(Performance and Audit) Sub-Committee

Agenda Item

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD (PERFORMANCE AND AUDIT) SUB-COMMITTEE

Minutes of meeting held in Committee Room 5, Council Offices, Almada Street, Hamilton on 29 May 2018

Chair: NHS Lanarkshire Board Philip Campbell, Non Executive Director (Depute)

Present: NHS Lanarkshire Board Tom Steele, Non Executive Director South Lanarkshire Council Councillor Jim McGuigan

Attending: Health and Social Care Partnership V de Souza, Director, Health and Social Care; M Moy, Chief Financial Officer NHS Lanarkshire C Cunningham, Head of Performance and Commissioning; M Docherty, Nurse Director; C MacKintosh, Medical Director South Lanarkshire Council Y Douglas, Audit Manager; M Kane, Health and Social Care Programme Manager; J McDonald, Administration Adviser

Also Attending: Audit Scotland S Lawton, Senior Auditor

Apologies: South Lanarkshire Council Councillor John Bradley (Chair)

1 Declaration of Interests No interests were declared.

2 Minutes of Previous Meeting The minutes of the meeting of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee held on 27 February 2018 were submitted for approval as a correct record.

The Sub-Committee decided: that the minutes be approved as a correct record.

3 Internal Audit Reports - Update A report dated 18 May 2018 by the Director, Health and Social Care was submitted on the delivery of the 2017/2018 Internal Audit Plan for the South Lanarkshire Integration Joint Board.

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At its meeting on 5 December 2017, the South Lanarkshire Integration Joint Board (IJB) had approved the 2017/2018 Internal Audit Plan which detailed the main areas of audit work to be undertaken through joint working arrangements within South Lanarkshire Council and NHS Lanarkshire’s audit functions.

Both the Council and NHS Lanarkshire’s internal auditors would continue to be responsible for undertaking audit assignments in relation to their respective operational matters across in-scope services. Joint working arrangements would be implemented in respect of IJB only audits together with any cross cutting audits that occurred in the year.

Details of the progress which had been made in relation to the main areas of audit work contained in the Internal Audit Plan 2017/2018 were provided in the appendix to the report.

The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 5 December 2017 (Paragraph 5)]

4 Draft Annual Governance Statement 2017/2018 Update A report dated 9 May 2018 by the Director, Health and Social Care was submitted on the South Lanarkshire Integration Joint Board’s (IJB) Draft Annual Governance Statement for 2017/2018.

The Draft Annual Governance Statement 2017/2018, which was attached as an appendix to the report, provided an assessment of the effectiveness of the IJB’s governance arrangements in supporting the planned outcomes.

The Draft Annual Governance Statement 2017/2018 had been updated to reflect the outcome of the ongoing review of the effectiveness of the governance framework and would be included in the IJB Unaudited Annual Accounts for 2017/2018 and submitted to the IJB for formal approval.

Following approval by the IJB, the Annual Governance Statement for 2017/2018 would be included in the IJB Annual Accounts for 2017/2018.

The Sub-Committee decided: that the Annual Governance Statement for 2017/2018 be included in the IJB Unaudited Annual Accounts for 2017/2018 and submitted to the IJB for formal approval.

[Reference: Minutes of 27 February 2018 (Paragraph 8)]

5 Risk Register A report dated 8 May 2018 by the Director, Health and Social Care was submitted on the updated Risk Register for the South Lanarkshire Integration Joint Board (IJB).

As part of the arrangements to support the integration of Health and Social Care, a Risk Register for the IJB had been prepared to capture strategic risks relating to the delivery of services likely to affect the Joint Board’s delivery of the Joint Strategic Commissioning Plan.

The Risk Register had been prepared in consultation with partners and had been reviewed against the existing risk registers of NHS Lanarkshire and South Lanarkshire Council.

The IJB, at its meeting on 12 September 2017, had approved the Risk Register for the IJB and had agreed that an update report be submitted to the IJB and the Performance and Audit Sub- Committee on an annual basis.

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It was proposed that the updated Risk Register, attached as an appendix to the report, be noted and that progress reports be submitted to the Sub-Committee on a regular basis.

Discussion then took place in relation to high risks identified by South Lanarkshire Council and NHS Lanarkshire that impacted on the IJB and how those would be reflected in the IJB Risk Register.

The Sub-Committee decided:

(1) that the updated Risk Register for the South Lanarkshire Integration Joint Board, as detailed in the appendix to the report, be noted;

(2) that a progress report on the Risk Register be submitted to a future meeting of the Sub- Committee; and

(3) that any high risks identified by South Lanarkshire Council and NHS Lanarkshire which impacted on the IJB be included in the IJB Risk Register.

[Reference: Minutes of South Lanarkshire Integration Joint Board of 12 September 2017 (Paragraph 8) and Minutes of 29 August 2017 (Paragraph 6)]

6 Partnership Performance Reporting Framework A report dated 30 April 2018 by the Director, Health and Social Care was submitted on the Performance Reporting Framework for the South Lanarkshire Health and Social Care Partnership.

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to establish performance monitoring reports in line with the agreed suite of 23 performance measures and 6 measures which had been identified by the Ministerial Steering Group.

Following the introduction of the 6 measures, a workshop had been held to identify a suitable reporting framework. As a result, it was proposed that a Performance Reporting Framework be established and reported to the Integration Joint Board and Sub-Committee on a 6 monthly basis, as detailed in the report.

The Sub-Committee decided: that the Performance Reporting Framework, as detailed in the report, be progressed.

7 Draft Annual Performance Report 2017/2018 A report dated 10 May 2018 by the Director, Health and Social Care was submitted on the draft Annual Performance Report for the South Lanarkshire Integration Joint Board (IJB).

The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Integration Joint Boards to prepare and publish Annual Performance Reports.

The Annual Performance Report was to ensure that performance was open and accountable whilst providing an overall assessment of performance in relation to planning and carrying out integrated functions. Guidance issued by the Scottish Government had recommended that the following areas be included within the report:-

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 a summary of progress against the 9 National Health outcomes using as a minimum the 23 core national performance indicators  financial performance and best value  reporting progress with localities  Inspection of Services, summarising any activity undertaken by Healthcare Improvement Scotland, The Care Inspectorate, Audit Scotland, Accounts Commission and Scottish Housing Regulator in the year of review  any plans to review or update the Strategic Commissioning Plan

The Annual Performance Report for the IJB, attached as an appendix to the report, would be submitted to the Integration Joint Board for approval, prior to it being published.

The Sub-Committee decided: that the content of the report be noted.

8 Any Other Competent Business – Performance Monitoring Report A report dated 21 May 2018 by the Director, Health and Social Care was submitted providing a summary of performance against the key performance measures assigned to the integration of Health and Social Care in South Lanarkshire.

Progress against the key performance actions and measures for the 23 national integration indicators and the 6 Ministerial Steering Group measures were provided in the appendices to the report.

There were a number of areas of development which had been identified in relation to performance management and those areas would be discussed more fully at a workshop on performance to be facilitated by the Head of Commissioning and Performance.

The Sub-Committee decided: that the report be noted.

[Reference: Minutes of 27 February 2018 (Paragraph 5)]

Chair’s Remarks The Chair advised that this would be the last meeting of the Sub-Committee that Tom Steele, Non Executive Director, NHS Lanarkshire Board would be attending as he was taking up a new position as Chair of the Scottish Ambulance Service. On behalf of the Sub-Committee, he thanked Mr Steele for his hard work and contribution to the Sub-Committee and wished him every success in the future.

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Agenda Item

Report 3

Report to: Performance and Audit Sub-Committee Date of Meeting: 28 August 2018 Report by: Director, Health and Social Care

Subject: Infection Prevention and Control Annual Report 2017/2018

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  provide members of the Performance and Audit Sub-Committee with an overview of Infection Prevention and Control activities during 01 April 2017 - 31 March 2018 in the form of our Annual Report. The report was ratified by the Lanarkshire Infection Control Committee at its meeting on 11 July 2018 and the Healthcare Quality Assurance and Improvement Committee on 12 July 2018 [1purpose] 2. Recommendation(s) 2.1. The Performance and Audit Sub-Committee is asked to approve the following recommendation(s):- [recs] (1) that the content of the report be noted. [1recs] 3. Background 3.1. There is a national requirement for Infection Prevention and Control Teams (IPCT) across NHS Scotland to produce an annual report as stated in the NHS Health Department Letter 2001-53 released 27 June 2001.

4. Key achievements from the Infection Prevention and Control (IPC) Annual Report 2017-2018 4.1. The IPCT made a number of achievements throughout their activity year in 2017- 2018 as noted below for ease of reference to Committee members:  the 2017/2018 Local Delivery Plan Standard for Clostridium difficile infection (CDI) was achieved for the second consecutive year with a rate of 0.24 (118 cases) against a national target rate of no more than 0.32 per 100,000 Acute Occupied Bed Days. The national year-end position across NHS Scotland was 0.27  in addition, NHS Lanarkshire (NHSL) improved CDI performance by reducing the number of cases by 26 (18%) against the 2016/2017 year end position  the 2017/2018 Local Delivery Plan Standard for Staphylococcus aureus bacteraemias (SABs) was not achieved however, NHS Lanarkshire improved SAB performance by reducing the overall number of cases by 11% against 2016/2017 position and also 11% reduction in the number of Healthcare Associated Infection SABs

- 5 -  the IPCT have successfully led a number of initiatives in relation to recognition and prompt management of outbreaks of infection. In 2017/2018 there was a significant decrease in the number of healthcare associated outbreaks of infection with a total of 27 outbreaks managed by the IPCT and frontline staff in comparison to 73 outbreaks in 2016/2017. This equates to a 64% reduction across Acute Services and a 50% reduction in the Health and Social Care Partnerships (HSCPs)  the organisation achieved the highest compliance scores since national monitoring of Meticillin Resistant Staphylococcus Aureus (MRSA) inpatient screening began in 2012/2013  IPCT won the best poster award at the Infection Prevention Society (IPS) at Manchester in September 2017. The poster titled ‘Vascular access device system assessment – a vital step before attempting system improvement’ details the significant work completed by the IPCT in relation to driving improvement in the management of intravenous devices  there were a number of successful quality improvement initiatives led by the IPCT including:  ‘Stay Safe – Stay Connected’ campaign in relation to the management of intravenous therapies  Manual for Best Practice with Invasive Devices is currently being progressed for local implementation in 2018/2019 to support staff in the safe preparation, insertion and maintenance of devices  there was an announced inspection by the Healthcare Environment Inspectorate (HEI) at Udston Hospital on 20-21 September 2017. The final report was published 29 November 2017 with one requirement and no recommendations and demonstrated significant improvement in the findings of external scrutiny reports in NHSL. This is the best report NHSL has received to date from an Healthcare Environment Inspection  a clinical skills laboratory was designed the IPCT in Ward 18 at University Hospital Hairmyres and used to highlight, to a range of staff, the importance of robust methodologies and equipment for cleaning of the environment and patient equipment. A total of seven sessions were completed during August – September 2017. The sessions were well received by those in attendance which included Executive Directors and Non-Executive Directors.  the Decontamination Clinical Nurse Specialist took up post in November 2017  an A-Z Template for Decontamination successfully implemented across wards and departments to demonstrate compliance with national standards in relation to decontamination of reusable medical devices  95% of the NHSL Infection Control Committee annual work plan was achieved

5. Employee Implications 5.1. There are no employee implications associated with this report.

6. Financial Implications 6.1. This paper does not describe any new financial implications.

7. Other Implications 7.1. There are no implications to note.

7.2. There are no sustainable development implications associated with this report.

7.3. There are no other issues to note.

- 6 - 8. Equality Impact Assessment and Consultation Arrangements 8.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore, no impact assessment is required.

8.2. This report has been worked up and presented to a number of forums prior to being presented to Performance and Audit Sub-Committee.

9. Directions 9.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 07 August 2018

Link(s) to National Health and Wellbeing Outcomes

People are able to look after and improve their own health and wellbeing and live in good health for longer People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities

People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

People who use Health and Social Care Services are safe from harm People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Resources are used effectively and efficiently in the provision of Health and Social Care Services

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Previous References  none

List of Background Papers  none

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:-

Emer Shepherd, Head of Infection Prevention and Control, NHS Lanarkshire Phone: 01698 366309 Email: [email protected]

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DRAFT

INFECTION PREVENTION & CONTROL

ANNUAL REPORT

1 April 2017 – 31 March 2018

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Contents The Team ...... 3 Introduction ...... 4 Executive Summary ...... 5 Key Achievements 2017-2018 ...... 6 Financial Cost of Healthcare Associated Infection ...... 7 Monitoring Programme...... 8 Infection Related Intelligence Service ...... 9 Staphylococcus aureus bacteraemia ...... 10 Carbapenemase producing enterobacteriaceae ...... 13 Clostridium difficile Infection ...... 14 Surgical Site Infection ...... 15 Escherichia coli Bacteraemia ...... 18 Hand Hygiene ...... 19 Outbreak Management ...... 20 Training and Education ...... 21 LICC and Sub-Groups...... 22 Glossary of Terms ...... 27

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The Team

Management Team IPC Nursing Team Irene Barkby, Executive Director Nursing Midwifery Linda Thomas, Clinical Nurse Specialist and Allied Health Professionals (NMAHPs) Carol Whitefield, Clinical Nurse Specialist Emer Shepherd, Head of Infection Prevention and Lee Macready, Clinical Nurse Specialist Control (IPC) Sandra Burke, Clinical Nurse Specialist Babs Gemmell, Scrutiny and Assurance Manager Lyndsay Quarrell, IPC Nurse Clare Mitchell, Senior Nurse Nicola Miller, IPC Nurse Sarah Whitehead, IPC Doctor Julie Burns, IPC Nurse Kaileigh Begley, IPC Nurse

Surveillance Team Administration Team Liz Young, Lead Surveillance Nurse Pauline Ferula, Administrative Lead Alison Gold, Surveillance Nurse Letitia McCafferty, Team Secretary Clare Penrice, Data Co-ordinator

Decontamination Lorna Barbour, Clinical Nurse Specialist

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Introduction Healthcare associated infections (HCAIs) can develop either as a direct result of healthcare interventions such as medical or surgical treatment, or from being in contact with a healthcare setting and pose a significant threat to patient safety.

The mandatory surveillance programme in place across NHS Scotland currently includes:  Staphylococcus aureus bacteraemias (SABs)  Meticillin resistant staphylococcus aureus (MRSA)  Meticillin sensitive staphylococcus aureus (MSSA)  Clostridium difficile infection (CDI)  Escherichia coli (EColi)

HCAIs cover any infection contracted:  As a direct result of treatment in, or contact with, a health or social care setting  As a result of healthcare delivered in the community  Outside a healthcare setting (for example, in the community) and brought in by patients, staff or visitors and transmitted to others (for example, norovirus)

The purpose of this annual report is to provide an overview of Infection Prevention and Control (IPC) activities in the past 12 months and to highlight service achievements.

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Executive Summary

Clostridium difficile infection (CDI) Staphylococcus aureus Bacteraemia (SAB) Local Delivery Plan (LDP) Standard: To achieve 32 CDI cases or less per 100,000 acute LDP Standard: To achieve 24 SAB cases or less occupied bed days (AOBD) in the aged 15 and per 100,000 AOBDs by 31 March 2018. over age group by 31 March 2018. NHSL performance in 2017/2018: NHS Lanarkshire (NHSL) performance in  Incidence rate of SABs was 0.37 per 100,000 2017/2018: AOBDs (160 cases).  Incidence rate in patients aged 65 and  Incidence rate of MRSA was 0.009 per above was 0.23 per 100,000 AOBDs (82 100,000 AOBDs (4 cases) cases)  Incidence rate of MSSA was 0.36 per 100,000  Incidence rate in patients aged 15 years AOBDs (156 cases) and above was 0.24 per 100,000 AOBDs  LDP Standard not achieved however there (118 Cases) equates to 18% reduction on was an 11% decrease in the number of SAB last year. cases compared to 2016/2017.

LDP STANDARD ACHIEVED for the second consecutive year.

Outbreak Incidence  27 separate outbreak Hand Hygiene situations; 7 in NHSL performance in University Hospital 2017/2018: Achieved 86% Monklands (UHM); 10 against a national in University Hospital requirement of 95%. Wishaw (UHW); 7 in University Hospital Hairmyres (UHH); 3 in the Health &Social Care Partnerships Escherichia coli (EColi) (H&SCPs) Bacteraemia (ECBs)  7 ward closures; 20 room restrictions – 5 597 cases of ECBs reported room closures led to a during 2017/2018. full ward closure  120 bed days lost  95 patients; 43 staff affected

Gram Negative Bacteraemia and Carbapenemase Producing Enterobacteriaceae (CPE) Surgical Site Infections (SSIs)

According to Health Protection Scotland (HPS) NHSL performance in 2017/2018 multidrug resistance amongst Gram Negative  1.91% C-Section SSIs (1466 cases/28 SSIs) bacteria has increased significantly since 2008 and  0.95% Hip Arthroplasty SSIs (421 cases/5 SSI) poses a major risk to public health and patient  7.53% Colorectal Surgery SSIs (332 cases/25 safety. SSIs)  108 cases of CPE were reported to HPS in  3.12% Vascular Surgery SSIs (256 cases/8 SSIs) 2017/2018 in comparison to 73 reported in 2016/2017.  3 cases of CPE were identified in NHSL in 2017/2018.

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Key Achievements 2017-2018 * The 2017/2018 LDP Standard for CDIs was achieved for the second consecutive year with a rate of 0.24 (118 cases) against a national target rate of no more than 0.32 per 100,000 AOCB. The national year-end position across NHS Scotland was 0.27. * In addition NHSL improved CDI performance by reducing the number of cases by 26 (18%) against the 2016/2017 year end position. * The 2017/2018 LDP Standard for SABs was not achieved however NHSL improved SAB performance by reducing the overall number of cases by 11% against 2016/2017 position and also 11% reduction in the number of HCAI SABs. * The Infection Prevention and Control Team (IPCT) have successfully led a number of initiatives in relation to recognition and prompt management of outbreaks of infection. In 2017/2018 there was a significant decrease in the number of healthcare associated outbreaks of infection with a total of 27 outbreaks managed by the IPCT and frontline staff in comparison to 73 outbreaks in 2016/2017. This equates to a 64% reduction across acute services and a 50% reduction in the H&SCPs. * The organisation achieved the highest compliance scores since national monitoring of MRSA inpatient screening began in 2012/2013. * IPCT won the best poster award at the Infection Prevention Society (IPS) at Manchester in September 2017. The poster titled ‘Vascular access device system assessment – a vital step before attempting system improvement’ details the significant work completed by the IPCT in relation to driving improvement in the management of intravenous devices. * There were a number of successful quality improvement initiatives led by the IPCT including:  ‘Stay Safe – Stay Connected’ campaign in relation to the management of intravenous therapies.  Manual for Best Practice with Invasive Devices is currently being progressed for local implementation in 2018/2019 to support staff in the safe preparation, insertion and maintenance of devices. * There was an announced inspection by the Healthcare Environment Inspectorate (HEI) at Udston Hospital on 20-21 September 2017. The final report was published 29 November 2017 with 1 requirement and no recommendations and demonstrated significant improvement in the findings of external scrutiny reports in NHSL. This is the best report NHSL has received to date from an HEI inspection. * A clinical skills laboratory was designed the IPCT in Ward 18 at UHH and used to highlight, to a range of staff, the importance of robust methodologies and equipment for cleaning of the environment and patient equipment. A total of 7 sessions were completed during August – September 2017. The sessions were well received by those in attendance which included Executive Directors and Non- Executive Directors. * The Decontamination Clinical Nurse Specialist (DCNS) took up post in November 2017. * An A-Z Template for Decontamination successfully implemented across wards and departments to demonstrate compliance with national standards in relation to decontamination of reusable medical devices. * 95% of the NHS Lanarkshire Infection Control Committee (LICC) annual work plan was achieved.

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Financial Cost of Healthcare Associated Infection

The outcomes of an HCAI include extended length of patient stay and extended length of treatment. There is currently a lack of robust information in relation to the actual financial cost of HCAIs across NHS Scotland.

In a bid to establish a cost specific to NHSL, the IPCT, in collaboration with colleagues from finance, have calculated the financial cost for cases of HCAI specifically SABs and CDIs to NHSL.

It should be noted that the length of the patient stay may or may not be extended due to infection and may vary due to other contributing factors e.g. some patients with CDI may require more than one course of treatment. Also the actual cost of antibiotic treatment has not been factored into the data as there is a variance in cost depending on types of antibiotics used.

The financial costs noted should be considered with caution as these are purely based on the average of an inpatient stay and number of days required to treat a patient with a SAB or CDI.

Using data from finance to cost an average inpatient stay for 24 hours (£567.00) against the average number of days required to treat a SAB (14 days of antibiotic treatment) and CDI (approximately 10 days of treatment) the IPCT have produced a table demonstrating costs for 2016/2017 versus costs from 2017/2018.

Average Cost Expected Course Number of HCAI Total cost for for 24 Hour of Treatment Cases HCAI Cases Patient Stay (=days) SAB Cases 2017/2018 £567 14 days 113 £896,994 CDI Cases 2017/2018 £567 10 days 54 £306,180

TOTAL COSTS 2017/2018 £1,203,174

SAB Cases 2016/2017 £567 14 days 127 £1,008,126 CDI Cases 2016/2017 £567 10 days 64 £362,880

TOTAL COSTS 2016/2017 £1,371,006

(Calculation=average cost for 24 hour patient stay x expected course of treatment x number of HCAI cases)

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Monitoring Programme

The role of an IPCT in healthcare is to prepare for, prevent, detect and manage outbreaks of infection. In order to achieve this, a key focus on prevention of infection is paramount – the greater the emphasis on prevention, the less time spent controlling.

July 2017 National Education for Scotland (NES) Standard Infection Prevention and Control Education Pathway (SIPCEP) IPCT Firstport August 2017 Appropriate patient placement and cleanliness of commodes September 2017 Norovirus awareness October 2017 Hand hygiene November 2017 – March 2018 Invasive device awareness January – March 2018 Training and education was provided as required in the management of outbreaks as well as other alert organisms during periods of data exceedance.

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Infection Related Intelligence Service

Every NHS Board in Scotland is mandated by the Standards for HAI (2015) to have robust and effective surveillance systems of alert organisms and conditions in place.

The IPCT in NHSL designed a bespoke surveillance system in 2016/2017 and at various points in 2017/2018 successfully tested the system to assure our internal processes were robust and in line with national guidance.

The Winter of 2016/2017 was a particularly challenging period for the IPCT. The IPCT experienced a significant increase in the number of patients referred to the service with confirmed or suspected Influenza. The IPCT dealt with 316 positive influenza cases in comparison to 60 positive cases for the same time period in 2016/2017. In addition, the service also received over 100 referrals for suspected influenza cases in January 2018 alone.

The IPCT extended working hours to provide a seven day service to the organisation and worked in close collaboration with colleagues to provide up to date status reports on the numbers of suspected and confirmed influenza cases. Successful and timely management of these cases using the IRIS allowed safe and effective management of all influenza and norovirus cases over the winter period despite significant challenges with patient placement at times.

The IPC Pink Star alert across NHSL and H&SCPs is now fully embedded with good awareness amongst front line staff in relation to the meaning of the alert and the requirement for effective patient placement. This is evidenced by the significant reduction in the number of outbreaks of HCAIs in 2017/2018.

Throughout 2017/2018, there were a total of 2,360 alert organisms referred via the laboratory to the IPCT to monitor and manage within an acute setting and 829 via General Practitioner (GP) samples received. The following chart provides an overview of the alert organisms:

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Staphylococcus aureus bacteraemia

When Staphylococcus aureus (S. aureus) breaches the body’s defence mechanisms, it can cause a wide range of illness from minor skin infections to serious infections such as bacteraemia or bloodstream infection.

LDP Standard:

All Scottish NHS Boards are required to achieve the SAB LDP Standard of 24 cases or less per  100,000 AOBD by 31 March 2018. The target did not change from the previous year. NHSL did

not achieve the SAB LDP Standard for 2017/2018.

 NHSL achieved a rate of 0.37 against a national requirement of 0.24. NHS Scotland year-end rate position in 2017/2018 was 0.33.  Despite not achieving the standard, NHSL had an 11% reduction on the number of SAB cases against last years performance.

S.aureus bacteraemia  160 SAB cases  0.37 annual incidence rate of SAB per 100,000 Quality Improvement and interventions to reduce AOBDs. S.aureus infections:

 A ‘Stay Safe – Stay Connected’ campaign was completed in relation to the management of intravenous therapies. Training and education was provided to all relevant MRSA bacteraemia clinical areas across NHSL by members of the IPCT.  4 MRSA cases  SAB multi-disciplinary reviews for patients with a SAB  0.009 annual incidence noted on the death certificate is completed. Clinical rate of SAB per 100,000 teams are involved and the outcomes/lessons AOBDs learned/actions from each review and taken forward via the respective hospital hygiene meetings and risk.  Providing additional data relating to source of SAB at each hospital hygiene group to enable sites to initiate MSSA bacteraemia improvement work & days between information available.  156 MSSA cases  Introduction of a SAB sticker to the medical notes when  0.36 annual incidence initiating investigation and completion of SAB review to rate of SAB per 100,000 assist with patient management. AOBDs

IPCT Focus for 2018/2019 63 HAI Cases  A Manual for Best Practice with Invasive Devices is currently being progressed for local implementation in 2018/2019 to support staff in the safe preparation, insertion and 50 HCAI Cases maintenance of devices.

47 CAI Cases

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MRSA Acute Inpatient Admission Screening

A national MRSA acute inpatient admission screening policy has been in place in Scotland since March 2012. An MRSA clinical risk assessment (CRA) is completed for all acute inpatient admissions and against the screening policy identifies a subset of patients at high risk of MRSA colonisation or infection on admission to hospital. These patients are then screened in line with national guidelines for MRSA screening. This method of screening reduces the number of patients that require to be laboratory tested for MRSA and allows high risk patients to be pre-emptively isolated in a single room whilst the results of the test are awaited.

LDP Standard:

Overall compliance was 91% against a national requirement of 90% or above. The highest level achieved against the national compliance level of 90% since reporting nationally began in 2012/2013.

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Carbapenemase producing enterobacteriaceae Enterobacteriaceae are a family of Gram negative bacteria (sometimes called coliforms) which are part of the normal bacterial gut flora. They include common pathogens such as E. coli, Klebsiella sp, Proteus sp and Enterobacter sp. When the bacteria live harmlessly in the gut without causing any problems, this is called colonisation. These organisms are some of the most common causes of many infections such as urinary tract infections, intra-abdominal infections and bloodstream infections.

Carbapenems are a class of very broad spectrum intravenous antibiotics which are reserved for serious infections or when other therapeutic options have failed. Carbapenemase producing enterobacteriaceae (CPE) is a type of extremely antibiotic resistant bacteria. These bacteria carry a gene for a carbapenemase enzyme that breaks down carbapenem antibiotics.

The emergence of CPE in the UK is of concern following extensive spread occurring within a number of European countries, with some countries moving to an endemic situation. The key principles in combating this threat are through:  Early detection (through clinical alertness, good diagnostic practice and surveillance),  Containment (through infection control measures together with patient and contact screening as required), and  Prudent prescribing of antibiotics.

A national CPE Screening Programme similar to the MRSA Screening Programme was launched in 2017 requesting that all NHS Boards complete risk assessments on acute inpatient admissions similar. UHM implemented CPE screening in late in 2017 followed by UHH and UHW in early 2018.

National reporting using the same monitoring system as MRSA commenced in April 2018. Local compliance levels are not available for this annual report however, the NHSL position will be provided for local reports from June 2018.

CPE Confirmed Cases 2017/2018 In advance of the completion of the local implementation of CPE Screening, the IPCT received 3 confirmed CPE results in UHH between 16-24 November 2017. This number of CPE referrals was classified as data exceedance and triggered further investigation including establishment of an Incident Management Team (IMT).

Debrief from the IMT provided useful learning for the organisation in relation to the repatriation of Lanarkshire residents from other UK hospitals and abroad. This has ensured a safe and robust process is now in place for timely isolation and screening of all potential admission at the earliest opportunity in line with national guidance.

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Clostridium difficile Infection

CDI is a significant HCAI, which usually causes diarrhoea and contributes to a significant burden of morbidity and mortality. Prevention of CDI is therefore essential and an important patient safety issue.

LDP Standard:  All Scottish NHS Boards are required to achieve the CDI LDP Standard of 32 cases or less per 100,000 AOBD in the aged 15 and over age group by 31 March 2018.

NHSL achieved the CDI LDP Standard in 2017/2018 for the second consecutive year with a rate of 0.27 against a national rate requirement of 0.32. NHS Scotland year-end rate position in 2017/2018

was 0.27. There was also an 18% reduction in CDI cases by comparison to the previous year. 

Patients 15 years and above  118 CDI cases  0.24 annual incidence rate of CDI per 100,000 AOBDs Quality Improvement and interventions to reduce CDIs:  Implementation of CDI Severity Marker Guidance and casenote sticker.  Multi-disciplinary severe CDI case review to support Patients aged 15 to 64 improvement in assessment / detection for early  37 CDI cases intervention and patient management.  0.26 annual incidence rate  Promotion of the Antimicrobial Stewardship Workbook to of CDI per 100,000 AOBDs raise awareness and promote best practice.  Prompt patient placement.  Improved information by Microbiology when electronic laboratory report sent out to clinical staff.

Patients aged 65 years and above  81 CDI cases  0.23 annual incidence rate of CDI per 100,000 AOBDs

54 HCAI Cases

56 CAI Cases

8 Unknown Source

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Surgical Site Infection

SSI is one of the most common HCAI and can cause increased morbidity and mortality. It is estimated on average to double the cost of treatment, mainly due to the resultant increase in length of stay. SSI can have a serious consequence for patients affected as they can result in increased pain, suffering and in some cases require additional surgical intervention.

Caesarean Section Hip Arthroplasty

1466 Procedures carried out 421 Procedures carried out

28 SSIs following procedure 5 SSIs following procedure

1.91% Infection Rate 0.95% Infection Rate

NHSL is unable to provide a comparison to NHSL is unable to provide a comparison to

the previous activity year as the national the previous activity year as the national

methodology for collecting SSI data has been methodology for collecting SSI data has been

changed from 10 days to 30 day surveillance changed from 10 days to 30 day surveillance

review. review.

Colorectal (large bowel) Surgery Vascular Surgery 332 Procedures carried out 256 Procedures carried out 25 SSIs following procedure 8 SSIs following procedure 7.53% Infection Rate 3.12% Infection Rate

No local or national baseline data available No local or national baseline data available for SSIs relating to colorectal (large bowel) for SSIs relating to vascular surgery. The surgery. The national mandatory standard national mandatory standard surveillance for surveillance for elective Colorectal (large elective vascular surgery commenced from bowel) commenced from April 2017. April 2017.

Quality Improvement and interventions to reduce SSIs:  The IPC Surveillance Nurses (IPCSN) attend the Hairmyres Theatre Patient Safety Meeting and Maternity Clinical Effectiveness Group to present SSI data to establish any areas of improvement with clinicians and nursing staff.  IPCSNs collaborated with the Enhanced Recovery After Surgery (ERAS) Midwives and Nurses to provide key points in relation to preventing SSI to be included in their surgery school presentations.  NHSL has access to SSI surveillance reports within NSS Discovery at board level, this method of reporting allows comparison of patients’ outcome with Scotland overall and other NHS boards.  The IPCSN liaises with the relevant clinician responsible for the patient following detection of an SSI to discuss the findings of the review, an electronic copy is also sent to the clinician.  Quarterly SSI surveillance reports comprising Statistical Process Charts (SPC) are used to provide feedback to clinicians.

- 23 -

- 24 -

* Currently there are still too few data points to assess against the statistical control methodology and therefore a run chart has been used to display the data to date for vascular and colorectal SSIs.

- 25 -

Escherichia coli Bacteraemia Gram-negative bacteria continue to be an emerging threat in healthcare and in 2017/18 the number of cases of bacteraemia reported increased in Scotland. These infections predominantly originate from community sources with a rate of 47.5 cases per 100,000 population. In NHSL, the majority of cases of HCAI in 2017/2018 were lower urinary tract infections, a trend replicated across NHS Scotland with over half of the total cases of bacteraemia reported as lower urinary tract infections originating in the community.

A system wide targeted improvement approach is required to drive improvement by focusing on preventative strategies such as Hydration Campaigns and the Catheter Passport. In NHSL, the IPCT have been working on a number of initiatives as part of the Invasive Devices Manual of excellence including defining criteria for insertion and removal of urinary catheters. Progress with these initiatives will be reported across the organisation throughout 2018/2019.

Total 597 Cases of EColi Bacteraemia during 2017/2018

- 26 -

Hand Hygiene Hand Hygiene is recognised as being the most effective cornerstone of IPC in healthcare and quality of care in healthcare settings.

Hand Hygiene is a term used to describe the decontamination of hands by various methods including routine hand washing and/or hand disinfection which includes the use of alcohol gels and rubs.

The 5 Moments for Hand Hygiene (as shown in the diagram) approach defines the key opportunities when health-care workers should perform hand hygiene.

NHSL has reached an overall compliance level of 86% during 2017/2018 for the second consecutive year against the national compliance level of 95% or above. The organisation reached its highest overall levels of 90% and above in December 2017 which is to be commended given the difficulties the organisation faced during winter pressures.

- 27 -

Outbreak Management

27 Separate Outbreak Situations in 2017-2018

In 2017/2018 there was a significant decrease in the number of healthcare associated

outbreaks of infection with a total of 27 outbreaks managed by the IPCT and frontline staff in comparison to 73 outbreaks in 2016/2017 (reduction of 63%).

 64% reduction across acute services (67 outbreaks in 2016/2017 compared to 24 in 2017/2018)

 50% reduction in the H&SCPs (6 outbreaks in 2016/2017 compared to 3 in 2017/2018).

7 UHM

10 UHW 7 Full Ward Closures 7 UHH 20 Room restrictions 3 H&SCPs

120 Bed days lost

95 Patients affected

43 staff affected

Next Steps  Completion of winter preparedness events across acute and H&SCPs  IPCT Attendance at Winter Planning forums to raise awareness  Engaging with staff to work proactively in managing patients / isolation / cohort to minimise effect  Apply learning from IMT and / or Outbreak Management Debriefs

- 28 -

Training and Education

IPCT Training & Education Sessions The organisation has 12,300 staff members  CAAS Follow-Up Half Day Event Launch (clinical and non-clinical roles). Throughout (All Acute and Site Specific)

2017, 142 training and educational sessions  Winter Preparedness Roadshows were completed by the IPCT. The training  SSI Surveillance ‘Buzz Sessions’ topics consisted of: University Hospital Wishaw – Attention to   Topic specific Golden Hour / Golden Detail Week

Nugget (ward based training)

 Hand hygiene The IPCT in NHSL provided support to  LanQIP National Education for Scotland (NES) in

Corporate Induction launching the foundation pathway for the  national SIPCEP.  Medical Induction  Newly Qualified Nurse Induction  Healthcare Support Worker (HCSW) Induction  Ward 18, UHH – Environmental Training for executive directors/senior management teams  Stop the Spread of Flu campaign

NHSL Staff Learnpro Modules Completed

5,542 Hand Hygiene 125 Safe 1,283 Management of Norovirus There are 7 key linen learnPro modules that new and existing staff members have access 8,312 to complete. Hand 270 Modules 657 Hygiene is mandatory Principles of Complete MRSA Aseptic Screening & for completion by staff Technique Patient Management and on a yearly basis. The other modules noted below are for

10 425 completion as part of HAI CLinical Clostridium individuals personal Induction difficile development plans (PDP).

- 29 -

LICC and Sub-Groups

Lanarkshire  There have been 6 meetings held during the activity year. Infection Control  The annual work plan for the LICC was 95% complete at year end with the Committee (LICC) remaining actions carried forward the 2018/2019 work plan.  Excellent progress been made over the last year in progressing the HCAI agenda for NHSL.  The quality and presentation of documentation to the LICC has continued to be of a high standard.

Policy Review  NHSL has a responsibility to ensure arrangements are in place to warrant the Group (PRG) continual health and safety of the population of Lanarkshire from the effects of infection or microbiological environmental hazards. The LICC and the Health Protection Committee (HPC) are the lead forums to oversee this area.  The PRG is a sub-group of the LICC and the HPC is the strategic group responsible for ensuring the policies, guidelines and Standard Operating Procedures (SOPs) relating to IPC are updated and reviewed on a 2 yearly basis in line with the Standards for HCAI (2015).  The PRG is a collaborative group which includes the Health Protection Team (HPT) and co-opts others on to the group as required e.g. antimicrobial pharmacist. Over the past year 13 policies have been reviewed and ratified.

Decontamination  Between April 2017 and March 2018 there were 5 meetings held, one of Expert Advisory which was given over to the production of an A-Z of equipment and cleaning Group (DEMG) responsibilities, in line with the HPS report (2015) “Roles and Responsibilities for reusable patient care equipment and environmental decontamination”  A DCNS was appointed in October 2017 and a situational assessment of decontamination across NHSL completed. The findings of the assessment have been used to inform the Work Plan for the DEMG in 2018/19.  The A-Z of decontamination of reusable patient equipment has been completed and is in use across NHSL.  A suite of guidance in relation to decontamination including guidance on the management of decontamination failures has now been approved by the LICC and uploaded to the Decontamination portal on the IPC pages within FirstPort.  Enhanced collaboration with external service providers is now in place to oversee the quality of service delivered for decontamination of reusable devices used in Theatres.

Water Safety Group  Following a number of temperature excursions and positive Legionella counts, (WSG) mitigation measures were put in place and a series of extraordinary meetings of the WSG (sub-group) was convened. Both the short, medium and long term management of the issues were discussed at length with the HubCo providers of Kilsyth, Hunter and Houldsworth Health Centres and a technical solution found. Mitigation measures and enhanced sampling were put into place and an agreed solution has now led to several months of 0 Legionella counts found through monthly sampling. The extra ordinary meeting was dissolved and the issue is being regularly managed in the normal way through the regular WSG.  Annual audit was undertaken by the Authorising Engineer for water and the results and actions for improvement are being managed through the WSG. Actions for improvement are few and relatively minor in nature, and the

- 30 -

formed action plan was managed to conclusion through the WSG.  A number of positive Legionella counts were found through regular sampling at UHM (in Ward 24 only). Again, mitigation measures were immediately put into place and the issues managed through WSG leads until repeat sampling showed no positive counts of Legionella in these locations.  UHH Ward 18A (Room 5), low positive Legionella count on WHB blended hot water was found. Tap cleaned and re-samples taken. Re-sample results returned clear. No further actions were required in this regard.  Humidifiers removed from UHH, and the plant at UHW disconnected with planned preventative maintenance in place to cover residual fittings which cannot be removed. This was an energy savings initiative, reducing electrical costs and maintenance costs and contributing to savings 2017/18.

Antimicrobial  New guideline developments, e.g. revised Acute and Primary Care Empirical Management policies and a new vancomycin dosage calculator made available to clinical Committee (AMC) staff for the first time as an I-phone/smart phone app. Antifungal policy review generated approximately £186,000 annual saving when generic caspofungin substitution was agreed amongst NHSL clinical stakeholders  Safety initiatives included two Allergy Awareness Weeks delivered at UHM and UHH and a national Allergy Point Prevalence Survey conducted at UHW site. Feedback of improvement in practice with unprecedented staff engagement presented at local site stakeholder meetings and national SAPG events; work also accepted as poster presentation at Federation of Infection Societies Conference, 30 November 2017, Birmingham.  Antimicrobial Stewardship Training delivered at acute site and prescribing management team staff inductions as well as other relevant clinical forums e.g. Regional FY2 Medical Education Event, CAAS Nurse Educational workshops. More targeted ‘buzz sessions’ at ward level also included e.g. a nurse led stewardship mentorship programme within Ward 2, UHM & ICPT Surveillance Nurse Team completion of NES/SAPG validated workbook. Additional Gentamicin and vancomycin training delivered at UHM site as part of a wider Medicines Awareness week at the specific request of UHM consultant leads.  Staff and Public Engagement was sought at Antimicrobial Guardian live sign up events (www.antibioticguardian.com) as part of the annual Winter Preparedness Road Show Events throughout October 2017 across various Lanarkshire Locality locations using validated national materials to promote public understanding and involvement in relation to antibiotic stewardship.  AMC audit and assurance activity included antimicrobial input to all severe case reviews for CDI and SAB conducted by the IPCT. “Management of high risk medicines – learning from Gentamicin” presentation delivered to NHSL Medicines Safety Sub Group focused on sharing themes of successful local improvement interventions and participation in a national SAPG sponsored Point Prevalence Survey assessed current performance and clinical management of patients prescribed Gentamicin and Vancomycin across all 3 acute NHSL hospital sites.  National hospital antimicrobial key performance indicator audit processes embedded across acute sites with collaborative input from medical, nursing and ward pharmacists drove improvement in local standards of antibiotic care. Data from NHSL local initiatives actively shared at national SAPG meetings to inform future national strategy.  NHSL met the Scottish Government ‘reducing total antibiotic use’ national level 3 quality indicator for 2017/2018 and a sustained reduction of 14% in primary care antibiotic use since 2012 has been delivered with further new initiatives planned in 2018/2019:

- 31 -

* Pharmacy First’ Antimicrobial Patient Group Directions for Urinary Tract Infection (UTI) and Impetigo launched across NHSL community pharmacies allowing patients greater access to appropriate antibiotic care and alleviating some service pressure on local GP practices. * Antimicrobial updates to Primary Care prescribers regularly cascaded via monthly Prescribing Bulletin and for the first time NHSL Healthcare Improvement Library at Law House promoted a suite of SAPG endorsed antimicrobial prescribing support materials directly to GP practices. * NHSL GP practices received antimicrobial prescribing data analysis from local prescribing management pharmacy projects and from the National Services Scotland co-ordinated FAPPC (Feedback of Antibiotic Prescribing to Primary Care) initiative with the purpose of stimulating local reflection and improvement. * NHSL collaboration with Health Improvement Scotland (HIS) delivered the first ‘One Health’ Antimicrobial Stewardship Stakeholder meeting with local NHSL Veterinary Practitioners with further related initiatives to improve antibiotic use in animals to follow.

UHH Hygiene Group  Following on from last year’s work with Beckton Dickinson® UHH had 471 days with no Peripheral Venous Cannula (PVC) related SABs. Two of our Senior Nurses will be presenting the work at an international conference.  A Band 5 Registered Nurse from within Ward 12 (respiratory) has been identified to work with the antimicrobial team on data collection and to be a ‘champion’ for this. This is an opportunity for forging stronger links between the antimicrobial team and the clinical areas, and is an excellent development opportunity for the Registered Nurse selected.  UHH have had our best staff uptake for the flu jab ever at UHH this year, with 50.04% of staff vaccinated across the hospital and 53.9% within the priority clinical areas, at the end of December 2017.  There was an unannounced HIS inspection in May 2017. The outcome of this inspection showed improvement from the previous one; however challenges were identified in the Medical Receiving Ward. The main changes implemented following this inspection were that there has been increased domestic hours put into this area, the Hospital Hygiene Agenda has been reviewed to reflect a more robust escalation process and our service providers now take full responsibility for cleaning of patient chairs.  New Hospital Cover HEI tool introduced identifying any issues found are highlighted both locally and to the Senior Nurse responsible for the area. The tests of change to embed the tool and processes continue and results are fed through the Hospital Hygiene Group meetings.

UHM Hygiene Group  There has been representation at the monthly hygiene meetings however this is going to be further reviewed to ensure there is more senior charge nurse representation to further enhance the delivery of the hygiene work plan.  The number of PVC related SABs has been a key action for the hygiene group from information provided by the IPCT which led to the PVC awareness week being arranged in May 2018 to raise awareness of PVC insertion and maintenance bundles, IV to oral switch, the stay safe stay connected campaign and for staff to pledge what actions they were taking forward. This was well received by all disciplines of staff and action plan devised and being taken forward to ensure sustainability. There was also work undertaken by Beckton Dickinson to undertake observational audits of the practice regarding safe use of PVC and devices. An action plan was developed and is being taken forward by the Senior charge nurses. Findings were shared with staff

- 32 -

via a newsletter. This work was undertaken by the IP&C Team within the site with drop in sessions and ward/department on site educational sessions. The uptake from staff was very good.  Hand hygiene compliance has been variable throughout the activity year. The IP&C Team arranged a series of drop-in and ward/department on site educational sessions. The uptake from staff was very good and work continues to improve the compliance levels on site.

UHW Hygiene  HEI Group session in 24/01/18. Positive feedback and assurance was given Group to HEI by the level of detail and evidenced provided.  The completion of three mock inspections in June 2017, August 2017 and October 2017 which inspected a total of 18 wards. There were 18 wards reviewed were overall good inspection, staff welcoming with good leadership. This was extremely worthwhile, well received in terms of the approach together with the key learning and improvements identified from the findings. The inspection process will continue into 2018/2019.  There has been improvement in LanQIP access which now allows the clinical areas / departments to upload their monitoring programme results to support local improvement programmes.  Directorate Safety huddles discuss compliance of cleaning schedules and provide support as required.  Audited Cleaning schedules in July 2017 and revised cleaning schedules across UHW.  There has been significant work undertaken in conjunction with Beckton Dickinson (BD) in identifying key areas for improvement with regard to PVC insertion and maintenance bundle compliance which is being taken forward locally and reported to the Hygiene Groups and LICC.

North H&SCP  Continuing to build on the sharing of good practice within the group through Hygiene Group the use of presentations and group discussions. A recent presentation on implementation of Daily Walkrounds to support sustaining high standards of hygiene in the ward and raising awareness of the risks posed to laundry staff following a recent Bagging & Tagging audit. There was also group discussion of local protocols used in learning disabilities and how they could be used elsewhere.  Hand Hygiene remains a key area of focus and IPCT ran a series of awareness sessions for the partnership. With the exception of the integrated services that have a mixture of NHS and North Lanarkshire Council staff, there has been a sustained improvement in Hand Hygiene this quarter, with local audits ranging between 80-100%. The integrated team have however, made considerable progress thanks to the leadership of the service manager and the service are showing improvement month on month. There are some environmental issues which will take longer but are being progressed.  There have been a number of unannounced inspections carried out by the IPCT, the reports have been good on the whole with a number of minor issues raised in each. The IPCT have commented on how welcoming the staff have been and praised not only their engagement the inspections but their timeous response to addressing any actions identified.  The hygiene group continues to develop and can see a greater degree of awareness and engagement from the attendees, reporting has improved however this remains variable and are focusing on sustaining the required standard, this is a key area of focus for this year.

South H&SCP  The Hygiene Group continues to meet monthly. Hygiene Group  The Group membership has increased during 2017/2018, to include additional

- 33 -

clinical teams, further enhancing assurance around infection prevention and control across South H&SCP.  Auditing and reporting processes have improved, whilst logging data onto LanQIP, from all clinical areas, continues to be refined.  Remedial and Improvement Action Plans are reported via the Governance Structure provided of the South Hygiene Group and reflective learning is shared broadly by means of this membership.

- 34 -

Glossary of Terms ABHR Alcohol Based Hand Rub AMC Antimicrobial Management Committee AMR Antimicrobial Resistant AOBDs Acute Occupied Bed Days BD Beckton Dickinson BSI Blood Stream Infection CAAS Care Assurance Accredited Scheme CAI Community Associated Infection CDI Clostridium difficile Infection CMT Corporate Management Team CPE Carbapenemase Producing Enterobacteriaceae CRA Clinical Risk Assessment CVC Central Venous Cannula DCNS Decontamination Clinical Nurse Specialist DEMG Decontamination Environmental Monitoring Group ECB Escherichia coli Bacteraemia ECDC European Centre for Disease Control Ecoli Escherichia coli ERAS Enhanced Recovery After Surgery FAPPC Feedback of Antibiotic Prescribing to Primary Care GP General Practitioner H&SCPs Health and Social Care Partnerships HAI Healthcare Associated Infection HCAI Healthcare Associated Infection HCSW Healthcare Support Worker HIS Health Improvement Scotland HPC Health Protection Committee HPS Health Protection Scotland IDEAG Invasive Device Expert Advisory Group IMT Incident Management Team IPC Infection Prevention and Control IPCSN Infection Prevention and Control Surveillance Nurses IPCT Infection Prevention and Control Team IPS Infection Prevention Society IRIS Infection related intelligence service LDP Local Delivery Plan LICC Lanarkshire Infection Control Committee MRSA Meticillin resistant staphylococcus aureus MSSA Meticillin sensitive staphylococcus aureus NES National Education for Scotland NHS National Health Service NHSL NHS Lanarkshire NMAHPS Nursing, Midwifery and Allied Health Professionals NPPS National Point Prevalence Survey NSS National Services Scotland PDP Personal Development Plan PMS Patient Management System PRG Policy Review Group PVC Peripheral Venous Cannula PVL Panton-Valentine Leukocidin SAB Staphylococcus aureus bacteraemia SAPG Scottish Antimicrobial Pharmacy Group SEED Surveillance, Education, Engagement, Devices SICPs Standard Infection Control Precautions

- 35 -

SIPCEP Standard Infection Prevention and Control Education Pathway SOP Standard Operating Procedure SPC Statistical Process Chart SPSP Scottish Patient Safety Programme SPUD Surveillance Prevalence Update Daily SSIs Surgical Site Infections TBPs Transmission Based Precautions UHH University Hospital Hairmyres UHM University Hospital Monklands UHW University Hospital Wishaw UTI Urinary Tract Infection VRE Vancomycin resistant enterococci WHO World Health Organisation WSG Water Safety Group

- 36 -

Agenda Item

Report 5

Report to: Performance and Audit Sub-Committee Date of Meeting: 28 August 2018 Report by: Director, Health and Social Care

Subject: Performance Monitoring Report

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  update the Performance and Audit Sub-Committee of performance against the key performance measures assigned to the integration of Health and Social Care  outline future performance reporting opportunities [1purpose] 2. Recommendation(s) 2.1. The Performance and Audit Sub-Committee is asked to approve the following recommendation(s):- [recs] (1) that the current performance trends be noted; and (2) that the proposed development work regarding performance management arrangements be noted. [1recs] 3. Background 3.1. Through the Public Bodies Joint Working (Scotland) Act 2014 and the associated regulations and guidance, an agreed suite of 23 performance measures were established for consistent application across Scotland. Consequently, Health and Social Care Partnerships (HCSP) use these measures as part of a minimum suite of performance data to report to the Integration Joint Board and its Sub-Committees.

3.2. Following this, the Scottish Government issued in December 2016, the Health and Social Care Delivery Plan which brought about a renewed focus on six measures prioritised by the Ministerial Steering Group (MSG) in relation to:  unplanned admissions  occupied bed days for unscheduled care  A&E performance  delayed discharges  end of life care  the balance of spend across Institutional and Community Services

3.3. In addition, a number of performance measures which relate to the functions managed by the HCSP are also reported to the NHS Lanarkshire Board; the South Lanarkshire Council Social Work Resources Committee; and South Lanarkshire Community Planning Partnership. A workshop with Performance and Audit Sub-

- 37 - Committee members took place on 07 March 2018 and the proposals emitting from this workshop were presented and approved at the June IJB meeting. Work is now progressing to build a new and more comprehensive performance framework.

3.4. This report outlines the trends in performance with regards to the six MSG measures.

3.5. Appendix 1 shows a useful longitudinal trend analysis of the MSG indicators.

4. Delayed Discharges 4.1. There has been significant work undertaken over the last 18 months to refocus efforts in supporting a reduction in the number of delayed discharges in line with the recent Audit Scotland report on this issue as well as the internally generated delayed discharge action plan.

4.2. Most significant of the various pieces of work undertaken, has seen the emphasis for both home care patients and CCA/complex assessment patients to be transferred from a hospital based approach to one which is locality led and owned. Initially, the social work/CCA element transferred to localities in November, whilst the home care transfer was undertaken in January.

4.3. By moving to a ‘locality-ownership’ approach, this has also seen the opportunity for increased integrated approaches, with NHS staff assisting to provide early rehabilitation/discharge support as well as Support Your Independence (SYI) home care staff. In turn, this has enabled SYI staff to more often take over care pending optimum re-ablement and independence of service users.

4.4. ISD published data for June 2018 shows that occupied bed days performance for South Lanarkshire delayed bed days has deteriorated. One factor which has contributed to the increase are the numbers of referrals received by localities, 390 were received, an increase of 47 when compared with June 2017.

Previous Current Increase/reduction year Year March 4048 2253 -1795 (Decrease) April 3856 2546 -1310 (Decrease) May 3939 2822 -1117 (Decrease) June 3453 3514 61 (Increase) ISD: Occupied bed days All delays

4.5. From the above table, it will be noted following a period of sustained and significant decrease in delayed discharge bed days there was an increase of 61 bed days in June 2018 against June 2017.

5. Summary and Next Steps 5.1. There are a number of areas of development which are being led by the Partnership, working alongside acute colleagues to make further improvements across the six main MSG targets. This will be supported by an Unscheduled Care workshop.

5.2. As outlined in point 3.3 a more comprehensive performance reporting framework is being developed and will be presented to a future Performance and Audit Sub- Committee.

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6. Employee Implications 6.1. There are no employee implications associated with this report

7. Financial Implications 7.1. There are no financial implications associated with this report.

8. Other Implications 8.1. There are no additional risks associated with this report.

8.2. There are no sustainable development issues associated with this report.

8.3. There are no other implications at this stage.

9. Equality Impact Assessment and Consultation Arrangements 9.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore, no impact assessment is required.

9.2. Consultation on this work has and will continue to be part of discussions with the Strategic Commissioning Group and Locality Planning Groups.

10. Directions 10.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 14 August 2018

Link(s) to National Health and Wellbeing Outcomes

- 39 - Health and Social Care Services contribute to reducing health inequalities

People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

Previous References  report of South Lanarkshire Integration Joint Board – Annual Performance Report to Performance and Audit Sub-Committee, 29 August 2017

List of Background Papers  Appendix 1 – six MSG Measures

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Craig Cunningham, Head of Commissioning and Performance Ext: 3704 (Phone: 01698 453704) Email: [email protected]

- 40 - Appendix 1

South Lanarkshire HCSP Health and Social Care Delivery Plan Measures

1. Context 1.1. The Health and Social Care Delivery Plan and the work of the Ministerial Steering Group (MSG) in Health and Social Care have identified six key areas through which trends overtime will be monitored, with a view to supporting improvement and learning within Partnerships and across Scotland.

1.2. A key emphasis behind this work is realising the national ambition to shift the balance of care through strategic commissioning which shifts the focus from acute and residential settings to community based alternatives. This report gives a short overview of the South Lanarkshire position with regards to the following areas:  unplanned admissions  occupied bed days for unscheduled care  A&E performance  delayed discharges  end of life care  the balance of spend across institutional and community services

2. Summary of the ‘Big Six’ in South Lanarkshire for year 2017/18:  A&E attendances up by 4% against 2016/17  emergency admissions up by 1.39%  unscheduled bed days down by 1% year on year  delayed discharge bed days down year to year by 9%  people spending last six months of life in community increased by 0.3%  balance of care is broadly in line with other similar Partnerships at just under 98%

a) A&E Attendances The following graphs show the performance against trajectory. The trajectory has been revised to reflect seasonality, this does not affect the overall target numbers. This trajectory has been calculated assuming that A&E attendances could be maintained at the previous year level. Attendances during April and May 2018 were above target levels, with 1285 attendances more than anticipated, 18,767 against a target of 17,482.

South Lanarkshire A&E Attendances 10,000 9,500 9,000 8,500 8,000 7,500 7,000 6,500 6,000 5,500 5,000

Attendances Target Attendances

- 41 - b) Emergency Admissions The graph below shows emergency admissions against the agreed trajectory. The Partnership performed well during April and May 2018 with 6295 admissions against a trajectory of 9591, 99 fewer admissions than anticipated.

South Lanarkshire Emergency Admissions April 2015 - May 2018 4,000

3,500

3,000

2,500

2,000

1,500

Jul-17 Jul-15 Jul-16

Jan-16 Jan-17 Jan-18

Jun-15 Jun-16 Jun-17

Oct-15 Oct-16 Oct-17

Apr-15 Apr-16 Apr-17 Apr-18

Feb-16 Feb-17 Feb-18

Sep-15 Sep-16 Sep-17

Dec-15 Dec-16 Dec-17

Aug-15 Aug-16 Aug-17

Nov-15 Nov-16 Nov-17

Mar-16 Mar-17 Mar-18

May-15 May-16 May-17 May-18 Emergency Admissions Target Admisssions c) Unscheduled Bed Days The graph below tracks the month on month actual performance longitudinally against the trajectory agreed for unscheduled bed days. Acute bed days for April and May 2018 were 8,174 fewer than anticipated, however it should be noted that there is routinely a few months lag in terms of completed episodes of care and bed day for April and May will increase.

South Lanarkshire Unscheduled Care Bed days Acute Specialties 24,000

22,000

20,000

18,000

16,000

14,000

12,000

10,000

Jul-15 Jul-16 Jul-17

Jan-16 Jan-17 Jan-18

Jun-15 Jun-16 Jun-17

Oct-15 Oct-16 Oct-17

Apr-15 Apr-16 Apr-17 Apr-18

Feb-16 Feb-17 Feb-18

Sep-15 Sep-16 Sep-17

Dec-15 Dec-16 Dec-17

Aug-15 Aug-16 Aug-17

Nov-15 Nov-16 Nov-17

Mar-16 Mar-17 Mar-18

May-15 May-16 May-17 May-18

Actual Target

Both Mental Health and Geriatric Long Stay bed days have shown a significant reduction January 2015 to March 2018, and are currently performing well against target levels.

- 42 -

South Lanarkshire Unscheduled Geriatric 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0

Geriatric GLS Target

South Lanarkshire Unscheduled Mental Health 20,000

15,000

10,000

5,000

Mental Health MH Target

d) Delayed Discharge Bed Days Delayed Discharge Bed day targets for December and January onwards were based on improvements in delays associated with homecare, and the reclassification of offsite beds as intermediate care. Homecare improvements have resulted in a decrease in bed days for this type of delay. However the Partnership is continuing to clarify the intermediate care coding arrangements. As such, all improvements shown are directly comparable to previous information.

The graph below shows revised targets which include patients in offsite beds.

A comparison with April – March the previous year shows a reduction of 9% in delayed discharge bed days. Improvement in bed days during December to March has been 31%. However bed days for April and May were beyond target by 373 and 348 respectively. Bed days performance for June deteriorated further with occupied bed days 1,531 beyond target.

- 43 - South Lanarkshire Delayed Discharge Bed Days (exc. Code 9s)

4,500

4,000

3,500

3,000

2,500

2,000

1,500

1,000

500

Non-code 9 Bed days Target incl offsite

e) Last six Months of Life by Setting Percentage of people who spend their last six months in a community setting has steadily increased over the previous three years. With a shift of resources from acute to community it is expected that the numbers of people who spend the last six months in the community will increase. Initially the Partnership aims to achieve the average of their benchmarking group, within three years the aim is to achieve above average in line with North Lanarkshire.

The table below confirms the Partnership is increasing the proportion of South Lanarkshire residents who spend the last six months of life in the community. More recent updates from ISD show that the Partnership was ahead of the 2017/18 target.

2013/2014 2014/2015 2015/2016 2016/2017p 2017/2018 2018/2019 Community 84.2% 84.4% 84.9% 87.0% 87.3% 87.0% Community Target 84.2% 84.4% 84.9% 87.0% 86.6% Large Hospital 14.0% 14.3% 13.9% 12.2% 12.1% 11.7% Large Hospital Target 14.0% 14.3% 13.9% 12.2% 12.2% f) Balance of care The percentage of people over 75 who are not thought to be in any other setting, or receiving any home care, has increased during 2015/16, South Lanarkshire are at the average level when measuring against the Discovery peer group. Given the increase in the 75+ age group it is suggested that the 2015/16 percentage remains the target through to 2018/19.

- 44 - 2013/2014 2014/2015 2015/2016 2016/2017p 2017/2018 2018/2019 Home (unsupported) 81.0% 81.8% 81.7% 82.2% Not available Home (unsupport) Target 81.0% 81.8% 81.7% 82.0% 82.0% 82.0% Home Supported 9.6% 9.0% 9.0% 8.8% Not available Home Support Target 9.6% 9.0% 9.0% 9.0% 9.0% 9.0%

Balance of care improvements figures, shown above, were based on the over 75 population, generally those with the more complex needs.

South Lanarkshire community based service provision remains just under 98%. The 98% figure presents the proportion of the overall population not in acute hospitals.

- 45 -

- 46 -

Agenda Item

Report 6

Report to: Performance and Audit Sub-Committee Date of Meeting: 28 August 2018 Report by: Director, Health and Social Care

Subject: Thematic Inspection - Self-Directed Support

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  advise the Performance and Audit Sub-Committee that South Lanarkshire Health and Social Care Partnership will undergo a formal inspection of Self-Directed Support in the autumn of 2018 [1purpose] 2. Recommendation(s) 2.1. The Performance and Audit Sub-Committee is asked to approve the following recommendation(s):- [recs] (1) that the content of the report be noted; and (2) that the planned actions to prepare the Health and Social Care Partnership for this inspection be supported. [1recs] 3. Background 3.1. South Lanarkshire Health and Social Care Partnership (HSCP) and its partners will undergo a formal inspection of Self-Directed Support (SDS) as notified by the Care Inspectorate in their letter of 19 June 2018. This inspection is part of the Care Inspectorate’s national programme of activity, whereby all council areas across Scotland will undergo a similar process across the next few years.

3.2. The format of this inspection will broadly follow similar national thematic based inspections and is comparable to the South Lanarkshire multi-agency inspection of Older People’s Services in 2015, albeit on a smaller scale.

3.3. Following the notification letter, the Care Inspectorate has also made follow-up contact with the Chief Social Work Officer as part of initial discussions and liaison. This contact was made through the two assigned lead inspectors (John Skouse and Mike Harking) for the South Lanarkshire SDS Inspection. Overall, there will be a team of eight inspectors supporting the process.

3.4. The inspection process will comprise of a number of different stages as outlined below:  week commencing 02 July and 09 July, a professional discussion will be held with key stakeholders

- 47 -  a staff survey will be sent through by the Care Inspectorate on 27 June for onward distribution to staff, with a closing date of 13 July 2018  advanced information and position statement requires to be sent to the Care Inspectorate by 20 July 2018. This is essentially a self-evaluation by the Council against the national Quality Indicator Framework. A total of 13 Quality Indicators out of the 28 Quality Indicators will be evaluated and an indicative scoring is required to be applied to these using the six point scale as outlined in Appendix 1. A copy of the Quality Indicator Framework is attached in Appendix 2 and for ease of reference, the inspection position statement requires that the Council submits a position against:  Quality Indicator 1.2  Quality Indicators 2.1 – 2.3  Quality Indicator 3.1  Quality Indicators 5.1 – 5.4  Quality Indicator 6.1  Quality Indicator 7.3  Quality Indicators 9.1 and 9.4  a Pre-Inspection Return or PIR covering key information on SDS personnel, organisational charts and a case file sample covering those in receipt of SDS is required to be submitted  an evidence bank/log to support the Position Statement and alerting inspectors to key pieces of information for reference. Again this requires to be submitted by 20 July 2018. This was duly submitted by this deadline date  in terms of on-site activity, the Inspectors will be on-site on the weeks commencing 22 and 29 October. In the first of these weeks, they will scrutinise a sample of 60 case files, associated provider files and up to a further 20 cases where the referrals to Social Work Services was not progressed to an SDS allocated budget stage. The second week (w/c 29 October), will be scrutiny week, whereby the inspection team will look to meet with staff, Senior Managers, IJB Senior Officers, providers, people who use services and their carer’s and other relevant stakeholders

4. Preparation Arrangements and Next Steps 4.1. In terms of preparing for this inspection, the Lead Officer will be the Chief Social Work Officer, who will be supported by a Core Preparation for Inspection Team comprising of the SDS Fieldwork Manager and staff from the Planning and Performance Team. This Core Group has weekly touchdown meetings already established to review progress against an already drafted project plan.

4.2. Work is already progressing against each of the above areas, with a project plan referred to above having assigned leads. From a submissions perspective, the PIR and Position Statement will be brought back to a future meeting as part of familiarising and communicating the position of the Council and its partners with regards to this. A summary information leaflet has been prepared for staff to highlight information in relation to the inspection and the position statement. A copy of this is attached in Appendix 3.

4.3. In terms of communication and engagement, there has already been initial communication with managers and frontline staff across localities. This will be followed up by further planned communications which summarise a number of aspects including the position statement and the areas that inspectors will wish to observe or speak to them about.

- 48 - 5. Employee Implications 5.1. Resourcing an inspection process is an intensive short-term piece of work. Although the intention is to resource this from within existing staffing complements, this will require some staff to be freed up from day-to-day tasks to prioritise inspection preparation as their immediate work objective.

6. Financial Implications 6.1. There are no financial implications associated with this report.

7. Other Implications 7.1. There is no risk implications associated with this report.

7.2. There are no sustainable development issues associated with this report.

7.3. There are no other issues associated with this report.

8. Equality Impact Assessment and Consultation Arrangements 8.1. This report does not introduce a new policy, function or strategy, or recommend a change to an existing policy, function or strategy and, therefore, no impact assessment is required.

8.2. There will be service user and carer engagement as part of this process. Service users and carers will be provided with full feedback of the outcome of this joint inspection.

9. Directions 9.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Liam Purdie Chief Social Work Officer/Head of Children and Justice Services

Val de Souza Director, Health and Social Care

Date created: 09 August 2018

Link(s) to National Health and Wellbeing Outcomes

- 49 - People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities

People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

Previous References  none

List of Background Papers  none

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Martin Kane, Programme Manager Ext: 3743 (Phone: 01698 453743) Email: [email protected]

- 50 - Appendix 1

Care Inspectorate

Level 6 Excellent Outstanding or sector leading Level 5 Very good Major strengths Level 4 Good Important strengths with areas for improvement Level 3 Adequate Strengths just outweigh weaknesses Level 2 Weak Important weaknesses Level 1 Unsatisfactory Major weaknesses

- 51 - Appendix 2

Quality Indicators

How well do we jointly meet the What key outcomes How good is our joint How good is our management of needs of our stakeholders through How good is our leadership? have we achieved? delivery of services? whole systems in partnership? person centred approaches? 1. Key performance 6. Policy development and plans to 9. Leadership and direction 2. Getting help at the right time 5. Delivery of key processes outcomes support improvement in service that promotes partnership

1.1 Improvements in 2.1 Experience of individuals and 5.1 Access to support 6.1 Operational and strategic planning 9.1 Vision ,values and culture partnership carers of improved health, wellbeing, arrangements across the partnership 5.2 Assessing need, planning performance in both care and support for individuals and delivering 6.2 Partnership development of a 9.2 Leadership of strategy and healthcare and social 2.2 Prevention, early identification care and support range of early intervention and support direction care and intervention at the right time services 5.3 Shared approach to 9.3 Leadership of people 1.2 Improvements in 2.3 Access to information about protecting individuals who are 6.3 Self-evaluation and improvement across the partnership the health and well- support options including self at risk of harm, assessing risk 6.4 Performance management and 9.4 Leadership of change and being and outcomes directed support and managing and mitigating quality assurance improvement for people, carers and risks families 6.5 Involving individuals who use 5.4 Involvement of individuals services, carers and other stakeholders and carers in directing their own support 6.6 Commissioning arrangements

10. Capacity for 3. Impact on staff 7. Management and support of staff improvement

3.1 Staff motivation and support 7.1 Recruitment and retention 10.1 Judgement based on an evaluation of performance 7.2 Deployment, joint working and team against the quality indicators work 7.3 Training, development and support

4. Impact on the community 8. Partnership working

4.1 Public confidence in community 8.1 Management of resources services and community 8.2 Information systems engagement 8.3 Partnership arrangements

What is our capacity for improvement?

- 52 -

Thematic Review of Self-directed Support South Lanarkshire

Information for employees

Introduction

South Lanarkshire Council and its Partners will undergo a formal Thematic Review which will be on Self-directed Support (SDS) as notified by the Care Inspectorate in their letter of 19th June 2018. The Review is part of the Care Inspectorate’s national programme of activity, whereby all Council areas across Scotland will undergo a similar process over the next few years. The purpose of this briefing is to keep staff updated on this subject, with reference to professional practice developments, external scrutiny and a range of other associated items.

The format of this review will broadly follow similar national thematic based inspections and is comparable to the South Lanarkshire multi – agency inspection of older people’s services in 2015, albeit on a smaller scale.

The review will take place in order to:

 Provide an evidence based assessment of SDS implementation, measurement and quality assurance of SDS delivery and compliance with the principles and values within both the Self-directed Support: A National Strategy for Scotland and the Social Care (Self-directed Support) (Scotland) Act 2013 implemented on 1 April 2014.  Ensure findings from the joint inspection activity will be examined by key stakeholders to consider and inform the opportunity for a future programme of supported self evaluation across Scotland in all the areas not subject to inspection.  Give public assurance that social care and social work in Scotland is rights-based and world- class, through robust and independent scrutiny and improvement processes.

The partnership is required to notify the lead inspector of a representative, who will lead in co- ordinating the inspection. The representative is Andrea Tannahill, SDS Development Manager.

Key dates

The Review takes place over a number of phases and the following provides key dates in relation to inspection activity.

Stage 1 June - July 2018  The partnership received a letter of notification.  The partnership returned a suite of information including a self evaluation by the Council against the national quality indicator framework. A total of 13 quality indicators out of the 28 quality indicators will be evaluated and an indicative scoring is required to be applied to these, using a 6 point scale (see page 6).  Staff survey issued with a closing date of 20 July 2018.

- 53 - Stage 2 22 October 2018  Inspection team on site analysing social work records of 60 supported people. The local file readers shall assist the inspection team in analysing the records. In addition to the main case files a further 20 cases, where the referrals to social work services was not progressed to an SDS allocated budget stage, will be reviewed by the inspectors.

29 October 2018  A range of Scrutiny sessions will take place, some of these will be in the form of Focus Groups and existing groups/meetings.

31 August 2018  The inspection team will be sending out a survey to a selection of Supported People from the case file list, which will lead to follow up interviews with a selection of individuals and unpaid carers, whose records have been read.

Stage 3 Final Stage Inspectors analyse their findings and publish an overview report based around the key themes. They will also produce a short evaluative report on each of the Partnerships inspected, highlighting key strengths and, if appropriate, recommendations for improvement. We will then be asked to prepare an action plan detailing how we will take these forward.

Who are the inspection team?

The Inspection team will comprise of:

John Skouse, Lead Inspector, Winnie Burke, Depute Lead Inspector Ian Kerr, Inspector Helen Samborek, Inspector Jess Wade, Inspector Cathy Asante, Inspector Dina Scott, Inspector

Administration: Ashley Martin, Strategic Support Officer

- 54 - The Context of Self-directed Support

Health and Social Care Integration The shape of Scottish society is changing - people are living longer and leading healthier lifestyles. So as the needs of our society change so too must the nature and form of our public services. New legislation, in the form of the Public Bodies (Joint Working) (Scotland) Act 2014 came into force on 1 April 2014. The Act requires Health Boards and Local Authorities to integrate their health and social care services.

Self-directed Support The following describes important elements of South Lanarkshire Health and Social Care Partnership professional practice approach to Self-directed Support. This approach capitalises on the supported person and their carer(s) abilities and strength based assets. It focuses on understanding what is working well in someone’s life and what requires support.

Self-directed Support: Values and Principles Social Work Resources are committed to the principles underpinning Self-directed Support of:

 participation  dignity  collaboration  informed choice

The approach incorporates the above values and principles throughout the process of assessment, outcome support planning and review. Supported people, carers or legal appointees must be encouraged to be as involved as they are able to be. The Lead Worker must take reasonable steps during the process of assessment, outcome support planning and review to ensure that individuals and carers are supported in order that they can make informed choices.

The role of the professional within Health and Social Care is enshrined in a range of legislative responsibilities and duties, some of which are outlined in legislation, while others may be outlined in policies and procedures.

Self-directed Support: Legislative Responsibilities The Social Care (Self-directed Support) (Scotland) Act 2013 provides the legal basis for choice and control over care and support by a supported person or a person legally appointed on their behalf. This extends the legal duties stipulated in Section 12A of the Social Work (Scotland) Act (1968) which places a duty on Social Work Resources to assess an adult’s need for care and support. In addition, the Self-directed Support (SDS) legislation, (Section 3) underlines Section 12A in the Social Work (Scotland) Act 1968, regarding the local authority’s responsibilities to support carers.

South Lanarkshire Health and Social Care Partnership Duties  The local authority should collaborate with the supported person when they undertake the assessment and provide support.  The local authority should take steps to ensure that the supported person makes informed choices as part of their assessment and in selecting their support options  The local authority should take steps to involve the supported person in their assessment and in selecting their support options  The local authority has the duty to evidence co-production within the assessment and offer the four funding options if the supported person is eligible for support.

- 55 - Understanding and choosing the appropriate Assessment Pathway

Pre SDS Assessment This assessment should be used when individuals have potential for re-ablement through short-term intervention using either people support (four to six weeks) or equipment. This is also particularly relevant for people who have experienced an acute period of ill health or injury and have potential to make a significant recovery. Consequently it is best used with individuals who have potential for re-ablement /rehabilitation that is Supporting Your Independence (SYI) via Homecare and Occupational Therapy.

Comprehensive SDS Assessment Co-produced assessments are used for case work where a supported person may be eligible for an Indicative Budget through Self-directed Support or may be considered for long term care within a nursing or residential setting.

The ‘SDS’ phase relates to supported people whose care and support needs are viewed to be “stable and ongoing” identified at point of assessment and that they are eligible for ongoing support.

The definition for “stable and ongoing” is when a supported person or carer’s life is as stable as it can be for them and is anticipated to remain so for a period of one year. This allows them to be in receipt of, and effectively manage their annual Personal Budget. It is acknowledged that unforeseen circumstances can occur within that one year period and that these can be responded to through review. Depending on the nature of the crisis situation there is scope for consideration to input services subject to discussion with Team Leader/Fieldwork Manager.

The Co-Worker is another professional (for example Occupational Therapist from Physical Disability and Sensory Impairment Team) who has been identified to provide a contribution to the Co- produced Assessment. They are responsible for providing information to support the Lead Worker’s assessment and for providing interventions/recommendations associated to their role and responsibility.

The Comprehensive Co-produced Assessment is the only assessment option which generates an Indicative Budget through a Resource Allocation System (RAS).

It is important that the professional completing the assessment understands the process and the roles of other staff who are involved in moving forward to securing a budget/service for the supported person and the payment of the services.

Staff Contribution It is essential that staff (or teams) take responsibility to enhance professional practice, seek clarity on matters or share suggestions to improve practice.

External Scrutiny External scrutiny is an essential element of measuring how our professional practices and service delivery, along with how we engage with the public, other services and the third sector. The main scrutiny is via the Care Inspectorate who regulate, check and inspect services using a range of measurements. Training and developments and appropriate use of procedures should guide staff to the highest professional practices; be this engagement with others, appropriate recording etc. It is acknowledged that staff work hard and provide quality services, hence it is important to ensure through our practices, that we are able to provide the appropriate evidence whenever the Care Inspectorate should visit our services.

Following the Audit Scotland Report in 2017, on the implementation of Self-directed Support, we conducted a staff survey to capture the views of our own staff. As a result we have introduced our new procedures, supported by training, and will continue to communicate with staff via this SDS

- 56 - Newsletter any information about the services we provide and the changes that are happening to assist us in the future development of SDS in South Lanarkshire.

This is a real opportunity for all to highlight the hard work and good practice carried out daily in our delivery of services to support people going through the SDS Assessment process.

Service Development and Support Team and points of contact.

The team consists of social work manager, social work team leader, finance officer and IT staff. The main function and responsibilities of the team is to work with Operational staff to promote, plan and develop the necessary work to embed SDS in both the culture and practice of this resource. There is a need to facilitate outcome support planning briefings, encouraging development within the existing workforce and new staff. Further updates will be provided.

The team are mainly located on Floor 9, Social Work Headquarters and can be contacted as follows:

Andrea Tannahill – SDS Development Manager, Phone: 01698 453744 Email: [email protected] Andrea Tallis – SDS Team Leader, Phone: 01698 453728 Email: [email protected] Marie McHugh – SDS Finance Officer, Phone: 01698 453907 Email: [email protected]

The team are augmented by resources from IT and include Business Analysts and Developers who will drive the significant systems changes needed.

Public Information material All SDS public information (available on the intranet) will be reviewed as part of the process of implementing SDS developments.

- 57 - How will the inspection team evaluate services in South Lanarkshire?

The inspection team will evaluate services in South Lanarkshire using a framework of quality indicators across 10 key areas:

1. Key performance outcomes 1.1 Improvements in the health and well-being and outcomes for people, carers and families

2. Getting help at the right time 2.1 Experience of individuals and carers of improved health, wellbeing, care and support 2.2 Prevention, early identification and intervention at the right time 2.3 Access to information about support options including self-directed support

3. Impact on staff 3.1 Staff motivation and support

5. Delivery of key processes 5.1 Access to support 5.2 Assessing need, planning for individuals and delivering care and support 5.3 Shared approach to protecting individuals who are at risk of harm, assessing risk and managing and mitigating risks 5.4 Involvement of individuals and carers in directing their own support

6. Policy development and plans to support improvement in service 6.1 Operational and strategic planning arrangements

7. Management and support of staff 7.3 Training, development and support

9. Leadership and direction that promotes partnership 9.1 Vision, values and culture across the partnership 9.4 Leadership of change and improvement

What is my role in the inspection?

As an employee helping to deliver services to adults over 65 in the South Lanarkshire Community Planning Partnership you may be:

 Interviewed by a member of the inspection team  Surveyed through a staff questionnaire  Participate in focus group discussions  Attend a meeting at which inspectors have been invited to attend  Asked about a particular adult’s case file  Asked about partnership working  Asked about how you undertake self-evaluation and improvement activity with colleagues and partner agencies

- 58 - Our Strengths and Areas for Improvement

From the self – evaluation submission, the following provides information on some of the key strengths and areas for improvement identified by the Partnership:

Strengths

 Good progress is being made in working with individuals and carers to improve their health, wellbeing, care and support. There is a better understanding across the Partnership in terms of supporting and empowering people to exercise choice.  The Partnership, has a well-established and embedded approach to accessible and readily available information on services and supports. Much of this information supports the pre-SDS pathway, but in doing so is an intrinsic part of the overall health and social care delivery model.  SDS has brought about significant cultural change and good progress has been made in supporting staff to embed a new approach to outcomes based support for individuals and carers.  Access to support is available to individual and carers both from a statutory and non-statutory perspective.  Through joint working we continue to develop effective systems to support and manage service demand, whilst ensuring that the individual or carer is empowered and engaged through a person – centred approach in assessing their needs and developing an appropriate support plan/intervention.  Reports have been developed which allows the Partnership to identify the number of people who have been supported and the options chosen.  Health and Social Care Integration has further enhanced what we do across staff groupings and disciplines to promote (as much as possible) a single system approach.

Areas for Improvement

 Full implementation of a Review module that will allow the Partnership to aggregate personal outcomes data that informs how well we are doing strategically and also to provide information regarding how SDS can facilitate the social care market.  Review and update current SDS public information to ensure that it provides all relevant information for the supported person and carers.  Promote the SDS options and opportunities to be introduced earlier across primary care and community supports. Wider engagement with NHS staff will be key to this.  Develop annual training plan and updates, as well as more frequent local briefings.  Support Plans should be prepared for all supported people assessed under SDS timeously  Wider engagement and development with Providers to promote and develop more innovative and imaginative use of budget for service users.

Case file reading There will be a random sample of 60 supported people files selected, plus 25 reserve cases. Similar to the Adult Inspection in 2015, the file reading will take place with an Inspector teaming up with local file readers.

What about confidentiality?

Inspectors will normally keep any personal information they access during the inspection confidential. It they identify information which leads them to believe an adult is at risk of harm, this information will require to be discussed further and may be shared more widely. Inspectors will not use names or describe individuals in their report. If during the inspection inspectors believe that an adult is at risk they will raise any issues as a matter of urgency.

- 59 - Further information

Further information about the inspection can be found on the Care Inspectorate website www.careinspectorate.com

Inspection support is being provided by:

Contact Email Phone Andrea Tannahill [email protected] 01698 453744 Andrea Tallis [email protected] 01698 453728 Marie McHugh [email protected] 01698 453907 Pat McCormack [email protected] 01698 453708 Martin Kane [email protected] 01698 453743 Janiece Mortimer [email protected] 01698 453703

- 60 -

Agenda Item

Report 7

Report to: Performance and Audit Sub-Committee Date of Meeting: 28 August 2018 Report by: Director, Health and Social Care

Subject: Development of Strategic Commissioning Plan 2019 - 2022

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  update the Performance and Audit Sub-Committee on the ongoing work to develop the next three year Strategic Commissioning Plan 2019-2022 [1purpose] 2. Recommendation(s) 2.1. The Performance and Audit Sub-Committee is asked to approve the following recommendation(s):- [recs] (1) that the content of the report be noted. [1recs] 3. Background 3.1. A part of finalising the Regulations and Orders to support the Public Bodies (Joint Working) (Scotland) Act 2014, Integration Joint Boards (IJBs) were required to prepare and agree three year Strategic Commissioning Plans (SCPs) to enable integration arrangements to ‘go live’ within local partnerships.

3.2. The main purpose of SCPs is to set out how IJBs will plan and deliver services for their area over the medium term, using the integrated budgets under their control. SCPs also provide clarity to the parties (Council and NHS Board) regarding what they are required to operationally deliver and this sits alongside annual Directions issued by the IJB.

3.3. In preparing and publishing SCPs, IJBs must ensure stakeholders are fully engaged in the preparation, publication and review of the SCP, in order to establish a meaningful co-productive approach, to enable integration authorities to deliver the nine national outcomes for Health and Wellbeing and achieve the core aims of integration.

4. Current Position – South Lanarkshire IJB 4.1. In March 2016, South Lanarkshire IJB approved its first SCP covering the planning period 2016-2019. This plan was very much seen as a first iteration of the future development of Health and Social Care Services in South Lanarkshire.

- 61 - 4.2 In developing the plan, an extensive and wide participation and engagement process was undertaken across the Partnership and within the four locality planning areas. From this process 10 key priorities were identified, together with an agreed suite of commissioning intentions which were matched against the priorities and national Health and Wellbeing Outcomes.

4.3. In recognition of the changing policy landscape, changing needs and further development of integrated delivery models, the IJB at its March 2018 meeting approved a refreshed and updated plan for final year (2018/2019) of the original plan.

4.4. This refresh will provide a solid foundation upon which to develop the next SCP for 2019-2022.

5. Summary of Next Steps 5.1. In developing the new SCP, the Strategic Commissioning Group, which is a constituted group of the Health and Social Care Partnership (as per the Public Bodies Act, 2014) will lead and oversee the development of a draft plan being presented for final approval to the IJB.

5.2. At the most recent meeting of the Strategic Commissioning Group (23 May 2018) a project plan was presented and agreed by the group. The project plan covers a number of key milestones with regards to:  reviewing the current plan and most recent 2018/2019 refresh referred to above  reviewing and updating the needs profile, incorporating projected demand in the future, including how this differs by locality  undertaking a wide range of participation, engagement and consultation activity within localities and across the Partnership, including with the wider public through a series of locality planning events in September and December, 2018  building a communications strategy around the development of the plan to ensure that as many stakeholders can be involved and shape the direction of travel  develop a market position statement for Health and Social Care to better understand where the market requires to be facilitated, thus ensuring the right blend of services and resources are developed to meet future demand  securing buy-in and understanding from the key Parties (Council and NHS Board) that the plan will help to achieve the national Health and Wellbeing Outcomes and wishes of the people of South Lanarkshire

5.3. A full copy of the project plan is outlined in Appendix 1 for information.

5.4 In terms of progress with the Project Plan, a number of areas are now being progressed, an update on which is given below:  consultation and engagement events have been arranged for each of the four localities for September and December. The programme is currently being developed for these  the Strategic Needs Assessment Group is now working on a revised strategic needs assessment for the Partnership area and this will include revised locality profiles. A key part of this work will also include developing projection of future demand, which will then allow the Strategic Planning Group to frame its commissioning intentions to address changes in demand  a communication plan is being developed to support the consultation and engagement process. This will include stimulating wider public awareness of the plan and also an on-line consultation, which members of the public can participate in and reflect their views on what is important to them

- 62 -  a performance framework for the IJB and localities was recently approved at the June, 2018 IJB. This framework will now be built electronically to enable future reporting to take place and connect with the new SCP as a means of demonstrating progress against the nine Health and Wellbeing Outcomes

6. Employee Implications 6.1. There are no employee implications associated with this report.

7. Financial Implications 7.1. This paper does not describe any new financial implications.

8. Other Implications 8.1. There are no additional risks associated with this report.

8.2. There are no sustainable development issues associated with this report.

8.3. There are no other implications associated with this report.

9.2. Planned consultation arrangements are as outlined in the project plan and report.

10. Directions 10.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

Date created: 08 August 2018

Link(s) to National Health and Wellbeing Outcomes

- 63 - Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services Health and Social Care Services contribute to reducing health inequalities

People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

Previous References  Integration Joint Board of 26 June 2018, Paragraph 19

List of Background Papers  none

- 64 - Strategic Commissioning Plan Timeline 2018 2019 No Milestone Lead Forum May June July August Sept October Nov Dec Jan Feb March April Review 2018-19 SCP and agree areas Strategic to be carried forward into new draft Commissioning 1 plan M Kane Working Group Review and update Strategic Needs Strategic Needs 2 Assessment for South Lanarkshire M Kane Group Strategic Needs Group & Locality 3 Review and update locality profiles M Kane Planning Groups Strategic Commissioning 4 Prepare Early Draft of the Plan C Cunningham Working Group Strategic Wider communication as plan is Commissioning 5 being developed E Duguid Working Group Strategic Work to develop Market Position Commissioning 6 Statement M Kane Working Group Undertake first Locality Event to Locality Locality Planning 7 shape input to the new Plan Managers Groups Review Feedback from events and Strategic further develop plan on the basis of M Kane/Locality Commissioning 8 this Managers Working Group Faciitate consultative sessions as Strategic requseted by groups or communities Commissioning 9 of interest All Group Undertake second locality events to provide feedback to date and progress with current development Locality Locality Planning 10 of priorities. Managers Groups Strategic Review plan again on the basis of M Kane/Locality Commissioning 11 locality input and update/amend Managers Working Group Strategic Undertake wider online public Commissioning 12 consultation E Duguid Working Group 13 Present early draft of plan to IJB C Cunningham 4th Dec Present more finalised draft of plan 14 to Strategic Commissioning Group C Cunningham 30th Jan 15 Further update report to IJB C Cunningham 12th Feb

Present progress report to 16 Performance & Audit Sub Committee C Cunningham 26th Feb 17 Present to NHS CMT C Cunningham 21st Jan 18 Present to Council CMT C Cunningham 24th Jan 19 Present to SW Committee V de Souza 20th Feb 20 Present to Executive Committee V de Souza tbc

- 65 - 21 Present to NHS Board V de Souza tbc 22 Final SCP to IJB for approval V de Souza tbc Strategic Commissioning 23 Engage Graphics to develop Plan E Duguid Working Group Strategic Commissioning 24 Publish Final Plan on website E Duguid Working Group

- 66 -

Agenda Item

Report 8

Report to: Performance and Audit Sub-Committee Date of Meeting: 28 August 2018 Report by: Director, Health and Social Care

Subject: Risk Register

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]  provide an update on the Integration Joint Board’s strategic risks to Performance and Audit Sub-Committee [1purpose] 2. Recommendation(s) 2.1. The Performance and Audit Sub-Committee is asked to approve the following recommendation(s):- [recs] (1) that the updated Risk Register as it relates to the Integration Joint Board be noted. [1recs] 3. Background 3.1. The South Lanarkshire Integration Joint Board (IJB)’s Risk Register was initially approved on conclusion of the preparatory work undertaken jointly by the members of the IJB and the Health and Social Care Management Team. The Risk Register is currently monitored by the Performance and Audit Sub-Committee which has oversight of the continuing risks as they relate to the IJB. Updated reports have therefore been presented to the Performance and Audit Sub-Committee as part of fulfilling this role.

3.2. As part of the continued commitment to ensure there is continuing oversight and governance in relation to risk management, a further risk workshop was held on 07 March 2018 to review the Risk Register. Existing risks were updated and account was taken of new and emerging risks.

3.3. This report outlines the further work that has been undertaken, including the assimilation of an updated Risk Register for the IJB.

4. Review of the IJB Risk Register 4.1. The Risk Managers of both partner organisations, in consultation with members of the Performance and Audit Sub-Committee and a cross section of staff working in the Health and Social Care Partnership, facilitated the review of the Risk Register in March 2018.

- 67 - 4.2. The Risk Register has now been updated to reflect the comments and requested amendments received. A number of transitional risks have now been removed from the original Risk Register, the remaining risks rescored and new risks added. At the same time, a suite of risk control actions to mitigate risks have been defined.

4.3. In developing and updating the IJB Risk Register, cognisance was also taken of the existing Risk Registers for NHS Lanarkshire and South Lanarkshire Council Social Work Resources. This provided assurance that the three Risk Registers had a consistency of approach, with all three capturing risks relevant to their strategic and operational scope, whilst at the same time, managing similar risks via the same approach. Resultantly, all three Risk Registers are comprehensive, complement each other and align ownership of the risks to the IJB and/or the relevant partner(s), as appropriate.

4.4. A copy of the current IJB Risk Register is detailed in Appendix 1 and both the Council and NHS Board Risks (as they relate to the IJB) are detailed in Appendix 2.

5. IJB Risk Profile and Key Risks 5.1. The table below shows the IJB risk profile for the 13 risks identified. The profile sets out the likelihood and impact of each risk, giving an overall assessed level of residual risk.

5.1.1. Impact Low Minor Moderate Major Extreme Score 1 2 3 4 5 Almost 5

Certain Likely 4 2 1 Possible 3 4 2 1 Unlikely 2 1 2

Likelihood Rare 1

5.2. The profile shows that one risk identified (8%) has a residual risk rating of low; 11 risks (84%) are rated as medium and one risk (8%) is rated as high. The attached Risk Register reflects the nature of risk proportionate with the maturity of the IJB. In- line with the IJB risk strategy, where required, actions have been identified to mitigate risks, particularly for the risk rated as high.

5.3. The 13 risks identified have been classified within nine risk classifications. The split per classification is shown below:

Strategic Planning 3 Communication 1 Financial 1 Political /Economic 2 Workforce 1 Governance 2 Locality Planning 1 Leadership 1 Statutory 1

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6. Next Steps 6.1. The Risk Register will remain a standing item at future Performance and Audit Sub- Committee meetings for consideration and oversight.

6.2. In addition to this, the Performance and Audit Sub-Committee will receive information on any potential changes which may affect the IJB Risk Register, for example, the development of the 2019-2022 Strategic Commissioning Plan or operational risks within the parties as they relate to the delegated functions of the IJB.

6.3. Where it is prudent to do so, changes and amendments to the IJB Risk Register will be presented to the Performance and Audit Sub-Committee for consideration prior to final approval through the IJB.

7. Employee Implications 7.1. The ongoing review and monitoring of the IJB Risk Register, including the processes of cross-assurance, will be met from within existing resources. Advice and support continues to be available from the Risk Managers of both partner organisations.

8. Financial Implications 8.1. There are no financial implications associated with this report.

9. Other Implications 9.1. There are no additional risks associated with this report.

9.2. There are no sustainable development issues associated with this report.

9.3. There are no other implications at this stage.

10. Equality Impact Assessment and Consultation Arrangements 10.1. This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore, no impact assessment is required.

10.2. Consultation has taken place with appropriate personnel within the partner organisations.

11. Directions 11.1. The extent to which the existing directions to each partner require to be varied is detailed in the table below:

Direction to: 1. No Direction required 2. South Lanarkshire Council 3. NHS Lanarkshire 4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care

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Link(s) to National Health and Wellbeing Outcomes

People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

Previous References  IJB (Performance and Audit Sub-Committee) Report – Risk Register Report, 26 June 2018

List of Background Papers  Risk Register 2018 – 2019 - Appendix 1

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Martin Kane, Programme Manager, Health and Social Care Ext: 3743 (Phone: 01698 453743) Email: [email protected]

- 70 - South Lanarkshire Council and NHS Lanarkshire Top Risks Impacting on the IJB Appendix 2

Risk Description Inherent Controls Residual Lead Partner Score Score Reduction in  Money Matters mitigating implications High  Ongoing monitoring of Money High Council Council funding of the welfare reform agenda. Matters service on Improve resulting in  Failure to achieve Resource savings  Active participation in the difficulties targets Efficiency agenda maintaining  Failure to collect care and grant  Annual budget meetings frontline services income  Service reviews and redesign  Assessment and care management arrangements and income maximisation opportunities  Review grants to voluntary organisations  Review service user prioritisation in terms of accessing service and support  Support carers in their caring role  Target resources on those with critical/substantial needs  Work in partnership with voluntary organisations to provide early intervention and preventative supports.

The Council is not  Implications for children and justice High  Children’s health services in the High Council sufficiently services partnership prepared to  Governance and accountability  Director Health and Social Care deliver the arrangements and senior management team in Integration Joint  Locality Planning models place Board strategic  Locality Service delivery models  Locality planning arrangements directions set out  Budgets and finance established and locality senior in the Strategic  Reputation managers appointed Commissioning  Strategic Commissioning Plan in Plan 2016 - 19 place  Strategic Needs Assessment activity underway

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Failure to work  Failure to deliver on the Community High  Key performance measures High Council with key partners Planning Partnership priorities. identified to achieve the  Health and Social Care Partnership  Structure reporting streams with outcomes of the  Getting It Right for South Lanarkshire individual partnerships Local Outcome Children’s Partnership  Clear terms of reference for Improvement Plan  Carers Strategy/Advocacy partnership groups and sub (LOIP) Partnership groups  Corporate Parenting Strategy  Clear action plans and progress  Competing demands from range of plans. partnerships  Health and Social Care Partnership is a stand-alone identified risk  Carers Strategy and the partnership working being reviewed as part of the Carers Act 2016.

Procurement  Inadequate monitoring of contracts for High  Governance arrangements in High Council practice and social care place management of  Failure to deliver statutory duties, that  Standard model contracts in contracts is, protect vulnerable children, young place people and adults if social care  Monitor Care Inspectorate contract not in place reports on purchased services  Failure to recognise that procurement  Deficiency in care meetings in of care and support services is a place for poor gradings of care complex area and requires special providers consideration within a public body's overall approach to the procurement of goods and services leading to service failure

GP input to There is a risk to NHSL that there is High  Advise from Scottish Health High NHS sustain current insufficient GP capacity to enable Council, and engagement with Lanarkshire community sustainable delivery of medical input to local communities has hospital clinical the community hospitals that are commenced to consider model of service. dependent on the GP's. Issues include a alternative services to be hosted

- 72 - change in portfolio career arrangements, in Lockhart with initial output age profile of existing workforce, expected June 2018. increased part time working and less  Focus on maintaining delayed medical students choosing GP practice discharges at low level. as a career. For NHSL, this has already  GP recruitment and retention resulted in one community hospital being fund from Scottish Government closed to admissions, with the potential to to enable local solutions to local recur in other areas. problems over 2 financial years  Commissioning of Service Model Options Appraisal integrated within the Strategic commissioning Plan 2019-2022  Community Bed Modelling Plan  Community Hospital Refresh Strategy, that outlines alternative approaches including advanced nurse practitioners and consideration for nurse-led model of care.  Work ongoing as part of Clydesdale Locality Plan to re- designate Lockhart and link to other bed provision in the locality based on the current information on bed usage/need, discussed at PPRC (June 2018).  Public meetings undertaken in Forth - 14/8 and Lanark - 16/8, with additional meetings planned for Biggar, Lesmahagow and Carluke. These will augment the Locality Planning process as part of the process highlighted at para 4 above with a view to formally re-designating hospital.

Community Bed There is a risk that the developing High  Strengthening of the integrated High NHS Reprovision to community bed reprovision for health and social care system Lanarkshire Align with Lanarkshire will not be directly aligned to through the North and South

- 73 - Balance of Care the balance of care need, adversely Strategic Commissioning Plans Need. impacting on unscheduled care, delayed and the NHSL Healthcare discharge and the principles of shifting Strategy: Achieving Excellence. the balance of care.  Bed Modelling Steering Group  Initial community bed reprovision plan set out and approved for planned moves with timescales for:  -contracted beds  -community hospitals  -out of area placements  Work concluded in replacing previous bed based provision at Douglas Ward, Udston with increased community care provision.  North Lanarkshire Intermediate Care Review underway, although has been delayed.

Sustainability of There is a risk that the 2 site model of High  Short - term increase in pay rates High NHS the 2 Site Model delivery of an Out of Hours (OOH) for GP sessions Lanarkshire for OOH Service service cannot be sustained resulting  New service Business Continuity from national and local disengagement of Plan salaried and sessional GMPs, resulting in  Continuous engagement with IJB the potential to adversely impact on and Acute patient care, partner services including  Monitoring of performance A&E, the national performance targets against the Key Quality and the reputation of the partner Indicators on a weekly basis agencies. through CMT  Implementation of a Liaison Nursing Service for Mental Health and Paediatrics  Planned approach to develop Advanced Practioners for Nursing and Paramedics, currently at early implmentation stage.  GP sustainability continues to be

- 74 - fully monitored through Primary Care Transformation Programme Board.  New GMS Implementation Group and Implementation Plan, overseen through the Primary Care Transformation Programme Board.  Paper on position discussed at PPRC (June 2018).

Delayed There is a collective risk that NHSL, and High  CMT have weekly oversight of High NHS Discharge North and South H&SCP's will not performance, reasons for delays Lanarkshire Performance and achieve the expected national and discuss actions Impact performance for delayed discharges,  Pan-Lanarkshire Unscheduled resulting from a range of issues, including Care and Discharge Group the undertaking of Community Care  National ISD exercise to ensure Assessments, provision of homecare all Partnerships are recording packages, care home placements, AWI correctly, work ongoing. and internal hospital issues eg pharmacy  Winter Bed Plan 2018/19 delays. This has the potential to approved. adversely impact on patient outcomes,  Improvement Support through loss of acute beds, waiting times, Driver Diagram and Integrated treatment time guarantee, hospital flow Action Plan. and reputation of the service providers.  There is an agreed trajectory as part of the IJB performance.

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