residential care and community settings, sending tests for analysis and management of the results.
Projected activity in Community Assessment Centres is expected to be around 100 at peak week with about 1200 over the predicted period of this cycle. This is well within the existing available capacity if appropriate staffing is available.
6. Non-COVID Activity
The NHS response to the pandemic has seen a re-prioritisation to emergency only since March 2020. It is clear that this has surprised both emergency and routine activity but there is growing evidence that demand is increasing and presenting as emergency activity.
This demand on top of the predicated COVID-19 demand needs to be taken into account within Argyll and Bute hospitals. The table below illustrates the scale of Inpatient demand which occurred at our hospitals during the period April 2019 to August 2020
Table 1: A&B HSCP Acute Inpatient Bed Occupancy Statistics 29 April 2019 to 09 June 2019
Other Bed Activity National Bed Occupancy Statistics Day Statistics Avge Avail Occ Inpatient *Same Ward Ward Bed Beds % Avge Day Bed Day Trans Trans Comp Occ LOS Cases Days Adm Disch Deaths Inpats In Out 144 13747 10294 74.9 5.2 1731 1658 85 222 301 234 234
Notes: *Same Day Inpatients (i.e. Inpatients Admitted and Discharged on the Same Day) are included in Inpatient Discharge or Inpatient Death Totals as appropriate.
This shows that our normal medical, surgical and GP inpatient acute bed complement was 144 beds and of this approximately 75% were occupied a total of 108 beds per day.
Our COVID-19 demand at peak is 52 beds and assuming this we would require 160 beds on the 31st May leaving a shortfall of 17 beds.
It is important to note the 2019 activity is only based on emergency inpatient admissions and as reflected our current activity is significantly suppressed at this time. The latest SitRep report of the 7th May 2020 reported 72 beds occupied and 84 available (156) as shown below.
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Table 2 - Daily Bed Occupancy
Hospitals Bed Beds Bed Allocate Number of Number of Escal Occupied Unoccupi Complemen d Beds suspected confirmed Level 1-4 ed t COVID-19 COVID-19 (Escalation –in beds * –in beds * plan) Bute 5 8 15 13 0 0 1 Cowal 9 10 30 19 2 0 1 Mid Argyll 6 14 86 20 1 0 1 Mid Argyll -MH 16 5 21 21 0 0 1 Campbeltown 6 15 74 21 0 1 1 Islay 3 5 21 8 0 0 1 Oban 25 27 68 52 1 3 1 Mull 2 0 3 2 0 0 1 All A&B Total 72 84 318 156 4 4 (Data Source: Bed compliment (Bed Occupancy Statistics Health BI-NHSH) updated midnight 06/05/2020 & Bed Occupancy Statistics via Health BI @ midnight 05/05/2020. * Daily Sit-Rep Report @ 07/05/2020)
Retaining this level of capacity we would not have enough capacity to meet the projected peak week demand, and as such would be using the contingency beds we have identified in our hospital COVID-19 escalation plans (Bed Complement).
Finally it is worth noting this is based on average data and real life does not follow averages, we are therefore likely to see peaks and troughs in COVID-19 activity in different localities at different times as we progress through this phase of the pandemic.
7. Community implications
COVID-19 will have significant implications for community health and social care services as well as the future of care homes. It is important to assess these implications as part of the system-wide modelling in order to ensure that our workforce is appropriately flexed to meet the service priorities. A system-wide approach will ensure that services are not relying on the same staff group to deliver different services.
Health and care services in the community include district nurses, rehabilitation teams and care at home staff, many of whom are employed by local authorities and other providers. These groups of staff do have high levels of staff absence due to sickness and self- isolation. They will be dealing with both COVID and non-COVID patients. Over the last few weeks, these service have had to move onto an emergency footing to prioritise visits, meeting only essential needs. Importantly, because some service users have stopped their own care at home services, care at home has not as yet been significantly affected, however there is potential vulnerability for those who have refused their care package.
There are some 340 people in care homes in Argyll and Bute and over 1,100 receiving home care. In addition there are now over 2,200 people who are in the shielded category.
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For health and care services in the community, the existing workforce has been able to cover essential non COVID work. However, as the pandemic goes on, these service will need to support two other groups of people in the community: those who are discharged from hospital after treatment for COVID and those being cared for with COVID in the community. The latter group will include a number of people in care and residential homes or supported living accommodation.
It remains too early in the process to assess the level of care and rehabilitation support required by those leaving hospital after COVID treatment, and this will vary significantly depending on home/family support. Our hospitals and care homes may require to provide step down beds or temporary housing for patients requiring support on leaving hospital to comply with testing criteria.
Early experience of caring for COVID-19 patients in the community is beginning to emerge. These patients require an intensive visiting schedule of around three visits per day by two people for a period of around 4 days. They may also need evening and night visits. Often they are unknown to the District Nursing and AHP team and have rapidly changing needs. Generally, they will require subcutaneous medication, and symptoms are difficult to manage, particularly for patients with dementia. The impact on unpaid carers is as yet unknown but it is likely that stress will feature as an ongoing issue.
8 Palliative Care
Predicting the number of people with COVID-19 likely to require palliative and end of life care is difficult and a range of figures is discussed in the Argyll and Bute HSCP COVID-19 – Community and Social Care Escalation Guidance. The numbers will depend on the number of people infected, the severity of the infection, existing health and age profile of those infected. However a proportion of people with COVID-19 disease will require palliative and end of life care not forgetting people with non COVID-19 palliative care needs.
Local pathways considering the presentation and flow of people who may require palliative and end of life care as a consequence of COVID-19 infection should be agreed. This may include:
People at home People discharged from hospital People in hospital for whom recovery is not possible People in Care Homes
Demand will dictate the shape of any service but the aim should be to provide the best practice palliative care for everyone who requires it. If the numbers are high then care may have to be delivered in a ward type of location. Location of provision of palliative care should be agreed in each locality as part of their escalation planning.
9 Looking forward- “Living and Working with COVID-19”
It is clear that the length of time we will have to deal with the implications of this pandemic is extending into the next 12 months. This disease burden is part of the new activity “norm”. However, the implications of the speed, intensity and scale of response to manage and constrain its impact is now self-evident.
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We need therefore to focus on two key aims
1) resuming and optimising routine, comprehensive health and social care; and
2) Simultaneously managing COVID-19 across the health and care system using ongoing preparedness and readiness to re-escalate response.
Resumption of routine service is however very different to what we were doing only 7-8 weeks ago as “living and working with COVID-19” will need to address:
Social and physical distancing will remain and this will affect our operational use of our estate (layout, facilities, hours of operation etc.) and may well accelerate shrinking our estate footprint further. Services such as day services in the community might have to be significantly reduced or redesigned.
Prevalence of PPE at work, play, social interaction and daily living in the community
Ubiquitous COVID-19 testing in hospitals and the community to prevent, isolate and contain any further outbreaks
Mental and physical well-being needs of staff, shielded community will rise and put increasing pressure on our social care and mental health services and we are already experiencing an increase in mental health referrals to the teams.
Vaccine development and delivery at scale is expected to be beyond 2020/21+ but its coverage and efficacy is as yet unknown
The scale of our mobile/agile/remote working will continue to increase, we will deliver more services via virtual or remote access removing geography and rurality as a barrier.
The need for online appointments and digital health and care services offering 24/7 response will become over whelming. We will see the use of “near me” video and telephone consultations becoming part of the norm in health and care services within and beyond Argyll and Bute.
Electronic health and care records and data linkage are key to comprehensive COVID-19 surveillance as well as managing non-COVID-19 clinical problems
Communities and health and care partners have a great opportunity to emerge from this stronger and more resilient. We have seen positive examples of working together with Independent Providers and the Care Home Task Force, for example and this will remain in place. We will however, see/need new contracting and funding partnerships with our care and 3rd sector partners.
Economic impact and its resultant burden on tax and employment is likely to be significant- resultant health and deprivation impact could exacerbate depopulation in Argyll and Bute.
How do we pay for this - Financial efficiency, productivity and value for money will continue to be a driver
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Logistic arrangements and supply chain may look different, quicker and enhanced access to diagnostic and distribution arrangements will require a greater diversity of transport infrastructure and methods.
As has been indicated, adult social care models of service delivery will have to change-the financial viability of some independent care homes is in doubt; there is emerging evidence of a significant rise in domestic violence; increased alcohol use with the resultant consequences, the impact of trauma on adults, children and staff and new ways of working to identify adults at risk of harm given increased isolation and reduced scrutiny. We will need to strengthen and develop new ways of working so that we remain strongly sighted on protection risks and how these are responded to.
These are some of the themes or issues or arrangements we will need to now assess, plan and review as we go forward.
This will require us to not only think about our operational services, but our current strategies and objectives and our governance and corporate operating arrangements. There is a need for a new normal to be developed and implemented over the next 12 months.
10 CONTRIBUTION TO STRATEGIC PRIORITIES This work supports/underpins the HSCPs strategic and operational response to this emergency pandemic GOVERNANCE IMPLICATIONS Guidance: Please ensure that you have followed the appropriate governance structure taking consideration of the following areas prior to submitting your paper. Financial Impact The programme of work responding to the pandemic and following on from it will need to be taken account of within current financial planning and return to business as usual which is in hand. Staff Governance The workforce consequences and staff and TU fantastic response to the crisis has epitomised the adoption and strengthening of good communication and formal engagement processes and partnership working. Clinical Governance Clinical governance response has been fundamental to the shaping and management of the public health projections and demand modelling and our response to ensure patient, client and staff safety.
11 PROFESSIONAL ADVISORY
Input from professionals across the stakeholders remain instrumental in the response to the COVID-19 pandemic.
12 EQUALITY & DIVERSITY IMPLICATIONS Will need to be reviewed and considered as we progress through this pandemic cycle and emergency operating arrangements.
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13 GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Compliance with GDPR remains critical and is being considered within the various pieces of work supporting the sharing of information and data to protect health and wellbeing of staff and the public and patients. 14 RISK ASSESSMENT Not required for this report 15 PUBLIC & USER INVOLVEMENT & ENGAGEMENT Is assumed within the COVID-19 response in place.
16 CONCLUSION The HSCP response to address the COVID-19 pandemic to date has been achieved through fantastic commitment and support of our staff and all our partners and stakeholders and the wider Argyll and Bute community as well as the SAS and NHS GG&C. The information and public health intelligence and evolving knowledge of the corona virus has been fundamental in informing our planning and emergency response to address the care and treatment needs of this disease and protect our most vulnerable. Our scale of mobilisation has flexed and adapted over the last 2 months and it is clear that we now have robust plans for an emergency response to COVID-19 outbreaks. We are however, now moving into or towards a new phase of this pandemic “COVID-19 normal” which is certainly going to extend into the next 12 months and probably longer. This requires the HSCP and partners to master and strengthen what we have achieved and strengthen and cement new ways of working and operating in our new COVID-19 world. The themes identified above have been captured as a starter for 10 to inform how we bring back suspended services on-line. Inform what we will need to cope with the post COVID-19 impact economically, socially and well-being as well as the yet unknown transition rules/time for the easing of lockdown e.g. how long will shielded people remain shielded. The SLT is asked to consider this report as it develops its business as normal resumption process.
17 DIRECTIONS
Directions to: tick Directions No Directions required x required to Council, NHS Argyll & Bute Council Board or both. NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board
REPORT AUTHOR AND CONTACT Author Name Stephen Whiston Email [email protected]
11 This page is intentionally left blank Page 37 Agenda Item 7
Integration Joint Board
Date of Meeting: 27th May 2020
Title of Report The role of Public Health to date in the COVID -19 response
Presented by: Nicola Schinaia, Associate Director of Public Health
The Integrated Joint Board is asked to: . Note the Public Health response to the COVID -19 outbreak in Argyll and Bute Health and Social Care Partnership area.
1. EXECUTIVE SUMMARY This paper reviews the work of Public Health in Argyll and Bute relating to COVID -19 and focuses on three main areas:
. Understanding the epidemiology of COVID -19 in Argyll and Bute . Caring for people work stream supporting our communities . Staff testing This work has enabled us to monitor the extent of the spread of the disease, to set up a robust mechanism to support most vulnerable people, as well as to promote a comprehensive and widespread process to allow symptomatic health and social care workers to undergo testing, with the aim at reducing the time spent in self-isolation.
2. INTRODUCTION COVID -19 is a serious disease that arises from a novel coronavirus infection. An outbreak originated in Wuhan, China at the end of 2019. This outbreak subsequently spread across the world and has been defined as an international pandemic by the World Health Organisation. Epidemiological data continues to consolidate but early indications of the severity of health outcomes necessitated the implementation of emergency planning procedures to minimise levels of infection and prevent health services being overwhelmed. National strategies to contain the virus involving social distancing and “lockdown” have shown success in reducing infection rates and “flattening the curve”. However, the virus remains present in our communities.
3. DETAIL OF REPORT This section of the report provides detail on epidemiology, caring for people and testing.
1 Page 38 a) Epidemiology
Confirmed cases
The first confirmation of COVID -19 in Scotland occurred in Tayside on 1st March. Since then, cases have been confirmed in all 14 territorial health boards across Scotland with 14,260 people confirmed positive reported by Scottish Government as of 15th May.
Numbers of confirmed cases are likely to underestimate the true number of people who had been infected as not everyone with COVID -19 will display symptoms and not all those with symptoms will be tested.
As of 15th May, the Scottish Government reported 331 confirmed cases of COVID -19 in NHS Highland. By residential postcode obtained by CHI linkage, Scottish Government reported 135 confirmed cases of COVID -19 in Argyll and Bute at 2pm on 15th May1.
The total (cumulative) number of cases in NHS Highland has increased over time as new cases are confirmed (Figure 3.1). The increase in numbers of confirmed cases should be interpreted with caution as this depends on the amount of testing conducted. The testing strategies employed over this time period have changed with increasing numbers of groups of people eligible for access to testing in more recent weeks.
Figure 3.1 Number of confirmed cases in NHS Highland with significant time points marked.
13th March: move from contain to delay
1st March: 23rd March: first lockdown confirmed case in Scotland
Source: Scottish Government reporting from ECOSS2. Note that data starts at the date 5 cases were confirmed. https://www.gov.scot/publications/coronavirus-COVID -19-trends-in-daily-data/
1 Note that this data is obtained via a live system and is subject to change as additional information becomes available. https://www.arcgis.com/apps/opsdashboard/index.html#/658feae0ab1d432f9fdb53aa082e4130
2 https://www.gov.scot/publications/coronavirus-COVID -19-data-definitions-and-sources/ 2 Page 39
Across Scotland, there are higher rates of confirmed cases in the oldest age groups, with the highest rates in those aged 85+ (Figure 3.2).
Figure 3.2 Rate of positive COVID -19 cases across NHS Scotland by Age Group, and sex as at 11 May 2020
Source: Public Health Scotland analysis from Source: ECOSS Database. Date extracted: 04/05/2020. https://beta.isdscotland.org/find-publications-and- data/population-health/COVID -19/COVID -19-statistical-report/
Deaths
National Records of Scotland (NRS) report weekly on the number of deaths registered as involving COVID -19. This includes people with positive diagnosis of COVID -19 and those with ‘presumed’ COVID -19. Any death in Scotland where COVID -19 is mentioned on the death certificate is included (3,213 deaths registered up to 10th May3),
Up to 10th May, 58 deaths involving COVID -19 had been registered of usual residents of Argyll and Bute with the number of registrations falling in week commencing 4th May compared to the previous weeks.
Caution is recommended in interpreting numbers of deaths compared to numbers of confirmed cases; deaths information includes all deaths involving COVID -19 and not just those confirmed positive, and in turn the number of people confirmed positive depends on the testing strategies and the timing of these testing strategies in relation to the pandemic within Argyll and Bute.
3 Provisional figure reported on 13th May. 3,058 deaths in Scotland were unidentified with COVID -19 as the underlying cause. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general- publications/weekly-and-monthly-data-on-births-and-deaths/deaths-involving-coronavirus-COVID -19- in-scotland 3 Page 40
Figure 3.3 Number of deaths involving COVID -19 of residents of Argyll and Bute, by week
Source: National Records of Scotland. Based on ‘usual’ residents. https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by- theme/vital-events/general-publications/weekly-and-monthly-data-on-births-and- deaths/deaths-involving-coronavirus-COVID -19-in-scotland
Up to 10th May, 22/58 (38%) deaths in Argyll and Bute involving COVID -19 were registered as occurring in a care home location. This compares to 45% deaths involving COVID -19 in Scotland occurring in a care home location, and 106/495 (21%) deaths from all causes in 2020 in Argyll and Bute occurring in a care home location3.
Data from NRS are available in appendix 1. b) Caring for People
BACKGROUND AND INTRODUCTION
Looking after people affected by an emergency is an essential element of an emergency response. The Scottish Government has a suite of guidance called Preparing Scotland that includes a requirement to care for people4. The COVID -19 outbreak posed and continues to pose significant threats to human health and wellbeing.
A Caring for People Tactical (CfP) Partnership was set up on 16 March 2020 to oversee this aspect of the emergency plan. It is an equal partnership of: Argyll and Bute Council Argyll and Bute Health & Social Care Partnership Argyll and Bute Third Sector Interface
4 Scottish Government (2017) Preparing Scotland. Scottish Guidance on Resilience – Care for People Affected by Emergencies https://www.readyscotland.org/media/1441/care-for-people-affected-by- emergencies-november-2017.pdf 4 Page 41
The Tactical Partnership met daily for 5 weeks and reverted to twice weekly meetings on 20 April 2020. Membership comprises officers of each partnership.
The strategic intentions of the CfP Partnership were mapped in week 2 and a visual representation is provided in the figure below:
Caring for People Workstreams
OUTPUTS (HIGHLIGHTS) Website and communications During week 1 of the CfP partnership, time was spent considering how to co- ordinate effective communication during the emergency plan and a communications plan was developed. This has ongoing involvement from the NHS and council communications teams. During the week of 20 April a dedicated communications sub-group of CfP convened to oversee the communications plan.
The first output of the CfP partnership was to develop online information for people. An early decision was made to use the Council’s website to host this information due to the presence of a local web support team and also the significant reach of this website across the population of Argyll and Bute.
The webpages went live on 17 March 2020 and these have been added to and evolved significantly since then. They can be viewed here - https://www.argyll- bute.gov.uk/coronavirus-help-and-advice By 17 May 2020 this page had been viewed 35,581 times with the average length of time spent on the page being 1 minute 8 seconds.
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A postal maildrop of the following graphic was sent to all households on 11 May.
4.2.2. Helpline
A Caring for People helpline to support the people in Argyll and Bute affected by the outbreak was launched on 27 March 2020. Argyll and Bute Council already had an existing customer helpline system and infrastructure in place and an early decision was made to use this to manage the service. The helpline is used for a range of other purposes, for example business and benefits advice. Table 1 outlines the number of call to the helpline.
Helpline wc wc wc wc wc wc wc Services 30/03 06/04 13/04 20/04 27/04 04/05 11/05 Care for People 51 264 510 526 392 346 468 Business 206 94 96 99 90 71 42 Health 31 42 78 69 66 32 56 Social Care 82 65 128 168 131 96 129 Benefits 51 25 66 56 54 45 39 Other 16 5 8 9 16 16 14 Out of Hours 56 164 180 78 30 181 42 Total 493 659 1066 1005 826 787 790 Table 1: Calls to helpline since inception by reason
The vast majority of Caring for People call requests are for support with food provision and delivery of medications or household supplies. Other requests are small but varied, for example household repairs, support with looking after pets
6 Page 43 or community transport request. Calls from people experiencing emotional distress, for example, loneliness and/or anxiety have also featured. Table 2 illustrates the number and range of requests for help and their geographical origin.
A total of 2,300 people have contacted the helpline for Caring for People support and this has generated 2870 individual job requests as many people require help with more than one thing. There has been variation in the volume of calls across Argyll and Bute and this may relate to different local promotion or in the incidence rate of infection, for example there have been more calls from Cowal and Bute.
Table 2: Call type by locality in Argyll and Bute
The number of new people contacting the helpline with Caring for People requests slowed toward the end of April into the beginning of May. This is similar to the “flattening the curve” trend of reducing infection rates of coronavirus in the community and the CfP group considered this could be symptomatic of people now having community and family support structures in place to enable them to remain safely at home. The latest week to 17 May shows a significant increase in helpline calls most likely due to an all household postal drop to 55,000 homes in Argyll and Bute. Table 3 shows the number of requests by category each week.
Table 3: Caring For People Requests Weekly and Cumulative Since Inception
All figures contain data up to close of play on 17 May 2020.
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Local Caring for People Teams and Volunteers There are eight local Caring for People teams to support the delivery of the helpline requests. These include NHS and council staff members who field the calls to local volunteer co-ordinators and volunteers. A volunteer recruitment exercise, co-ordinated by the Third Sector Interface (TSI) commenced in week 1 of the emergency plan. This was complemented by the Ready Scotland volunteer recruitment two weeks later resulting in more than 900 people in Argyll and Bute volunteering to date.
The number of volunteers now exceeds the amount of activity needing to be fulfilled so volunteer recruitment has ceased. The CfP group is now reviewing how volunteers can be used effectively going forward, for example with getting key messages out to their communities, supporting people who have to self- isolate at short notice as a result of contact tracing, and with long term community resilience in the recovery phase.
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Opportunity Area Number Total Helensburgh and 64 Lomond Cowal 28 Bute 11 Kintyre 17 Delivery/Collection Mid Argyll 32 234 Islay and Jura 15 Oban and inner 59 islands Mull, Iona, Coll, 8 Colonsay and Tiree Helensburgh and 25 Lomond Cowal 7 Bute 6 Kintyre 5 Emergency 89 Transport Mid Argyll 15 Islay and Jura 4 Oban and inner 26 islands Mull, Iona, Coll, 1 Colonsay and Tiree Helensburgh and 3 Lomond Cowal 2 Bute 0 Fuel Kintyre 1 Delivery/Emergency Mid Argyll 6 19 Repairs Islay and Jura 1 Oban and inner 5 islands Mull, Iona, Coll, 1 Colonsay and Tiree Telephone Argyll-wide 205 Befriending Counselling Argyll-wide 16 Funeral Planning Argyll-wide Not yet open Table 4: Numbers and categories of volunteers for the 8 health and wellbeing network areas of Argyll and Bute
In parallel to the volunteer teams, there are also eight community food teams who oversee the delivery of food parcels and free school meals to eligible families. These are led by Argyll and Bute Council and supported by redeployed staff and local volunteers.
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PROTECTING VULNERABLE PEOPLE
Background
The Scottish Government announced a strategy to protect people who are most vulnerable to serious illness following coronavirus infection on 24 March 2020. This activity is commonly referred to “shielding” by the media. The particular groups to protect include: organ transplant recipients; people with certain cancer (eg active chemotherapy or radiotherapy, bone marrow transplant, blood cancers); people with severe lung conditions (eg cystic fibrosis, chronic asthma, COPD); people with rare diseases that predispose them to increased infection (eg sickle cell anaemia); people on immunosuppression treatment; and pregnant women with severe heart disease on other congenital problem. More information is available here - https://www.gov.scot/publications/COVID - shielding/
Approach in Argyll and Bute
The shielding programme is led by Argyll and Bute Council with officers overseeing activity and reporting to Scottish Government. Key messages from shielding activity as of 18 May 2020 include:
There are 2965 people identified in the above shielding categories in Argyll and Bute. This figure has been reached by a number of trawls of national patient data sources complemented with local GP and hospital consultant searches. GP practices have the ability to add people to the list.
The master database of shielded people is held by the customer services team at the council who provide ongoing communication and support. People can opt out of receiving ongoing communication if their support needs are met, for example by family or friends.
Shielded people received a letter from the Chief Medical Officer of Scotland outlining the support that would be provided to ensure they minimised their risk of infection. This included a request to stay at home and self-isolate for a minimum of 12 weeks.
Subsequent to this, people on the list received a phone call from Council customer services operators. This was to ensure they had received their letter and understood the requirements, and to investigate what support needs people had to comply with the shielding request. Anticipated support needs included food deliveries and prescription supplies.
Shielding Activity to 18 May 2020
Considerable time and effort has been invested in the shielding programme in Argyll and Bute resulting in the following activity:
1790 people require no further support.
571 people have signed up for the national food parcel delivery service (dry food goods).
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795 people have signed up for the local supplementary food parcels (including fresh and dairy products and specialist diet requirements).
249 people have requested support with the delivery of medication and other medical consumables.
Call operatives are in the process of carrying out follow up pastoral support calls to people in receipt of support. This includes signposting to the emotional support pathway. To date 10 people have requested this assistance.
A new pathway is in development to support people who are shielding to maintain appropriate levels of physical activity while remaining at home. The importance of this to future health and wellbeing outcomes is recognised, for example frailty and falls.
CARING FOR PEOPLE - NEXT STEPS
Emotional wellbeing pathway The CfP partnership recognises the significant impact this emergency is having on our emotional wellbeing. An emotional wellbeing pathway to support people experiencing adverse effects like loneliness, anxiety or low mood was launched in early May. This includes befriending phonecalls and a form of short mental health triaging (by staff with mental health skills and experience) followed by matching with suitable self-help support services. This has been developed in partnership with mental health colleagues but is separate from existing HSCP delivery). More information is available here – https://argyllandbute.custhelp.com/app/VOL/Emotional_Support To date the number of requests for assistance is low (approximately 76) and ongoing promotion is being incorporated into the communications plan.
Evaluation and Mainstreaming Caring for People during COVID There is acknowledgement that Caring for People activity will be required for the foreseeable future. An evaluation plan is being developed to measure the impact of the Caring for People helpline and to investigate any ongoing learning in order to improve the service during this or subsequent phases of the outbreak. This includes the support role for people who may be asked to isolate during the Test, Trace, Isolate, Support phase of the response.
Recovery The CfP group is sighted on the long term nature of the recovery from this emergency and is anticipating what role this group will play in the recovery phase. This will be co-ordinated and link with Argyll and Bute Council’s recovery response which has already convened.
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c) Testing
This section describes in detail how the testing programme is realised in Argyll and Bute. It hinges on four separate pathways, and one governance process, as outlined below. NHS staff in AB will follow the process of referral by manager to NHS Highland (NHSH) Occupational health (OH); AB council staff, council contracted services e.g. care at home and care homes, referral by their manager to single point of contact (SPOC) [identified with AB Human Resources (HR) support]; GPs practices - referral via practice manager to Joyce Robinson (who will use NHSH OH referral system to send request to Inverness); Glasgow Airport facility will also be utilised by any staff who live within 90 minutes. We have planned a Monitoring and Evaluation process, managed in the Public Health team. Programme Referrer Follow Up
NHS staff testing inc. GP and Persons line Test at local CAC, follow up by OH their practice staff manager, for GP Team Inverness. surgeries likely the Practice Manager A&B Council H&SC provision, Line manager, team Result communicated by CAC. SAS, Private H&SC providers, manager, home Positive tests followed up at regular SDS Carers manager, employer intervals with retests until clear. Advice from HP team/NHS Inform. National Testing (Army) – Line Manager (Not Result is texted to individual who Glasgow Airport (for A&B staff NHS) shares with line manager. Follow up who live nearby only) then as A&B council staff. Mobile Testing Units ( Army) People self-refer As for Glasgow Airport. through an online N.B. Mobile units will be deployed to portal. areas of outbreak for mass testing.
The above table summarises the key elements of this activity.
Management, administrative and clinical protocols have been developed for the following staff groups:
NHS Highland directly employed staff, pharmacy staff and dental staff; A&B Council staff including Care at home and Care Homes, Scottish Ambulance Service based in Argyll and Bute, Private Providers of Care at Home and Care Homes including those Carers employed by direct payments; and, General Practitioners and Primary Care staff. 12 Page 49
Development of testing activity:
Processes for staff testing were agreed at Bronze and Silver command and were distributed to all relevant people in all the staff groups on Friday 23rd April and went live on Monday 26th April. Data collection processes were initiated and continue to be revised, using mainly displaced staff from the H&L area.
Key workers and household members with symptoms can attend community Army Mobile Testing Units (MTUs). A schedule of dates and locations is planned ahead and communicated via social media and front line staff. National guidance is subject to changes for who is eligible for testings. Up to date information can be found here –
https://www.gov.scot/publications/coronavirus-COVID -19-getting- tested/
This staff testing workstream fits closely with that of Care Home Testing, who are currently planning the role out of testing as per SG guidance of Friday 1st May.
Up to 15th May 2020, 100 referrals have been made through the single point contact for testing for COVID -19, including for 82 care staff.
4. RELEVANT DATA AND INDICATORS Data have been reported in the above section. In summary, we have presented trends on: confirmed cases of COVID -19 infection, overall and COVID -19- specific mortality.
5. CONTRIBUTION TO STRATEGIC PRIORITIES This work supports/underpins the HSCPs strategic and operational response to this emergency pandemic.
6. GOVERNANCE IMPLICATIONS Financial Impact These activities - responding to the pandemic and following on from it - have employed a larger number of resources, primarily in terms of person-time. Such increased spending has been tagged to dedicated COVID -19 funding and will be accounted under this budget line work will need to be taken account of within current financial planning and return to business as usual which is in hand.. Staff Governance The workforce consequences and staff and TU fantastic response to the crisis has epitomised the adoption and strengthening of good communication and formal engagement processes and partnership working. Clinical Governance
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Clinical governance response has been fundamental to the shaping and management of the public health projections and demand modelling and our response to ensure patient, client and staff safety.
7. PROFESSIONAL ADVISORY Inputs from professionals across stakeholders remain instrumental in the response to the COVID 19 pandemic. There has been a close collaborative working between the Departments of Public Health in Argyll and Bute and North Highland. We expect this to be a long-lasting positive outcome of this major incident.
8. EQUALITY & DIVERSITY IMPLICATIONS Equality and diversity will need to be reviewed and considered as we progress through this pandemic cycle and emergency operating arrangements. Experience from other countries shows that marginalised communities fair worst in relation to both infection rates and health outcomes. An impact assessment will be developed for the response in due course, but in the meantime principles of equality have informed specific programmes of activity. Examples of this include targeted activity with gypsy/traveller communities and developing communications materials for different audiences eg learning disability friendly and subtitles for people with hearing impairment.
9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Compliance with GDPR remains critical and is being considered within the various pieces of work supporting the sharing of information and data to protect health and wellbeing of staff and the public and patients.
10.RISK ASSESSMENT Not required for this report.
11.PUBLIC & USER INVOLVEMENT & ENGAGEMENT A comprehensive communications strategy exists to provide accurate information on the COVID -19 response to staff, partners and the wider population. The Third Sector Interface contributes to the Caring for People Tactical Partnership and provides a link to local community resilience activity, third sector organisations and community members.
12.CONCLUSION Following the declaration of major incident in NHS Highland to respond to the COVID -19 pandemic, the Department of Public health identified a number of key activities to contribute to the overall HSCP response. Human resources have been focused to the response. Our overriding working principles of cooperative working within the HSCP have strengthened and it is expected that may be helpful in the management of the subsequent phases of the pandemic and the post-COVID -19 work.
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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
Author Name Nicola Schinaia, Associate Director of Public Health Email [email protected]
15 This page is intentionally left blank Argyll & Bute Local Authority Page 53 Deaths involving coronavirus (COVID-19) up to 10th May 2020
As of 10th May, 58 Cumulative deaths involving COVID-19 by week Argyll & Bute residents had a death registered 55 58 which mentioned 42 COVID-19 The first mention of 28 COVID-19 in a death 16 registration in Scotland 9 5 was in the week 0
beginning 16th March Week Commencing Week Commencing 2020. 16th March 4th May
In the week Total deaths and deaths involving COVID-19 by week beginning 4th May, 41 12.5% of all deaths 34 35 31 29 29 in Argyll & Bute 24 were COVID-19 16 12 14 13 7 related. 5 4 3 This is down from 42% 0 in the previous week.
Week Commencing Week Commencing 16th March 4th May All causes COVID-19 related
Deaths vary by Number of deaths involving COVID-19 by location location of death, up to 3rd May 2020 Most COVID-19 deaths have occurred in 58 Hospital (48%). A further 38% happened in Care Homes. There 28 22 were 8 deaths that occurred within the 8 Home/ Non- institution, this is around 14% of All Home / Non- Care Home Hospital COVID-19 deaths. institution
For definitions/ methodology, please visit: www.nrscotland.gov.uk/covid19stats Source: Deaths involving coronavirus (COVID-19) in Scotland, week 18 (27 April to 10 May 2020) This page is intentionally left blank Page 55 Agenda Item 8
Integration Joint Board
Date of Meeting: 27 May 2020
Title of Report: Update on progress with the Sturrock Review Actions including a report on the Argyll & Bute Culture Survey and plans for the launch of the Healing Process
Presented by: Joanna Macdonald
The Integration Joint Board is asked to: . Note the NHS Highland Board paper.
1. EXECUTIVE SUMMARY
On Friday 15 May NHS Highland held a Board Development Session to hear the outcome of the Argyll and Bute Culture Survey.
The survey was carried out as a specific action resulting from the Sturrock Review. The link below indicates the paper which will be presented at the NHS Highland Board on 26 May to update on the Culture Fit for the Future Activity and contains the presentation which has been shared by the Chief Officer during her Health & Social Care Partnership staff engagement sessions.
We will be working hard to ensure that the culture across all of the Argyll & Bute HSCP is one where colleagues are treated fairly and with kindness and caring, dignity and respect and are focussed on working together for a common purpose.
2. INTRODUCTION In November 2019, as recommended in the Sturrock Review report, NHS Highland Board commissioned Progressive Partnership Ltd to carry out a survey for colleagues working in Argyll & Bute. NHS Highland ensured that the Argyll & Bute Health and Social Care Partnership (HSCP) were consulted on the work being undertaken. The HSCP has 1540 NHS Highland employees and 770 Council employees but the scope of the review did not include Council employees, so the report only covers two thirds of the HSCP. The report sets out more fully the findings of the survey which sought to understand the experience of bullying and harassment of NHS Highland colleagues within the Argyll & Bute HSCP.
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The key findings are deeply concerning and we accept them fully and offer a full apology to every colleague who has experienced bullying or harassment. We would also like to thank those who responded for having the bravery to respond, as we know how challenging it is for colleagues to confront the issues they are sharing with us. 3. DETAIL OF REPORT
Staff and Stakeholder engagement commenced in Argyll & Bute on the afternoon of the 15 May 2020. The Chief Officer met with the IJB, Senior staff and the Argyll & Bute Partnership Forum directly after the NHS Highland Board development session.
A communication was circulated to all staff. NHS Highland’s Chief Executive, Paul Hawkins, said: “I fully accept the results of the survey and I sincerely apologise to any colleague who has experienced bullying or harassment. I am extremely concerned by the outcome of the survey and I am determined to make the changes necessary to improve the experience for colleagues. I will work with the senior leadership team to rebuild trust and confidence across NHS Highland, Argyll and Bute.
“The results of this survey reinforce the need to continue our efforts to address cultural issues in our organisation. We have immediately put in place a 100 day action plan to address the key findings, which integrates into our wider culture improvement programme and will be delivered in partnership with colleagues and independent agencies.”
Argyll and Bute Health and Social Care Partnership Chief Officer, Joanna Macdonald, added: “It is distressing to see that a significant number of our colleagues have experienced bullying and harassment and addressing the implications of this report is our highest priority.
“We would like to thank those who have responded to the survey for having the bravery to respond. We know how challenging it is for colleagues to confront the issues they are sharing with us.
“We will work in close partnership with colleagues and stakeholders across all of the organisation to deliver the actions necessary to achieve a culture that is based upon dignity and respect for each other.
Subsequent to the NHS Highland Board development session nine further virtual engagement sessions took place in Argyll & Bute on 18/19 May. In total 341 people attended by Skype receiving a presentation and additional individuals/groups participants by phone who received an audio only update.
The Chief Officer has requested collation of all communications (anonymously) stimulated by these presentations.
Two further opportunities for reflection on the survey will take place on 28/29 May. Weekly staff check in sessions with the Chief Officer will commence week beginning 1 June.
4. RELEVANT DATA AND INDICATORS
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Sturrock Review and Argyll & Bute Culture Survey.
5. CONTRIBUTION TO STRATEGIC PRIORITIES All priorities under staff governance.
6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact No specific financial impact for this paper 6.2 Staff Governance A partnership approach will be taken to any potential culture change and development and co-production of a detailed action plan. 6.3 Clinical Governance N/A to this paper
7. PROFESSIONAL ADVISORY Guidance: Please provide details of the consultation undertaken with professional leadership and the outcome of discussions. 8. EQUALITY & DIVERSITY IMPLICATIONS Any potential change will require to take full account of any implications for Equality and Diversity. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Compliant
10.RISK ASSESSMENT Any potential risks from a change of culture will require to be fully scoped.
11.PUBLIC & USER INVOLVEMENT & ENGAGEMENT Staffside representation will be fully involved in the co-production of any culture change activity. As noted previously the Chief Officer has identified an opportunity for continued dialogue with all staff.
12.CONCLUSIONS A 100 day plan has been circulated to provide a framework to take forward a co-produced approach to developing the culture in Argyll & Bute Health and Social Care Partnership.
13.DIRECTIONS Directions to: tick
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Directions No Directions required x 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
Author Name Charlotte Craig Email [email protected]
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NHS Highland
Meeting: NHS Highland Board Meeting date: 26 May 2020 Title: Update on progress with the Sturrock Review Actions including a report on the Argyll & Bute Culture Survey and plans for the launch of the Healing Process
Accountable Executive: Chief Executive Responsible Executive: Director of HR and OD
1 Purpose This is presented to the Board for: Discussion / Decision
This report relates to a: The completion of the initial Sturrock Report Action Plan, a report on the Argyll & Bute Culture Survey and the Launch of the Healing Process
This aligns to the following NHSScotland quality ambition(s): Person Centred
2 Report summary
2.1 Situation In November 2018, John Sturrock QC was appointed by Scottish Government to carry out an independent review into allegations of bullying at NHS Highland. His report was published on 9th May 2019 and this included a recommendation for a further review into culture within Argyll & Bute.
One year on from the report publication, this paper summarises the progress made to date, including the findings of the Argyll & Bute Culture Survey carried out between February and April 2020, which was one of the recommendations in the report and an update on the launch of the Healing Process.
2.2 Background NHS Highland made a full and public apology for the harm caused to colleagues at the Board meeting on 28th May 2019 and published their initial action plan on 31st May 2019. This tactical Culture Fit for the Future plan formed the initial response to the review and recommendations and is attached as Appendix 1.
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The Board also began a period of Listening, Understanding and Learning between June and October. This was critical as Mr Sturrock QC was only able to engage with 340 of the Board’s 10,500 colleagues during his review. It was felt important that our longer term actions and plans were informed by a wider understanding of our colleagues’ experiences and requirements.
As part of our Responding and Acting on the review findings and recommendations, in addition to the delivery against the initial plan, a longer term plan and approach to changing our Culture was drawn up in collaboration with colleagues, management and staffside. This included the Board commissioning a review of Culture within Argyll & Bute, which was one of the Sturrock Report recommendations, the findings of which are included within this report as Appendix 3.
It is clear that while some progress has been made over the past year, this is a long term programme with much still to do. NHS Highland has a programme and action plan to build a culture where colleagues feel listened to, valued and respected. The findings of the Argyll & Bute Culture Survey report reinforces the need for the ongoing work that we are doing in support of our action plan.
2.3 Assessment
Progress made on the initial Culture Fit for the Future plan This tactical response set out 5 key focus areas with associated actions. Initially this was overseen by a group of senior leaders and staffside colleagues as part of the Delivery Group which was replaced by an expanded Culture Programme Board in November 2019 and is now chaired by our External Culture Advisor. There is a short summary below and a full analysis is attached as Appendix 2.
Communications and Engagement This included taking action to improve sharing of information and increase the visibility of leadership. Significant progress was made to increase engagement across the board area and ensure robust channels of internal communication were in place. A small number of actions are still in progress and form part of our ongoing culture plan
HR Processes This included taking action to improve colleagues’ experience and confidence in reporting concerns and having them effectively managed, as well as implementing a single point of contact. We also now have external investigation and mediation support. Our top priority over the next 100 days is conducting an external and independent review of our key people processes, including bullying and harassment, grievance and disciplinary to create a robust action plan for management, HR and trade unions to work more effectively for the benefit of our colleagues and for their roles and responsibilities to be clear.
Organisation and Workforce Development This was focussed on increasing our learning and management development support. This included Courageous Conversations training for managers, which is progressing alongside our Once for Scotland policy training, as a tactical leadership intervention. We also launched our Corporate Induction Portal.
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We are working on our board wider strategy, vision and embedding of the NHS Scotland values and considering our longer term approach to building leadership and management capability.
Support for Staff We now have a wide range of additional support for colleagues including our Employee Assistance Programme and are about to launch our Speak up service. We are about to launch our wellbeing website and have created additional resources and tools to support colleagues through Covid-19 and beyond.
Governance We have ensured all of our governance channels work effectively and all Board members are fully trained and developed in their roles. The Board held a two day workshop to reflect on the Sturrock report and prioritise our actions. We are in the process of finalising a complete review of the governance committee structures, timings, membership and terms of reference
Two other critical actions which were core components of the Sturrock recommendations have been undertaken and are reported separately here: Carry out a Culture Survey in Argyll & Bute Development and approval of a healing process to support current and former colleagues
Argyll & Bute Culture Survey In November 2019, as recommended in the Sturrock Review report, NHS Highland Board commissioned Progressive Partnership Ltd to carry out a survey of NHS Highland colleagues working in Argyll & Bute. NHS Highland ensured that the Argyll & Bute Health and Social Care Partnership (HSCP) were consulted on the work being undertaken. NHS Highland Board and the Argyll & Bute Health & Social Care Partnership (HSCP) in November 2019 commissioned Progressive Partnership Ltd to carry out a survey of NHS Highland colleagues working in Argyll & Bute, as recommended in the Sturrock Review report. The HSCP has 1540 NHS Highland employees and 770 Council employees but the scope of the review did not include Council employees, so the report only covers two thirds of the HSCP.
The attached report in Appendix 3 sets out more fully the findings of the survey which sought to understand the experience of bullying and harassment of NHS Highland colleagues within the Argyll & Bute HSCP.
The key findings are deeply concerning and we accept them fully and offer a full apology to every colleague who has experienced bullying or harassment. We would also like to thank those who responded for having the bravery to respond, as we know how challenging it is for colleagues to confront the issues they are sharing with us.
The key survey findings are below: 68% (344) of the 508 respondents to the survey (which includes 62 former colleagues) reported experiencing bullying or harassment withn the Argyll & Bute Health and Social Care Partnership (HSCP).
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65% (291) of the 446 respondents who are still employed (i.e. current not ex- staff) reported experiencing bullying and harassment. This represents 19% of the current1540 NHS Highland employees in the Argyll & Bute HSCP. 49% (167) of those 344 respondents who said they had experienced bullying reported experiencing issues within the last 6 months. This represents 11% of the current 1540 NHS Highland colleagues in the Argyll & Bute HSCP. 41% (140) of those 344 respondents who said they had experienced bullying reported that it happened/happens frequently. This represents 9% of the current 1540 NHS Highland colleagues in Argyll & Bute.
The main themes from the survey were in line with the Sturrock findings and are part of our ongoing programme and action plan to transform the culture to one where colleagues feel listened to, valued and respected, which has been set out in this report.
As set out below, we have brought forward timelines and increased resource in order to deliver improvement in several key areas as a result of these findings and we have additional actions created to specifically address the themes of rurality and history within the Argyll & Bute HSCP.
Actions already put in place are as follows: Launch of our Employee Assistance programme for confidential advice and support (including a dedicated manager support and advice line) Communication of support available and contact points to raise concerns across NHS Highland has been reissued Independent external hotline for discussion and support for bullying concerns put in place before the Guardian Service goes live in July 2020. The Chief Officer of the Argyll & Bute HSCP will host a series of sessions for all colleagues within Argyll & Bute, to share the results and gather feedback The Healing Process to help current and former colleagues deal with past concerns and gain resolution and support has been approved
Our 100 day plan is attached in the Appendix 3 and covers the following key actions: o Discuss with Scottish Government the process and timing if we wished to change the board name to NHS Highland, Argyll & Bute o Carry out an independent review of the key people processes (including bullying & harassment, disciplinary, grievance and recruitment) and define the future model and processes with engagement from managers, colleagues, HR and staffside. o Establish an independent monthly assurance panel to review selection decisions and provide feedback o Roll out online / virtual Courageous conversations training across all colleagues in Argyll & Bute o Create and implement colleague and manager standards, which are linked to our vision, values and objectives
Healing Process Launch A Healing Process for current and ex-employees was co-produced with members of the whistle-blowing group and staff-side and approved by the Board in March 2020.
A crucial element of the Healing Process is that it is provided by external service providers and Independent Panel members with 4 potential options which are - being heard; an apology; access to psychological therapies; access to an Independent Review Panel and participants may opt for more than one of these options
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At the time of the Board approval, the impact of the Covid-19 pandemic on NHS Highland was beginning to emerge and lockdown provisions had recently come into force. Consequently, the Board decided to postpone the launch of the Healing Process until the situation was clearer, with the Board meeting of 26 May identified as a suitable review date for this decision.
Planning is underway to launch the Healing Process including the requirement for the virtual delivery of this process given the current circumstances regarding Covid-19 and necessary social distancing measures. In addition, with the Covid-19 pandemic likely to be a feature of health and care services for some time to come and with the results of the Argyll and Bute survey acting as a further reminder of the need for urgent action, this paper recommends that the Board now formally agrees to proceed with launch plans and for the process to be able to start to receive applications of interest by the end of May.
Communication will continue with whistle-blowers and staff representative colleagues during this launch mobilisation phase to ensure the impact of Covid-19 is understood by everyone and plans to address the impact are subject to review and discussion among these groups.
The Healing Process will continue to be delivered and led by an independent team with the Chief Executive Officer maintaining the role of Senior Responsible Owner of this critical programme.
2.3.1 Quality/ Patient Care Our ongoing focus on improving culture and addressing concerns for our colleagues will have a positive impact on quality and patient care.
2.3.2 Workforce Further attention on our Culture programme will ensure our workforce is engaged, motivated, clear on their roles and priorities and are working to our values.
2.3.3 Financial Scottish Government has already been committed to deliver the Culture programme and plans. The specific additional items mentioned in this paper, including provision of a temporary support line, increasing the roll out of the courageous conversations training and commissioning an external review of our people processes can be managed within this.
2.3.4 Risk Assessment/Management There is a risk that further internal and external attention around bullying at NHS Highland may cause some colleagues concern or distress about their past or present experiences. We are providing an Employee Assistance Programme to all colleagues for confidential support and counselling. The launch of our Healing Process for former and current colleagues to access will also provide a channel for people to seek resolution.
2.3.5 Equality and Diversity, including health inequalities Fairness along with Dignity and Respect are core principles of our Culture where our values are embedded in all we do as an organisation.
2.3.6 Other impacts Ongoing concerns related to bullying and harassment affect the reputation of NHS Highland and the Argyll & Bute HSCP.
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2.3.7 Communication, involvement, engagement and consultation We have an ongoing plan of communication and engagement activity linked to the Culture programme and the findings of the Argyll & Bute survey.
The contents of this paper and progress with the plans will be further discussed by the Culture Programme Board on 1st June 2020 and the Highland Partnership Forum and Staff Governance Committee.
2.3.8 Route to the Meeting
This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report.
Executive Directors' Group – Monday 18th May 2020
2.4 Recommendation
Discussion – Examine and consider the implications of the update on progress with the Culture Action Plan Discussion / Decision – Examine and consider the implications of the results of the Argyll & Bute Culture Survey and approve the action plan to address Decision – Approve the decision to progress the launch of the Healing Process
3 List of appendices
Appendix 1 – Culture Fit for the Future Action Plan (May 2019) Appendix 2 – Delivery against the Culture Fit for the Future Action Plan Appendix 3 – Argyll & Bute Health and Social Care Partnership Culture Review – Survey results
Page 6 of 6 Page 65
31 May 2019 1 Version: Draft 01
Page 66 Contents
Page
Introduction 3
Theme 1: Communications & Engagement 7
Theme 2: Human Resource Processes 9
Theme 3: Organisational and Workforce Development 12
Theme 4: Support for Staff 14
Theme 5: Governance 15
Action Plan Table 17
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Introduction
1 Context
1.1 On 9 May 2019, John Sturrock QC issued his “Report to the Cabinet Secretary for Health and Sport into “Cultural issues related to allegations of bullying and harassment in NHS Highland” (“the Report”).
1.2 On 10 May 2019 the Cabinet Secretary for Health and Sport wrote to the Chair and Chief Executive of NHS Highland to request a briefing on the actions which NHS Highland were planning to take to address the recommendations in the Report.
1.3 Specifically, the Cabinet Secretary for Health and Sport has requested NHS Highland to address the following three specific questions:
1. Details of the immediate actions the Board have taken/plan to take on the back of the recommendations made in the Sturrock Report. 2. What support the Board have put in place/will put in place for any member of staff who has been affected by bullying and harassment; and 3. Details of your Board’s plan for staff engagement to consider these recommendations and a timeline of when this will be carried out.
1.4 On 20 May 2019 the Cabinet Secretary for Health and Sport also wrote to all Boards requesting that they provide a response on the following issues which needs also to be incorporated in our response:
a) Are fostering opportunities and active dialogue with all staff, in the spirit of the Everyone Matters Workforce Vision and Values; b) Senior leaders are challenging themselves and their teams to ensure that a culture in which our vision and values are routinely modelled, and that positive behaviours permeate through the whole organisation; c) Remain assured that their local Staff Governance Monitoring arrangements effectively scrutinise implementation of the Staff Governance Standards, in particular that staff continue to be treated fairly and consistently, with dignity and respect, in an environment where diversity is valued; d) Are using systems for staff engagement and feedback, including iMatter, effectively and that the Board continues to take action where issues are identified; e) That the Board reviews the implementation of workforce policies relating to bullying and harassment and whistleblowing; that they promote staff awareness of these policies including how they can safely and confidentially raise concerns, the sources of support available and that staff are supported throughout the process; and f) That the Board reviews their existing workforce training and development needs and makes use of the talent development and management programmes NHS Scotland has in place, including Project Lift, to ensure that we are equipping all our staff with the skills and abilities they need to be effective managers of people.
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1.5 NHS Highland has already taken steps to begin to address the recommendations of the Sturrock Report.
1.6 One of our first steps has been to develop this draft “Culture Fit for the Future” Action Plan as a helpful starter which will evolve in consultation with our staff and other stakeholders. Once finalised it will provide the framework against which NHS Highland will rebuild the trust and empowerment of its people and achieve its ultimate aspiration of becoming an employer of choice in the Highlands, Argyll & Bute.
1.7 This draft “Culture Fit for the Future” Action Plan seeks to address the three key questions identified in Section 1.3 and the specific areas of assurance sought in Section 1.4.
2 Introduction
2.1 NHS Highland has already publicly acknowledged it’s thanks to all of those involved in the production of the Sturrock Report and it accepts that there are a number of people who have been bullied, affected and harmed by the issues raised. The Board apologises for the distress and upset which those people have suffered and it intends to do everything it can to guarantee that lessons have been learned and that organisational failings are rectified. It wishes to reiterate that bullying and harassment in any form is fundamentally unacceptable and will not be tolerated by NHS Highland. The following statement was made at the Board meeting on 28 May 2019:
We welcome publication of the Sturrock report commissioned by the Scottish Government into
allegations of bullying within the health Board and fully accept the recommendations.
As a Board we would like to express our gratitude to John Sturrock and to all of those who contributed to the report. The report finds that bullying or inappropriate behaviour have occurred
within NHS Highland and we apologise unreservedly to those members of staff who have not been treated according to the high standards we expect. The Board acknowledges that there were short
comings in the way it dealt with the issues raised and will reflect upon how it must improve.
The report is comprehensive and contains a number of important conclusions and proposals which are currently being carefully considered and an initial draft Action Plan prepared. The Board will
consult with a wide range of staff groups and external stakeholders to ensure that, in taking action, it represents as broad a spectrum of views as possible.
We realise that there are varying views about the content of the Sturrock report and that people have reacted to it in different ways. The report recognises the concerns raised by the whistleblowers but also acknowledges that others feel hurt by some of the allegations. It is important as a Board that we consider the needs of all our people.
The Board will provide assurance and take full responsibility for ensuring that the issues raised in the report are addressed and that we will lead by the same constructive, respectful and compassionate approach we expect others to follow.
In the coming months the Health Board will focus on healing, reconciliation and building a positive culture based upon care and compassion, dignity and respect for everyone. Values such as openness, honesty and responsibility will underpin an approach which will deliver quality care and team-working.
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2.2 NHS Highland fully accepts the findings of the Report and this Action Plan describes how it will address the proposals within it. The Board aims to ensure that all staff members feel valued, respected and listened to. Over-time and with a great deal of hard work, NHS Highland intends to become recognised as an employer of choice and a great organisation within which to work.
2.3 In its recently published Annual Report, NHS Highland identified three core priority areas – caring for patients, looking after its own people and achieving financial balance. This Action Plan identifies ways in which the recommendations of the Report can be delivered in such a way as to support these priorities, especially concerning the care of Health Board staff.
2.4 Since its publication, the contents of the Report have been studied in depth by NHS Highland and it is clear that there are a range of opinions about the allegations and many different ideas about how best to respond to them. The Board will therefore be consulting widely across staff groups and with external stakeholders to ensure that, in taking action, it represents as broad a spectrum of views as possible.
2.5 The proposals within the Sturrock Report have been considered along with recommendations and suggestions from other parallel pieces of work commissioned by NHS Highland looking at issues of culture, workforce development and staff opinions. These include the Gallanders Reports (November 2018 and March 2019), audit results on culture (March 2019), medical survey results (January 2019), the organisational development review (March 2019) and tools such as iMatter.
2.6 In the coming months, the intention of the Health Board is to focus on healing, reconciliation and building a positive culture based upon care and compassion, dignity and respect for everyone. Values such as openness, honesty and responsibility will underpin an approach which will deliver quality of care and teamwork.
2.7 The implementation of the Action Plan will be led by the Chief Executive with assistance from the Senior Responsible Officer. The “Culture Fit for the Future” Action Plan will be coordinated by a delivery group established with senior representation from the Area Clinical Forum, the Staff Partnership, the Medical Directorate, the HR Directorate, the Communications Department and the Nursing, Midwifery and Allied Health Professions and will also include a member of staff who has “lived the experience” and the Whistleblowing Champion.
2.8 Specific plans may require to be considered for particular areas which were identified in the Sturrock Report, including Argyll & Bute but, as a founding principle, it is intended that there will be consistent implementation of actions across the whole of NHS Highland.
2.9 This Action Plan will be reviewed regularly by the Senior Leadership Team of NHS Highland and staff will be regularly updated about how the implementation process is developing. Importantly, the Board will listen to any feedback which stakeholders may provide in the months ahead and will respond positively to ideas for improvement.
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2.10 Clearly, the publication of the Sturrock Report presents an opportunity for NHS Highland to build upon the many positive strengths which the report acknowledges exist right across the Health Board. The actions in this Action Plan will begin to rectify the identified shortcomings but will also build upon those strengths and help to create a positive working environment where everyone feels valued, respected and listened to.
3 Action Plan Format
3.1 The Action Plan is structured around 5 themes:
Communications & Engagement Human Resource Processes Organisation and Workforce Development Support for Staff Governance
3.2 Following the Chief Executive’s appointment in January 2019, some proposals identified in the Sturrock Report have already been implemented and these are noted in the Action Plan. Other actions are differentiated into completed, short, medium and long-term timescales. The timescales are:
Short-term 0 – 3 months Medium-term 4 – 12 months Long-term over 12 months
3.3 Each action within the plan has an associated success factor, identified by
3.4 In addition, a more detailed Action Plan is provided in table form at the end of this document.
4 Conclusion
4.1 This draft Action Plan has been developed as a first step in addressing the proposals highlighted in the aforementioned reports. The intention now is to build upon and enhance this plan with ongoing positive engagement with staff and stakeholders.
4.2 NHS Highland embraces this opportunity to implement the proposals and make the necessary improvements required for the organisation to be “Fit for the Future”. NHS Highland is confident and committed to bring about positive change.
4.3 NHS Highland is developing a positive working culture where staff will feel valued, respected, trusted and empowered to play their part in a leading health organisation.
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Page 71 Action Plan Theme 1: COMMUNICATIONS & ENGAGEMENT
Completed Actions
Appointment of Director of Communications: NHS Highland requires to develop an effective and fit for purpose communications & engagement strategy with an infrastructure to enable the organisation to effectively and comprehensively communicate with internal and external stakeholders going forward. The appointment of the Director of Communications is the first stage in leading this improvement.
Director of Communications appointed
Weekly Chief Executive’s Bulletin: A weekly bulletin direct from the Chief Executive issued to all our employees to provide a personal message on organisational priorities and to celebrate success.
Weekly bulletins are issued every Friday
Team Brief: A monthly team brief established, providing updates on service delivery and other important information. This is cascaded to all staff through line managers, delivered face to face and supplemented by local information.
Team Brief issued each month
Short Term Actions
Communication Department Structure Review: Develop a robust communication structure to enable NHSH to fully meet the communication and engagement needs of the organisation.
Revised structure developed, agreed, resourced and implemented.
Leadership Roadshow - Employee Engagement Sessions: Roadshows to take place across the whole organisation led by the Chief Executive and/or Senior Leadership Team and Non-Executive Directors. The aim will be to discuss the Sturrock Report and shape the Action Plan going forward with input from staff. This will reinforce NHS Highland’s values and our commitment to provide opportunities for staff to engage with important issues.
Staff will feel included and engaged in the development of the Action Plan and understand NHS Highland’s commitment to creating a healthy, positive culture. Visible leadership of Chief Executive, Senior Leadership Team and Board.
Focus Groups: A series of planned events across the organisation to consult with staff on specific areas of the Action Plan.
Staff are engaged through active listening, face to face communication and the opportunity to bring out real experiences and identify common themes.
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Fireside Chats: A series of informal chats with the Chief Executive. No agenda will be set with staff having the opportunity to speak directly with the Chief Executive. Fireside chats are small gatherings of staff and are intended to be intimate. Fireside chats occur throughout the organisation with staff feeling listened to by the Chief Executive.
Briefings with Highland partnership fora and advisory groups: Regular engagement with Local Partnership Forum, Area Clinical Forum and advisory committees on Action Plan development and progress.
All partnership and advisory groups provided with the opportunity to engage, contribute and shape the Action Plan.
Medium Term Actions
Communications & Engagement Strategy: A comprehensive communication strategy to ensure all stakeholders are engaged and informed about the organisation via a range of communication tools and channels.
A fully developed and approved communications and engagement strategy to dovetail with the organisation’s overall strategic plan and direction. As a result all stakeholders feel fully engaged and informed.
Mind Your Language Campaign: Internal campaign to support culture change and ask staff to consider the language they use when communicating with one another. Language should be collaborative and supportive e.g. important rather than imperative. This includes: posters, postcards, intranet, vlogs, social media and workshops.
Improved organisational culture around staff communications with staff more aware of the language they use and the impact on others.
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Theme 2: HUMAN RESOURCE PROCESSES
Completed Actions
Appointment of Whistleblowing Champion: A locally appointed Whistleblowing Champion to provide critical oversight and assurance in making sure that these responsibilities are acted upon and working effectively and where not, bring these issues to the attention of the Board.
New Whistleblowing Champion appointed with staff actively encouraged and supported to report any concerns and confident that these concerns will be acted upon and investigated as appropriate.
Appointment of independent investigation provider: Engagement of external organisation to assist with internal investigations.
Investigations are undertaken in an efficient and effective manner and conclusion achieved for all parties.
Investigation Training: Appropriate staff provided with skills and confidence to undertake a consistent quality approach to timely investigations.
Investigations are undertaken in an efficient and effective manner and conclusion achieved for all parties.
Single point of contact: To provide a single telephone number and email address within HR to enable staff to report any issues or concerns as they arise.
The provision of a 24/7 telephone number and email address facility within HR and staff are aware of this facility to raise any issues or concerns.
Short Term Actions
Appointment of Director of Human Resources & Organisational Development: NHS Highland requires a full time substantive HR & OD Director to develop an effective and fit for purpose workforce strategy and infrastructure providing a sustainable, skilled and capable workforce to deliver high quality and person centred care now and in the future. The appointment of the Director of HR & OD is the first stage in leading this improvement.
Director of HR & OD appointed.
HR Directorate Structure Review: Ensure a robust HR and OD structure is in place to enable NHSH to develop an effective and fit for purpose workforce strategy and infrastructure providing a sustainable, skilled and capable workforce to deliver high quality and person centred care now and in the future.
Capacity reviewed, requirements agreed and resourced as appropriate.
Whistleblowing Reporting: Information on whistleblowing cases reported to the Board for monitoring and assurance purposes to ensure that investigations are carried out in a timely and appropriate way.
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Regular assurance to the Board that there is a robust and working policy and process available for anyone who wishes to raise concerns.
Reporting channels: Increase staff awareness on how to raise concerns and the various channels available.
Staff are confident in raising concerns and fully aware of available routes.
People Management Programme: Ensure the organisation recognises and understands roles and responsibilities of HR and line managers in order that they work effectively together.
HR and line management clarity on roles and responsibilities around people management.
Review of live suspensions: To ensure that suspensions are used appropriately and for as short a period as possible to safeguard health and well-being of employees and delivery of services by ensuring that a risk assessment is completed and in discussion with HR.
Individuals are only suspended where necessary and for as short a period as possible.
Outstanding Cases Process: External support from other NHS Boards sought to undertake reviews of cases where necessary to address the concerns raised by individuals during the Sturrock review.
All outstanding cases brought to resolution or conclusion.
Resolving concerns using informal processes: Supported by Once for Scotland polices, promote and encourage the appropriate use of informal methods such as mediation, pastoral care, group facilitation and coaching to managers and staff.
Increased use of informal processes to bring about resolution at an early stage and reduced requirement for formal processes.
Medium Term Actions
Once for Scotland Policies and Processes: Promotion and implementation of the policies as they are launched and provide training throughout the organisation on the application of the policy to ensure that NHSH is applying national policies fairly and consistently.
New policies are implemented in Partnership, staff are aware and managers trained.
Workforce Performance Information: Review and improve workforce performance information to NHSH Board, Staff Governance Committee, Highland Partnership Forum and other fora as required to provide assurance on workforce performance metrics and monitor improvement where required.
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Board and SLT aware of workforce performance information for whole organisation, holding the whole organisation and services to account.
Partnership Working: Review partnership working within the organisation and improve effectiveness and create a positive supportive culture
Improved decision making through partnership working and collaborations, evidenced via Staff Governance Monitoring Framework.
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Theme 3: ORGANISATION AND WORKFORCE DEVELOPMENT
Short Term Actions
Induction Programme: Refresh, expand and develop the existing induction programme to incorporate Board, local, statutory and mandatory requirements.
All new staff are aware of the organisation’s values and strategy, their role in the delivery of services and have the skills and knowledge to carry out their roles efficiently and effectively.
Supporting Teams: Ensure leaders and managers are connected to their teams and operating effectively through the provision of appropriate training for team development. . Develop alignment through team and individual objectives and job planning for clinical staff.
Training has been provided to ensure teams are well led, effective and individuals feel that their contribution is valued.
Training in Courageous Conversations: Training for managers on having difficult conversations to increase confidence and competence in managing staff.
Managers trained to enable effective performance and reduce over reliance on formal processes.
Medium Term Actions
Senior Leadership Team Structure: Given recent significant changes, have a Senior Leadership Team in place to ensure the organisation is led effectively and fit for the future.
Senior Leadership Team in place who will lead NHSH and deliver first class services for the people in Highland.
Workforce Strategy: Develop and implement a Workforce Strategy in partnership, covering key themes, Effective and Sustainable Workforce, Healthy Organisational Culture, Effective Leadership and Management, Capable Workforce and an Integrated Workforce.
The workforce is sustainable, skilled and capable of delivering high quality and person centred care now and in the future.
Values: Review organisation’s published values and where appropriate refresh, ensuring staff engagement in their development and adoption to ensure the organisation’s values are clearly aligned to NHS Scotland.
Refreshed values adopted throughout the organisation.
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Clinical Relationship Management: Review the role and functioning of the advisory structures in order to engage clinicians in the development of strategy.
A Professional Alliance formed to bring together over 30 senior medical, nursing, allied health, managerial and social work staff to help oversee the transformation of NHS Highland.
Long Term Actions
Succession Planning: Develop an NHSH succession planning framework which aligns with NHS Scotland’s Project Lift to identify staff with the attributes to become leaders and managers of the future.
An established talent pipeline which ensures NHSH is able to attract, recruit and retain future workforce.
iMatter Engagement: Ensure organisation prioritises the roll out of iMatter including survey responses and Action Planning at local and Board level to ensure the highest level of staff participation.
Achieve a minimum of 60% response level and high Action Planning rates to ensure a Board report to develop and inform future actions.
Leadership and Management: Roll out leadership and management development programme to ensure they have the necessary skills and demonstrate the organisation's values in the way they work, including Bullying Behaviours - How to Handle and How to Avoid
All leaders and managers will have received appropriate training and development to undertake their role effectively.
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Theme 4: SUPPORT FOR STAFF
Completed Actions
Pastoral Support: Pastoral care available to support staff who have suffered harm as a consequence of bullying or inappropriate behaviour in the workplace.
Staff are aware of the pastoral support available and can access the service when required.
Short Term Actions
Mediation: Access to mediation is required as a preventative and restorative measure providing a safe space for people to talk. This is essential for both those perceived as 'victims' as well as those perceived as 'perpetrators' for healing to occur.
A fully established and resourced mediation service to be available at an early stage to avoid formal processes.
Medium Term Actions
Confidential Contact Officers: Trained individuals within the organisation to support staff who have concerns. The contact officers will also be able to signpost for options of how to manage situations.
Established and trained confidential contact officers in place.
Health and Wellbeing Strategy and Framework: To develop a framework to improve the health and wellbeing of staff and prevent/reduce absenteeism.
A healthier workforce is in place as evidenced by improved attendance, reduced turnover, fewer ill health retirements and increased stability factor.
Long Term Actions
Counselling and Therapy: Explore options to provide additional support to staff who may require counselling or psychological therapy.
Options for counselling and psychological therapy identified and access where appropriate
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Theme 5: GOVERNANCE
Completed Actions
Blueprint for Good Governance: Board Development session to consider NHS Highland's response to the Blueprint for Good Governance confirming priority areas for development through an external governance review.
A development plan generated in support of the Blueprint for Good Governance agreed and submitted to Scottish Government.
Board Behavioural Protocol: Completion of the national self-assessment survey on the functions of good governance set out in the Blueprint document
Revised Board Behavioural Protocol in place to provide a better understanding of the way in which behaviours in the Boardroom impact on effective governance.
Short Term Actions
Executive Lead Appointment: Appointment of a Senior Responsible Officer to assist the Chief Executive in implementing the “Culture Fit for the Future” Action Plan.
To ensure appropriate, adequate and high level dedicated resource to enable successful delivery.
Delivery Group: Group established with key stakeholders to influence, contribute and facilitate the delivery of the “Culture Fit for the Future” Action Plan.
Delivery group agreed and established with success factors delivered in the timescales specified.
Medium Term Actions
Board Training: A formal induction and ongoing training programme for both Executive and Non-Executive Board members, developed and implemented to rebuild confidence and provide more support in their role and better connection with organisational purpose and cultural ethos.
Board members provided with induction and ongoing training and more confident in fulfilling their role.
Effective Board leadership and Accountability: Board members trained in their corporate governance which includes leadership, accountability and information assurance, recognising a balance between the Executive and Non-Executive roles and between their roles of support and challenge.
Effective training delivered and success measured through the national Self- Assessment Survey.
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Review of Governance Structure and Committee Network: A review of the remits of the governance committees to minimise duplication and clarify the roles of and relationships between the Board and its committees.
A refreshed, appropriate and accountable governance and committee structure that will enable the Board to take seriously any future cultural concerns through the committee structures, providing a recognised and formal channel for whistleblowers to raise any concerns.
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Theme 1: Communications Strategy & Staff Engagement
Indicative Activity Description Lead Resources Success Factors Source Timescales Required Completed Appointment of NHS Highland requires to CEO n/a Director of Sturrock Director of develop an effective and fit Communications Communications for purpose communications appointed and engagement strategy with an infrastructure to enable the organisation to effectively and comprehensively communicate with internal and external stakeholders going forward. The appointment of a Director of Communications is the first stage in leading this improvement. Completed Weekly CEO Bulletin A weekly bulletin direct from CEO n/a Weekly bulletins Sturrock Page 81 the CEO is issued to all our are issued every employees to provide a Friday personal message on organisational priorities and to celebrate success.
Completed Team Brief A monthly Team Brief Director of n/a Team Brief issued Internal established providing Communications each month updates on service delivery and other important information. This is cascaded to all staff through line managers , delivered face to face and supplemented by local information.
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Short term Communication Develop a robust Director of Internal team Revised structure Internal Department communication team Communications developed, Structure Review structure to enable the agreed, resourced organisation to fully meet the and implemented communication and engagement needs of the organisation.
Short term CEO/SLT Roadshow Roadshows to take place Director of Communications Staff will feel Sturrock - Employee across the whole Communications/ Department included and Engagement organisation led by Chief SLT engaged in the Sessions Executive and/or Senior development of Leadership Team and Non the Action Plan Executive Directors. The aim and understand will be to discuss Sturrock NHS Highland's Report and shape the Action commitment to Plan going forward with input creating a healthy from staff. This will reinforce positive culture. NHSH values and our Visible leadership commitment to provide from Chief Page 82 opportunities for our staff to Executive, Senior engage with priority issues. Leadership Team and Board. Short term Focus groups A series of planned events Director of External Staff are engaged Gallanders across the organisation to Communications/ Resource for through active consult the views of staff on Director of HR&OD facilitation being listening, face to specific areas of the Action organised Internal face Plan. resource communication communications/ and the HR teams opportunity to bring out real experiences and identify common themes Short term Fireside Chats A series of informal chats Director of Communications Fireside chats Internal with the Chief Executive. No Communications Department occur through the agenda will be set with staff organisation with having the opportunity to staff feeling speak directly with the CEO. engaged and
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Fireside chats are small listened to by the gatherings of staff and are Chief Executive intended to be intimate.
Short term Briefings with Regular engagement with Director of Communications All Partnership Internal Highland Highland Partnership Forum, Communications/ Department and and advisory Partnership Fora Local Partnership Fora, Area Director of HR&OD committees groups provided and Advisory Clinical Forum and Advisory with the groups Committees on Action Plan opportunity to development and progress. engage, contribute and shape the Action Plan going forward. Medium term Communications & A comprehensive Director of Communications A fully developed Brown, Engagement communication strategy to Communications Department and approved Sturrock, Strategy ensure all stakeholders are communications Gallanders, engaged and informed about and engagement Culture the organisation via a range strategy to audit of communications tools and dovetail with the Page 83 channels organisation's overall strategic plan and direction. As a result all stakeholders feel fully engaged and informed. Medium term Mind your language Internal campaign to support Director of External Improved Internal Campaign culture change and ask staff Communications Resource organisation to consider the language they culture around use when communicating staff with one another. Language communications should be collaborative and with staff more supportive e.g. Important aware of the rather than imperative. To language they include: Posters/Postcards, use and the Intranet, social media, vlogs. impact on others
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Theme 2: Human Resources Processes
Indicative Activity Description Lead Resources Success Factors Source Timescales Required Completed Appointment of A locally appointed Board Chair n/a New Internal Whistleblowing Whistleblowing Champion to Whistleblowing Champion provide critical oversight and Champion assurance in making sure that appointed with these responsibilities are staff actively acted upon and working encouraged and effectively and where not to supported to bring these issues to the report any attention of the Board. concerns and confident that these concerns will be acted upon and investigated as appropriate Completed Appointment of Engagement of external Director of HR External Investigations are Gallanders independent organisation to assist with undertaken in an Page 84 investigation internal investigations efficient and provider effective manner and resolution/conclu sion achieved for all parties.
Completed Investigation Appropriate staff provided Director of HR&OD CMP, HR Teams, Appropriate staff Sturrock, Training with skills and confidence to Chief Officers, provided with Gallanders undertake a consistent quality SLT skills and approach to timely confidence to investigations undertake a consistent quality approach to timely investigations
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Completed Single Point of To provide a single telephone Director of HR HR Team The provision of a Internal Contact for HR number and email address 24/7 telephone within HR to enable staff to number and email report any issues or concerns address facility as they arise. within HR and staff are aware of this facility to raise issues or concerns Short term Appointment of NHS Highland requires a full Executive Lead for Recruitment Director of HR & Sturrock, Director of HR&OD time and substantive Director HR OD appointed Gallanders of HR & OD to develop an effective and fit for purpose workforce strategy and infrastructure providing a sustainable, skilled and capable workforce to deliver high quality and person centred care now and in the future. The appointment of a Page 85 Director of HR & OD is the first stage in leading this improvement. Short term HR Directorate Ensure a robust HR and OD Director of HR&OD HR Teams Capacity Internal Review structure is in place to enable reviewed, NHSH to develop an effective requirements and fit for purpose workforce agreed and strategy and infrastructure resourced as providing a sustainable, appropriate. skilled and capable workforce to deliver high quality and person centred care now and in the future.
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Short term Whistleblowing Information on whistleblowing CEO/Director of HR Non executive, Regular Sturrock Reporting cases reported to Board for & OD HR assurance to the Review and monitoring and assurance Board that there Blueprint purposes and to ensure that is a robust and for GG investigations are carried out working policy Action Plan in a timely and appropriate and process way available for anyone who wishes to raise concerns
Short term Reporting channels Increased staff awareness on Director of HR&OD HR teams Staff are Sturrock how to raise concerns and the confident in various channels available raising concerns and are fully aware of available routes
Short term People Management Clarify HR roles and Director of HR&OD HR team through HR and Line Sturrock, Programme responsibilities through a training and management Gallanders Page 86 people management awareness clarity on roles programme to ensure the and organisation recognises and responsibilities understands the roles and around people responsibilities of HR and management Line Managers in order that they work effectively together
Short term Review of live To ensure that staff are Director of HR&OD HR teams Individuals are Sturrock suspensions appropriately suspended and only suspended for as short a period of where necessary possible to safeguard the and for as short a wellbeing of employees and period as the delivery of services by possible ensuring that a risk assessment is undertaken in discussion with HR.
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Short term Outstanding cases External support from other Director of HR&OD External All outstanding Sturrock process NHS Boards sought to resources cases brought to undertake reviews of cases resolution or where necessary to address conclusion the concerns raised by individuals during the Sturrock review
Short term Resolving concerns Supported by Once for Director of HR&OD HR Teams, Line Increased use of Sturrock, using informal Scotland policies promote Managers informal process Gallanders processes and encourage the to bring about appropriate use of informal resolution at early methods such as mediation, stage and pastoral care, facilitation and reduced coaching to managers and requirement for staff formal processes
Medium term Once for Scotland Promotion and Director of HR&OD HR teams & New policies are Sturrock, HR Policies implementation of the policies national implemented in Gallanders as they are launched and resources from Partnership, staff Page 87 provide training throughout Once for Scotland are aware and the organisation on the programme managers trained application of the policy to ensure NHS Highland is applying national policies fairly and consistently.
Medium term Workforce Review and improve Director of HR&OD HR Teams Board and SLT Sturrock, performance data workforce performance aware of Gallanders information to NHS Board, workforce Staff Governance Committee, performance HPF and other fora as information for required to provide assurance whole on workforce performance organisation, metrics and monitor holding improvement where required. organisation and services to account
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Medium term Partnership Working To review partnership working Employee Director APF Improvement in Sturrock within the organisation and to decision making improve effectiveness and through create a positive supportive partnership culture working and collaborations, evidenced via Staff Governance Monitoring Framework
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Theme 3: Organisational and Workforce Development Indicative Activity Description Lead Resources Success Factors Source Timescales required Short term Induction Refresh, expand and develop Director of HR&OD HR teams All new staff are Sturrock, Programme the existing induction aware of the Gallanders, programme to incorporate organisation's OD review, Board, local and values and culture statutory/mandatory strategy, their audit requirements. role in the delivery of services and have the skills and knowledge to carry out their roles efficiently and effectively
Page 89 Short term Supporting teams in Ensure leaders and managers Director of HR&OD HR Teams Training has been Sturrock, difficulty are connected to their teams provided to Gallanders, and operating effectively ensure that teams OD Review through the provision of are well led, appropriate training for team effective and development. Develop individuals feel alignment through team and that their individual objectives and job contribution is planning for clinical staff valued
Short term Training in Training for managers on Director of HR&OD CMP, HR Teams, Managers trained, Sturrock, courageous having difficult conversations Chief Officers, to enable Gallanders conversations to increase confidence in SLT effective managing staff performance and reduce over reliance on formal processes
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Medium term Senior Leadership Given recent significant CEO/Director of HR HR Senior Sturrock Team Structure changes, have a senior & OD Leadership Team leadership team in place to in place who will ensure that the organisation lead NHS is led effectively and fit for the Highland and future. deliver first class services for the people of Highlands. Medium term Workforce Strategy Develop and implement a Director of HR&OD HR Teams The workforce is Gallanders, Workforce Strategy in sustainable, OD Review Partnership, covering key skilled and themes, Effective and capable of Sustainable Workforce, a delivering high Healthy Organisational quality and Culture, Effective Leadership person centred and Management, Capable care now and in Workforce and Integrated the future. Workforce Page 90 Medium term Values Review the organisation's Director of HR&OD HR. SLT Refreshed values Gallanders, published values and where adopted OD Review appropriate refresh, ensuring throughout staff engagement in their organisation development and adoption to ensure that the organisation's values are fully aligned to those of NHS Scotland Medium term Clinical Relationship Review the role and Director of HR&OD All clinical staff A Professional Sturrock, Management functioning of the advisory Alliance formed Gallanders, structures in order to engage to bring together OD Review clinicians in the development 30 senior of strategy. Professional medical, nursing, Alliance group established allied health, managerial and social work staff to oversee the transformation of NHS Highland
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Long term Leadership and Roll out leadership and Director of HR&OD HR teams All leaders and Sturrock, Management management development managers will Gallanders, programme to ensure have received OD review, managers and supervisors appropriate culture have the necessary skills and training and audit demonstrate the development to organisation's values in the undertake their way they work, including role effectively impact of bullying behaviours - how to handle and how to avoid.
Long term Succession Develop an NHS Highland Director of HR & SLT An established Gallanders, Planning succession planning OD talent pipeline Sturrock, framework which aligns with which ensures OD review NHS Scotland's Project Lift to NHS Highland is identify staff who have the able to attract, attributes to become leaders recruit and retain and managers of the future. the future workforce Page 91
Long term iMatter engagement Ensure the organisation Director of HR&OD HR teams, line At least 60% Gallanders, prioritises the rollout of managers, SLT response rate and OD Review iMatter including survey high Action responses and Action Planning rates to Planning at local and Board obtain a Board level to ensure the highest report to develop level of staff participation. and inform improvements actions
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Theme 4 : Support for Staff
Indicative Activity Description Lead Resources Success Factors Source Timescales Required Completed Pastoral Support Pastoral care available to Director of Internal: Staff are aware of Sturrock, support staff who have Nursing/Director of chaplaincy the pastoral Gallanders suffered harm as a Public Health service, public support available consequence of bullying or health, and can access inappropriate behaviour Occupational when required Health
Short term Mediation Access to mediation is Director of HR & External support A fully Sturrock, required as a preventative and OD being considered established and Gallanders restorative measure providing resourced a safe space for people to mediation service talk. This is essential for to be available at both those perceived as an early stage to 'victims' as well as those avoid formal Page 92 perceived as 'perpetrators' for processes. healing to occur.
Medium term Confidential Contact Trained individuals within the Director of HR & Internal - Established and Gallanders Officers organisation to support staff OD individuals to be appropriately 1 who have concerns. The identified and trained contact officers will also be appropriately confidential able to signpost for options of trained contact officers in how to manage situations place Medium term Health & Wellbeing To develop a framework to Director of Public Internal - group A stable healthier Gallanders Framework improve the health and Health/Director of established led by workforce as 1 wellbeing of staff and HR & OD Head of Health & evidenced by prevent/reduce absenteeism Occupational improved Safety to attendance, progress reduced turnover, framework fewer ill health retirements, increased stability factor. 28
Long Term Counselling and Explore options to provide Director of HR & Internal and/or Options for Sturrock Therapy additional support to staff who OD external counselling and may require counselling or psychological psychological therapy. therapy identified and access where appropriate
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Theme 5: Governance
Indicative Activity Description Lead Resources Success Source timescales Factors Completed Blueprint for Board Development session Board Chair External A development DL (2019) 02 Good held to consider NHS Highland's support plan generated Blueprint for Governance response to the Blueprint for required in support of GG Action Good Governance confirming the Blueprint Plan priority areas for development for Good through an external governance Governance review agreed and submitted to Scottish Government Completed Board Completion of the national self- Board Chair n/a Revised Board Development Behavioural assessment survey on the Behavioural Plan Blueprint
Protocol functions of good governance Protocol to for Good Page 94 set out in the Blueprint provide a Governance document better understanding of the way in which behaviours in the Boardroom impact on effective governance Short term Executive Lead Appointment of a Senior CEO/ Executive HR/CEO To ensure Sturrock Appointment Responsible Officer to assist the Lead for HR appropriate, CEO implementing Culture Fit adequate and for the Future Action Plan high level dedicated resource to ensure successful delivery
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Short term Delivery Group Group to be established with CEO Internal staff Delivery Group Sturrock set up key stakeholders to influence, agreed and contribute and facilitate the established delivery of the Culture Fit for the with success Future Action Plan factors delivered in the timescales specified Medium term Effective Board Board members will receive CEO /Board Chair/ External Effective Sturrock Leadership and training in their corporate Board Secretary resources training Review Polley Accountability governance which includes delivered & Review leadership, accountability and success Brown Review information assurance measured recognising a balance between through the the Executive and Non national self Executive roles and between assessment their roles of support and survey challenge. Medium term Review of A review of the remits of the Board Chair/Board Board Chair, A refreshed, Sturrock Governance governance committees to Secretary Board appropriate Review Polley Page 95 Structures and minimise duplication and clarify Committee and Review Brown Committee the roles of and relationships Chairs, Chief accountable Review Network between the Board and its Executive and governance & committees. Board committee Secretary structure to enable the Board to take seriously any future cultural concerns. It also provides a recognised and formal channel for whistleblowers to raise any concerns
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Medium term Board Training A formal induction and ongoing CEO /Board Chair/ External Board Sturrock training programme for both Board resources members Review Polley Executive and Non-Executive Secretary/Executive provided with Review Board members developed and Leadership induction and Brown Review provide more support in their ongoing role and better connection with training and organisational purpose and are more cultural ethos. confident in fulfilling their role
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Delivery against the Culture Fit for the Future Action Plan
This paper documents the progress made against the Culture Fit for the Future Action Plan, which was published on 31st May 2019, in response to the Sturrock Review.
The Culture Fit for the Future Action Plan was structured around 5 themes:
Communications & Engagement Human Resource Processes Organisation and Workforce Development Support for Staff Governance
Some of the recommendations in the Sturrock Report had already been implemented before 31st May 2019 but were noted in the Action Plan. Other actions were differentiated into short, medium and long-term timescales, as follows.
Short term - 0-3 months Medium term - 4-12 months Longer term over - 12 months
The Culture Fit for the Future Action Plan was developed as a first step and the intention was to build upon and enhance this plan with ongoing positive engagement with staff and stakeholders.
The updates on progress against the short, medium and long term actions are set out in this paper, organised by the 5 themes. This lists actions taken, those still in progress and those which are in plan.
Significant work has since been completed to establish a Culture Programme Board, overseen by an External Culture Advisor and to develop our longer term Culture Programme Plan and Commitments,These have been widely consulted on and are due to be approved and launched alongside our work on the wider Strategy, Vision and Values in the coming months.
Our Culture Programme will pick up those actions noted below as still in progress or planned from this original action plan which can now be regarded as complete. Page 98
Communications and Engagement This included taking action to improve communication of information and visibility of leadership. Actions delivered include: Weekly CEO emails and Team Briefs Meetings with the Board Chair and Chief Executive, for individuals and the whistleblower group A programme of 23 colleague engagement sessions across the Board area Appointment of an External Culture Advisor Launch of a Culture Programme Board including staffside, whistleblower and public members as well as members from key governance meetings
There are also some actions which are still in progress and form part of our ongoing culture plan o Development of a Communications and Engagement strategy including guidance on our tone and language o Expanding our Communications, Engagement and Participation team
HR Processes This included taking action to improve colleagues’ experience and confidence in reporting concerns and having them effectively managed. Actions delivered include: External Mediation and Investigation support Creation of a single point of contact (phone and email) for HR Promoting channels of support and ways to report concerns to colleagues Review of colleague suspensions Appointment of a permanent, full time HR Director Appointment of a Whistleblowing champion Launch of the Once for Scotland policies and training in these and the various roles
There are also some actions which are still in progress and form part of our ongoing culture plan o Improving our people processes and resolving outstanding cases o Further work on our Whistleblowing policy to align to the new national standards Page 99
o Review of our HR structure and resource o Improving our workforce information as part of our performance framework o Review of our partnership working
Organisation and Workforce Development This included improving our colleague experience and our learning proposition and management development support. Actions delivered include: Launch of Corporate induction portal Key appointments made to the Senior Leadership Team IMatter survey delivered and action planning carried out Tactical support for teams in difficulty Courageous Conversations training for managers Improved Clinical engagement via Professional Alliance and then Clinical Expert Group
There are also some actions which are still in progress both as part of the Culture Plan and our wider organisational strategy work. o Creation of a long term leadership and management development proposition o Development of our long term workforce strategy, linked to the Board strategy and objectives o Full roll out of the NHS Scotland Values as part of our refreshed Vision and Strategy o Further refinement of our Executive Leadership structures and roles
Support for Staff This included provision of a range of additional support to colleagues and to ensure they were aware of all the support available to them. Actions delivered include: Promotion of pastoral support and values based reflective practice Access to external mediation External Speak Up service commissioned as additional channel of support Establishment of an Employee Assistance Programme to provide increase counselling and support to colleagues, in addition to current Occupational Health provision Focus on Health and Wellbeing resources and support Page 100
We continue to work on the following elements and this also forms part of our long term colleague support for dealing with the impact of Covid-19 o Development of our long term Health and Wellbeing strategy o Creation of a dedicated Wellbeing website
Governance This included taking action to ensure all of our governance channels were working effectively and all Board members are fully trained and developed and can operate with confidence in their assurance and oversight capacity.
Two day board workshop to reflect on Sturrock report and prioritise key actions Creation of a self assessment and development plan for the board linked to the Blueprint for good governance Initial delivery group set up to oversee the Culture Programme (replaced by Programme Board in November) Board trained in effective leadership and accountability on an ongoing basis
We are in the process of: o Finalising a complete review of the governance committee structures, timings, membership and terms of reference Argyll & Bute Health and Social Care Partnership Page 101 Culture Review – Survey results – Summary Commissioned by NHS Highland in partnership with Argyll & Bute Health and Social Care Partnership May 2020 Executive Summary
• NHS Highland Board and the Argyll & Bute HSCP in November 2019 commissioned Progressive to carry out a survey of NHS Highland colleagues working in Argyll & Bute, as requested in the Sturrock report. The HSCP has 1540 NHS Highland employees and 770 Council employees and the scope of the review did not include Council employees , so this report only covers two thirds of the HSCP.
• 68% (344) of the 508 respondents to the survey (which includes 62 former colleagues ) reported experiencing bullying or harassment with in
the Argyll & Bute Health and Social Care Partnership (HSCP). Page 102
• 65% (291) of the 446 respondents who are still employed (i.e. current not ex-staff) reported experiencing bullying and harassment. This represents 19% of the current1540 NHS Highland employees in the Argyll & Bute HSCP.
• 49% (167) of those 344 respondents who said they had experienced bullying reported experiencing issues within the last 6 months. This represents 11% of the current 1540 NHS Highland colleagues in the Argyll & Bute HSCP.
• 41% (140) of those 344 respondents who said they had experienced bullying reported that it happened/happens frequently. This represents 9% of the current 1540 NHS Highland colleagues in Argyll & Bute.
• This report sets out the background, the findings and the actions that are being taken to address the findings.
2 Background
• In November 2018, the Scottish Government announced a fully independent external review into allegations of a bullying culture at NHS Highland which includes the Argyll & Bute Health and Social Care Partnership (HSCP), as an integrated arrangement under the direction of the Argyll & Bute Joint Board. The Review was commissioned following the public disclosure of concerns about bullying and harassment in September 2018.
• The Sturrock Review was published in April 2019 and was based on engagement with 340 people across the NHS Highland area. One of the report’s recommendations was that an independent review of NHS Highland Culture in Argyll & Bute HSCP should be carried out, since only 6% of respondents to the Review were from Argyll & Bute, although they are around 15% of the colleague population. Page 103
• In November 2019, NHS Highland Board commissioned Progressive Partnership Ltd to carry out a survey of NHS Highland colleagues working in Argyll & Bute and ensured the A&B HSCP were consulted upon the work being undertaken. The HSCP has around 1540 NHS Highland employees and 770 Council employees and the scope of the review did not include Council employees, so this report only covers two thirds of the HSCP.
• It was agreed the review focus should be on gaining a quantitative measure of the problem that provides evidence of where any problems lie and from where they emanate, which will give NHS Highland the tools it needs to concentrate efforts where they are most needed.
• This research was therefore designed to focus on obtaining robust data about people’s experience and what action staff members would prioritise now and in the near future, as well as obtaining a measure of the extent and nature of inappropriate behaviour and/or bullying, undermining and harassment reported by colleagues.
• This document is co-produced by Progressive and NHS Highland. All of the data has been provided by Progressive and this pack has been reviewed and quality checked or accuracy and validity of content. The summary of findings , themes and actions as a result of the finding have been validated by Progressive as being in line with the data and findings of both their qualitative and quantitative research.
3 Details of the Survey
• This was a quantitative online survey. It was freely open to anyone with no restrictions to ensure widespread access, but that does mean it could be accessed by anyone or completed multiple times. Paper copies were also available on request.
• Questionnaire content was developed based on 20 in-depth interviews with self-nominated colleagues, plus a small number of management, human resources and trade union colleagues. This information, along with the free text aspects of the survey also provided some qualitative data which has been drawn upon. Page 104 • The target audience was current and former NHS Highland employees who work/worked in Argyll and Bute HSCP.
• The survey was hosted by Progressive, invitations sent by NHS Highland with the survey link which was unrestricted to access whether internal or external to NHS Highland. The survey was open between 18th February and 3rd April 2020.
• Sample size: From a population of 1540 current NHS Highland colleagues in Argyll & Bute, 446 completed the survey , which is 29%. This represents 19% of the overall Argyll & Bute HSCP population of 2310 which includes 770 council colleagues who are not included in the survey. The 29% response rate from the target population is a good return for a survey of this nature. Another 62 were former employees, making a total response of 508, with 496 electronic and 12 hard copy returns.
• However, because the sample is self-selecting and without access control, the findings may not be representative of the wider HSCP or NHS Highland population. The survey was widely promoted to those in scope, but was specifically about people’s experience of bullying and so it is possible that those who have not experienced bullying would not see this as relevant to them.
4 Summary of findings
The survey referenced the ACAS definition of bullying and harassment:- “offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient. Bullying or harassment may be by an individual (perhaps by someone in a position of authority such as a manager, or a colleague) or involve groups of people. It may be obvious or it may be insidious. It may be persistent or an isolated incident. It can also occur in written communications, by phone or through email, not just face to face. Whatever form it takes, it is unwarranted and unwelcome to the individual.” Page 105 Further survey data is presented in chart form later in the pack, but these are the key headlines:
• 68% (344) of the 508 respondents to the survey (which includes 62 former colleagues ) reported experiencing bullying or harassment within the Argyll & Bute Health and Social Care Partnership (HSCP).
• 65% (291) of the 446 respondents who are still employed (i.e. current not ex-staff) reported experiencing bullying and harassment. This represents 19% of the current 1540 NHS Highland employees in the Argyll & Bute HSCP.
• 49% (167) of those 344 respondents who said they had experienced bullying reported experiencing issues within the last 6 months. This represents 11% of the current 1540 NHS Highland colleagues in the Argyll &Bute HSCP.
• 41% (140) of those 344 respondents who said they had experienced bullying reported that it happened/happens frequently. This represents 9% of the current 1540 NHS Highland colleagues in Argyll & Bute.
5 Summary of findings
• It was reported that both managers and colleagues were responsible for bullying, although individuals were able to report bullying by more than one type of person, so it is difficult to assess this more specifically.
• Bullying was reported across all grades from the 344 who responded that they had experienced bullying and harassment (out of the 508 respondents from the target population of 1540 )
• Respondents from Bands 1 to 4 (99 of the 160 respondents from this grade range, which is 62%) were significantly less likely than those in Page 106 Bands 5 to 7 to experience this (191 of the 266 respondents from this grade range, which is 72%).
• Bands 1-4 also had greater confidence than Bands 5-7 that reported incidents would be treated seriously .
• Those working for NHS Highland within the Argyll & Bute HSCP for less than 2 years were least likely to have experienced bullying (42% which is 30 of the 71 respondents, versus 66% which is 100 of the 151 respondents with 3-10 years service and 75% which is 212 of the 283 respondents with 10+ years’ employment).
• Those working less than 2 years were also more confident that any issue they reported would be taken seriously (42% agreed which is 25 of the 60 respondents versus 24% which is 31 of the 131 respondents with 3-10 years service and 25% which is 62 of the 244 respondents with 10+ years service).
• 67% (129) of the 271 respondents who had experienced bullying and answered this question had reported it via one of the formal channels, although 61% (264) of the 435 respondents who answered this question (from the target population of 1540) believe there is a culture of discouraging reporting. 6 Experience and witnessing of bullying and harassment
Whether respondents have experienced and/or witnessed bullying and harassment
Experience: summary Yes – I have experienced bullying or harassment myself Page 107 Experienced only 8% Yes – I have witnessed bullying or harassment of Witnessed only colleagues/other members of staff 13% 26% Both
No – I have never experienced or witnessed bullying or 12% Neither harassment at work 42% Don't know
I am unsure if what I witnessed/experienced was bullying or harassment
0% 20% 40% 60% 80% 100%
Q12. Have you ever experienced or witnessed any bullying or harassment while working at NHS Highland? We are interested in bullying and harassment as we explained earlier in the definition of bullying, which occurred in the course of employment. Please tick all that apply? Base (all): 508 7 Types of bullying or inappropriate behaviour reported by those who have experienced it
Types of bullying and harassment experienced Being spoken to in a disrespectful way Being undermined Having your opinions or concerns ignored Exclusion from decision making/meetings ‘Gaslighting’ (e.g. denial of events and conversations)
Excessive workloads Page 108 Excessive criticism Being micro-managed unnecessarily Being publicly humiliated Unfair recruitment or promotion practices Shouting/verbal abuse Refusing reasonable requests (e.g. for leave or training) Setting unrealistic targets Being asked to do work below your level of competence Being the subject of excessive teasing/sarcasm Exclusion from social events Being left under-employed/not given appropriate tasks to do Threats of physical violence Physical violence Other
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Q13. What kind of bullying or harassment have you personally experienced? Please tick all that apply. Base (all who have experienced): 344 8 Frequency and timescales of incidents experienced
Last time respondents experienced bullying or harassment Frequency of experiencing bullying or 40% harassment
30% Page 109 Once or twice 13% Several times 20% 41%
46% Frequently 10%
0% It is Within the Within the Within the 4+ years ago Don’t happening at last 6 months last year last 2-3 years know/can’t the moment remember
Q15. How often have you experienced bullying or harassment while working at NHS Highland? Q17. When was the last time you experienced bullying and harassment at work? Base (all who have experienced): 344 Base (all who have experienced): 344 9 Action taken in relation to incidents experienced
Action(s) taken
ANY FORMAL REPORTING Net code for ‘Any formal reporting’: 67% of respondents Reported it to my line manager mentioned any of these reporting actions (in green) Told a union representative
Reported it to HR Page 110
Raised a formal grievance
Told my family/friends
Told a colleague
Removed myself from the situation
Confronted the perpetrator Others include: • Kept my head down Someone else intervened • Turned to occupational health • Turned to medication Other • Reported to senior management • Requested redeployment Nothing – have never done anything about it
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Q21/Q22. What action, if any, have you ever taken in relation to any incidents of bullying or harassment you have experienced/witnessed? Please tick all that apply. Base (all who have experienced): 344 10 Respondents thoughts on dealing with bullying and reporting
Priorities for action Remove known perpetrators of bullying and harassment from post Implement a zero tolerance approach to bullying and harassment Review recruitment/promotion, ensure managers have necessary people skills
Ensure managers have the right skills and training to manage cases Page 111 Ensure action is taken where investigations show B/H has taken place Implement awareness training for all staff about what constitutes B&H Ensure policies/procedures about reporting are followed by HR/management
Provide guidance/training on how to respectfully challenge negative behaviour Main priority Ensure policies/procedures about reporting are well publicised/easy to find All actions Speed up the process of dealing with reports of bullying and harassment Have informal / peer reporting options for dealing with less serious concerns Ensure timely access to mediation services Other Don’t know/not sure
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Q28. What do you think NHS Highland should prioritise in dealing with any issues of bullying and reporting? Please select any/all actions you think are important to address. Base (all): 508 Q29. And which of these is the most important thing for the Board to address? Base (all excl DK): 500 11 Sample profile – staff grade and group Broadly representative of workforce
Staff grade Staff group
Band 1 1% Nursing and midwifery 34%
Band 2 12% Administration 18% Allied health professionals Band 3 9% 12% Page 112 Domestic/support services 7% Band 4 10% Medical 7% Band 5 17% Corporate services 5% Band 6 20% Dental 5% Band 7 14% Personal and social care 4% Band 8 (a-d) 6% Management 3% Band 9 <1% Senior management/executive/board 1% Medical/dental 8% Healthcare science <1%
Senior manager/executive 1% Other <1%
Other 4% Prefer not to say 5%
12 Reflections
• It is important to acknowledge that a significant number of our colleagues have reported experience of bullying, many in the last year, and that we need to address this as a matter of urgency. • The results are deeply concerning and we accept them fully and offer a sincere apology to every colleague who has experienced bullying or harassment. We would also like to thank those who responded for having the bravery to respond - we know how challenging it is for colleagues to confront the issues they are sharing with us. • NHS Highland Board and Management and that of the Argyll & Bute IJB fully accept the findings and are committed to making the Page 113 necessary changes to improve the experience of these colleagues and to rebuild trust and confidence. • While significant work has already begun to address cultural issues across NHS Highland including the development of the Healing process, Courageous Conversations training, Employee Engagement sessions, launch of an Employee Assistance Programme and launch of an independent Speak up service on 1st July 2020, this report reinforces the need for the ongoing work and that our key priorities must be acted on rapidly. • The themes and experiences from the survey broadly reflect those within the Sturrock report, although they are heightened by issues of rurality as well as the legacy of the dissolution of the Argyll & Clyde Health Board in 2006, which saw Argyll & Bute health colleagues moved to NHS Highland. These will need additional efforts to resolve.
13 Themes Confidence in our processes • There is a lack of trust and confidence from some colleagues in the effectiveness of key people processes, particularly from those who have been in the organisation for longer. This includes inconsistency in application of policy or recruitment decisions, the operation and pace of discipline and grievance processes and our ability to support informal resolution of concerns. Leadership and Management skills • Many of the types of bullying concerns reported arise in the management relationship and could be easily resolved with quick action and discussion at an early stage. Managers are reported as capable in operational matters, but lacking leadership skills.
Individuals’ expectations Page 114 • Requests for action such as dismissal as the desired outcome for complaints came through strongly. This can add to the adversarial nature of the situation and the sense that there is a right or wrong approach; but when dealing with relationships and perceptions and feelings, this is not often the case. This means that the process will rarely achieve a satisfactory outcome. History and connection to NHS Highland • The change to being part of NHS Highland in 2006 was difficult and it failed to recognise the need to change the name of the Board, to reflect Argyll & Bute, which impacted colleague and patient perceptions. This lack of connection is heightened by distance from Inverness and working in different models of integration, so language and communications don’t feel inclusive Challenges of remote and rural communities • There are limited opportunities for promotion and a lack of alternative employment, so people stay longer than in other areas • Working in small communities makes it hard to differentiate between work and home, and colleagues often are friends or family • Work-based disagreements can affect the wider community or vice versa. There are also pressures in the workforce having to cover very wide geographical areas and managers not being as visible or able to spot problems as a result.
14 Actions underway
• We have launched our Employee Assistance programme for confidential advice and support (including a dedicated manager support and advice line)
• A Colleague Communication on the survey is being issued later today to all NHS Highland colleagues in Argyll & Bute, including information on the support available and contact points to raise concerns. Page 115 • This is includes details of a temporary Independent External hotline we have put in place with for discussion and support for bullying concerns until our Guardian Speak Up Service goes live on 1 July
• The Chief Officer of the Argyll & Bute HSCP has arranged a programme of engagement sessions for colleagues across Argyll & Bute to talk through the survey results and for colleagues to provide thoughts and feedback. These will take place across both daytime and evening slots on Monday 18th / Tuesday 19th May.
• Our Healing Process is opening to applications by the end of May to help current and former colleagues deal with past concerns and gain resolution and support in a fair and non judgemental setting is about to launch.
15 Conclusion
• This report has set out the findings of the survey commissioned to understand the experience of bullying and harassment of NHS Highland colleagues within the Argyll & Bute HSCP, following the recommendation within the Sturrock review.
• The key findings which are repeated below are deeply concerning and we accept them fully and offer a sincere apology to every colleague who has experienced bullying or harassment. We would also like to thank those who responded for having the bravery to respond. Page 116
• The main themes from the survey were in line with the Sturrock findings and are part of our ongoing programme and action plan to transform the culture to one where colleagues feel listened to, valued and respected. We have brought forward timings and increased resources as a result of the findings and address the themes of rurality and history within the Argyll & Bute HSCP.
• We have also created a 100 day plan setting out 5 priority actions which will rapidly address the specific outcomes of this survey. Some of these were already part of our wider culture programme plans, but we have advanced the pace and resources on these. Others are specific action to address the themes that are specific to Argyll & Bute.
16 100 Day Action Plan
Theme Action SRO / Lead
Increase the sense of inclusion of Argyll & Bute colleagues and Discuss with Scottish Government the process and timing if Paul Hawkins / Joanna communities within the NHS Highland Board area we wished change the board name to NHS Highland, Argyll MacDonald & Bute
Urgently accelerate the review and improvement of the Carry out an independent review of the key people Fiona Hogg / External Consultant operation of key People Processes (disciplinary, grievance, processes and define the future model and processes with bullying and harassment, recruitment ) across NHS Highland input from managers, colleagues, HR and staffside. Page 117
Provide assurance and oversight of hiring decisions across NHS Highland to build trust and confidence of colleagues Establish a monthly assurance panel to review selection Fiona Hogg / Emma Pickard decisions and provide feedback
Build good relationship skills across the organisation through Deliver short video introduction via team leaders / Joanna MacDonald / Jane Fowler training all colleagues and managers in Courageous managers Conversations Rollout of virtual training sessions at rate of 6 sessions per week , 10 per session. Set clear role expectations and behaviours for all colleagues and Create and cascade colleague and manager role and Fiona Hogg / Jennifer Swanson & managers across NHS Highland behaviour standards linked to our vision, values and Caroline Morrison objectives
17 This page is intentionally left blank Page 119 Agenda Item 9a
Integration Joint Board Agenda item:
Date of Meeting: 27th May 2020
Title of Report: Employee / Staff Wellbeing and Resilience / Covid-19
Presented by: Jane Fowler, Head of Customer Support Services
The Integration Joint Board is asked to: . Note the approach taken and progress to date to support staff wellbeing and resilience . Note that this builds on work that was already underway . Note that this is an integrated and inclusive approach across 2 employers and expands out to the 3rd and independent sector providers . Note that the approach aligns with the National Wellbeing Network led by the Minister for Health, Claire Haughey.
1. EXECUTIVE SUMMARY 1.1. This report outlines the approach and progress with support measures being put into place for staff within Argyll and Bute HSCP during the current Covid-19 crisis.
1.2. Within the HSCP the council and NHS already have a number of measures in place to support the health and wellbeing of their staff. These measures were reviewed in light of the current Covid-19 pandemic and have been enhanced or, where appropriate, new measures have been introduced or are being planned. Some of these are also being reviewed in terms of what can also be offered to other partners within the partnership in addition to ongoing national plans.
1.3. These actions have been taken in response to the needs of staff at this difficult and unprecedented time and also in response to the letters from Claire Haughey, the Minister for Mental Health (Appendix A) dated 26th March and 20th April (Appendix B) encouraging the promotion of Mental Health and Wellbeing during Covid-19 for the health and social care workforce. A paper and action plan went to the HSCP SLT, Council SMT and Covid-19 Tactical Group for feedback including Trade Unions in early April.
2. INTRODUCTION 2.1The Minster for Mental Health highlights in her first letter “Our workforces always respond professionally in times of need. However the scale of the
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challenge is unprecedented. We are asking people to work in unfamiliar settings and many will be asked to learn new skills and will be working in new roles. We recognise that many will be personally impacted by the Covid-19 virus. Some will be caring for their own families, some may be at high risk themselves. This is no small ask. Therefore it is absolutely essential that we look after their mental health and well-being”. 2.2Staff mental health and wellbeing is paramount for Argyll and Bute HSCP and particularly during the Covid-19 pandemic. All staff are likely to be under increased pressure over this period and need appropriate support. As well as many staff working in the frontline in a variety of different roles with people suffering from Covid-19, staff are also part of their local communities. People may be anxious about contracting or passing on the virus. Some may have been ill with the virus or have been affected by family, friends or colleagues who have been, and sadly some will be experiencing loss and bereavement. Many are working from home, sharing this space with others and coping day to day with being isolated from friends, family and colleagues for long periods of time. They are juggling home and work life and caring responsibilities with many home schooling.
3 DETAIL OF REPORT 3.1Wellbeing covers basic physical and mental health needs, information, peer support and psychological first aid. It is not just about helping staff when there is a crisis, although there is that support, but about encouraging a focus on keeping ourselves mentally and physically well and paying attention to our own needs as a matter of course. Good self care routines such as a healthy approach to diet, exercise, relaxation and sleep. This is even more important at this time particularly given the duration of the pandemic.
3.2An Argyll and Bute HSCP Wellbeing Group has been established to share resources, coordinate where possible, and ensure the full range of health and social care staff are supported with their wellbeing and mental health. The group links closely with the NHS Highland Wellbeing Group, the Council’s Wellbeing Team and the National Wellbeing Champions’ Network. It includes organisational development, public health, mental health and psychological support services and a Council wellbeing representative. The group has co-produced an action plan which has been agreed by the HSCP Senior Leadership Team, Council SMT and reports to A&B HSCP Silver Command.
3.3 It is recognised that this a rapidly changing situation and additional support measures are being developed in response to new and changing demands on an ongoing basis. Further national developments continue including: National Workforce Wellbeing Network. The aim is to promote and support good psychological mental health and wellbeing of the health and social care workforce across Scotland. Jane Fowler is the Staff Mental Health and Wellbeing Champion for the HSCP and Council and Fiona Hogg (Director of Human Resources & Organisational Development for NHS Highland
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Recommendations are being developed on how best to spend a donation from the NHS Charities Together
3.4 Our approach to staff wellbeing is illustrated by the pyramid below.
3.5To help to ensure the best use of resources, staff have been categorised in three areas of need although it is acknowledged that individuals may cross over into more than one category at any one time. These groups are:
1. Those who may require Referral to Specialist support (Red section) (i.e. front-line NHS and HSCP Key-Workers who are in direct contact with Covid-19 cases). 2. Those who may require Physical, mental and emotional support (Yellow section) (i.e. staff in roles who are able to continue working either on-site or remotely, and who may be facing increased demand/pressure). 3. Those with concerns over their General health and wellbeing and self-care (Green section) (All staff, but particularly those not affected by Covid-19-related demands at work, but who will be affected by the situation in general).
3.6 The key activities to date are outlined below under the three levels whilst acknowledging as before that individuals may cross over into more than one.
3.7 Referral to Specialist support NHS Highland has established a Staff Psychological Wellbeing Network. This service is available to all health and social care staff within Argyll and Bute HSCP, clinical and non clinical, if they need it. This Network provides advice and support to build and maintain the psychological wellbeing of colleagues, to increase resilience
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and to reduce the likelihood of burnout, trauma, or other emotional injury during the Covid-19 outbreak. Occupational Health (OH) Services are available for Council and NHS employees. NHS OH capacity focussed on Covid-19 testing. Employee Assistance Programmes (EAP). The Council has a service provided by Health Assured. NHS Highland launched their new service on 1 May, this was due to launch later and was brought forward to support staff now. The service is delivered by Validium.
3.8 Physical, mental and emotional support The Department of Spiritual Care (Chaplaincy) is offering support to HSCP staff by creating opportunities to talk about issues that matter most and the impact work has on us. The department of spiritual care is uniquely placed to help address some of the difficult topics people may have at this time. Support via the intranet and internet: Argyll and Bute Council has a wellbeing webpage that is available to all employees and to the general public, in addition to the EAP for staff; a Wellbeing webpage is being developed by NHS Highland building on some strategic work that had previously started. Some localities have set up various local supports utilising local skilled professionals and volunteers. Establishing Wellbeing Champions – SLT have been asked to nominate colleagues who can help to signpost and promote wellbeing support services as well as provide feedback to A&B wellbeing group from staff on the ground. These could be sustained into the future renewal phase Resources for building resilience that include establishing a pilot for 50 staff of Resilience Engine’s online guide to resilience and wellbeing. This is bite sized chunks, 2-3 hours of guidance, tools and stories on how to boost resilience. This will be alongside OD support. One area of focus as we move forward is ensuring that managers are well trained to support employees’ continued well-being and to understand, recognise and better deal with mental health issues in the workplace to support more good days at work where staff can thrive and flourish.
3.9 General health and wellbeing and self-care Practical Covid-19 information for staff – PPE, Infection Control, Virus information, Risk Assessment so that staff are informed and feel safe at work. This work is being lead and co-ordinated by colleagues in Health and Safety, however the impact of any difficulties in accessing PPE can impact on staff wellbeing. Wellbeing Wednesday – a now weekly feature of emails to staff highlighting where to find support covering: o General health and wellbeing guidance and tips o Brief, themed messages aimed at promoting wellbeing, along with links to useful support and reference materials (available in the national Communications toolkit that is a living document 4 Page 123
o Details of other key information and resources available and about working at home o Reminder of our internal support resources including chaplaincy, Employee Assistance Programme and psychological support o Links to Council e-learning and national NHS e-learning, which have specific wellbeing modules o Free access to wellbeing, mindfulness and sleep apps Posters designed by NES (NHS Education Scotland) illustrating psychological and self-soothing support have been circulated to all Local Area Managers and care home contacts The Going Home Checklist designed by MIND/NHS has been circulated to all buildings and included in staff email The importance of communication channels within the HSCP are being reviewed as part of a communications plan to enable key messages to get to staff quickly and efficiently.
4 RELEVANT DATA AND INDICATORS 4.1 A “pulse-check” staff survey will be carried out at regular intervals to assess the state of wellbeing and compare data to check that the wellbeing activities are supporting staff. This will be done jointly with health and council staff. The aim is the Wellbeing Champions can also provide feedback from their localities and areas of work.
5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 We anticipate that staff will continue to need wellbeing support in the longer-term and that the work we are doing now will provide a sound foundation. This is an unprecedented situation for our employees, our patients and clients and our communities. Learning from countries who are coming through the pandemic is that the psychological impact of working in this environment can have long term effects. It is important that we are able to support our colleagues with all the resources that we can.
5.2 This builds on previous work that started around health and wellbeing and will help to build a better workplace for the future with more good days at work.
6 GOVERNANCE IMPLICATIONS 6.1 Financial Impact None – developments all taking place within existing resources
6.1Staff Governance The Action Plan has been developed in partnership with TUs and Staff Side.
6.2Clinical Governance
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7 EQUALITY & DIVERSITY IMPLICATIONS
8 RISK ASSESSMENT
9 PUBLIC & USER INVOVLEMENT & ENGAGEMENT Feedback from colleagues will be assessed through the pulse surveys.
10 CONCLUSIONS
The HSCP value all staff and are committed to supporting them during the Covid-19 pandemic. The existing and proposed support measures outlined in the attached Action Plan will provide a range of resources to help support the health and wellbeing of all staff and their families during these difficult times. We are currently in this phase, however we will need to plan for the next renewal phase and there are opportunities from this pandemic to make real, significant and sustainable improvements to the strategic approach of the health and wellbeing of staff in the HSCP
11 DIRECTIONS Directions to: tick Directions No Directions required X 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
Name: Jane Fowler, Head of Customer Support Services Email: [email protected]
APPENDICES
Appendix A – Letter from Claire Haughey, Minister of Health, 26 March Appendix B – Letter from Claire Haughey, Minister of Health, 20th April
6 Page 125 Appendix A
Minister for Mental Health Clare Haughey MSP T: 0300 244 4000 E: [email protected]
NHS Board Chief Executives Local Authority Chief Executives IJB Chief Officers Chief Executive, Care Inspectorate Chief Executive, Scottish Social Services Council
26 March 2020
Dear Colleague,
NHS and Social Care Staff: Mental Health & Wellbeing Support during COVID-19
I am writing to thank you and your teams for your hard work and commitment at this time to meet the needs of people during the pandemic.
I want to note my sincere appreciation for the extraordinary work that health and social care staff in our hospitals and community care settings are doing to protect and care for people in these difficult times. Our workforces always respond professionally in times of need. However the scale of the challenge is unprecedented. We are asking people to work in unfamiliar settings and many will be asked to learn new skills and will be working in new roles. We recognise that many will be personally impacted by the COVID-19 virus. Some will be caring for their own families, some may be at high risk themselves. This is no small ask. Therefore it is absolutely essential that we look after their mental health and well-being.
You will already have local arrangements in place and it is vital that we work with you to maintain these support structures at this time. Valuable work is also taking place across organisations to provide resources and assistance to as many staff as possible. We should all be signposting colleagues to support they can access including through trade unions and professional bodies.
I am leading the work on the health and wellbeing of the Health and Social Care Workforce over this period for the Scottish Government. My officials have been asked to develop an approach to supporting and expanding this work. This is likely to include practical support and messaging which I hope will complement your response and help you as an employer and commissioner of services. Further information will be provided in due course.
Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot
St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot
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I know you will agree that we need to engage directly with staff at this time. I have attached some key messages, which could be shared at huddles and team handovers or equivalent with immediate effect. Consideration is also being given to the co-ordination of online messaging across the system to ensure as wide a reach as possible.
I am conscious that you and your senior management teams are also facing unprecedented pressures. I would encourage you to also consider your own needs and that of your senior teams, discussing the content of this letter and the key messages with them too.
In the next week I would suggest that you engage your leadership teams in a discussion about how they will implement the key messages in their area, as many of you will I know have already started. I would also suggest that the going home check list, where appropriate, could be implemented for teams and help you. If you have not already, you may want to identify a champion for staff wellbeing locally. Your staff governance committee or equivalent could take on the lead responsibility for positive mental health and wellbeing of the workforce, including practical support, for example on food and accommodation. We will include these issues in the feedback that we will provide to NHS Boards regarding Local Mobilisation Plans.
Thank you again for your extraordinary work.
CLARE HAUGHEY
Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot
St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot
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Mental Health and Wellbeing: Key Messages for Staff
You are likely to be under increased pressure over this period and you will need appropriate support. It is going to be crucial that we are all able to talk openly and honestly about our mental health and wellbeing, and that we have access to the right help and support when we need it. Looking after our mental health is just as important as our physical health.
You Need Care Too
Here are some tips for staying safe and well:
Information and social media
Get timely, accurate and factual information about COVID-19 from a reliable source no more than a couple of times a day. If you are feeling stressed or anxious, consider how you feel when you have constant exposure to media coverage and graphic news stories. Although it is important to stay informed, consider taking a break if you feel things are getting on top of you.
Looking after your basic needs
Take care of your basic needs at work. Eat and drink regularly and healthily. Always take regular breaks during shifts. Allow time for sleep, rest and respite between shifts. Try and stay as connected to your friends and family as much as possible via technology. Maintain, where possible, your normal daily routine and a healthy diet, and get fresh air when you can. Avoid using unhelpful coping strategies that involve alcohol, tobacco or an unhealthy diet. Think about creating a consistent routine to ensure you get the amount of sleep you need, but also about ensuring your bedroom is quiet, dark and a relaxing environment to sleep in.
Looking after each other
Speak to colleagues, line managers and professional leaders, building this into your team’s daily huddles and handovers. They may be feeling the same way. It’s good to talk. Peer and social support are often the best buffers against stress and adversity. Look out for each other and share small successes about what’s gone well. Be kind to each other. This can have a profound impact on staff wellbeing. Use the Going Home checklist, where relevant, to leave work in work. It’s good to talk, but not all of you will be ‘talkers’. That’s OK too but make sure you give yourself space to process the events of the day and deal with your feelings.
Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot
St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot
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Additional information
It is perfectly normal to feel worried during exceptional times such as these. However, if you are starting to feel overwhelmed, it’s important to acknowledge your feelings and speak to someone you trust, whether that’s a friend, a family member, or a colleague. A helpline such as NHS24 (shortcode 111) or Breathing Space (0800 83 85 87) may also help.
You may find the following websites of assistance:
NHS Education for Scotland NHS Inform Support in Mind Scotland Breathing Space Mental Health Foundation
Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot
St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot
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Health and Social Care Workforce and Unpaid Carers
Health and Wellbeing Communications Toolkit
Version 1.0 20th April 2020
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Introduction From Clare Haughey MSP, Minister for Mental Health
I recently wrote to you to express my sincere appreciation for the extraordinary work that the health and social care workforce and unpaid carers in our hospitals and community care settings are doing to protect and care for people in these difficult times.
Individuals across health and social care continue to work incredibly hard at this time of unprecedented challenge. We are asking people to work in unfamiliar settings and in situations with little or no certainty. Whether they are based in a hospital setting, care home or in the community, many will be asked to learn new skills and will be working in new roles. We recognise that many will be personally impacted by coronavirus (COVID-19) and these factors are likely to place emotional burdens on the workforce.
I know you will agree that it is absolutely essential that we maintain support for the mental health and wellbeing of our workforce and unpaid carers. Engaging directly with them will be critical, and we have developed this communications toolkit to provide some practical support and messaging which I hope will complement your response and help you as an employer, support organisation and commissioner of services.
We know that NHS Boards, local authorities and care providers in the independent and third sectors have identified local staff wellbeing champions who have already been involved in establishing local arrangements for supporting staff health and wellbeing. There are some interesting local approaches emerging such as wellbeing hubs. The first meeting of Scotland’s Health and Social Care Champions Network for Staff Mental Health and Wellbeing has now taken place. This will enable good practice to be shared across the country, ensuring the wellbeing needs of the health and social care workforce and unpaid carers are at the forefront in the development of national policy, resources and support going forward.
We have encouraged organisations to clearly signpost their workforce to support that can be accessed, including through trade unions and professional bodies. National and local carer services are also providing emotional support to unpaid carers and it is my hope that these resources will be valuable for them too.
Consistency of messaging is of fundamental importance at this challenging time, so we would appreciate your support in sharing these approved messages across your existing networks to ensure that they reach as many members of the workforce as possible.
Thank you again for your extraordinary work.
Clare Haughey MSP Minister for Mental Health
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Supporting Our Workforce and Unpaid Carers
Below we’ve provided some messages, links and resources on a range of key areas of health and wellbeing which you may find it useful to share. We’ll continue adding to these over the coming weeks.
At this time it is vital that we remain consistent in our messaging and support offering to individuals across the health and social care workforce. Therefore we would ask you to use these messages with minimal revisions.
The themes covered in this toolkit are:
Staying Safe and Well Emotional Wellbeing Sleep Social Connections Eating Well Physical Activity Resilience Culture and Behaviours Compassionate Leadership The Role of Teams
You may also find the materials at the following links useful:
NHS 24 Breathing Space – social media toolkit. MIND.org - Going Home Checklist
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Approved Messages (The following communications have been signed-off by Ms Haughey, Minister for Mental Health)
Staying Safe and Well (Message below was circulated in Ms Haughey’s letter of 26 March 2020)
You are likely to be under increased pressure over this period and you will need appropriate support. It is going to be crucial that we are all able to talk openly and honestly about our mental health and wellbeing, and that we have access to the right help and support when we need it. Looking after our mental health is just as important as our physical health.
You need care too
Here are some tips for staying safe and well:
Information and social media
Get timely, accurate and factual information about COVID-19 from a reliable source no more than a couple of times a day. If you are feeling stressed or anxious, consider how you feel when you have constant exposure to media coverage and graphic news stories. Although it is important to stay informed, consider taking a break if you feel things are getting on top of you.
Looking after your basic needs
Take care of your basic needs at work. Eat and drink regularly and healthily. Always take regular breaks during shifts. Allow time for sleep, rest and respite between shifts. Try and stay as connected to your friends and family as much as possible via technology. Where possible, maintain your normal daily routine and a healthy diet, and get fresh air when you can. Avoid using unhelpful coping strategies that involve alcohol, tobacco or an unhealthy diet. Think about creating a consistent routine to ensure you get the amount of sleep you need, but also about ensuring your bedroom is quiet, dark and a relaxing environment to sleep in.
Looking after each other
Speak to colleagues, line managers and professional leaders, building this into your team’s daily huddles and handovers. They may be feeling the same way. It’s good to talk. Peer and social support are often the best buffers against stress and adversity. Look out for each other and share small successes about what’s gone well. Be kind to each other. This can have a profound impact on staff wellbeing. Use the Going Home Checklist, where relevant, to leave work in work. It’s good to talk, but not all of you will be ‘talkers’. That’s OK too but make sure you give yourself space to process the events of the day and deal with your feelings.
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Additional information
It is perfectly normal to feel worried during exceptional times such as these. However, if you are starting to feel overwhelmed, it’s important to acknowledge your feelings and speak to someone you trust, whether that’s a friend, a family member, or a colleague. A helpline such as NHS 24 (111) or Breathing Space (0800 83 85 87) may also help.
You may find the following websites of assistance:
NHS Scotland Staff Governance Website - Governance and partnership working NHS Education for Scotland - Psychosocial mental health and wellbeing support NHS Inform – Coronavirus (Covid-19) advice Support in Mind Scotland – Mental health support Breathing Space - Listening, information and advice Mental Health Foundation - Mental health and psychosocial support
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Emotional Wellbeing
It’s OK not to feel OK
This is an unprecedented scenario, and it is okay to feel stressed or anxious at this time. This is entirely normal, and it is highly likely that many of your co-workers, family and friends will be feeling the same way. But if it is not passing or your usual coping strategies aren’t helping, think about where you are able to get more support (see additional guidance).
This is something we’re all going through together. That means over the coming months, it’s going to be crucial that we’re all able to talk openly and honestly about our mental health. That also means being able to access the right help and support if you need it.
It is perfectly normal to feel strong feelings during exceptional times such as these. This can include feelings of anger. However, if you are starting to feel overwhelmed, it’s important to acknowledge your feelings and speak to someone you trust, whether that’s a colleague, a friend or a family member, or a helpline such as NHS 24 (111) or Breathing Space (0800 83 85 87).
Helplines:
NHS 24 (111) Breathing Space (0800 83 85 87) Samaritans (116 123)
Online support:
NHS Scotland Staff Governance Website - Governance and partnership working NHS Education for Scotland - Psychosocial mental health and wellbeing support Breathing Space - Listening, information and advice Mental Health Foundation – Mental health and psychosocial support NHS Inform - Coronavirus (Covid-19) advice Support in Mind Scotland - Mental health support See Me – Resources to help challenge mental health stigma SAMH – Coronavirus mental health information hub NHS – Mental Health Apps Cruse Bereavement Care Scotland Marie Curie - Information and support
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Sleep
Sleep well
Allow time for sleep, rest and respite between shifts.
Getting a good sleep is crucial for feeling mentally and physically healthy. We all feel better after a good sleep. Think about creating a consistent routine to ensure you get the amount of sleep you need, but also about ensuring your bedroom is quiet, dark, and a relaxing environment to sleep in.
It is important that you allow yourself to wind down before bedtime. This could include not using social media or your phone an hour before bed, taking a bath or reading.
If possible, try to maintain your normal routine. This means going to bed at the same time and waking at the same time.
Online support:
NHS Inform – How to get to sleep Mind - How to cope with sleep problems
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Social Connections
It’s good to talk
Speak to colleagues, line managers and professional leaders, building discussions on wellbeing into your team’s daily huddles and handovers. They may be feeling the same way. It’s good to talk. Peer and social support are often the best buffers against stress and adversity.
It’s good to talk, but not all of you will be ‘talkers’. That’s OK too but make sure you give yourself space to process the events of the day and deal with your feelings.
It is important to try and stay as connected to your friends and family as much as possible via email, video-calling and telephone.
This is something we’re all going through together.
Helplines:
NHS 24 (111) Breathing Space (0800 83 85 87)
Online support:
NHS Education for Scotland - Psychosocial mental health and wellbeing support Breathing Space - Listening, information and advice Mental Health Foundation - Mental health and psychosocial support NHS Inform - Coronavirus (Covid-19) advice Support in Mind Scotland - Mental health support SAMH – Looking after your mental health in challenging times Penumbra – Coronavirus info hub Samaritans – Coronavirus resources
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Eating Well
Rest, refuel and rehydrate
Try to take regular breaks, were possible away from your workplace or caring responsibilities. Frequent shorter breaks are better for reducing fatigue and stress.
Drinking water often throughout the day will help to keep you hydrated. This is especially important for people wearing PPE for long periods of time.
Life isn’t easy at the moment but eating well and as healthily as you can will help your body cope better with the demands placed on you during busy shifts. Focussing your meals and snacks around starchy food such as pasta and rice and filling up on fruit and vegetables will help keep your energy levels maintained.
Where possible, set aside some time to plan your meals and shopping to help you eat healthily when you are busy.
Online support:
WHO – Food and nutrition tips during self-quarantine NHS Inform – Food and nutrition Food Standards Scotland – Eat well everyday Parent Club – Eating well at home Priority shopping hours – During Covid-19 outbreak
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Physical Activity
Stay safe, stay active
Being active can help to enhance your mood and wellbeing by reducing stress, anxiety and increasing energy levels. Now more than ever, it’s important to move more.
Any amount of physical activity, however small, is good for you. Continuing to enjoy short, local walks, jogs or cycles is a great way to clear your head and stay active. Remember to observe social distancing guidance and stay local or try to build into your daily commute.
You can also stay active at home, by walking up and down stairs, dancing, gardening or taking part in a virtual fitness class. It doesn’t matter what you do, as long as you do something that you enjoy and keep moving.
Online support and resources:
NHS – Fitness Videos Mind - Physical activity and your mental health Sport England - Stay In, Work Out #StayInWorkOut WHO - Be Active During Covid-19 Paths for All - Home based exercises
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Resilience
Keep things in balance as best you can
Being resilient doesn’t mean that we’re unaffected by the adversity we encounter in life. Instead, resilience refers to the ability to recover, and this ability to “bounce back” depends on the balance between the demands that are made on us and the resources we have available at any given time.
The current pandemic is disrupting this balance as it places extra demands on us while limiting our ability to do the things that help us cope. It can be hard to bounce back when things are so out of kilter
Have a think and/or talk to someone you trust to see if there are any demands that can be reduced, either at work or at home. And what alternative or additional resources might sustain you during this difficult time?
Try to keep things in balance as best you can. Please take care of yourself and make use of the support on offer.
Helplines:
NHS 24 (111) Breathing Space (0800 83 85 87) Samaritans (116 123)
Online support:
NHS Education for Scotland - Psychosocial mental health and wellbeing support Breathing Space - Listening, information and advice Mental Health Foundation - Mental health and psychosocial support NHS Inform - Coronavirus (Covid-19) advice Support in Mind Scotland – Mental health support See Me – Talking about mental health during the Coronavirus outbreak SAMH – Coronavirus mental health information hub NHS – Mental Health Apps Lifelines - How to stay well
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Culture and Behaviours
As our Health and Social Care organisations rise to the challenges of the COVID-19 pandemic, it is important that we now focus on enhancing the behaviours and values that positively impact our workplace cultures. 1 Compassion is essential to building team connections and resilience; nurture this by regularly reflecting and debriefing together. Self-care and self-compassion is essential to allow us to be as well and as full a participant in a team as possible. To avoid burnout, we must take the time we need to consider how we are and what, if any, help we need.
Four behaviours can really make a difference to our wellbeing and the wellbeing of those around us: 2
Paying Attention to how staff and colleagues around us are acting and asking them how they are feeling – this can be really impactful. Understanding the situations they face Empathising with the way they feel Helping by taking thoughtful and appropriate action to help relieve their suffering if possible
We all know the benefit of being treated kindly. Evidence shows that being on the receiving end of uncivil behaviours can negatively impact our wellbeing and ability to provide high quality care.3 It may be easy to recognise and feel aggrieved by unkind behaviours, not rising to these is another matter.
When someone has been rude to us, take time to consider: the thought processes and situational factors that may have contributed to their actions how to best deal with this, with kindness - should we speak to them about their behaviour? If so when and where? And, most importantly, how we do so; we should aim to underpin these conversations with curiosity and respect. 4
No matter our position in an organisation, our behaviours have ripple effects. If someone speaks to us about our own behaviours, we need to pause to consider how we may have come across and how we can change things going forward. Taking some time to reflect before we react can allow us to get to a faster and kinder resolution. 4
A respectful and kind workplace brings enormous benefits to those who work in it and we all have a crucial role to play in ensuring that this is the case.
Useful Resources:
The Kings Fund - Michael West: collective leadership for culture change The Kings Fund - Improving NHS culture Civility Saves Lives
References 1 Work and wellbeing in the NHS: why staff health matters to patient care. Royal College of Physicians 2015. 2 Atkins PWB, Parker SK (2012). ‘Understanding individual compassion in organisations: the role of appraisals and psychological flexibility’. Academy of Management Review, vol 37, no 4, pp 524–46. 3 Katz, Daniel, et al. "Exposure to incivility hinders clinical performance in a simulated operative crisis." BMJ quality & safety 28.9 (2019): 750-757. 4 Turner, Chris. Advice on calling out uncivil behaviour. Adapted from ‘Calling it out with compassion workshop’ by the Civility Saves Lives Movement.
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Supporting Positive Mental Health and Wellbeing through Compassionate Leadership
During the pandemic many within the Health and Social Care workforce will be asked to learn new skills, work in different settings, on their own or with new team members or utilise alternative approaches to how they would usually deliver care. This includes digital technologies such as Near Me, Skype and Microsoft Teams 365. The impact of change both professionally and, importantly, personally can understandably cause people to feel anxious or stressed and calls for compassionate professional leadership.
Compassionate leadership means creating the conditions – through consistently listening, understanding, empathising and helping.
Research suggests that the most effective leaders consistently demonstrate compassion by:
Being present; they pay attention to people and "listen with fascination" Empathising with people and their situation Having the motivation to help; taking action to make a difference where necessary Developing a shared understanding of the situation they face.
Leaders can lead by example, creating a culture where asking for help is seen as courageous and insightful, rather than a sign of weakness; it is ok not to feel ok all of the time. They can also sign- post and engage staff with appropriate support and help.
Regular individual or peer supervision for all team members is essential. Through enacting the principles of compassionate leadership, individuals can be supported to:
Articulate how they feel Consolidate new learning into practice, and remain competent and confident practitioners Share experiences and comfortably seek support both professionally and personally Have a sense of belonging as part of a team with autonomy and control Support each other with empathy and kindness Influence decision making within their own area and more widely within their organisation.
Useful Resources:
SAMH - Coronavirus mental health information hub NHS NES - Coronavirus (COVID-19) Learning materials for professionals Healthy Working Lives
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The Role of the Team in Staying Well
Everyone is playing an essential role contributing to the national response to COVID-19. A common feature of a crisis response is the need to form new teams. These often bring together people who are unfamiliar to one another. Currently facing COVID-19, many people within these teams are also faced with new roles that are unfamiliar to them.
The team has a critical role not just in delivering essential health and care services, but also in sustaining resilience and protecting workforce wellbeing. Mental wellbeing in threatening situations is supported by the resilience that exists between people. The connections between team members are, therefore, an essential component in our response to COVID-19 in protecting individuals’ physical and mental health both in the immediate and long term. It is vital that within teams in Health and Social Care - whether newly formed or familiar - that meaningful team engagement and participation is enabled.
No matter how short a time, building rapid team reviews into daily team routines – virtual or in person - provides dedicated, predictable space allowing team members to learn together, support each other, understand the team’s shared values, celebrate success and reflect on their experiences shared. According to the Kings Fund, time spent on the above reaps a 35% improvement in wellbeing.
When working with teams beyond your own, key principles to hold in mind include:
Be respectful of other teams when you discuss them Be clear with your communication with others to uphold safety and highlight relevant critical information Do what is within your team’s capability and reflects your responsibilities If uncertainty exists between teams, take steps to clarify as a priority Don’t make commitments on behalf of other teams Be mindful that all teams have considerable pressures on them at this time.
Be thoughtful about the needs of others; the success of your team depends on the effective functioning of others.
Useful Resources:
CIPD podcast 'Building the best team' Civility Saves Lives Learning from Excellence
References 1FMLM Leadership and management standards for medical professionals 2RCGP/SA paper on working in teams sent in email to accompany. 3Professor Neil Greenberg, Professor of Defence Mental Health - Wellbeing webinar on behalf of NHS England and NHS Improvement via YouTube, 8th April 2020.
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Appendix of Support and Resources
Staying Safe and Well Online support: NHS Scotland Staff Governance Website - Governance and partnership working NHS Education for Scotland - Psychosocial mental health and wellbeing support NHS Inform – Coronavirus (Covid-19) advice Support in Mind Scotland – Mental health support Breathing Space - Listening, information and advice Mental Health Foundation - Mental health and psychosocial support
Emotional Wellbeing Helplines: NHS 24 (111) Breathing Space (0800 83 85 87) Samaritans (116 123)
Online support: NHS Scotland Staff Governance Website - Governance and partnership working NHS Education for Scotland - Psychosocial mental health and wellbeing support Breathing Space - Listening, information and advice Mental Health Foundation – Mental health and psychosocial support NHS Inform - Coronavirus (Covid-19) advice Support in Mind Scotland - Mental health support See Me – Resources to help challenge mental health stigma SAMH – Coronavirus mental health information hub NHS – Mental Health Apps
Sleep Online support: NHS Inform – How to get to sleep Mind - How to cope with sleep problems
Social Connections Helplines: NHS 24 (111) Breathing Space (0800 83 85 87)
Online support: NHS Education for Scotland - Psychosocial mental health and wellbeing support Breathing Space - Listening, information and advice Mental Health Foundation - Mental health and psychosocial support NHS Inform - Coronavirus (Covid-19) advice Support in Mind Scotland - Mental health support SAMH – Looking after your mental health in challenging times Penumbra – Coronavirus info hub Samaritans – Coronavirus resources
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Eating Well Online support: WHO – Food and nutrition tips during self-quarantine NHS Inform – Food and nutrition Food Standards Scotland – Eat well everyday Parent Club – Eating well at home Priority shopping hours – During Covid-19 outbreak
Physical Activity Online support and resources: NHS – Fitness Videos Mind - Physical activity and your mental health Sport England - Stay In, Work Out #StayInWorkOut WHO - Be Active During Covid-19 Paths for All - Home based exercises
Resilience Helplines: NHS 24 (111) Breathing Space (0800 83 85 87) Samaritans (116 123)
Online support: NHS Education for Scotland - Psychosocial mental health and wellbeing support Breathing Space - Listening, information and advice Mental Health Foundation - Mental health and psychosocial support NHS Inform - Coronavirus (Covid-19) advice Support in Mind Scotland – Mental health support See Me – Talking about mental health during the Coronavirus outbreak SAMH – Coronavirus mental health information hub NHS – Mental Health Apps Lifelines - How to stay well
Culture and Behaviours Useful Resources: The Kings Fund - Michael West: collective leadership for culture change The Kings Fund - Improving NHS culture Civility Saves Lives
Compassionate Leadership Useful Resources: Mind - Taking care of you - our work with emergency departments SAMH - Coronavirus mental health information hub NHS NES - Coronavirus (COVID-19) Learning materials for professionals Healthy Working Lives
The Role of the Team Useful Resources: CIPD podcast 'Building the best team' Civility Saves Lives Learning from Excellence
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Page 145 Agenda Item 9b
Integration Joint Board
Date of Meeting: 27th May 2020
Title of Report: HR Resourcing
Presented by: Jane Fowler, Head of Customer Support Services
The Integration Joint Board is asked to: . Note the current HR team structure and capacity . Note the increase in current and future HR demands from service change, policy change and Culture Fit for Future outcomes . Note the impact on the HSCP of under-supported managers, employees and TU/SS . Approve the proposal for increased resource (temporary and permanent) for the HSCP HR team as set out in para 3.14 totalling £104,585.95
1. EXECUTIVE SUMMARY The HROD team is dealing with increased demands from service change, national policy changes and Culture Fit for the Future outcomes and this is impacting on the team’s capacity to deliver. This report proposes an increase in temporary and permanent HR resources to ensure that the team can fully support managers, employees and staffside colleagues and reduce risk to the HSCP.
2. INTRODUCTION This paper presents the IJB with an update on the reports submitted to SLT on 4th March and 6th May 2020 taking into account feedback from SLT specifically around being clear on what an increase in HR resources will achieve and the issues that will be sorted or minimised by further investment by the HSCP.
3. DETAIL OF REPORT
3.1 Following agreement between the two parent bodies, it was decided that in the interests of improved people management in the HSCP, the HR service for Argyll and Bute HSCP would be integrated and be under the leadership of the Council’s Head of Customer Support Services. This has been in place since 1 September 2019.
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3.2 The HR team works closely alongside the 3 person OD team. This report focuses solely on HR capacity. 3.3 The HR team consists of: Operational HR - 6 wte staff – 1 wte band 7, 2 wte band 6, 2.3 wte band 5 (one temp) and 0.7 wte band 4. Recruitment - 2.5 WTE staff – 0.5 wte band 5 and 2 wte band 3 ABC HR Officer – 0.5 FTE LGE11
Head of Customer Support Services
Organisational & HR Lead Workforce development (1 wte) manage (1 wte)r
Learning & Development Business Partners HR Advisors Resourcing Manager HR Admin Assistant OD Lead Lead (2 wte) (2.3 wte) (0.5 wte) (0.7 wte) (1 wte) (1 wte)
Resourcing Assistants (2 wte)
The team delivers: Operational HR support and guidance – Employee Relations, Organisational Change, Redeployment, Fixed Term Contracts, Absence, Maternity, Relocation and Terms & Conditions of Service. Recruitment – all recruitment, excluding medical staffing, for staff employed by NHS Highland in the Argyll & Bute HSCP All associated contractual documents Attendance management support including OHS referrals advice, ill-health retiral, reasonable adjustments etc. Representation at all NHSH HR Sub and T&C’s Sub groups, HPF and working groups Support for staff liaison, JPF and other ad hoc TU/SS meetings Roll out of NHSH initiatives and policy changes such as TURAS, Learnpro and JobTrain to date. Business Partner support at management team meetings. HR advice on and participation in change management SLWGs and other working groups Workforce Monitoring
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The HR Officer in the Council carries out the HR advice, change, redesign and attendance management elements of the above. Other parts of the Council’s HROD team are not HSCP specific and deal with pay, pensions, policy, ER, attendance management, policy change, procedures, recruitment etc.
3.4 HR Advisory support is allocated across the HSCP as follows:
HR Lead and HR Adviser Helensburgh & Lomond Cowal & Bute Dental HR
HR Business Partner, HR Adviser (temp) Oban, Lorn & Islands Children & Families Estates
HR Business Partner, HR Adviser (0.5 wte) Mid Argyll, Kintyre & Islay Mental Health Corporate (excluding HR)
The Council’s 0.5 FTE HR Officer covers the entire Argyll and Bute area – i.e. all Children and Families, Adult Services and Council employees in Strategic Planning and Performance.
3.5 As reported previously the team has recently recruited to the part time Admin Assistant post. This is an essential part of the team and has been vacant for some time, putting significant pressure on the team to maintain service delivery. Due to the COVID-19 pandemic, the Admin Assistant has been temporarily deployed to MAKI to assist with Admin support there.
3.6 HR Adviser (Temp) Post
This post was originally established with funding within the Investment fund in October 2017. The premise of the post was to support the redesigns that required to be undertaken over the next 2 years. Other than Estates Review, this work did not transpire but other work was undertaken by the post holder including support covering:
ER investigations Advice to line managers for sickness absence Informal interventions such as facilitated discussion, informal mediation Providing HR data and analysis for staff governance reporting to IJB
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The post holder was also assigned as Co-ordinator for LearnPro in Argyll & Bute. This entails ensuring A&B’s staff have a single point of contact to get guidance and support on the system. The HR Advisor managed the roll-out of the updated Learnpro capability to ensure statutory and mandatory training is the focus for improvement in terms of take up.
In consultation with Finance, we identified sufficient additional resource from within the small HROD budget to extend this post for a further 6 months at the end of the original 2 year FTC. This was done as an emergency measure to cover long-term absence within the team.
Another extension for a further 3 months was recently approved by workforce monitoring due to the nature and volume of current and future HR workload which takes the term to end of June 2020 equating to 2 years and 9 months service by the post holder.
3.7 HR Lead Capacity
After Shared Services was established, in addition to the existing role requirements, this role took on formal responsibility for overseeing recruitment, where previously it was managed by the Head of Service.
The HR Lead also manages a full employee relations caseload as well as meeting the management demands of a busy team, liaising on complex cases with NHSH HR, participating in the NHSH and HSCP HR and staff side governance structures/meetings, advising on change, leading on the implementation of new policy and procedures and managing an increasing volume of TU/SS correspondence. The level of activity relating to policy change, team management, organisational change and restructure is significant alongside the progression of ER caseloads is a significant challenge in this context.
3.8 Employee Relations Caseload
The team has seen ER cases double over the last 12 months. Despite cases being completed each month, there continue to be new cases coming on stream. This is evidenced in quarter 3 where we completed 3 cases but another 4 were started. Timescales for undertaking all HR processes have been longer than previous policy dictates for a number of reasons i.e. availability of managers, trained Investigating Officers and HR support. It must be stressed that the HR Team prioritise all ER work above all else so are rarely unable to accommodate dates for meetings etc.
Overall workloads are impacting on managers’ availability to investigate, report on and participate in employee relations cases is a challenge which has resulted from pressure on resources and their time and also the temporary management arrangements that are in place pending the implementation of the management restructure.
The temporary management arrangements could be contributing to an increasing number of ER cases coming forward. The ongoing programme
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of change and redesign also has an impact on our employees and could again be contributing to the increasing number of ER cases.
The team is seeing an increase in the number of formal ER processes as opposed to informal, which is increasing resource demands.
The Culture Fit for the Future work, post-Sturrock, and the current Argyll and Bute Engagement exercise (culture survey) are and will continue to increase demands on the team for ER investigations, appeals, informal support and mediation, advice to management and staff and actions required as part of the CFFTF action plan.
It is acknowledged that our HR process timescales require to be significantly improved and become “reasonable” which is referred to in the new "Once for Scotland” Workforce Policies.
3.9 Once for Scotland Workforce Policies Roll Out
The consultation and roll-out of all NHS PIN Policies, which are being revised, will have a significant impact on the HR & OD Team, as support for training is expected from HR Business Partners and HR Advisers to ensure that all line managers have knowledge and understanding of the changes to the policies.
The most significant change is to the Attendance and Investigation Process, however training for managers in HR processes has been needed over a number of years so this is the ideal opportunity to start filling this gap in knowledge, skills and experience. The first phase covering the Core Policies will require significant input by the HR Team to support the implementation and training for these policies. This will be joint training with TU/Staffside.
It should be noted that the Once for Scotland policies dictate the level of HR support that should be provided and therefore we cannot review the level of HR involvement locally. In contrast, the Council can amend their processes locally after agreement with TUs.
The second phase is currently being consulted on and involves revising 23 NHS PIN Policies covering Work Life Balance Policies such as Special Leave, Parental Leave etc. It’s envisaged that the implementation date for the roll-out will be 1st March 2021 at the latest. A third and final phase is expected after this. This phased plan demonstrates that there is a continuing demand on HR & OD in regards to this area of work over the next couple of years.
Universal understanding, effective training and consistent implementation of the Once for Scotland policies and procedures is an extremely important step for the HSCP to take in building confidence amongst colleagues in our people processes.
3.10 Organisational Change/Redesigns
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The complexity of supporting change management in the HSCP is increasingly placing additional demands on the team. The recent Children and Families Management restructure implementation has been completed with an implementation date of 1 July 2020, however the work involved in supporting the necessary HR processes was considerable such as:
Developing new joint HR process for TU/Mgt consideration and approval Support in 1 to1 interviews with managers Preparation of paperwork for matching panels for Integrated posts, NHS and Council posts from expression of interest submissions; Supporting matching panels and confirming matches with relevant managers
This work was supported by 1 HR BP, and 2 team members virtually for the all time taken which was approximately six months. The process for implementing the Adult Services redesign will be more involved due to the increased number of integrated and non integrated posts. An estimate of time to complete this is nine months. This clearly demonstrates the resource required around redesign and it is expected and required that other major redesigns will require similar HR support from NHS and Council HR.
3.11 TU/Staffside Relations
The current environment of change in the HSCP is contributing to an intensification of relations between HR and staff side. Some ER cases are particularly complex with protracted, written correspondence associated with them and this can be in part linked to the issues highlighted above regarding time taken to progress ER cases. However, this is time consuming for both sides without necessarily reaching a satisfactory resolution. It is anticipated that the roll out of Once for Scotland Policies will support an improvement in this, with an increase in informal resolution at an early stage. Essential to this is the HR and mediation support the team can deliver alongside well trained and confident managers alongside our colleagues in staff side.
The staff governance procedures and arrangements in the integration environment are still complex and bureaucratic. Further work is required to simplify these to support better management of change in partnership and staffside colleagues are committed to working constructively with HR and management to improve this.
Resourcing the HSCP HR Team
The current pressure on the HR Team is one that is, as set out above, driven by the current environment that the HSCP is operating in. It is anticipated that this is a temporary situation that will be improved by a number of measures over the next 2 year period.
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The management structure implementation and stabilises, as the engagement exercise progresses and as we develop improvement actions and a positive and improved culture, it is anticipated that the current critical situation facing HR will resolve itself and a new ‘norm’ of more settled employee relations will be established. It is likely, however, that change will remain with us and the HR team must be in a position to be able to continue to support the HSCP to manage this.
3.12 In order to stabilise the HR team and manage the current and projected future demands of change and CFFTF over the next period, this paper notes that SLT agreed the following request for additional temporary resource:
Proposal: 1 x Band 6 HR Business Partner (temp 23 months)
Rationale – to remove HR case load from the HR Lead and enable them to focus on management , provide professional and general support, liaison with NHSH HRD and team, strategic change management procedures, revised staff governance, reports to IJB and SLT, overview and analysis of improvements, lead in liaising with TU/SS to try and deal with issues at a lower level rather than being escalated to Inverness as is the current situation.
The recurring cost of this provision is £43,600 per annum plus £1000 travel allow.
Proposal: 1 x Band 5 HR Adviser permanent (currently temp)
Rationale – the size of the organisation and the complexity of staffing groups requires permanent resource and resilience at the HRA level. The team will not be able to meet policy timescale targets for ER cases without this post at the normal level of demand. In addition, the work associated with Learnpro would need to be reallocated to another post within the HR/OD side as this was determined by NHSH in Inverness as an essential requirement within HR & OD function within A&B.
The recurring cost of this provision is £35,400 per annum plus £1000 travel allow.
Proposal: 0.5 FTE LGE11 HR Officer (temp 23 months)
Rationale – the current Business partner resource for the HSCP from the Council team (equivalent to the other BP level of resource) is not proving sufficient to manage the current levels of absence and amount of change in the HSCP. The postholder attends service management teams, advises on change processes for council employees, contributes to integrated procedures, supports statutory consultation duties, reports on detailed absence etc.
The recurring cost of this provision is £25,585.95 per annum.
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3.13 The NHSH HR Director and the Head of Customer Support Services keep in regular contact and this proposed change has been discussed. Any future changes to structure either in NHSH or in Argyll and Bute will be discussed fully with engagement where appropriate.
3.14 Targeted Improvements
The benefits and improvements for the HSCP associated with investing in more resources within HR & OD at this time are as follows:
Attending SLT/ Senior Management team meetings and providing high level HR advice to ensure strategic oversight of all people issues within HSCP Provide professional HR advice to local managers to help ensure absence, ER cases, FTC etc, are being managed in accordance with HR Policy and definitive and reasonable timescales are being met: o Once for Scotland roll-out and training o eESS and SSTS roll out leading to more effective and efficient ways of working e.g. online Manager and Employee self service o Reduction of absence levels. New absence management policy with 4 stage process for escalation should facilitate this, with HR support. o Target for completion of single process investigations within 18 weeks be 50% year 1 and 75% in year 2. These targets would be subject to A&B HSCP following North Highland and A&B Council practice of Senior Management ownership of ER cases. Reduce organisational and reputational risk including potential costs associated with litigation and Tribunal cases (£60,000 was paid out to former staff last year in settlements pre-Tribunal) Spending sufficient and appropriate time to guide and coach managers in soft skills to minimise issues escalating to formal processes, e.g. courageous conversations. Improve the culture of the organisation by increasing the amount of proactive HR work to ensure staff are well managed Provide more focus and resource for strategic input to recruitment challenges particularly around hard to fill posts e.g. Nursing and AHP posts. Supporting recruiting managers with roll-out of Job Train for all internal and external posts which will have a positive effect on existing timescales for recruitment i.e. average of 5.5 weeks internal, 15.5 weeks external. Target would be 4 weeks and 12 weeks respectively.
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Total Cost Overall Annual employment Annual travel cost allowance
1 x Band 6 HR Business £43,600.00 £1000 Partner (temp 23 months)
1 x Band 5 HR Adviser £35,400.00 £1000 permanent
0.5 FTE LGE11 HR Officer £25,585.95 - (temp 23 months)
TOTAL COST per year £104,585.95 £2,000.00
4 RELEVANT DATA AND INDICATORS SMART delivery measures are being developed for regular reporting.
5 CONTRIBUTION TO STRATEGIC PRIORITIES Effective HR is essential to supporting a stable workforce, to ensure recruitment is processed, to manage employee relations, to facilitate change, to facilitate relations with the Trade Unions and ensure that change is progressed in line with policy and procedure.
6 GOVERNANCE IMPLICATIONS 6.1 Financial Impact No additional financial implications. SLT propose that the costs will be met through pro-rata top slicing existing budgets. Potentially the additional investment in the HR team could reduce the likelihood of ER related settlement pay outs, absence costs and save money in the longer term. 6.2 Staff Governance Effective and fair recruitment of staff is a core element of ensuring appropriate staff governance 6.3 Clinical Governance None
7. EQUALITY & DIVERSITY IMPLICATIONS The proposal raises no adverse EQIA issues.
8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None
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9. RISK ASSESSMENT An under-resourced HR service presents a risk to the HSCP in managing and delivering change, in ensuring compliance with statutory policies and procedures and in managing employee relations.
10.PUBLIC & USER INVOLVEMENT & ENGAGEMENT None
11.CONCLUSIONS The paper presents a proposal for a temporary and small permanent increase in the resource available to the HSCP HR Team. This is to address the current and anticipated increase in ER cases as a result of change and the Argyll and Bute engagement exercise, the roll out of once for Scotland policies and procedures and the implementation of service restructures.
It is anticipated that the majority of this work will reduce over the 2 year period and a ‘steady state’ in the Team will be established, resulting in the removal of the temporary resource at that stage.
SLT considered the report and agreed to recommend to the IJB a funding arrangement based on pro rata allocation of existing budgets.
12.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 x
The paper highlights the impacts both financially and on stakeholder groups in line with statutory guidance on direction. We would seek to progress to delivery of the direction with immediate effect pending IJB support.
The IJB directs NHS Highland to move to recruit 2 staff as follows: 1 x Band 6 HR Business Partner (temp 23 months) 1 x Band 5 HR Adviser permanent (currently temp)
The IJB directs Argyll and Bute Council to move to recruit 1 employee as follows: 0.5 FTE LGE11 HR Officer (temp 23 months)
REPORT AUTHOR AND CONTACT
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Author Name: Charlie Gibson, HR Lead; Jane Fowler, Head of Customer Support Services
Email: [email protected]; [email protected]
11 This page is intentionally left blank Page 157 Agenda Item 10
Integration Joint Board
Date of Meeting: 27th May 2020
Title of Report: Enhanced Care Home Assurance
Presented by: Caroline Cherry, Head of Adult Service, Older Adults and Community Hospitals
The Integration Joint Board is asked to:
. To note the highlighted risks to older adults within care homes from COVID-19.
. Note the assurances to support care homes within the context of COVID -19.
1. EXECUTIVE SUMMARY
1.1 The purpose of this report is to describe the scope and purpose of strategic reporting of care home assurance and describe local responses given the context of COVID -19. 1.2 We have 17 older adult homes in Argyll and Bute, around a third internally provided to two thirds commissioned by independent providers.
2. INTRODUCTION
2.1 COVID -19 has had a devastating impact on care homes and older adults. A significant percentage of deaths from COVID -19 have occurred in care homes for older adults globally. In Argyll and Bute, at the time of writing the report, there have been two ongoing outbreaks within two residential settings for older adults. At the 3rd May there were 21 deaths in older adult care homes out of a total of 55 COVID -19 related deaths. Additionally, the overall number of available placements within the independent sector has risen from 25 to 87 in the space of 4 weeks.
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2.2 A letter was sent to Health Boards, around the 21st April, requiring each Board to give enhanced assurance on care homes in the midst of COVID -19, the letter is attached at Appendix 1. This reporting function lies with Public Health. Argyll and Bute worked, as part of NHS Highland, and contributed to the overall response which was sent as a high level overview on Friday 24th April. Following the initial work, Boards are asked to consider areas of intervention-including potential visits. Boards, through the Directors of Public Health, report weekly to the Scottish Government.
2.3 Argyll and Bute Health and Social Care Partnership had already developed a joint response with care homes to address risks, problem solve and offer support. This will be further described in section 3.5.
3. DETAIL OF REPORT
3.1 The questionnaire for use is attached at Appendix 2 the main focus for assurance was:
1. Social Distancing including visits 2. Staffing levels 3. Infection Control 4. Testing-Staff* 5. Testing-Residents* note guidance changed via letters from the Scottish Government 1st May 2020.
3.2 All 17 care homes took part, this is a brief overview: Themes at the time of the report:
A few homes did not know how to contact the Health Protection Team or report an outbreak.
A few homes had some concerns on infection control; identifying areas of isolation within a care home can be challenging.
Understanding of testing and how to get staff tested was not clear to many homes.
Some contingency planning was reliant on other local homes, which gives difficulty at the time of COVID -19.
PPE overall was concerning but generally improving.
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Support identified as being of help to staff to deal with COVID -19 included: • Financial help due to increased costs of staff, PPE and infection control supplies. • Consistent information that addresses concerns in one place. • Ideas to boost morale. • Staff debriefs led by external professionals.
3.3 This questionnaire was a snapshot in time, however there were homes that needed follow-up because of concern regarding responses and significant pressure as a result of outbreaks, staffing etc. Some of the issues identified were addressed through improved communication.
3.4 The themes and issues that require to be urgently addressed are:
Emergency Mobilisation in an outbreak (or where staff require to be isolated following a positive result), we have not got this fully in place although work is in progress. Some of the issues for the HSCP are consideration of the use of external care at home staff and social work staff supporting homes and the liabilities therein.
Financial Strain: increasing additional care costs and income replacement needs clarified urgently, we view financial risks as red and note a care home may close or fold.
Testing implementation: managing this process for staff and residents quickly and safely. Testing for staff, coming from other disciplines, to go into homes.
PPE: Consistent monitoring of the process of supply, the situation fluctuates.
3.5 Local Approach Prior to the Scottish Government letter, the HSCP had identified the need for greater assurance around care homes, given their vulnerability, and the following measures had been put in place:
Care Home Daily report: carried out by Scottish Care, co-ordinated by Gillian Maidment from commissioning, giving a snapshot of issues.
Care Home Clinical Pathway: developed by Dr. Helliwell, Clinical Lead and agreed by NHS Highland, this is a flowchart of clinical intervention, seen as good practice by the Care Inspectorate. This should assure care homes that ‘older adults’ needs should be assessed individually.
Well Being: The Scottish Government have advised HSCP’s that equity of mental health listening services; provision to all care services is a key priority. We are scoping the cost of an Employee Assistance Programme
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and access to psychological therapies for care home staff and other resources have been circulated and discussed.
3.6 Care Home Task Force The task force was established on the 21st April following dialogue with local care homes, clinical leads and Scottish Care. The remit for the group is attached at Appendix 3. The Vice Chair of the group is a Care Home owner and the agenda is shared. The group have been able to discuss issues that affect providers whilst there has been a sharing of learning, skills and knowledge across HSCP staff, Providers and the Care Inspectorate. Providers say they like the format and it is envisaged that this will continue post COVID -19. In essence this co-production approach of working together is how we should collectively support older adults in care homes.
3.7 Care Home Leadership
This smaller group comprising Scottish Care, HSCP colleagues, and finance staff meet together, twice a week, to advance pieces of work in more depth. The last two sessions have, for example, focused on emergency mobilisation with a focus on Dunoon and Helensburgh.
4. RELEVANT DATA AND INDICATORS
N/A
5. CONTRIBUTION TO STRATEGIC PRIORITIES
The work in this report contributes to the COVID -19 response.
6. GOVERNANCE IMPLICATIONS
6.1 Financial Impact
Issues arising from financial constraints and strain on care homes at this time. 6.2 Staff Governance
Issues arising from HSCP staff mobilisation considerations.
6.3 Clinical Governance
Issues arising from HSCP staff mobilisation considerations.
7. PROFESSIONAL ADVISORY
Professional advisors are involved in many aspects of this work. 4 Page 161
8. EQUALITY & DIVERSITY IMPLICATIONS
We need to ensure that older adults are treated with the same level of assurance as the rest of the population. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE
N/A.
10. RISK ASSESSMENT
N/A
11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT
N/A
12. CONCLUSIONS
This report has summarised both the Enhanced Care Home Assurance requirements and the processes in place to support older adults in care homes. Given that COVID -19 will come in waves, there will have to be sustainability in the approaches outlined including managing workforce across organisations; support for staff; virtual visiting, clinical interventions. The Care Home Task Force has been welcomed as a co- production approach working with homes.
With a high projection of deaths in care homes worldwide, our role has to be to do everything we can to both prevent COVID -19 in care homes and support residents, families, care homes and staff of those care homes affected.
There are some very real national considerations about the early approach of isolation and impact on leaving care homes to manage these risks. Finally, the very sustainability of care homes is at stake and further work is required on care home provision for older adults.
13. DIRECTIONS
Directions to: tick
Directions No Directions required x required to Argyll & Bute Council Council, NHS Board or NHS Highland Health Board both. Argyll & Bute Council and NHS Highland Health Board
REPORT AUTHOR AND CONTACT
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Author Name: Caroline Cherry, Email: [email protected]
Appendix 1
Health Performance and Delivery Directorate Chief Performance Officer, NHSScotland and Director of Delivery and Resilience
T: 0131-244 2480 E: [email protected]
To: Health Board Chief Executives cc: Directors of Public Health Chief Officers, HSCPs Chief Executives of LA’s
20th April 2020
Dear Colleague,
CARE HOMES: ENHANCED SYSTEM OF ASSURANCE - RESIDENTS & STAFF
On 17 April, the Chief Executive of NHS Scotland wrote to you to request that your Health Board take immediate action to deliver an enhanced system of assurance around the safety and wellbeing of care home residents and staff in response to the COVID -19 emergency. I know that your Directors of Public Health will already be taking forward this work but wanted to further outline our immediate expectations.
Firstly, Boards should undertake an initial assessment of every care home in your area, either by telephone or direct visit by 24 April, against the criteria from the above referenced letter:
a) knowledge and implementation of infection prevention and control measures; b) knowledge and observance of social distancing measures, both for staff and residents; c) staffing levels at all times and for all functions; d) availability and quality of training for all staff in particular on infection control and the safe use of PPE; and e) the effective use of testing.
Secondly, Boards should undertake a programme of associated visits to each local care home on a risk prioritised basis, as informed by the assessments carried out under the initial request. These visits should be carried out as quickly as practicable, drawing upon all the appropriate resources in your Board. I would be grateful if you could provide your outline, initial programme of visits by 24 April. Thereafter, I would expect weekly updates on the local programme.
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Thirdly, on testing, I recognise that considerable work has gone into providing access to testing for health and social care workers, or people in their households that are isolating; and where a negative test can support their return to work. I would be grateful if you could also provide assurance in the response by 24 April that, within your area, there is: a robust pathway for workers, or people in their households, to testing with a single point of access; and that has been clearly communicated to all employers in social care; both within the care home setting and employers providing care at home.
It will of course be important to work closely with relevant partners including HSCPs and the Care Inspectorate.
Finally, you will want to be aware that Elinor Mitchell last week asked Chief Officers to submit their local HSCP plan for supporting care homes in their areas. A summary report of the submissions from your Partnership/s will be forwarded separately.
Notwithstanding the request to undertake the above actions by 24 April, I would be grateful if you could provide confirmation that you can carry these out by return; and no later than close of play on 23 April.
Should you have any questions about this request, please get in touch.
Yours sincerely
JOHN CONNAGHAN CBE Chief Performance Officer, NHS Scotland and Director of Delivery and Resilience
7 Page 164 Appendix 2 Argyll & Bute Care Home Name CARE HOME AUDIT – SELF-ASSESSMENT QUESTIONNAIRE YES NO UNSURE Do you have a COVID -19 plan (which includes all the issues addressed in this questionnaire)? BUSINESS CONTINUITY ARRANGEMENTS Do you have a business continuity plan to deal with sudden staff shortages? Could you advise what these are Are you able to access additional staff if you have staffing shortages, without pulling in staff working in other care settings? INFECTION PREVENTION AND CONTROL Do all staff members in your care home have a good understanding of the characteristics of COVID -19 (e.g. routes of transmission, incubation period, symptoms)? Could you advise what you believe these to be Do all staff members in your care home have a good understanding of the principles of infection prevention and control? Do all staff members in your care home have the necessary practical skills to practice effective hand hygiene, cough etiquette, use of PPE (e.g. donning and doffing, gloves, apron , eye protection, mask), waste and linen management, and environmental cleaning? How can you evidence this Is your care home able to obtain the necessary PPE and other materials required to care for residents with suspected COVID -19 infection? Have you implemented social distancing within the care home for residents and staff? Please give examples What specific support would you like for infection prevention and control going forwards? E.g. STAFF EDUCATION AND TRAINING Are your staff able to access education about the . characteristics of COVID -19 (e.g. routes of transmission, incubation period, symptoms)? Are your staff able to access education and training in infection prevention and control? Are your staff able to access practical skills training in effective hand hygiene, cough etiquette, use of PPE (e.g. donning and doffing, gloves, apron, eye protection and mask), waste and linen management, and environmental cleaning? What are you accessing for the above 3 training areas – can you give examples of things that have been useful? E.g. NES website What specific education or training would help you at this time? 8 Page 165
PATHWAYS TO HEALTHCARE AND TESTING Can all staff members in your care home identify the symptoms of possible COVID -19 infection in your residents? Please ask 5 staff members prior to your expected call Do you and your staff know how to contact primary care in the event of illness in one or more of your residents? Do you and your staff know how to obtain diagnostic testing for your residents? Do you and your staff know what to do once you are informed of test results? Request explanation SUPPORT ARRANGEMENTS Do you have a proven way to obtain support or assistance from your local health and social care partnership? Do you know how to contact NHS Highland health protection team or relevant Infection Prevention and control nurse? CASE, CLUSTER AND OUTBREAK REPORTING Do you always report single cases of fever, new continuous cough, pneumonia, or influenza like illness to your NHS health protection team /Infection Prevention and Control Nurse? Do you always report clusters of fever, new continuous cough, pneumonia, or influenza like illness to your NHS health protection team/Infection Prevention and Control Nurse (two or more possible cases within 14 days)? Do you always report outbreaks of COVID -19 to your NHS health protection team/Infection Prevention and Control nurse (two or more clinically or laboratory confirmed cases within 14 days)? Do you report outbreaks/clusters of residents with non-specific symptoms? E.g. lethargy, diarrhea, increased confusion OUTBREAK MANAGEMENT Do you have daily contact with your NHS health protection team/Infection Prevention and control nurse when you have a cluster or outbreak of possible or confirmed COVID -19? Do you know how you will isolate residents with COVID -19? Do you know how you will cohort residents with COVID -19? Do you know how you will cohort members of staff who are caring for residents with COVID -19? Please give an example VISITOR AND STAFF MANAGEMENT Are you restricting access to prevent non-essential visitors? If visitors do require to visit are they provided with PPE, instructions on its use and strict instructions on 9 Page 166 where they are allowed to go within the care home? Are you minimising your use of agency staff? Are you minimising use of staff who are working in different care homes or across different care settings? Are you minimising staff rotation between different units or wings in your care home? Are staff maintaining social distancing during nursing report and breaks STAFF SICKNESS AND ABSENCE POLICY Are you ensuring that staff do not come to work if they have symptoms of fever, new continuous cough, or influenza-like-illness and understand to self-isolate for 7 days? Are you ensuring that staff who have household members who have symptoms of fever, new continuous cough, or influenza-like-symptoms do not come to work while they remain in household isolation for 14 days? Do you know how to advise your staff on obtaining keyworker testing? Do you know where to seek advice in relation to negative and positive results? STAFF SUPPORT Are you and your staff being supported with their own physical and mental health and wellbeing? What support would be of help to you to deal with COVID -19? E.g.: Staff debrief either at the end or every few months – lead by external professionals QUALITY ASSURANCE AND QUALITY IMPROVEMENT Do you routinely use quality improvement methods to assure quality of care, such as clinical audits or PDSA cycles? E.g. examples Is there anything else you wish to raise? E.g.
Thank you for completing this questionnaire
Please return to:
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Appendix 3
Argyll and Bute HSCP and Care Homes Joint Care Home Task Force COVID -19
Chair-Caroline Cherry, Head of Service, Older Adults and Community Hospitals Vice Chair: Care Home Representative Fortnightly meeting by Skype (with agreed actions in between meetings)
Remit: Strategically co-ordinate support to Care Homes by the Health and Social Care Partnership during COVID -19 Ensure there is a strong partnership approach to every aspect of our COVID -19 response Take national guidance, discuss and disseminate offering training where required Formulation of more robust admission protocols needed for transfers of patients from Hospital to Care Homes (to include discussion on isolation and testing pre admission) A clinical discussion on the care strategy for treating COVID -19 positive residents in their Care Home Discuss rapid reaction multi-disciplinary crisis response teams to assist Care Homes with Suspected or Positive Cases Discuss clinical guidance and its implementation throughout care homes- including palliative care Listen to care homes, their experience of COVID -19 and work together to improve the safety and well-being of residents and staff bringing in HSCP staff for advice and support Discuss and look at morale within and across care homes Feed back to Silver Command issues that need escalated Discuss Public Health guidance and its impact-for example guidance on testing of staff Ensure Champions of PPE work with care homes to protect staff Ensure Care Homes are involved and included in the strategic decision making of the HSCP with reference to the response to COVID -19 Oversight of financial sustainability of care homes Members: HSCP Head of Service Older Adults Care Home Representatives Scottish Care Care Inspectorate Public Health NHS Care Home Education Staff Clinical Lead-Key Link Pharmacy Link Primary Care Link Commissioning Link Locality Manager Representative 11 Page 168
Infection Control Nurse District Nursing Input PPE support links Finance Feedback from carers and residents on developments/issues
12 Page 169 Agenda Item 11a
Integration Joint Board Agenda item:
Date of Meeting: 27 May 2020
Title of Report: Budget Monitoring as at 31 March 2020
Presented by: Judy Orr, Head of Finance and Transformation
The Integration Joint Board is asked to: Note the outturn position for 2019-20 is an overspend of £2.446m as at 31 March 2020 which includes a provision of £1.324m for the on-going dispute with NHS Greater Glasgow & Clyde. Excluding this, the outturn would have been an overspend of £1.122m.
Note the repayment arrangements for the overspend described at 3.6.
Approve the new earmarked reserves set out at 3.5.2.
Instruct the Chief Officer to bring back further information on the negotiations within NHS GG&C for Board approval, noting the delegated powers agreed on 25 March 2020.
1. EXECUTIVE SUMMARY
1.1 This report provides a summary of the financial position of the Health and Social Care Partnership as at 31 March 2020.
1.2 There is a full year overspend of £2.446m as at 31 March 2020. This consists of an overspend of £1.166m within Social Work delivered services and an overspend of £1.280m within Health. The position has deteriorated by £1.134m in the month which relates mainly to the need to make a year- end provision of £1.324m for the ongoing dispute with NHS Greater Glasgow & Clyde. Without this provision, the position would have improved by £190k. Most of the improvement was on Social Work.
1.3 NHS Highland have received brokerage from the Scottish Government which requires to be repaid from 2022/23 at the earliest, but the detail of this is unlikely to be negotiated until next year. The overspend on Social Work related services requires to be repaid to Argyll and Bute Council and repayment arrangements are in place for both the 2017-18 and 2018-19 overspends over financial years 2020-21 to 2023-24. The 2019/20 overspend is likely to be repaid in 2024/25.
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1.4 New earmarked reserves have been created at the end of 2019-20 within NHS Highland totalling £555,018 – details set out at 3.5.2.
2. INTRODUCTION
2.1 This report provides information on the financial position of the Health and Social Care Partnership as at the end of financial year 2019-20.
3. DETAIL OF REPORT
3.1 Summary of Final Outturn Position
3.1.1 The forecast outturn position as at the end of February, reported verbally to the IJB on 25 March 2020 and by written report to Finance & Policy Committee on 27 March 2020, was a forecast overspend of £1.312m, made up of an underspend of £21k for Health related services (excluding any provision for the ongoing dispute with NHS GG&C) and £1.333m for Social Work related services.
3.1.2 The final year end position is an overspend of £2.446m, made up of an overspend of £1.280m for Health related services and £1.166m for Social Work related services. This final position is a deterioration of £1.134m since the February position which relates mainly to the need to make a year-end provision of £1.324m for the ongoing dispute with NHS Greater Glasgow & Clyde. Without this provision, the position would have improved by £190k. Most of the improvement was on Social Work, reversing much of the deterioration between January and February.
3.1.3 The movements for Social Work is described at 3.3.1 below. The overspends are mainly on Adult Services - Older People Care Home placements, Learning Disability Joint Residential and Supported Living, and Physical Disability Residential and Supported Living arising due to service demand and a failure to deliver planned savings.
3.2 Outturn – Health
3.2.1 Within Health, apart from the need to make a provision for the ongoing dispute with NHS GG&C of £1.324m, there is a slight improvement of £23k change from the underspend of £21k reported at the end of February. Including the provision for the dispute (which was previously kept outwith the forecast outturn) the deterioration is £1.301m. 3.2.2 There are a number of significant cost pressures that are being absorbed within the overall financial position. The main ones are:
Mull GP services - £668k overspent due to extensive reliance on GP locums Psychiatric medical services - £603k overspent due to reliance on locums LIH general medical services - £308k overspent due to locums and loss of income from NES Cost per case charges from NHSGG&C - £239k overspent, of which £181k relates to cystic fybrosis drugs
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Charges from other HBs (excl. GG&C) - £178k over, of which £117k relates to one patient in New Craigs and Fife LIH Laboratory - £136k over due to agency staffing and increased biochemistry service costs GP prescribing, Campbeltown Practice - £123k over due to new medications and high cost patients Rothesay Victoria Hospital Nursing - £112k over due to extensive sickness absence cover LIH Ward B - £106k overspent due to extensive use of agency nurses (£273k spend on agency nurses) Campbeltown Hospital Nursing - £102k over due to extensive use of agency and bank nurses Kintyre Medical Group - £92k over due to use of locum GPs GP Prescribing, Millig Practice Helensburgh - £84k over due to not reviewing prescribing practice
More detail is given at Appendix 1.
3.3 Outturn – Social Work
3.3.1 The outturn position for Social Work for 2019-20 is an overspend of £1.166m which is an improvement of £167k from the position reported at end of February, fulling reversing the deterioration in February. The changes have largely been in the following main areas: Chief officer – due to increase in budget due to £107k being transferred for vacancy savings; Learning Disability overspend reduced by £214k mainly due to raising recharges to Health for shared cases; Older people overspend increased by £116k mainly on home care (some inaccurate previous forecasting) and care homes (staffing costs and lower income than expected); Physical Disability – overspend reduced by £80k mainly due to Integrated Equipment Store year end adjustment following stock take.
3.3.2 The overspends are mainly on Adult Services - Older People Care Home placements(£486k) and Older People Other costs (£281k), Learning Disability Joint Residential (£727k) and Supported Living (£568k), and Physical Disability Residential (£214k) and Supported Living (£486k) arising due to service demand and a failure to deliver planned savings.
3.3.3 Children and Families overall has an outturn overspend of £88k (improved by £57k) driven mainly by an overspend on Looked After Children in residential placements of £505k offset by underspends on Fostering, Child Protection and Criminal Justice. In addition the management restructure saving of £150,000 has not yet been delivered as the new structure will only be implemented from July 2020.
3.3.4 Chief Officer forecast positive variance has increased by £107k to £679k mainly due to an increase in vacant payroll budgets now skimmed centrally.
3.3.5 The biggest single area of Social Work overspend continues to be on Learning Disability (£1.133m) where there has been a failure to deliver
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anticipated savings so far, along with higher than budgeted demand. This has improved this month by £214k.
3.3.6 The next largest area of forecast overspend is Physical Disability at £598k, mostly on supported living and this is improved since last month by £80k.
3.3.7 Further information is provided within Appendix 2.
3.4 Savings Delivery
3.4.1 As at end of March, £7.665m of the target £10.877m savings have been delivered, 70% of the total – this includes £1.080m non-recurring savings. This has increased by £598k since last reported at end of February. Further information is provided at Appendix 2.
3.4.2 The outturn shortfall for Social Work is £3.212m. This has increased by £127k from £3.085m at the end of February. The increase in shortfall is due to the difficulty in declaring actual savings made on homecare against the individual savings lines.
3.4.3 The outturn shortfall for Health of £1.080m was fully offset by non-recurring savings many of which relate at least in part but where the saving cannot yet be regarded as recurring. The Health savings are being tracked through the Project Management Office approach co-ordinated by NHS Highland which includes greater visibility of progress against agreed milestones. This approach is now rolled out to Social Work savings through the Finance team. The regular meetings to review the savings have been paused in March due to work on the Covid response but are planned to restart in late May.
3.4.4 An updated action tracker against the savings has not been presented as all progress effectively stopped due to the Covid-19 pandemic as at the date of the last update presented as at 31 March.
3.4.5 It is clear that the failure to deliver on all savings (overall shortfall of £3.212m) is the key driver in the outturn overspend of £2.446m (apart from the dispute with NHS GG&C). As nearly all these savings are being carried forward to next year, it is imperative that efforts to deliver the previously agreed savings are continued. Although we now have permanent heads of service in post across all areas which will assist, efforts are now being hampered by the need to prioritise responses to Covid-19 pandemic. Where we can, we will ensure that actions for Covid-19 are aligned and capitalised on such as increasing use of Near Me.
3.5 Reserves
3.5.1 The only reserve brought forward continues to be the £50,000 for supporting the move from Analogue to Digital for 200 telecare service users. This requires to be carried forward into the new financial year. The previous reserve for the Primary Care Improvement Fund was fully utilised during the year.
NHS Highland has been requested to create the following new earmarked reserves, all of which are in respect of specific monies received but not yet
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3.5.2 spent for this purposes:
Name £ Comment Primary Care Improvement Fund 102,616 Underspend on SG specific grant Action 15 Mental Health Strategy 123,418 Underspend on SG specific grant Alcohol & Drugs Partnership 59,517 Underspend on SG specific grant GP Fellowship MH Funding 74,000 12 months fellowship TEC funding 50,902 Rec’d Sep 2019 Supporting improvements to GP 55,565 Rec’d Sep 2019 premises Best Start maternity services 60,000 New SGHD allocation Scotgem Lochgilphead 10,000 NES funding for accommodation upgrade ACT widen access 19-20 10,000 NES funding for Oban TOTAL £555,018
In all the above cases, there is a clear expectation from the funder that these monies should only be used for the specified purposes and returns on spend 3.5.3 require to be made. These funds cannot therefore be released to reduce the year end deficit.
If the new earmarkings are approved, this would increase the earmarked reserves from £50k to £605k. 3.5.4 The IJB has a reserves policy. In addition to earmarked reserves, the IJB should seek to hold reserves to build up a contingency to cushion the impact 3.5.5 of unexpected events or emergencies. The Reserves Policy suggests a prudent level of general reserve be set at 2% of the IJB net revenue budget, this would equate to around £5.5m. The 2% is in line with the position taken by a number of Integration Joint Boards facing similar strategic, operational and financial risks as Argyll and Bute and is also in line with the Council reserves policy. Currently this target is aspirational and should be viewed as an optimum level of reserves to be built up over time, recognising the tensions between prudent financial planning and budgetary constraints.
3.6 Repayment of Additional Funding from Partners
3.6.1 NHS Highland have received brokerage from the Scottish Government that covers the health overspend in 2017-18 and 2018-19 and includes the Health related services within the Health and Social Care Partnership. The brokerage is not required to be repaid and therefore the overspend on Health related services for these years has effectively been written off. However it is expected that the brokerage for 2019-20 will require to be repaid possibly from 2022/23 at the earliest. The detail of the repayment is unlikely to be negotiated until next year. However if the dispute with NHS GG&C were to be settled in our favour, this could remove the requirement for such a repayment to NHS Highland.
The overspend on Social Work services in 2017-18 and 2018-19 still 5 Page 174
3.6.2 requires to be paid back, as does the overspend for 2019-20. The Council’s Business Continuity Committee is to consider the repayment profile at its meeting in May 2020 when the 2019/20 overspend will be confirmed. The Council also agreed that “in the event of the HSCP underspending in 2020/21 or any future years, the Council will seek earlier repayment of outstanding debts. Notes that the level of future years funding is subject to the level of Scottish Government funding and the Council’s overall financial position in future years.”
The expected new repayment schedule is presented below: 3.6.3 Repayment Repayment Repayment Total Status 2017-18 2018-19 2019-20 Repayment Overspend Overspend Estimated £000 £000 £000 Overspend £000 2020-21 500 0 0 500 agreed 2021-22 655 545 0 1,200 indicative 2022-23 0 1,255 0 1,255 indicative 2023-24 0 1,327 0 1,327 Not yet agreed 2024-25 0 0 1,165 1,165 Not yet agreed Total 1,155 3,127 1,165 5,447
4. RELEVANT DATA AND INDICATORS
4.1 Information is derived from the financial systems of Argyll and Bute Council and NHS Highland.
5. CONTRIBUTION TO STRATEGIC PRIORITIES
5.1 The Integrated Joint Board has a responsibility to set a budget which is aligned to the delivery of the Strategic Plan and to ensure the financial decisions are in line with priorities and promote quality service delivery. This needs to be considered when options are developed to balance the budget.
6. GOVERNANCE IMPLICATIONS
6.1 Financial Impact – The outturn position for 2019-20 was an overspend of £2.446m as at the year end. The overspend requires to be repaid to the parent bodies as outlined in the report. If the ongoing dispute with NHS GG&C is settled, this may reduce the overspend.
6.2 Staff Governance – None directly from this report but there is a strong link between HR and delivering financial balance.
6.3 Clinical Governance - None
7. PROFESSIONAL ADVISORY
7.1 Professional Leads have been consulted on implications of all savings.
8. EQUALITY AND DIVERSITY IMPLICATIONS
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8.1 None directly from this report but any proposals to address the estimated budget gap will need to consider equalities.
9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE
9.1 No issues arising directly from this report.
10. RISK ASSESSMENT
10.1 It has been reported throughout the year that there was a risk to not achieving financial balance in 2019-20 and the dispute with NHS GG&C was regularly reported.
10.2 The other significant risk is the effort now being prioritised on the Covid-19 response which has removed focus from delivery of savings, at least in the short term. The impact of this will be felt more in the next financial year. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT
11.1 None directly from this report but any proposals to address the estimated budget gap will need to take into consideration local stakeholder and community engagement.
12. CONCLUSIONS
12.1 This report provides a summary of the financial position of the Health and Social Care Partnership budget as at the end of financial year 2019-20. The final year end position is an overspend of £2.446m, made up of an overspend of £1.280m for Health related services and £1.166m for Social Work related services. The outturn includes provision for new earmarkings totalling £555k.
12.2 The overspend requires to be repaid to the parent bodies as set out in the detail of the report.
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 Judy Orr, Head of Finance & Transformation [email protected]
APPENDICES: Appendix 1 – Final Outturn as at 31 March 2020 Appendix 2 – Savings achieved as at 31 March 2020
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8 ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 2
REVENUE BUDGET MONITORING OUTTURN - AS AT 31 MARCH 2020
Reporting Criteria: +/- £50k or +/- 10%
Service Annual Budget Outturn Variance % Explanation £000 £000 £000 Variance
COUNCIL SERVICES: The underspend arises due to the over recovery of vacancy savings (£730k) and surplus funding for Frank's Law held centrally (£373k), partially offset by slippage on agreed savings (£277k), provision for bad debts (£80k) and overspends on central repairs, recruitment costs Chief Officer 1,477 798 679 46.0% and computer software. The annual budget has increased compared to February due to £107k of unused payroll budgets being transferred for vacancy savings.
The forecast overspend arises mainly due to slippage on agreed savings (£150k) and an unbudgeted SIO post being covered by vacancies in Children with a Disability and Criminal Children and Families Central Management Costs 2,285 2,399 (114) (5.0%) Justice. This is partially offset by a surplus in funds set aside to meet the cost of new overnight working arrangements in the children's homes and school hostels.
3,347 3,067 280 8.4% The forecast underspend arises mainly due to lower than anticipated service demand for Child Protection contact and welfare services and underspends on staff costs and related staff travel expenses in the area teams. The forecast underspend arises due to staffing vacancies and underspends on third sector
Children with a Disability 859 800 59 6.9% grants and services partially offset by slippage on agreed efficiency savings (£23k). Page 177
The forecast underspend arises due to staff vacancies and related reduced staff travel Criminal Justice 151 (36) 187 123.8% expenses as well as underspends on computer software and stationery partially offset by agency staff costs. The forecast overspend arises due to service demand for external residential placements, overspends on the Life Changes Trust project, overspends on staffing costs within children's Looked After Children 6,875 7,375 (500) (7.3%) homes and slippage on agreed savings in residential placements (£200k) partially offset by underspends in fostering arising due to lower than budgeted service demand.
Adult Services Central Management Costs 440 403 37 8.4% Outwith reporting criteria. The overspend reflects higher than budgeted demand for services and slippage on agreed savings (£813k) in supported living and residential placements partially offset by underspends on day services and respite. The outturn is better than expected due to Learning Disability 9,904 11,037 (1,133) (11.4%) increased income and lower than expected spend in the HSCP's resource centres. These are partially offset by deteriorations in care home placement costs and utility costs.
The forecast underspend arises due to lower than budgeted demand for residential care and community support services, an underspend on assessment and care management staffing and underspends accross the integrated addiction service. This is partially offset by higher than budgeted demand for supported living services and agency expenditure in the Mental Health 1,905 1,680 225 11.8% assessment and care management team. The main cause for the increase in forecast underspend this month is due to income from 18/19 within the integrated addiction service being received in this financial year which was not accrued for last year end (43k). Service Annual Budget Outturn Variance % Explanation £000 £000 £000 Variance
The overspend reflects higher than budgeted demand for care home placements and slippage on agreed savings (£640k) offset by higher than expected income from fees and charges in Telecare, the recovery of unused Direct Payment funds from clients and underspends on progressive care and respite. The main causes for the deterioration in the outturn compared to the forecast are due to higher than expected costs in homecare and a Older People 29,476 29,767 (291) (1.0%) combination of higher staff costs and lower income in the HSCP care homes. These are partially offset by lower than planned spend on assessment and care management staffing and travel costs, support for carers equipment and staffing costs, respite and telecare.
The overspend reflects higher than budgeted demand for service in supported living and residential placements and slippage on agreed savings (£28k). This is partially offset by an underspend in respite and payments to other bodies in sensory impairment which reflects the service spending plan. The improvement in the outturn is mainly due to the lower than Physical Disability 1,542 2,140 (598) (38.8%) forecast spend within the integrated equipment service (IES) and the year end adjustment to transfer the value of stock to the balance sheet following the year end IES stock take, lower than expected spend on respite and a combination of lower spending and increased income to the supported living budget.
Service Development 412 409 3 0.7% Outwith reporting criteria. COUNCIL SERVICES TOTAL 58,673 59,839 (1,166) (2.0%)
HEALTH SERVICES: Explanation
Savings not being achieved and several budget overspends, including; Mull Medical Page 178 Group - GP locums £668k, Psychiatric medical services - locums £603k, LIH General Medical Services - locums £308k, GP prescribing C'tn £123k , LIH Laboratory - Adult Services - West 54,702 56,314 (1,612) (2.9%) agency staffing £136k, LIH Ward B - agency nurses £106k, Kintyre Medical Group - GP locums £92k, Campbeltown Hospital nursing £102k, and Jura out of hours GP service Adult Services - East 30,237 30,230 7 0.0% Outwith reporting criteria. Children & Families Services 7,257 7,031 226 3.2% Mainly due to vacancies NHS GG&C disputed element of SLA accounted for as per NHS accounting rules, Commissioned Services - NHS GG&C 65,457 66,925 (1,468) (2.2%) £1.324m. Balance of variance relates to cost per case charges, mainly cystic fibrosis drug costs Charges relating to one patient who received treatment in New Craigs and now at a Commissioned Services - Other 3,929 4,044 (115) (2.8%) low secure unit in NHS Fife General Medical Services 17,720 17,409 311 1.8% Prior year non-recurring rates rebates & changes in payments for enhanced services Community and Salaried Dental Services 3,793 3,493 300 8.6% Mainly due to vacancies Other Primary Care Services 9,406 9,406 0 0.0% Outwith reporting criteria. Public Health 1,812 1,656 156 9.4% Vacancies and slippage on in year allocations Lead Nurse 1,516 1,433 83 5.8% Vacancies Management Service 3,230 3,089 141 4.6% Non-recurring prescribing rebate and vacancies Planning & Performance 2,190 2,144 46 2.1% Outwith reporting criteria. Depreciation 2,516 2,494 22 0.9% Outwith reporting criteria. Income (1,533) (1,920) 387 20.2% Revised tariffs implemented for 19/20, 2 long stay mental health inpatients Estates 5,322 5,501 (179) (3.3%) Settlement payments, salary arrears and water leak at A&B Hospital site People & Change 578 590 (12) (2.0%) Outwith reporting criteria. Budget Reserves 427 0 427 Uncommitted budget reserves HEALTH SERVICES TOTAL 208,559 209,839 (1,280) (0.6%)
GRAND TOTAL 267,232 269,678 (2,446) (0.9%) ARGYLL & BUTE SOCIAL WORK SAVINGS PLAN 2019/20 Year to 31 Mar 2020 Target Achieved Unachieved % Ref. Savings Description Manager £' 000 £' 000 £' 000 Achieved 1819-7 Thomson Court Jane Williams 10 0 10 0% 1819-8 Assessment and Care Management Caroline Cherry 42 0 42 0% 1819-14 Pamela Hoey Redesign of Internal and External Childrens Residential Placements 200 0 200 0% 1819-15 Children and Families Management Structure Alex Taylor 150 0 150 0% 1819-17 Alex Taylor School Hostels review of Catering, Cleaning and Income Generation 60 60 0 100% 1819-19 Review and Redesign of Physical Disability Services Jim Littlejohn 28 0 28 0% 1819-19 Review and Redesign of Learning Disability Services - Sleepovers Jim Littlejohn and Technology Argyll Wide 299 0 299 0% 1819-19 Review and Redesign of Learning Disability Services - Packages of Alison McKerracher Care Cowal 125 0 125 0% 1819-19 Review and Redesign of Learning Disability Services - Packages of Linda Skrastin Care Helensburgh 152 0 152 0% 1819-19 Review and Redesign of Learning Disability Resource Centres Jim Littlejohn/Donald Watt 36 36 0 100% 1819-19 Review and Redesign of Learning Disability Rothesay Resource Jane Williams Centre 14 0 14 0% Page 179 1819-19 Review and Redesign of Learning Disability Assist Cowal Resource Jayne Lawrence Winch Centre 30 0 30 0% 1819-19 Review of Ext Residential Learning Disability Placements Jim Littlejohn 194 0 194 0% 1819-22 Adult Care West - Restructure of Neighbourhood Teams (SW & Caroline Cherry Health) 250 0 250 0% 1819-25 Older People Day/Resource Centre - Address high levels of Caroline Cherry management - consolidate opening hours - shared resource 212 0 212 0% 1819-31 Alex Taylor/ Kirsteen Larkin Integrate HSCP Admin, digital Tech and Central Appoint System 125 21 104 17% 1819-33 Alex / Jayne Jones / Catering, Cleaning and other Ancillary Services Caroline Cherry 100 30 70 30% 1819-40 SLA and Grants operate within allocation Alex Taylor 23 0 23 0% 1819-41 Criminal Justice - Manage Service within SG Grant Allocation Shona Williams 20 20 0 100% 1819-42 Contract Management reducing payments to Commissioned External Stephen Whiston providers 33 0 33 0% 1819-45 Review Care Management - consistent application of Priority of Need Jim Littlejohn/Donald Watt Framework 107 107 0 100% 1819-46 Adopt a Single Community Team Approach to undertaking Caroline Cherry Assessment and Care Management 120 0 120 0% 1819-47 Withdrawal of Lunch Club and Meals on Wheels David Forshaw 31 31 0 100% 1819-49 Amend Non-Residential Charging Policy Jim Littlejohn 113 113 0 100% 1920-10 Increase Workforce Vacancy Savings David Forshaw 156 156 0 100% 1920-13 Right-size External Care Home Budget Jim Littlejohn 400 400 0 100% 1920-14 Amend Charging Order Income Budget David Forshaw 120 120 0 100% 1920-15 Mark Lines Right-size Children & Families Budgets in line with tighter control CRP 100 100 0 100% 1920-16 Criminal Justice - Manage Service within SG Grant Allocation Shona Williams 20 20 0 100% 1920-18 Right-size Non-Residential Income Budgets David Forshaw 160 160 0 100% Year to 31 Mar 2020 Target Achieved Unachieved % Ref. Savings Description Manager £' 000 £' 000 £' 000 Achieved 1920-19 Right-size budget for external care home placements (mental health) Jim Littlejohn/Donald Watt – in line with spend. 154 154 0 100% 1920-20 Recovery of unused funds from clients who receive Direct Payments. David Forshaw
40 40 0 100% 1920-21 Right-size income budget for clients in residential homes. David Forshaw 29 29 0 100% 1920-33 Review of management structure Joanna Macdonald 102 0 102 0% 1920-37 Permanently close the moth-balled dementia day service based at Donald Watt Ardfenaig Bungalow, Ardrishaig. Dementia Day Services. 71 71 0 100% 1920-40 Implement best practice approaches for care at home and re- Linda Currie / Caroline ablement across all areas following Bute pilot Cherry 300 0 300 0% 1920-41 Extend use of external home care transferring hours as gaps occur Donald Watt 33 0 33 0% 1920-42 Step up/step down of care to be suspended except for exceptional Judy Orr cases 227 0 227 0% 1920-43 Cap on overtime Donald Watt / Morven Gemmill 87 0 87 0% 1920-44 Reduction on adult services social work travel Jim Littlejohn/ Donald Watt 25 0 25 0% Page 180 1920-45 Planned changes in staffing for Bowman Court in line with Lorne Morven Gemmill / George Campbell Court structure Morrison 28 0 28 0% 1920-46 Cap on Care Home placements equivalent to £30,000p.a. LMs / HoS 160 0 160 0% 1920-47 Review of lower priority (P3 and below) cases to ensure appropriate LAMs and in line with best practice 170 0 170 0% 1920-48 Reinforcement of guidelines on self-directed support (SDS) direct LAMs payment packages and limit to appropriate standard hourly rates 15 0 15 0% 1920-49 Reduction of overtimes being worked in internal home care LAMs 4 0 4 0% 1920-50 Review provision of respite flat at Jura Progressive Care Centre Donald Watt 5 0 5 0%
Totals 4,880 1,668 3,212 34% New savings approved by IJB on 7 August 2019 added 1920-40 onwards
ARGYLL & BUTE HEALTH SAVINGS PLAN 2019/20 Year to 31 Mar 2020 Target Achieved Unachieved % Ref. Savings Description Manager £' 000 £' 000 £' 000 Achieved
1819-4 Closure of West House / Argyll & Bute Hospital site David Ross 120 100 20 83% 1819-5 Closure of Aros (running costs) David Ross/ Charlotte Craig 40 0 40 0% 1819-10 Medical Physics department - HAU109 Caroline Henderson 2 2 0 100% 1819-16 Children & Families services staffing Alex Taylor 50 0 50 0% 1819-30 Admin pays - Lochgilphead Donald Watt 5 34 -29 680% 1819-32 Domestic services - Argyll & Bute wide Caroline Cherry 25 25 0 100% 1819-32 Portering services - Argyll & Bute wide Caroline Cherry 5 5 0 100% 1819-44 Advanced Nurse Practitioners - Oban Caroline Henderson 14 0 14 0% 1819-48 Value Management Structure for AHPs Linda Currie 10 10 0 100% 1819-53 Vehicle Fleet Services Stephen Whiston 40 22 18 55% Year to 31 Mar 2020 Target Achieved Unachieved % Ref. Savings Description Manager £' 000 £' 000 £' 000 Achieved 1819-54 OLI efficiency target - 1% target Lorraine Paterson 11 11 0 100% 1819-55 Lead Nurse Liz Higgins 5 5 0 100% Reduction to Investment Fund - 247 247 0 100% 1920-0 Complex care packages funded via NHS Highland Liz Higgins 400 400 0 100% 1920-1 Provision of drugs for Hepatitis C (GGC) Stephen Whiston 40 40 0 100% 1920-2 Income from patients services etc Stephen Whiston 100 200 -100 200% 1920-3 Health Promotion Discretionary Budgets Alison McGrory 100 46 54 46% 1920-4 Review of Service Contracts Stephen Whiston 100 14 86 14% 1920-5 Flight costs for Tiree patients attending appointments Morven Gemmill 100 100 0 100% 1920-6 Ferry ticket costs for staff and patients George Morrison 25 0 25 0% 1920-7 Accommodation and subsistence costs for staff George Morrison 50 50 0 100% 1920-8 GP Prescribing Fiona Thomson 500 500 0 100% 1920-9 Workforce vacancy savings George Morrison 750 750 0 100% 1920-11 Slippage on SG in-year allocations and budget reserves George Morrison 1,000 1,000 0 100% £598k achieved M12 1920-12 Remove reprovision reserve George Morrison 500 500 0 100% 1920-17 Knapdale Ward Donald Watt 115 115 0 100% 1920-22 Dunoon Medical Services Rebecca Heliwell 100 0 100 0% 1920-30 Alcohol and Drugs Partnership Funding Sandra Cairney 138 138 0 100% 1920-31 Review of SLAs with GGC Stephen Whiston 345 55 290 16% 1920-32 Review of management structure Joanna MacDonald 200 0 200 0% 1920-34a Integrated Care Fund - OLI Lorraine Paterson 23 23 0 100% 1920-34b Integrated Care Fund - MAKI Donald Watt 25 25 0 100% Page 181 1920-34c Integrated Care Fund - C&B Alison McKerracher 28 28 0 100% 1920-34d Integrated Care Fund - H&L Jim Littlejohn 24 24 0 100% 1920-35 Bed reduction savings : Dunoon Alison McKerracher 150 0 150 0% 1920-36 Mental Health Bridging Funding - 300 300 0 100% 1920-38a LIH Theatre nurse staffing - HAK112 Caroline Henderson 60 22 38 37% Caroline Henderson / 1920-38b Lorn & Islands Hospital staffing George Morrison 200 76 124 38% 1920-39 Learning Disabilities Nikki Gillespie 50 50 0 100% Totals 5,997 4,917 1,080 82%
Non-recurring savings - Health 1920-35 Bed reduction savings : Dunoon 0 120 -120 1920-3 Health Promotion Discretionary Budgets 0 54 -54 1920-9 Workforce vacancy savings 0 500 -500 1920-2 Income from patients services etc 0 206 -206 Rates rebates 0 200 -200 Non-recurring totals 0 1,080 -1,080
Health totals (net of non-recurring) 5,997 5,997 0
ARGYLL & BUTE HSCP TOTAL SAVINGS PLAN 2019/20 10,877 7,665 3,212 70% This page is intentionally left blank Page 183 Agenda Item 11b
Integration Joint Board Agenda item:
Date of Meeting: 27 May 2020
Title of Report: Budget Outlook 2021-22 to 2023-24
Presented by: Judy Orr, Head of Finance and Transformation
The Integration Joint Board is asked to: Consider the current estimated budget outlook report for the period 2021-22 to 2023-24.
1. EXECUTIVE SUMMARY
1.1 This report summarises the budget outlook covering the period 2020-21 to 2022-23 taking into consideration the budget decisions taken at the Integrated Joint Board (IJB) on 25 March 2020. The budget outlook presented to the IJB on that date has been rolled forward for a further year and the NHS Highland funding assumptions have been updated in line with the financial directions issued which reflect month 12 funding allocations.
1.2 The month 12 funding allocations from NHS Highland included a reduction in non-discretionary primary care services which is matched by an equivalent change in expected expenditure. The outturn for 2019/20 was an overspend of £1.280m, all wholely due to the dispute with NHS GG&C. This has not been paid over, but had to be accrued in accordance with NHS accounting rules. Although this will be covered through Scottish Government brokerage in the first instance, this will eventually require to be paid back to NHS Highland, but the timescale for that is unlikely to be agreed for another year so is not reflected in this outlook.
1.3 There have been no changes to the funding from the Council. We note that they plan to consider the repayment programme for previous years’ overspends at their next Policy & Resources Committee meeting. The outturn for 2019/20 was an overspend on social care of £1.165m, and this will require repayment to the Council in future years. The plan for this has not yet been agreed.
1.5 A number of minor changes have been to update the estimates for Council payroll inflation, non-pay inflation and for future cost and demand pressures through re-basing the calculations. None have been significant.
1.6 Some amendments have been made to the cost and demand pressures for
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Health. The growth in prescribing drugs has been increased, and additional allowances has been made for Microsoft licencing costs, new high cost care and some further refurbishment of Aros residences.
1.7 The usual best, mid-range and worst case scenarios are presented for the next three years. In the mid-range scenario, the Health and Social Care Partnership budget gap estimated over the three year period 2021-22 to 2023-24 is £18.193m with a gap of £6.613m in 2021-22.
1.8 In contrast, the budget gap in the best case scenario over the three years is £7.635m and in the worst case scenario, the budget gap over the three years is £31.262m. A summary of all three scenarios is included within Appendix 1.
1.9 The budget gap over 2020-21 to 2022-23 across each scenario is summarised in the table below:
Budget Gap 2021-22 2022-23 2023-24 Total £000 £000 £000 £000 Best Case 3,246 2,002 2,387 7,635 Mid-Range 6,613 5,515 6,065 18,193 Worst Case 10,992 9,835 10,434 31,262
2. INTRODUCTION
2.1 This report summarises the budget outlook covering the period 2021-22 to 2023-24. The outlook is based on three different scenarios, best case, worst case and mid-range. The detail of all three scenarios is provided at Appendix 1.
2.2 The updates include new funding estimates following month 12 funding allocations from NHS Highland and a review of inflation and post and demand pressures.
3. DETAIL OF REPORT
3.1 Funding Estimates
NHS Highland 3.1.1 The assumptions for funding from NHS Highland has been amended for 2021/22 to a 2.5% mid-range increase, now using the opening funding offer from NHS Highland for 2020/21. To this, we have added the expected allocations for Primary Medical Services and other recurring funding. The Other recurring funding figures are now based on allocations as at end of Month 12 which are matched by equivalent expenditure. For future years, the mid-range forecast still assumes a 2.5% uplift.
3.1.2 The table below outlines the updated estimated funding from NHS Highland over the next three years within the mid-range scenario. All figures have been updated and rolled forward for another year.
2021-22 2022-233 2023-24
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£000 £000 £000 Baseline funding 185,867 185,867 185,867 Baseline funding uplift (2.5%) 4,516 9,144 13,888 Other Recurring Funding 32,738 32,738 32,738 Resource Transfer baseline 7,057 7,057 7,057 Resource Transfer uplift (2.5%) 308 623 946 Total Funding NHS 230,486 235,429 240,496
Council Funding 3.1.3 The estimates for Council funding are rolled forward for another year but otherwise unchanged from the previous Budget Outlook. All scenarios now assume a flat cash position as per the settlement for 2020/21.
3.1.4 The Council’s Business Continuity Committee is to consider the repayment profile at its meeting in May 2020 when the 2019/20 overspend will be confirmed. The Council also agreed that “in the event of the HSCP underspending in 2020/21 or any future years, the Council will seek earlier repayment of outstanding debts. Notes that the level of future years funding is subject to the level of Scottish Government funding and the Council’s overall financial position in future years.”
3.1.5 The expected new repayment schedule is presented below:
Repayment Repayment Repayment Total Status 2017-18 2018-19 2019-20 Repayment Overspend Overspend Estimated £000 £000 £000 Overspend £000 2020-21 500 0 0 500 agreed 2021-22 655 545 0 1,200 indicative 2022-23 0 1,255 0 1,255 indicative 2023-24 0 1,327 0 1,327 Not yet agreed 2024-25 0 0 1,165 1,165 Not yet agreed Total 1,155 3,127 1,165 5,447
3.1.6 The table below outlines the funding from Argyll and Bute Council expected over the next three years.
2021-22 2022-23 2023-24 £000 £000 £000 Baseline funding 60,577 60,577 60,577 Total Funding Council 60,577 60,577 60,577 Less 2017-18 and 2018-19 (1,200) (1,255) (1,327) overspend payment Net Payment from Council 59,377 59,322 59,250
3.1.7 The table below summarises the total estimated funding over the next three years within the mid-range scenario.
2020-21 2021-22 2022-23
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£000 £000 £000 Funding NHS 230,486 235,429 240,496 Funding A&B Council 59,377 59,322 59,250 Total Funding 289,863 294,751 299,746
3.2 Savings Measures Already Approved
3.2.1 A number of additional savings for 2021-22 were agreed at the IJB on 27 March 2019 as part of setting the 2019/20 budget. These new savings totalled £520k and comprise a further £500k on prescribing and £20k for criminal justice.
3.2.2 In addition saving 2021-65 of £50k, review of support payments to GP practices, was deferred to 2021/22 at the budget meeting on 25 March 2020.
3.3 Base Budget
3.3.1 The base budget is the approved budget from 2020-21 and includes the second year of the agreed investment in financial sustainability for 2021/22 only.
3.3.2 The table below summarises the base budget in the mid-range scenario.
2021-22 2022-23 2023-24 £000 £000 £000 Base Budget NHS 213,358 213,358 213,358 Base Budget Council 60,077 60,077 60,077 Investment in financial 318 0 0 sustainability – 2nd year Resource Transfer 12,304 12,304 12,304 Base Budget 286,057 285,739 285,739
3.4 Employee Cost increases
3.4.1 For Health staff, a 3 year pay deal has already been agreed for 2018-19 to 2020-21 at 3% each year. For 2021-22 to 2023-24, it has been assumed that the 3% will continue within the best case and mid-range scenarios, with a 3.5% increase in the worst case scenario.
3.4.2 For Social Work staff, an agreement has been reached on the pay award and the increase in 2020-21 is 3%. For 2021-22 and 2020-23, the best case scenario assumes the public sector pay commitment which averages around 2.7%, the worst case scenario assumes a 3.5% increase (similar to the 2018-19 offer) and the mid-range scenario assumes a 3% increase.
3.4.3 There are also additional costs in relation to incremental drift and an estimate has been built into all three scenarios.
3.4.4 The increases to the employee budgets estimated over the next three years within the mid-range scenario are summarised in the table overleaf.
2021-22 2022-23 2023-24 £000 £000 £000 4 Page 187
Health pay award 1,936 3,929 5,979 Health pay increments 185 370 555 Social Work pay award 964 1,957 2,980 Social Work pay increments 82 164 246 Total Employee Cost 3,167 6,420 9,760 Changes
3.5 Non-pay Inflation
3.5.1 A review of the non-pay inflation assumptions, previously reported to the IJB on 29 January 2020, has been undertaken by the Senior Leadership Team during February and the following assumptions have been updated:
Prescribing – increased £900k (best), £1000k (mid) and £1100k worst p.a. for next year recognising increased level of costs experienced in current year SLAs increased by 2.5% p.a. on mid range (best 2%; worst 3%) All others have simply been rolled forward for a further year
3.5.2 The table below summaries the updated non-pay inflation estimated over the next three years within the mid-range scenario. Further information is included within Appendix 1.
2021-22 2022-23 2023-24 £000 £000 £000 Health: Prescribing 1,000 2,000 3,000 Hospital Drugs 79 162 249 Main GG&C SLA 1,340 2,782 4,326 Other SLAs 618 1,252 1,885 Energy Costs 148 295 443 Social Work: Catering Purchases 41 86 135 National Care Home Contract 240 489 749 NHS Staffing Recharges 140 295 465 Purchase and Maintenance of 11 22 34 Equipment CPI Essential increases 23 45 70 Scottish Living Wage 882 1,790 2,726 Carers Allowances 34 68 103 Utilities 29 60 94 Total Non-Pay Inflation 4,585 9,346 14,279
3.6 Cost and demand pressures
3.6.1 As with non-pay inflation, the cost and demand pressure assumptions have been rolled forward and the following assumptions have been updated:
An allowance made for Health new high cost care package of £120k in 2021/22 Microsoft licence fee allowance of £300k added for 2021/22 based on increase notified for 2020/21
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A one off provision for further refurbishment of Aros residences of £60k made for 2021/22 The allowance for unknown cost and demand pressures has been reinstated at £1m p.a. as we are at the star of a new financial year.
3.6.2 The table below summaries the updated cost and demand pressures estimated over the next three years within the mid-range scenario. Further information is included within Appendix 1.
2021-22 2022-23 2023-24 £000 £000 £000 Health: LIH* Laboratory 50 100 150 New high cost care packages 120 120 120 Other NSD* developments 50 100 150 Oncology medicines demand 450 900 1,350 Microsoft Licence fees 300 300 300 Refurbishment of Aros 60 0 0 residences
Social Work: Older People Growth 340 685 1,035 Care Services for Younger 278 548 818 Adults National Care Home Contract 339 691 1,058 Continuing Care demand 250 500 750 pressure in Children & Families
Allowance for Unknown Cost 1,000 2,000 3,000 and Demand Pressures Total Cost and Demand 3,237 5,944 8,731 Pressures
*LIH: Lorn & Isles Hospital *NSD: National Services Division
3.7 Updated Budget Outlook
3.7.1 The updated budget outlook for the mid-range scenario, taking into consideration all the factors noted within this report, is summarised in the table below:
2021-22 2022-23 2023-24 £000 £000 £000 Base Budget 286,057 285,739 285,739 Employee Cost Changes 3,167 6,420 9,760 Non-Pay Inflation 4,585 9,346 14,279 Cost and Demand Pressures 3,237 5,944 8,731 Management/Operational (520) (520) (520) Savings agreed March 2019 Management/Operational (50) (50) (50)
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Savings agreed March 2020 Total Estimated Expenditure 296,476 306,879 317,939 Estimated Funding 286,306 290,429 295,317 Estimated Budget Surplus (6,613) (12,128) (18,193) /(Gap) Cumulative Estimated Budget Surplus / (6,613) (5,515) (6,065) (Gap) In Year
3.7.2 In the mid-range scenario, the Health and Social Care Partnership budget gap estimated over the three year period 2021-22 to 2023-24 is £18.193m with a gap of £6.613m in 2020-21.
3.7.3 In contrast, the budget gap in the best case scenario over the three years is £7.635m and in the worst case scenario, the budget gap over the three years is £31.262m. A summary of all three scenarios is included within Appendix 1.
3.7.4 The changes from the previous anticipated outlook to 2022-23 (as noted at the IJB meeting on 25 March 2020) are summarised in the table below based on the mid-range scenario:
2021-22 2022-23 £000 £000 Previous Reported Budget (5,136) (10,417) Gap (mid-range) Decrease in NHS Funding (566) (566) estimates Change in Council funding 0 0 estimates Base budget adjustment 249 567 Employee cost changes (28) (85) (increase) Increase in non-pay inflation (523) (1,004) Increase in cost & demand (659) (673) pressures Savings agreed 50 50 Revised Budget Gap (mid- (6,613) (12,128) range)
3.7.5 The budget gap over 2021-22 to 2023-24 across each scenario is summarised in the table below:
Budget Gap 2021-22 2022-23 2023-24 Total £000 £000 £000 £000 Best Case 3,246 2,002 2,387 7,635 Mid-Range 6,613 5,515 6,065 18,193 Worst Case 10,992 9,835 10,434 31,262
4. RELEVANT DATA AND INDICATORS
4.1 The budget outlook is based on a number of assumptions, using a best,
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worse and mid-range scenario. These assumptions will be regularly reviewed and updated as appropriate.
5. CONTRIBUTION TO STRATEGIC PRIORITIES
5.1 The Integrated Joint Board has a responsibility to set a budget which is aligned to the delivery of the Strategic Plan and to ensure the financial decisions are in line with priorities and promote quality service delivery. This needs to be considered when options are developed to balance the budget.
6. GOVERNANCE IMPLICATIONS
6.1 Financial Impact – There is a significant budget gap for future years that requires to be addressed.
6.2 Staff Governance – None directly from this report but there is a strong link between HR and delivering financial balance.
6.3 Clinical Governance - None
7. PROFESSIONAL ADVISORY
7.1 There are no recommendations from this report which require to be consulted on with Professional Advisory leads.
8. EQUALITY AND DIVERSITY IMPLICATIONS
8.1 None directly from this report but any proposals to address the estimated budget gap will need to consider equalities.
9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE
9.1 None directly from this report.
10 RISK ASSESSMENT
10.1 There is a risk that sufficient proposals are not approved in order to balance the budget in future years. Any proposals will need to consider risk.
11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT
11.1 None directly from this report but any proposals to address the estimated budget gap will need to take into consideration local stakeholder and community engagement.
12. CONCLUSIONS
12.1 A budget outlook covering the period 2021-22 to 2023-24 has been prepared rolling forward the previous outlook by a further year. In the mid- range scenario, the Health and Social Care Partnership budget gap estimated over the three year period is £18.193m with a gap of £6.613m in 2021-22. This has deteriorated from the outlook previously presented by
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£1.477m mainly due to additional provision for cost and demand pressures.
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
APPENDICES: Appendix 1 – Budget Outlook Best, Worst and Mid-Range Scenarios AUTHOR NAME: Judy Orr, Head of Finance and Transformation [email protected]
9 This page is intentionally left blank BUDGET OUTLOOK 2021-22 TO 2023-24 APPENDIX 1 INTEGRATION JOINT BOARD 27 MAY 2020
Best case scenario Mid-Range scenario Worst case scenario 2021-22 2022-23 2023-2024 2021-22 2022-23 2023-2024 2021-22 2022-23 2023-2024 £000 £000 £000 £000 £000 £000 £000 £000 £000
Base Budget: Base Budget 285,739 285,739 285,739 285,739 285,739 285,739 285,739 285,739 285,739 Base Budget Adjustments 318 0 0 318 0 0 318 0 0 Revised Base Budget 286,057 285,739 285,739 286,057 285,739 285,739 286,057 285,739 285,739
Employee Cost Changes: Pay Award 2,804 5,688 8,653 2,900 5,886 8,959 3,071 6,247 9,530 Pay Increments/change to employee base 226 452 678 267 534 801 452 904 1,356 Total Employee Cost Changes 3,030 6,140 9,331 3,167 6,420 9,760 3,523 7,151 10,886
Non-Pay Inflation: Health: Page 193 Prescribing 900 1,800 2,700 1,000 2,000 3,000 1,100 2,200 3,300 Hospital Drugs 47 97 150 79 162 249 116 232 348 Main GG&C SLA 1,099 2,226 3,381 1,340 2,782 4,326 1,649 3,338 5,067 Other SLAs (GPs, GG&C, other HBs, service inputs) 494 998 1,502 618 1,251 1,885 742 1,503 2,263 Utilities 106 215 324 148 295 443 187 374 561 Social Work: Catering Purchases 41 86 135 41 86 135 41 86 135 National Care Home Contract 178 362 551 240 489 749 303 621 954 NHS Staffing Recharges 140 294 464 140 295 465 140 295 465 Purchase and Maintenance of Equipment 8 17 25 11 22 34 14 28 43 Specific CPI Increases 17 34 51 23 45 70 29 59 90 Scottish Living Wage 791 1,604 2,439 882 1,790 2,726 1,034 2,104 3,212 Carers Allowances 25 51 77 34 68 103 42 86 130 Utilities 28 57 90 29 60 94 30 62 97 Total Non-Pay Inflation 3,874 7,841 11,889 4,585 9,346 14,279 5,427 10,987 16,665
Cost and Demand Pressures: Health: LIH Laboratory 50 100 150 50 100 150 100 200 300 Out of Hours - GPs option out of hours 0 0 0 0 0 0 0 0 0 Share of national charge for HEPMA 0 0 0 0 0 0 0 0 0 New high cost care packages 120 120 120 120 120 120 220 220 220 Other NSD developments 50 100 150 50 100 150 50 100 150 Oncology Medicines Demand 350 700 1,050 450 900 1,350 550 1,100 1,650 Best case scenario Mid-Range scenario Worst case scenario 2021-22 2022-23 2023-2024 2021-22 2022-23 2023-2024 2021-22 2022-23 2023-2024 £000 £000 £000 £000 £000 £000 £000 £000 £000 Bute Dialysis 0 0 0 0 0 0 0 0 0 Microsoft Licence Fees 300 300 300 300 300 300 300 300 300 Cystic Fibrosis Treatments 0 0 0 0 0 0 106 212 318 Asbestos Removal 0 0 0 0 0 0 0 0 0 LIH Clinical Lead 0 0 0 0 0 0 0 0 0 Salen relocation of surgery to Mull PCC 0 0 0 0 0 0 0 0 0 Refurbishment of Aros residences 60 0 0 60 0 0 60 0 0 Council: 0 0 0 Older People Growth 0 0 0 340 685 1,035 689 1,400 2,133 Care Services for Younger Adults 0 0 0 278 548 818 564 1,103 1,642 National Care Home Contract 252 511 778 339 691 1,058 428 877 1,348 Continuing care demand pressure in Children & Families 0 0 0 250 500 750 500 1,000 1,500 Allowance for Unknown Cost and Demand Pressures 500 1,000 1,500 1,000 2,000 3,000 1,500 3,000 4,500 Total Cost and Demand Pressures 1,682 2,831 4,048 3,237 5,944 8,731 5,067 9,512 14,061
Savings Previously Agreed:
Management/Operational Savings - Agreed March 2019 (520) (520) (520) (520) (520) (520) (520) (520) (520) Page 194 Management/Operational Savings - Agreed March 2020 (50) (50) (50) (50) (50) (50) (50) (50) (50) Total Savings (570) (570) (570) (570) (570) (570) (570) (570) (570)
Total Estimated Expenditure 294,073 301,981 310,437 296,476 306,879 317,939 299,504 312,819 326,781
Funding: NHS 231,450 237,411 243,552 230,486 235,429 240,496 229,134 232,670 236,269 Council 59,377 59,322 59,250 59,377 59,322 59,250 59,377 59,322 59,250 Total Funding 290,827 296,733 302,802 289,863 294,751 299,746 288,511 291,992 295,519
Budget Surplus / (Gap) Cumulative (3,246) (5,248) (7,635) (6,613) (12,128) (18,193) (10,992) (20,827) (31,262) Budget Surplus / (Gap) In Year (3,246) (2,002) (2,387) (6,613) (5,515) (6,065) (10,992) (9,835) (10,434)
Partner Bodies Split: Health 22 95 188 (1,770) (3,616) (5,569) (4,445) (8,865) (13,393) Social Work (3,268) (5,343) (7,823) (4,843) (8,512) (12,624) (6,548) (11,962) (17,869) Budget Surplus / (Gap) Cumulative (3,246) (5,248) (7,635) (6,613) (12,128) (18,193) (10,992) (20,827) (31,262) Budget Surplus / (Gap) In Year (3,246) (2,002) (2,387) (6,613) (5,515) (6,065) (10,992) (9,835) (10,434) Page 195 Agenda Item 11c
Integration Joint Board Agenda item:
Date of Meeting: 27 May 2020
Title of Report: Covid-19 response and financial implications
Presented by: Judy Orr, Head of Finance and Transformation
The Integration Joint Board is asked to: Note the details provided in relation to Covid-19 response and associated mobilisation plan costing Acknowledge the uncertainties in the cost elements submitted Note that the Scottish Government has in principle approved all mobilisation plans, but that approval for individual cost lines has not yet been received
1. EXECUTIVE SUMMARY
1.1 This report provides an overview of the HSCP’s Covid19 mobilisation readiness and its future planning for living and operating with Covid-19. It also provides a snapshot of the financial estimates of the costs of dealing with the Covid-19 response. These cost estimates are updated on a weekly basis, and are still subject to considerable uncertainties.
1.2 The Scottish Government has in principle approved all mobilisation plans. However all expenditure items over £500k require formal approval and this is still awaited for all lines submitted. In the interim, the Scottish Government has issued a first tranche of funding on 12 May 2020 of £50m nationally on an NRAC/GAE allocation basis and A&B HSCP is to receive £903k as its share. This is “particularly to support immediate challenges in the social care sector”.
1.3 A small amount of expenditure was incurred in 2019/20 of £41,000 which is matched by a specific funding allocation. In addition the additional FHS (Family Health Services) Prescribing cost accrual of £324,000 (reflecting people ordering prescriptions earlier than usual in March because of the impending lockdown) will be funded through NHS Highland directly in 2019/20, and then offset in 2020/21 where there is a reduction in costs expected in the first quarter.
2. INTRODUCTION
2.1 This report provides information on the Health and Social Care Partnership’s response to Covid-19 pandemic and associated estimated costs.
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3. DETAIL OF REPORT
3.1 Summary of Covid-19 status update and look forward
3.1.1 The IJB has a separate report on the agenda which provides a detailed review of the HSCP’s status of mobilisation in response to Cov-19 pandemic.
3.1.2 Our current best estimate is that we are around week 7 of the pandemic in Scotland, although different areas of Scotland are likely to be in different weeks. The peak NHS demand in Argyll and Bute is now projected to occur at the end of May. We are now working with an assumption of a 9% infection rate, well reduced from the worst case 80% infection rate. This would mean 21 beds required for critical care for COVID-19 in NHSGG&C and 42 other hospital beds required for COVID-19 in Argyll and Bute and 14 in NHSGG&C. As such no net additional beds are estimated to be required. This is a significant reduction from early estimates as a result of the effective social distancing now in place. However if and when these measures are relaxed, the situation may change. Over the coming weeks we will model our actual activity against projections to provide some assurance around the shape and length of the projected demand curve
3.1.3 Community Assessment Centres (CACs) have been established to maximise the numbers of symptomatic people who can be cared for in the community, reserving our hospitals for those with the most serious illness, and minimise the exposure of patients using GP practices to COVID-19. There are eight CACs in Argyll and Bute, 7 of which operate 24/7 and Helensburgh day time hours Monday to Friday. In addition, they will be responsible for distribution of testing kits to residential care and community settings, sending tests for analysis and management of the results.
3.1.4 There are some 340 people in care homes in Argyll and Bute and over 1,100 receiving home care. In addition there are now over 2,800 people who are in the shielded category. Currently there are 3 care homes closed to new admissions as a result of Covid outbreaks and two further homes are under surveillance awaiting test results. This picture can change quickly. Early experience of caring for Covid19 patients in the community is beginning to emerge. Local pathways considering the presentation and flow of people who may require palliative and end of life care as a consequence of COVID- 19 infection should be agreed
3.1.5 It is clear that the length of time we will have to deal with the implications of this pandemic is extending into the next 12 months. This disease burden is part of the new activity “norm” and we will have to focus on simultaneously managing Covid19 whilst resuming routine, comprehensive health and social care. The report sets out a number of considerations on how this could be managed going forward.
3.2 Covid 19 Mobilisation costing
3.2.1 Since the start of April, the HSCP has been required to contribute to a local mobilisation plan cost return on a weekly basis, submitted to Scottish
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Government through NHS Highland.
3.2.2 The format of the return has changed regularly in this period. The initial return of 2 April provided certain parameters for expected staff absence rates rising from 15% in March to a peak of 25% in May and June and reducing gradually to 0% in March 2021. Similarly there was a predetermined phasing for costs associated with additional beds from a peak of 100% in April to June down to 0% in March 2021. The most recent return allows for these parameters to be varied.
3.2.3 The return includes 3 tabs relevant to the HSCP. There is an approval tracker which lists our local approvals for items above £30k (approved at Silver Command meetings) and this is amalgamated into the Health Board’s overall approval tracker which will also record approvals from Scottish Government for items over £500k – none received as yet.
3.2.4 The next tab is a bed model and this shows that we are now expecting zero net additional beds, although we have 61 designated as Covid beds for the first quarter, reducing down to 0 by March 2021. Acute beds provided by NHS GG&C are included in their return and will not be recharged to us. Covid costs are being recorded and refunded on a Board of Treatment basis.
3.2.5 The final tab shows the costs expected to be incurred across all cost lines. The calculations for these have followed the assumptions provided to HSCPs from the Chief Financial Officer Network. These cost estimates are updated on a weekly basis, and are still subject to considerable uncertainties.
3.2.6 A small amount of expenditure was incurred in 2019/20 of £41,000 which is matched by a specific funding allocation. In addition the additional FHS Prescribing cost accrual of £324,000 (reflecting people ordering prescriptions earlier than usual in March because of the impending lockdown) will be funded through NHS Highland directly in 2019/20, and then clawed back in 2020/21 where there is an offsetting reduction in costs expected.
3.2.7 Actual costs are being carefully tracked. Social care providers have been asked to invoice additional Covid related costs separately and detailed guidance has been given to them on what type of additional costs (such as PPE, equipment and additional staffing) is expected. Care Homes nationally are looking for funding of vacant beds due to closures, and this is being discussed nationally before the detail is agreed. Direct costs for supplies and equipment are being charged to Covid cost centres. Where additional staff are being employed, and for additional hours over normal working, this is also being tracked through codes on time sheets and specific Covid approvals through workforce monitoring. There is some time lag before these costs are shown in the financial ledgers and the position on actual costs will not begin to be seen for a few weeks yet.
3.2.8 The Scottish Government has in principle approved all mobilisation plans. Two meetings have been held with Scottish Government officials on our plan submissions but no individual lines have been formally approved. Nationally the Scottish Government has funding available of £600m plus £20m for
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hospices and it is understood that the submissions to date far exceed the funding available. Of course, actual costs may prove to be lower. Regionally, it is planned to conduct some peer review and benchmarking but the arrangements for this are not yet final.
3.2.9 Our estimated costs on the plan as at 28 April 2020 total £17.4m covering the following key areas:
Cost area £000s Additional hospital beds 500 Reduction in delayed discharges (17) 816 PPE 675 Deep cleans 157 Estates & facilities 270 Additional staff overtime 1,129 Additional temporary staff 1,164 Scottish Living Wage national implementation 141 Additional costs for externally provided services 3,453 Mental Health services 900 GP practices 120 Additional prescribing (1%) 192 Community hubs (CACs) 1,200 Revenue equipment (beds, screens etc) 318 IT costs 100 Additional hospital drugs 500 Underachievement of savings 5,800 Total 17,437
3.2.10 On 12 May, the Cabinet Secretary for Health & Sport wrote to all Integration Authority Chief Officers to confirm initial funding of £50m particularly to support immediate challenges in the social care sector whilst further work is ongoing to fully understand the financial implications of responding to Covid- 19. This initial funding is being allocated via NHS Boards. The allocation for A&B HSCP is £903k. This is described as a “share of funding for community care (based on NRAC/GAE funding formula)”. Our share is just over 1.8%, a little below our NRAC share of 1.84%.
Cosla has been engaging with Chief Financial Officers to agree a set of principles for supporting the financial sustainability of care home providers who particularly affected by deaths and vacant beds. This is still to be agreed nationally with Scottish Government. In the interim, we have agreed to support local care homes based on the normal occupancy levels which we would be funding, at the normal NCHC (National Care Home Contract) and FPN (Free personal & nursing care) rates for self funders.
4. RELEVANT DATA AND INDICATORS
4.1 Information is derived from the financial systems of Argyll and Bute Council and NHS Highland.
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5. CONTRIBUTION TO STRATEGIC PRIORITIES
5.1 This work supports/underpins the HSCPs strategic and operational response to this emergency pandemic. It is likely that the Strategic Plan will require revision to recognise the new normal of working with Cobid-19 in the future.
6. GOVERNANCE IMPLICATIONS
6.1 Financial Impact – The additional costs for responding to Covid-19 are estimated and set out in Appendix 2. There are considerable uncertainties surrounding these estimates and in the funding that will be made available from Scottish Government.
6.2 Staff Governance – The workforce deserves significant credit for their flexibility and proactive response.
6.3 Clinical Governance - Clinical governance response has been fundamental to the shaping and management of the public health projections and demand modelling and our response to ensure patient, client and staff safety.
7. PROFESSIONAL ADVISORY
7.1 Input from professionals across the stakeholders remain instrumental in the response to the Covid19 pandemic. 8. EQUALITY AND DIVERSITY IMPLICATIONS
8.1 These will need to be reviewed and considered as we progress through this pandemic cycle and emergency operating arrangements
9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE
9.1 Compliance with GDPR remains critical and is being considered within the various pieces of work supporting the sharing of information and data to protect health and wellbeing of staff and the public and patients.
10. RISK ASSESSMENT
10.1 There is considerable uncertainty around the funding that will be made available from the Scottish Government for Covid-19 mobilisation plans. Approval has been received in principle but we do not yet have approval for any specific expenditure lines for 2020/21. Funding for the 2019/20 costs of £41,000 has been confirmed. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT
11.1 None directly from this report.
12. CONCLUSIONS
12.1 This report provides an overview of the HSCP response to address the
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Covid19 pandemic. This has been achieved through fantastic commitment and support of our staff and all our partners and stakeholders and the wider Argyll and Bute community as well as the SAS and NHS GG&C. 12.2 Our scale of mobilisation has flexed and adapted over the last 2 months and we now have robust plans for an emergency response to Covid19 outbreaks. We are however, now moving towards a new phase of this pandemic “Covid19 normal” which is certainly going to extend into the next 12 months and probably longer. This requires the HSCP and partners to cement new ways of working and operating in our new covid19 world. The report discusses the issues in how to resume routine, comprehensive health and social care whilst simultaneously managing Covid19. Work on planning for this is now underway but as yet we do not know transition rules/time for the easing of lockdown and this is a major uncertainty in planning for the future.
12.3 The appendix provides a snapshot of the costing for the Covid-19 mobilisation as at 28 April 2020. This will be updated regularly as assumptions are refined and actual costs are incurred.
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 Judy Orr, Head of Finance & Transformation [email protected]
APPENDICES: Appendix 1 – Covid-19 local mobilisation tracker weekly return as at 28 April 2020
6 Decision/Approval Tracker Yes HB COVID costs Approved Increased Expenditure
Please present a consolidated tracker, covering all Health and HSCP decisions. This should not materially differ from the total cost
Further Offsetting Status of proposal NHS/IJB/LA If below If over Total Costs Internal Decision Is the total cost Date Costs to be budgets/ Body (e.g. NHS, Impact on Capacity (e.g. additional Risk Rating: (e.g. in progress, Contact- Name Description of financial Total Cost threshold, threshold, Final Incurred to Reference Request Logged Category of spend Proposed Action title Proposed action description above the agreed SG Approver Effective Duration of cost incurred in savings in H&SCP) beds in acute, social care) (High, Medium, Low) commissioning , and Phone impact (£000s) approved decision Decision Date Date Number Date financial threshold? from 2020/21 2020/21 planning) Number internally? outcome? (£000s) (£000s) (£000s)
To ensure consistency please rate as ' High' if NEW- Please provide Body which is two of the following category of spend in Costs Value of seeking apply; urgent deadline Please include Add details of What period does this Balance of For Date action is financial return this Please provide detail around the Is this revenue or capital? Date spend incurred in any additional Short title of proposed Further detail around proposal, what is additional funding timescale, significant What stage is this Please provide the total cost in Yes/No as who in SG Add date of decision cover? Does costs to be NHS/IA/LA logged on tracker relates to. e.g. change in system capacity that will What assumptions have Yes/No Yes/No starts to 19/20 and offsetting financial action for? cost or major impact if proposal at? contact details 19/20 and per SG confirmed SG approval this run into future incurred in reference or raised with SG additional temporary occur as a result of approval been made? occurr to date in budgets/ resource from not approved. Please 20/21. approval finanical years? 2020/21 staff, additional 20/21 savings SG rate as 'Medium' if 1 hospital beds applies and 'Low' if none apply.
Additional hospital Originally 200, now 93 screens to separate temporary Supports provision of additional John Dreghorn 101 07-Apr A&B HSCP Screens Medium Approved Revenue non-recurring £26,500 No Yes, on 16/4 N/A N/A N/A Delivery date 2020/21 - no 0 26.5 0 beds beds hospital beds 07500 068421
Additional hospital John Dreghorn 102 16-Apr A&B HSCP Beds 100 Covid beds Provides 100 additional hospital beds High Approved Revenue non-recurring £80,000 No Yes, on 16/4 N/A N/A N/A Delivery date 2020/21 - no 0 80 0 beds 07500 068421
Judy Orr 01586 103 16-Apr A&B HSCP Community Hubs Helensburgh CAC set up Set up costs for Helensburgh Covid Assessment Centre Creates a Covid Assessment Centre High Approved Revenue non-recurring £40,000 No Yes, on 16/4 N/A N/A N/A 1st April 2020 2020/21 - no 0 40 0 555280
Helensburgh CAC Ongoing running costs for Helensburgh Covid Judy Orr 01586 104 16-Apr A&B HSCP Community Hubs Creates a Covid Assessment Centre High Approved Revenue non-recurring £57,000 No Yes, on 16/4 N/A N/A N/A 1st April 2020 2020/21 - no 0 57 0 ongoing costs Assessment Centre 555280
Personal Protection Purchase of 40,000 IIR masks @ cost of £1.28 each as Supports safe delivery of social care Judy Orr 01586 105 17-Apr A&B HSCP Purchase of IIR masks High Approved Revenue non-recurring £51,200 No Yes, on 16/4 N/A N/A N/A Delivery date 2020/21 - no 0 51 0 Equipment contingency community stocks services 555280
Personal Protection Purchase of further social Purchase of 100,000 fluid resistant masks, 650,000 Supports safe delivery of social care Judy Orr 01586 106 21-Apr A&B HSCP High Approved Revenue non-recurring £89,500 No Yes, on 21/4 N/A N/A N/A Delivery date 2020/21 - no 0 90 0 Equipment care PPE aprons and 500,00 gloves services 555280
Scottish Living Wage Supports safe delivery of social care Judy Orr 01586 107 21-Apr A&B HSCP Scottish Living Wage Scottish Living Wage Uplift High Approved Revenue recurring £141,625 No Yes N/A N/A N/A 1st April 2020 2020/21 - yes 0 142 0 implementation services 555280 implementation
Covid response forecast Judy Orr 01586 Not yet required as these are forecast figures 23rd April 999 23-Apr A&B HSCP Everything else Covid response forecast costs Supports response to Covid pandemic Medium Forecast Massive £16,950,824 Yes N/A 2020/21 - no 0 19,246 0 costs 555280 which will change 2020
Total £17,436,649 Page 201 Check total £0 This page is intentionally left blank COVID-19 General Bed Modelling (for HSCP)
COMPLETE ALL CELLS IN YELLOW
SECTION A - BED NUMBERS
Number of Beds Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Designated Covid Beds General 0 61 61 61 46 46 31 31 16 16 6 6 0 Offsetting Releases General 0 -61 -61 -61 -46 -46 -31 -31 -16 -16 -6 -6 0 Total (Net change - All Beds) # Total 0 0 0 0 0 0 0 0 0 0 0 0 0
SECTION B - EXPENDITURE Normal Rate Premium Bed Cost Staff Linen Catering Equipment Drugs Oxygen Cleaning Other Check (NR) Rate (PR) Breakdown Cost of a General non-Covid bed per month (£) £10,000 £10,000 8300 100 200 200 £1,200 £0 £0 £0 0 (NR) Cost of a General Covid bed per month (£) £10,000 £11,312 8300 100 200 200 £1,200 £0 £0 £0 0
Selection of Rate Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Rate used - Designated Covid Beds NR PR PR PR PR PR PR PR PR PR PR PR PR Rate used - Offsetting Releases NR NR NR NR NR NR NR NR NR NR NR NR NR
Forecast Expenditure (£000s) Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Total Page 203 Designated Covid Beds General Covid 0 690,052 690,052 690,052 520,367 520,367 350,682 350,682 180,997 180,997 67,874 67,874 0 4,310,000
Forecast Cost Reductions (£000s) Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Total Offsetting Releases General non-Covid 0 -610,000 -610,000 -610,000 -460,000 -460,000 -310,000 -310,000 -160,000 -160,000 -60,000 -60,000 0 -3,810,000
Total Forecast Costs (£000s) Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Total Net Costs 0 80,052 80,052 80,052 60,367 60,367 40,682 40,682 20,997 20,997 7,874 7,874 0 500,000 This page is intentionally left blank COVID-19 Local Mobilisation Plan- Financial Plan- H&SCP
Instructions Please complete the below table to reflect your indicative financial plan for response to COVID19. Duplicate tabs as necessary for each HSCP Update cells in yellow Figures are in £s Please include sufficient narrative to support figures recorded in the template. Where costs do not fit into any of the categories given, please put in 'other', with description in the notes column of what this is for. Please use additional rows where required (under 'Other'). Costs should only be included for additional costs incurred as a result of COVID-19 emergency
Name of Body Argyll & Bute H&SCP Finance Contact: George Morrison Date of last update 22-Apr-20
Key Assumptions Additional Hospital Beds Please complete tab 'Bed Model (HSCP)'
Mar-20 Apr-20 May-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 Staff absence rates assumption (%) 15% 20% 25% 20% 20% 15% 15% 10% 10% 5% 5% 0%
Average Unit Delayed Discharge Reduction- Assumptions Number Supporting Narrative Cost (£) Delayed Discharge Reduction- Additional Care Home Beds 10 Delayed Discharge Reduction- Additional Care at Home Packages 7 Delayed Discharge Reduction- other measures Delayed Discharge Reduction- other measures Delayed Discharge Reduction- other measures Delayed Discharge Reduction- other measures Page 205
Revenue Capital Revenue Capital Body incurring H&SCP Costs 2019/20 2019/20 Apr-20 May-20 Jul-20 Aug-20 Sep-20 Oct-20 Nov-20 Dec-20 Jan-21 Feb-21 Mar-21 2020/21 Supporting Narrative cost (NHS or LA) Additional Hospital Bed Capacity/Costs - 80,052 80,052 60,367 60,367 40,682 40,682 20,997 20,997 7,874 7,874 - £500,000 NHS Delayed Discharge Reduction- Additional Care Home Beds Delayed Discharge Reduction- Additional Care at Home Packages Delayed Discharge Reduction- other measures £68,000 £68,000 £68,000 £68,000 £68,000 £68,000 £68,000 £68,000 £68,000 £68,000 £68,000 £816,000 LA Delayed Discharge Reduction- other measures Delayed Discharge Reduction- other measures Delayed Discharge Reduction- other measures Personal protection equipment £71,668 £121,666 £50,000 £50,000 £50,000 £40,000 £40,000 £40,000 £30,000 £30,000 £30,000 £675,000 Both Expected high level of purchasing for social care Deep cleans £15,000 £15,000 £15,000 £15,000 £15,000 £12,500 £12,500 £12,500 £10,000 £10,000 £10,000 £157,500 Both Estates & Facilities cost £30,000 £30,000 £30,000 £30,000 £30,000 £20,000 £20,000 £20,000 £10,000 £10,000 £10,000 £270,000 NHS Additional staff overtime £172,768 £172,768 £132,076 £132,076 £91,384 £91,384 £50,692 £50,692 £26,277 £26,277 £10,000 £1,129,162 Both Additional temporary staff spend 33,000 £173,773 £173,773 £137,830 £137,830 £101,886 £81,886 £45,943 £45,943 £24,377 £24,377 £10,000 £1,164,391 Both Additional cost from Contract Rate Uplift £57,750 £7,625 £7,625 £7,625 £7,625 £7,625 £7,625 £7,625 £7,625 £7,625 £7,625 £141,625 LA Scottish Living Wage implementation Additional costs for externally provided services £556,931 £556,931 £417,698 £417,698 £278,465 £278,465 £139,233 £139,233 £55,693 £55,693 £0 £3,452,971 LA Cost to 3rd Parties to Protect Services (where services are currently stopped) Additional costs to support carers Mental Health Services £75,000 £75,000 £75,000 £75,000 £75,000 £75,000 £75,000 £75,000 £75,000 £75,000 £75,000 £900,000 Both Additional FHS Payments- General Opthalmic Services Additional FHS Payments- GP Practices £15,000 £15,000 £15,000 £15,000 £15,000 £5,000 £5,000 £5,000 £5,000 £5,000 £5,000 £120,000 NHS Additional FHS Prescribing 324,000 £16,000 -£146,000 £16,000 £16,000 £16,000 £16,000 £16,000 £16,000 £16,000 £16,000 £16,000 £192,000 NHS 1% growth anticipated Community Hubs £150,000 £150,000 £150,000 £100,000 £100,000 £100,000 £100,000 £50,000 £50,000 £50,000 £50,000 £1,200,000 NHS Other Community Care Staff Accommodation Costs Additional Travel Costs Loss of income Testing for virus £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 £0 Revenue equipment 8,000 £200,000 £10,000 £10,000 £10,000 £10,000 £10,000 £10,000 £10,000 £10,000 £10,000 £10,000 £318,000 NHS Includes purchase of beds and screens IT costs £25,000 £25,000 £25,000 £0 £0 £0 £0 £0 £0 £0 £0 £100,000 NHS Additional hospital drug spend £50,000 £50,000 £50,000 £50,000 £50,000 £50,000 £30,000 £30,000 £30,000 £30,000 £30,000 £500,000 NHS Offsetting savings - HSCP Total 365,000 - 1,756,942 1,404,815 1,259,596 1,184,596 949,042 896,542 640,990 590,990 425,846 425,846 331,625 11,636,649 Subtotal 11,636,649 Expected underachievement of savings (HSCP) 483,333 483,333 483,333 483,333 483,333 483,333 483,333 483,333 483,333 483,333 483,333 5,800,000 Total 365,000 - 2,240,276 1,888,149 1,742,930 1,667,930 1,432,376 1,379,876 1,124,324 1,074,324 909,179 909,179 814,958 17,436,649 Total 17,436,649 This page is intentionally left blank