Assynt House Beechwood Park Inverness, IV2 3BW Telephone: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Date of Issue: Typetalk: Tel 0800 959598 Friday 22 November 2013 www.nhshighland.scot.nhs.uk
HIGHLAND NHS BOARD
MEETING OF BOARD
Tuesday 3 December 2013 at 8.30 am Board Room, Assynt House, Beechwood Park, Inverness
AGENDA
1 Apologies
1.1 Declarations of Interest – Members are asked to consider whether they have an interest to declare in relation to any item on the agenda for this meeting. Any Member making a declaration of interest should indicate whether it is a financial or non-financial interest and include some information on the nature of the interest. Advice may be sought from the Board Secretary’s Office prior to the meeting taking place.
THE HIGHLAND QUALITY APPROACH
1.2 Highland Quality Improvement System – Tier 1 Report Out to the Board – Care at Home Inverness Presentation by Gavin Hookway, Senior Quality Improvement Lead, Nigel Small, Director of Operations, South & Mid Operational Unit and Frances Gair, Adult Services Lead
The Board is asked to Note the Tier 1 Report to the Board on the Highland Quality Improvement System.
2 Minute of Meeting of 1 October 2013 and Action Plan (attached) (PP 1 – 22) The Board is asked to approve the Minute.
2.1 Update on Membership of Committees Report by Garry Coutts, Chair, NHS Highland (attached) (PP 23 – 24) The Board is asked to: Agree the updated membership of committees following the recent process to fill outstanding vacancies. Agree that the revised membership should be until 30/06/14 with a further report to the Board in June 2014. 3 PART 1 – REPORTS BY GOVERNANCE COMMITTEES
3.1 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 23 October 2013 (attached) (PP 25 – 44) 3.2 Highland Health & Social Care Governance Committee Assurance Report of 7 November 2013 (attached) (PP 45 – 66) 3.3 Clinical Governance Committee – Assurance Report of Meeting on 2 October 2013 (attached) (PP 67 – 76) 3.4 Improvement Committee Assurance Report of 4 November 2013 and Balanced Scorecard (attached) (PP 77 – 90) 3.5 Area Clinical Forum – Draft Minute of Meeting held on 26 September 2013 (attached) (PP 91 – 98) 3.6 Asset Management Group – Draft Minutes of Meetings of 11 September and 22 October 2013 (attached) (PP 99 – 106) 3.7 Pharmacy Practices Committee – Summary of Meeting of 8 October 2013 – Apple Pharmacy Group for premises at Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP (attached) (PP 107 – 108) The Board is asked to: (a) Confirm adequate assurance has been provided from the Governance Committees. (b) Note the Assurance Reports and agreed actions from the Highland Health & Social Care Governance Committee, Clinical Governance Committee and the Improvement Committee.
Council/Highland NHS Board Joint Committees
3.8 Highland Council Partnership – Adult & Children’s Services Committee (a) Minute of Meeting of 25 September 2013 (attached) (b) Update from Chair / Chief Executive on Assurance to the Board (PP 109 – 126) The Board is asked to Note the Minute.
4 PART 2 – THE HIGHLAND QUALITY APPROACH
4.1 Highland Quality Approach – Progress Report Report by Linda Kirkland, Director of Quality Improvement on behalf of Elaine Mead Chief Executive (attached)
The report provides both an update on work in progress and a proposal to establish the Highland Quality Improvement Leadership Group to provide direction and governance. (PP 127 – 138)
2 The Board is asked to:
Note the update on the progress within the three themes of the Highland Quality Approach, Leadership and Culture, Focus and Delivery and Methodology. Note the update on the delivery of Quality Improvement (Lean) training.
Note the update on the timetable of Rapid Process Improvement Workshops (RPIWs) and the proposal to generate an annual work plan effective for 2013/14. Note the emerging development of the Highland Quality Improvement System Note the establishment of the Highland Quality Approach (HQA) Leadership Group and the draft Terms of Reference.
4.2 Update on Possible Major Service Redesign Report by Nigel Small, Director of Operations (South and Mid) and Gill McVicar, Director of Operations (North and West) on behalf of Deborah Jones, Chief Operating Officer (attached)
The Board approved an update to NHS Highland Asset Strategy 2013 at its meeting on 1 October 2013. This document makes specific reference to the work underway to review and redesign services in Badenoch and Strathspey (part of South and Mid Operational Unit) and Skye, Lochalsh and South West Ross (part of North and West Operational Unit). (PP 139 – 146) The Board is asked to:
Note the strategic case for change across the areas of i) Badenoch and Strathspey and (ii) Skye, Lochalsh and South West Ross. Note the requirement to carry out formal public consultation where any proposed changes are considered to be major. Note and Approve the key milestones and associated timeline.
5 PART 3 – CORPORATE GOVERNANCE / ASSURANCE
5.1 Services for Children and Young People in Argyll & Bute: Report of a Pilot Joint Inspection Report by Pat Tyrrell, Lead Nurse, Argyll & Bute CHP on behalf of Margaret Somerville, Director of Public Health and Health Policy (attached)
The pilot joint inspection of services for children and young people in the Argyll and Bute Community Planning Partnership area took place over three weeks in March 2013 and April 2013. The full report was published in September 2013 and was presented to Argyll and Bute Council in September. (PP 147 – 170) The Board is asked to:
Note the findings of the report. Discuss the actions arising from the findings.
3 5.2 NHS Highland Financial Position as at 31 October 2013 Report by Nick Kenton, Director of Finance (attached) (PP 171 – 184) The Board is asked to:
Note the continued forecast out-turn of break-even overall. Note the requirement of a £8.5m improvement to achieve this.
5.3 Caithness General Connection to District Heating Report by Eric Green, Head of Estates on behalf of Nick Kenton, Director of Finance (attached)
NHS Highland has set an ambitious target to reduce its carbon emissions by 30% over 5 years. This project is another significant step in achieving this target; this will reduce the carbon produced at Caithness General Hospital by 1200 tonnes a year. This is a step change improvement towards reaching our climate change targets. (PP 185 – 204) The Board is asked to:
Approve the business case to connect CGH to the Ignis Wick District Heating Scheme. Note the savings this scheme will generate. Note the environmental benefits of this project.
5.4 Infection Prevention and Control Report Report by Liz McClurg, Infection Control Manager and Dr Jonty Mills, Consultant Microbiologist/Infection Control Doctor on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control (attached) (PP 205 – 232) The Board is asked to:
Note the performance position for the Board. Note the progress to keep infection under control.
5.5 NHS Highland Allied Health Professions Musculoskeletal Redesign Report by Katherine Sutton, Associate Director AHPs on behalf of Elaine Mead, Chief Executive (attached)
Following the update in the Chief Executive’s Report to the October Board on Implementation of the Allied Health Professions (AHP) National Delivery Plan, this report updates on the AHP Musculoskeletal Redesign Programme. (PP 233 – 238) The Board is asked to:
Support the NHS Highland Allied Health Professionals Musculoskeletal Redesign Programme. Support the implementation of an appropriate NHS Highland admin hub to support the transformational change required. Support the transition of AHP services onto the TRACK care patient management system once implemented. Note the benefits to be realised as a result of full Allied Health Professionals Musculoskeletal redesign.
4 5.6 Chief Executive’s and Directors’ Report Emerging Issues and Updates Report by Elaine Mead, Chief Executive (attached)
This month’s report incorporates updates on: Children’s Services Inspection Report – Highland Council Update Freedom of Information Requests Update Health Promoting Health Service Update – Addendum to CEL(2012)01 Regional Planning – North of Scotland Planning Group and West of Scotland Planning Group (PP 239 – 248) The Board is asked to Note the Emerging Issues and Updates Report.
6 FOR INFORMATION
6.1 Date of next meeting The next meeting of the Board will be held on 4 February 2014 in the Board Room, Assynt House, Inverness.
6.2 Any Other Competent Business
7 Close of Meeting
5 1 Highland NHS Board 3 December 2013 Item 2(a) Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 HIGHLAND NHS BOARD Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk/ DRAFT MINUTE of MEETING of the BOARD Board Room, Assynt House, 1 October 2013 – 8 30 am Beechwood Park, Inverness
Present Mr Garry Coutts, Chair Dr David Alston Mr Robin Creelman Mrs Myra Duncan Mr Mike Evans Dr Michael Foxley – from 9.00 am Dr Iain Kennedy Mr Alasdair Lawton Dr Rhona MacDonald Mrs Gillian McCreath Mr Okain McLennan Mr Adam Palmer Ms Sarah Wedgwood Ms Elaine Wilkinson Ms Elaine Mead, Chief Executive Dr Ian Bashford, Board Medical Director Mrs Anne Gent, Director of Human Resources Mr Nick Kenton, Director of Finance Ms Heidi May, Board Nurse Director Dr Margaret Somerville, Director of Public Health & Health Policy Also present Mrs Jan Baird, Director of Adult Care (Items 109, 110 & 111) Mr Evan Beswick, Service Manager, Administration, Raigmore (Item 112) Ms Rosalind Box, Team Administrator (Item 95) – by VC Mr Tom Davison, Communications Manager Ms Brenda Dunthorne, Head of Finance, Raigmore (Item 118) Mr Jonathan Gray, Nurse Consultant Learning Disabilities (Item 110) Mr Eric Green, Head of Estates (Items 114 & 118) ) Ms Geraldine Hannon, Community Psychiatric Nurse (Item 95) – by VC Ms Moira Harrison, Primary Mental Heal Community Worker (Item 95) – by VC Gavin Hookway, Senior Quality Improvement Lead (Item 95) Mrs Linda Kirkland, Director of Quality Improvement Mr David Knowles, Director, Practitioner Services Mr Derek Leslie, Director of Operations, Argyll & Bute (Item 95) – by VC Ms Tracy Ligema, Area Manager – West (Item 120) Ms Anne MacDonald, Connecting Carers (Item 109) Ms Fiona Margach, Guided Self Help Worker (Item 95) – by VC Mr Kenny Oliver, Board Secretary Ms Valda Parnaby, Occupational Therapist (Item 95) – by VC Mr Douglas Philand, Team Leader, Community Mental Health (Item 95) – by VC Mrs Lorraine Power, Board Services Assistant Mr Simon Sawhney, Senior Trainee in Acute Medicine, Raigmore Mr Nigel Small, Director of Operations, South & Mid (Item 113) Ms Maimie Thompson, Head of Public Relations & Engagement Mr Philip Wilson, Management Trainee, Raigmore
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Apologies – Apologies were received from Cllr John McAlpine and Ms Deborah Jones.
Welcome – Prior to commencement of business, the Chair welcomed Adam Palmer, Employee Director who had been appointed for a four-year term from 1 October 2013. He also welcomed David Knowles, Director, Practitioner Services and Philip Wilson, Management Trainee at Raigmore Hospital who were attending the meeting as observers.
93 Declarations of Interest
Board members declared the following interests:
Garry Coutts – University of the Highlands and Islands. Myra Duncan – Scottish Government Joint Improvement Team Action Group Mike Evans – ILM Highland
The Board a Noted the Declarations of Interest.
94 Review of Committee Membership
The Chair confirmed that Mr Palmer would be a member of the committees attended by Ray Stewart, the previous Employee Director. There was a forthcoming vacancy on the Pharmacy Practices Committee, which was chaired by a Non-Executive Director. Mr McLennan advised that the next meeting would be held on Tuesday 8 October, with a training session for members on the afternoon of Monday 7 October and suggested that anyone interested in this committee should contact him direct. The Chair noted that there were also vacancies on the District Partnerships and confirmed that this would be considered further.
The Board a Noted the update on Committee membership and work in progress to fill the vacancies.
THE HIGHLAND QUALITY APPROACH
95 Highland Quality Improvement System – Tier 1 Report Out to the Board – Mid Argyll Community Mental Health Team – Assessment Appointments Presentation by Derek Leslie, Director of Operations, Argyll & Bute Operational Unit and Gavin Hookway, Senior Quality Improvement Lead
The Chair welcomed Gavin Hookway, Senior Quality Improvement Lead to the meeting and Derek Leslie, Director of Operations, Argyll & Bute and members of the team who were linking into the meeting by videoconference.
The team presenting to the Board were introduced and comprised:
Derek Leslie, Director of Operations, Argyll & Bute CHP (Team Leader) Gavin Hookway, Senior Quality Improvement Lead (Workshop Leader) Douglas Philand, Team Leader, Community Mental Health (Process Owner) Ms Rosalind Box, Team Administrator Ms Geraldine Hannon, Community Psychiatric Nurse Ms Moira Harrison, Primary Mental Health Community Worker Ms Fiona Margach, Guided Self Help Worker Ms Valda Parnaby, Occupational Therapist
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Derek Leslie advised that the aim of the Rapid Process Improvement Workshop (RPIW) was to improve triage and case lists management in Community Mental Health, to minimise number of clients waiting for first appointment and to ensure any related waiting time targets are met. Gavin Hookway outlined the Target Progress Report and the Takt Time Calculation Worksheet and Douglas Philand explained the Value Stream Map for the current state of play at the start of the process and the Standard Worksheet showing the flow of the information. Geraldine Hannon advised that the team had thought of 34 ideas to improve the current system. A standard process was developed and all work was now done electronically which had significantly reduced the time and documentation involved. Rosalind Box highlighted the benefit of electronic access to diaries and Moira Harrison referred to the priority checklist for assessment and the revised allocation of administrative duties. Valda Parnaby updated on the use of the 5S Audit tool and the presentation included before and after photographs of the work areas involved. Douglas Philand advised that a skills matrix had been developed including all team members and all core team activities were recorded. A regular team meeting was now held every Tuesday at the same time so every team member was aware of work in progress. In terms of improvements made:
Triage was now done electronically Electronic diaries were used for appointments Needs could be assessed more quickly and directed to the most appropriate team member The lead time which had been 52 weeks had been reduced to 22 weeks The time from receipt of referral to booking of 1st appointment had been reduced from 34 weeks to 10-12 minutes. In relation to 5S, the team was now at level 3 rather than level 1. Further work was in process to reduce the Takt time and in relation to the flow of work.
Derek Leslie offered his thanks to the Team Coach, the Quality Improvement Team and his own Personal Assistant for their help and support during the process. He also thanked clients for their patience with the team while the service was being improved. Elaine Mead, Chief Executive asked how the Away Team of those involved in the RPIW had kept engaged with the Home Team. It was noted that few members of the team were not involved at some point in the process and regular meetings were held with the Home Team to update on progress.
The Chair thanked the team for the update and confirmed the Board’s support for this method of improvement and redesign of services.
The Board a Noted the Tier 1 Report to the Board on Mid Argyll Community Mental Health Team.
96 Minute of Meeting of 13 August 2013
The Director of Finance referred to item 86, the NHS Highland Financial position to 30 June and advised that the figure for the 2012/13 non-recurrent carry forward in relation to Raigmore should read £2.6m and confirmed that this had been amended since the issue of the draft minute. The minute of meeting held on 13 August 2013 was approved, subject to the advised amendment.
Mr Evans referred to the first item on the Board Rolling Action Plan relating to Hospital and Community Health payments to GPs in Argyll & Bute. It had been hoped that the position would be clarified by the national review of the GMS Contract and it was remitted to the Director of Finance to contact Scottish Government regarding the position and provide written feedback to the Audit Committee.
The Board a Approved the Minute of Meeting held on 13 August 2013, subject to the advised amendment.
61 4 b Noted the Board Rolling Action Plan. c Remitted to the Director of Finance to contact Scottish Government regarding the position relating to Hospital and Community Health payments to GPs in Argyll & Bute and provide written feedback to the Audit Committee.
97 Matters Arising
Highland Council – Adult & Children’s Services Committee – Dr MacDonald sought feedback on progress in relation to assurance regarding this committee. The Chair advised that meetings were planned with Highland Council to discuss this issue and there would be an update to the next meeting of the Board.
The Board a Noted that an update on assurance in relation to the Highland Council Adult & Children’s Services Committee would be submitted to the next meeting of the Board.
REPORTS BY GOVERNANCE COMMITTEES
98 Argyll & Bute CHP Committee – Draft Minute of Meeting held on 21 August 2013
Mr Robin Creelman, Chair of Argyll & Bute CHP updated on the August meeting of the Committee. This included maternity services on Mull, Substitute Prescribing and an update on the Islay Clinical Services Review. It was noted that the sentence on page 9 of the minute under “Acute Services” should be amended to read, “standardised mortality figures”. In relation to Hospital Standardised Mortality Ratios (HMSR), Dr Bashford advised that while NHS Highland had the second lowest figures in Scotland that there had still been an upward trend between October and December 2012. He also confirmed that Board would be asked to undertake routine mortality reviews in future, therefore there was a need to standardise the reporting mechanisms. Dr Bashford took the opportunity to congratulate Argyll & Bute CHP on their reporting on the Scottish Patient Safety Programme (SPSP), which was considered exemplar. Reference was made to the recent Joint Inspection of Children’s Services in Argyll & Bute, which the Chair suggested should be circulated to Board members. It was confirmed that a full report on this subject would be submitted to the December meeting of the Board. Sarah Wedgwood referred to the Whistleblowing Policy, which was mentioned in item 9.2 of the minute. Anne Gent, Director of Human Resources advised this had been reviewed nationally and a national alert line set up for staff.
99 Highland Health & Social Care Governance Committee – Assurance Report of 12 September 2013
The Assurance Report from the meeting of the Health & Social Care Committee meeting held on 12 September 2013 updated on the topics discussed at the meeting. Mrs Myra Duncan confirmed that the Committee had held its first development session in August with the focus on health inequalities. The Committee was also in the process of establishing two sub-committees – a Professional Executive Committee (PEC), which would be chaired by the Clinical Director, North & West and a Performance and Finance Sub-Committee, which would scrutinise performance within North Highland. There had been a detailed update on the Raigmore Hospital Financial Plan and reporting arrangements and a further detailed presentation was scheduled for the next meeting of the Committee. It was noted that the reference on page 10 of the report to the “Choice and Transport Policy” should read “Choice and Transfer Policy”.
The next HH&SCC Development Day was scheduled for 1 November and would consider governance of the Committee and the management of the agenda. Mrs Duncan extended an invitation to all Board members to attend this event.
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It was noted that a Lead Nurse had now been appointed for Raigmore Hospital. Dr Bashford noted the update on HSMR in Raigmore Hospital and suggested that this should be a standing item on the agenda for all operational units. It was remitted to Dr Bashford to discuss this further with the Chair and Lead Executive for the Committee. There was some discussion around delayed discharges and the Chief Executive confirmed that work was in progress with the contracting team and providers. Ms Mead also referred to the concerns raised regarding oncology services at the last meeting of the Board, by the Chair of the Area Clinical Forum and confirmed that there was now agreement to recruit two Clinical Oncologists, although it was recognised that this might prove difficult. The Communications Team had also been working on a recruitment DVD for NHS Highland. In relation to Head and Neck cancer, the team in NHS Highland had developed a particular technique, which was exemplar, and state of the art and the Chief Executive extended her congratulations to the team in this regard.
100 Audit Committee – Draft Minute of Meeting held on 10 September 2013
Mr Mike Evans, Chair of the Audit Committee updated on the September meeting of the Committee, including Argyll & Bute CHP Governance and Management in relation to SLA Quality Standards, Endowment Funds, Internal and External Communication, Phase 2 of Integrating Care in the Highlands and Belford and Islay Hospital Reviews. In relation to Raigmore Hospital Financial Management, it was noted that a further review of governance was ongoing and a further report would be submitted to the next meeting of the Audit Committee.
101 Clinical Governance Committee – Assurance Report of 6 August 2013
Ms Sarah Wedgwood, Chair of the Clinical Governance Committee updated on the August meeting of the Committee, including the first case study based on a Serious Event Review (SER). Further work was ongoing to ensure learning points are disseminated. There was also an update on the Internal Audit Review of Paper Records Management. It was noted that a number of items had to be deferred to the agenda for the next meeting due to too much business on the day. Accordingly, items on complaints and the Scottish Public Services Ombudsman’s national report would be considered at the next meeting of the Committee.
102 Staff Governance Committee – Draft Minute of Meeting held on 27 August 2013
Mr Alasdair Lawton, Chair of the Staff Governance Committee updated on the August meeting of the Committee, including the Workforce 20:20 Vision – Everyone Matters. Anne Gent, Director of Human Resources advised that the vision had five key themes: Integration Capability Sustainability Healthy Organisational Culture Effective Leadership and Management Development.
Key prioritised work would be integrated into the Local Delivery Plan (LDP) and monitored in the same way.
103 Improvement Committee – Assurance Report of 2 September 2013 and Balanced Scorecard
The Chair updated on the last meeting of the Improvement Committee including work in relation to stroke. Dr Bashford highlighted that part of the standard we were not so good at meeting was in relation to the one-hour timeframe. The Chief Executive highlighted concerns in relation to a backlog of MRI scans, CT scans and plain films and advised that a number of these were being outsourced at present. The Rapid Process Improvement Workshop (RPIW) for Radiology had looked at how to reduce the pressure on MRI scanning and reducing the backlog. Mr McLennan referred to DNA rates and suggested that this might be an issue to highlight in the next NHS Highland newspaper.
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104 Area Clinical Forum – Draft Minute of Meeting held on 8 August 2013
Dr Iain Kennedy, Chair of the Area Clinical Forum updated on the meeting. He advised that there had been an update on Point of Care Testing, highlighted the discussion on cancer services and the recommendations of the Area Clinical Forum and updated on the recent National Area Clinical Forum Chairs Group. The Chair confirmed that the issues in relation to oncology were being progressed and would be reported back to the ACF in due course.
105 Asset Management Group – Draft Minutes of Meetings held on 23 July and 20 August 2013
Mr Alasdair Lawton updated on the July and August meetings of the Group. He highlighted the NHS Highland Asset Strategy and the Endoscopy Business Cases, which had been discussed at both meetings and would be considered by the Board later on the agenda. Gillian McCreath referred to the item on Raigmore Food Trolleys and the reference to no catering budget. Mr Kenton clarified that this related to there being no specific budget in relation to catering equipment, which meant that the funding would need to be allocated from contingency. It was agreed that the minute should be amended to clarify this.
106 Health & Safety Committee – Draft Minute of Meeting of 15 August 2013
Mr Alasdair Lawton updated on the May meeting of the Committee, including the Medical Gases Committee and the Health & Safety Work Programme for 2013/15.
The Board a Noted the Minutes. b Noted the Assurance Reports and agreed actions from the Highland Health & Social Care Governance Committee and the Improvement Committee. c Agreed that the Argyll & Bute CHP minute in relation to Acute Services be amended to read, “standardised mortality figures”. d Noted that a report on the Inspection of Children’s Services in Argyll & Bute CHP would be submitted to the December meeting of the Board. e Agreed that the reference on page 10 of the HH&SCC report to the “Choice and Transport Policy” be amended to read “Choice and Transfer Policy” f Noted the invitation to all Board members to attend the next HH&SCC Development Day on 1 November 2013. g Remitted to the Board Medical Director to liaise with the Chair and Lead Executive of the HH&SCC regarding HSMR as a standing item on the agenda for the committee. h Remitted to the Head of PR& Engagement to consider DNA rates as a potential issue to highlight in the next NHS Highland newspaper. i Agreed that the Asset Management Group minute of 20 August 2013 be amended in relation to the reference to the catering strategy budget.
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107 NHS Board and Board Development Meeting Dates 2014 and NHS Highland Calendar of Meetings 2014 Report by Elaine Mead, Chief Executive
A list of dates for Board meetings and Board Development Meetings had been drafted for approval, as well as a list of dates for NHS Highland Governance and Professional Advisory Committee meetings for 2014.
The Board a Approved the dates for meetings of the NHS Board and Board Development Sessions for 2014. b Approved the Calendar of Meetings for 2014.
Council/Highland NHS Board Joint Committees
108 Highland Council – Adult & Children’s Services Committee – Minute of Meeting of 21 August 2013
Dr Somerville updated on the meeting, highlighting the discussion on Preventative Spend and the recommendation to establish Community Health Co-ordinator posts in deprived areas. She also updated on the Performance Report in relation to Children’s Services and Child and Adolescent Mental Health Services. Dr Foxley again highlighted the need for links with District Partnerships and referred to the discussion paper on Additional Hours Early Learning and Children, which would be brought to each District Partnership. He also suggested that the issues around Child and Adolescent Mental Health Services should be discussed at District Partnership level. The Chair agreed that this work was relevant for District Partnerships and suggested that the reporting mechanisms should be reviewed in another three months to ensure this was progressed.
The Board a Noted the minutes b Recommended that the reporting mechanisms in relation to District Partnerships should be reviewed again in three months to ensure relevant issues were being included on the agendas.
THE HIGHLAND QUALITY APPROACH
109 Supporting Highland’s Adult Carers Report by Theresa James, Adult Care Integration Manager on behalf of Jan Baird, Director Adult Care and Presentation by Connecting Carers
The development of strategies for adult carers and for young carers had been progressed in partnership with key stakeholders to reflect the aspirations of the new National Strategies, which set out key actions to improve support to carers and young carers. These strategies give recognition to the major contribution that carers make to our communities and the need to support them as full partners in the delivery and planning of care services.
Jan Baird, Director of Adult Care introduced Anne MacDonald, Connecting Carers. Ms MacDonald then presented the report to the Board. The six core principles for working with carers developed by NHS Education for Scotland and the Scottish Social Services Council had been used as a framework for the work on the strategy:
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Carers are identified Carers are supported and empowered to manage their caring role Carers are enabled to have a life outside of caring Carers are fully engaged in the planning and shaping of services Carers are free from disadvantage or discrimination related to their role Carers are recognised and valued as equal partners in care
It was noted that not all people who were carers identified themselves with the term “carer”. Ms MacDonald encouraged the Board to support NHS Highland staff who are carers. It was recognised that one size did not fit all and that all carers and those they care for have very different needs. In working on the strategy, existing strategies in relation to alzheimer’s, autism, learning disability etc. were also referred to. The Carers Strategy Reference Group would have an ongoing role in monitoring the implementation. Anne Gent, Director of Human Resources confirmed that there had recently been positive discussion at the Highland Partnership Forum in relation to supporting staff who are carers.
The Board a Noted the presentation from Connecting Carers on the progress to date on the development of the new Adult Carers Highland Strategy. b Approved the proposal for further development and review arrangements for the strategy.
The Board adjourned at 10.35 am and resumed at 10.50 am.
110 National Strategy for Learning Disability – NHS Highland Position Statement Report by Jonathan Gray, Nurse Consultant – Learning Disabilities and Jan Baird, Director of Adult Care on behalf of Elaine Mead, Chief Executive
‘The Keys to Life: Improving the Quality of Life for People with Learning Disabilities’ was launched in June 2013 as Scotland’s new learning disability strategy setting the direction of travel for the next ten years. The strategy has the human rights of people with learning disabilities at its heart and is aligned with the goals of the NHS Scotland Healthcare Quality Strategy. Jonathan Gray, Nurse Consultant for Learning Disabilities presented the report to the Board. The keys areas of challenge for NHS in implementing the recommendations from ‘The Keys to Life’ are:
Improve access to personal life plans in North Highland Health and Social Care Partnership Continue to develop our day services to offer a broad range of person centred services that promote inclusion in our communities whilst ensuring that we can offer more intensive levels of support to undertake day activities to people with complex needs Continue to improve our planning for housing and support needs for people with learning disabilities We need to work with people with learning disabilities and their carers to assist the development of social networks Continue to develop further opportunities for people with learning disabilities to access further education and gain employment Develop strategic links between criminal justice services and specialist learning disability services Continue to develop services locally that will enable people in out of area placements to live in Highland and prevent out of area placements occurring in the first instance.
As well the challenges detailed above NHS Highland and local authority partners have made significant progress in improving the quality of life of people with learning disabilities since the launch of the ‘Same as You?’ in 2000.
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No one with a learning disability now calls a hospital a home, we have made our health services more accessible and we can evidence that we adjust how we provide care to accommodate the needs of people with learning disabilities.
The Board noted that the strategy would be implemented across NHS Highland with the Learning Disability Improvement Committee reporting to the HH&SCC in North Highland and to the Strategic Partnership in Argyll & Bute CHP area. There was some discussion around the outcomes for the strategy. Jan Baird confirmed that these were already set and the new national policy had more focus on inclusion and equality.
The Chair confirmed that it would be beneficial for the Board to have a report on the specific outcomes to evidence this and suggested that a further report be submitted to the Board in due course. The follow up report should update on the development of plans in both the partnership areas.
The Board a Noted the themes from ‘The Keys to Life’. b Noted the areas of challenge for NHS Highland. c Recommended that a further report updating on the development of plans in both partnership areas and detailing specific outcomes be submitted to a future meeting of the Board.
111 National Telehealth and Telecare Delivery Plan for Scotland – The Highland Position Report by Jan Baird, Director of Adult Care, on behalf of Elaine Mead, Chief Executive
The National Delivery Plan for Telehealth and Telecare produced in late 2012 set out the expectations of Scottish Government, COSLA and NHS Scotland over the next three years and beyond. Jan Baird, Director of Adult Care presented the report to the Board. Dr Foxley referred to action 1.4 and the need to maximise and expand the use of improved video conferencing facilities. He highlighted issues with broadband links, specifically in west Highland confirming that this was an issue for rural learning centres. Mrs Baird confirmed that this issue had been highlighted nationally and the Programme Manager in Argyll & Bute was continually raising the profile of this issue. The Chief Executive confirmed that she and the Chair had also raised this issue at the Highlands & Islands Convention and would continue to highlight this issue at every opportunity. Dr Foxley asked if there was a detailed analysis of areas that did not have adequate coverage. The Chair suggested that NHS Highland write to Highlands & Islands Enterprise regarding this and asking whether a map was available showing the relevant areas.
Mrs Baird then updated on telecare in NHS Highland. There had been a number of improvements and the aim was for a single point of access within integrated teams. The Chair welcomed the report and noted the amount of work in process. He noted that the delivery plan did not really capture what the changes would mean for people using services and suggested that this be captured more fully in the next update to the Board.
The Board a Noted the process of assessing actions needed. b Agreed the proposed way forward to monitor progress.
67 10 c Agreed nominations for executive sponsors/benefit owners for the Highland Living it Up programme. d Remitted to the Director of Adult Care to contact Highlands & Islands Enterprise regarding the query on broadband coverage.
112 What are the Leadership Lessons to be Learned from the Integration of Health and Social Care in North Highland? Report by Evan Beswick, Service Manager, Administration, Raigmore Hospital (on behalf of Jan Baird, Director of Adult Care) on behalf of Elaine Mead, Chief Executive
This report focused on the work preceding the signing of the Partnership Agreement in April 2012. It sought to identify leadership lessons to be learned both for the benefit of the teams within NHS Highland and the Highland Council, and of other Boards within Scotland moving towards integrated models of health and social care. Evan Beswick, Service Manager presented the report to the Board. Research was conducted through face-to-face interviews with individuals identified as leaders of the Planning for Integration journey. These were recorded and reviewed using thematic content analysis to identify key themes and issues, grouped around three areas of enquiry:
What were the key leadership challenges, and how were they dealt with? Why did this happen in Highland? Is it a special case, or are the challenges and successes generalisable? In hindsight, would leaders have done anything differently?
Some major themes had emerged including the importance of clarity and vision for integration, the commitment from leaders to progress integration, the requirement for resources, including staff time and issues around staff terms and conditions. The need for the entire process to be done in partnership and some of the challenges and rewards of working in partnership. Other issues included the issues around professional leadership for staff transferring and the importance of a date for integration. Mr Beswick advised that next steps included work with Dr Cameron Stark, Consultant in Public Health Medicine to publish his report and he would update the Board on this in due course.
There followed a detailed discussion by the Board on the report. In response to a query regarding how we take forward the lessons learned during the process, Jan Baird advised that all staff involved in integration were asked regularly about where we are now and the impact of integration on the Operational Units, staff, users and carers and we were now seeing some very tangible improvements. This would be monitored and collected over the first five years of integration. The Communications Team were also involved in some work on the impact and this would be shared with Highland Council.
The Board a Noted the findings of the research.
113 Brain Injury Rehabilitation in Adults (SIGN 130) Report by Nigel Small, Director of Operations, South and Mid Operational Unit, on behalf of Deborah Jones, Chief Operating Officer
In March 2013, the Scottish Intercollegiate Guidelines Network (SIGN) published new guidelines SIGN 130: Brain Injury Rehabilitation in Adults. This paper provided a brief summary of the SIGN guidelines and details the structure within which NHS Highland will seek to develop and improve Brain Injury services in the future. It also provided assurance to the Board on NHS Highland’s response to the SIGN guidelines.
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Nigel Small, Director of Operations, South & Mid Operational Unit presented the report to the Board. It was noted that SIGN 130 applied to all NHS Boards. The guideline provides recommendations about post acute assessment for adults over 16 years of age with brain injuries. It recommends a range of interventions for cognitive, communicative, emotional, behavioural and physical rehabilitation. As part of its response to SIGN 130, NHS Highland has established a Service Improvement Group for Adults with Brain Injuries. The Improvement Group reports to the Health and Social Care Committee via the Adult Services Commissioning Group. Membership of the Improvement Group was currently being finalised but would include the following posts/services:
Director of Operations (South/Mid) Chair Consultant in Rehabilitation Medicine Lead Nurse Clinical Neuropsychology representatives Consultant in Public Health Primary Care representative Third Sector representative from Headway Highland
As the Group was currently being established, it was expected that the above membership would be expanded following wider discussion. Mr Small also updated on the specific actions of the group and existing services in NHS Highland.
Mr Creelman asked about services for patients in Argyll & Bute and whether these were arranged via SLA with NHS Greater Glasgow & Clyde. Mr Small confirmed that this was the case for the majority although there was work in progress to identify any areas not covered by the SLA. The Chief Executive advised the Board not to underestimate the cost to NHS Highland of Out of Area Referrals and that it would be more beneficial if such patients could be repatriated to services within NHS Highland. Mr Small confirmed that there was also work in progress in this area, looking at the potential in-patient services based in Highland. He also confirmed that it was very expensive to treat patients Out of Area and ideally patients did not want to be treated a long distance from home and family.
Dr MacDonald welcomed the report and guidance in relation to adults and asked what services were in place for children. She also asked about the 100 patients currently being treated and whether this was an appropriate number. Mr Small advised that some work had been done relating to the epidemiology regarding rates per 1,000 etc. In relation to the first question, Dr Somerville advised that work was in progress with both local authorities regarding children who often had very complex care arrangements.
Dr Kennedy welcomed the report and requested that consideration be given to an Allied Health Professional being a member of the Service Improvement Group. Dr Alston highlighted wider issues such as housing needs. Mr Small confirmed that these requests would be actioned when considering membership of the Group.
The Board a Noted the guidelines SIGN 130: Brain Injury Rehabilitation in Adults. b Supported the establishment, role and remit of the Service Improvement Group for Adults with Brain Injury. c Remitted to the Director of Operations, South & Mid to progress the requests for additional membership of the Service Improvement Group for Adults with Brain Injuries.
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114 NHS Highland Asset Strategy 2013 Report by Eric Green, Head of Estates, on behalf Nick Kenton, Director of Finance
NHS Highland is required to produce an Asset Management Strategy for Scottish Government annually. This report updated on the 2013-2018 strategy, which built on the work and achievements of the previous two strategies. Nick Kenton, Director of Finance introduced the strategy to the Board confirming that NHS Highland continued to work on backlog maintenance and space utilisation. Eric Green, Head of Estates confirmed that the strategy included social care and advised that the main areas of work were in relation to backlog maintenance including updating water tanks and fire compartmentalisation works. Alasdair Lawton, Chair of the Asset Management Group confirmed that the strategy had been considered by the Group, who had made some comments, and the strategy had been amended to reflect these prior to being re-submitted and approved by the Asset Management Group.
The Board a Approved the NHS Highland Property Asset Management Strategy. b Noted the progress made towards integrating asset management decisions. c Noted the progress made in dealing with backlog Maintenance. d Noted the challenges that remain.
CORPORATE GOVERNANCE / ASSURANCE
115 Annual Report of the Director of Public Health 2013 Presentation and Report by Margaret Somerville, Director of Public Health and Health Policy
The Director of Public Health is required to publish an annual report each year on the health of the Board’s population, or specific aspects of it. The 2013 report concentrates on children and young people in the Board area and makes recommendations for health and social care services to improve the health of this section of the population. Dr Margaret Somerville, Director of Public Health and Health Policy gave a detailed presentation to the Board on her 2013 Annual Report. The report described: the demographic features of the population aged under 18 years in NHS Highland key public health challenges that children and young people face as they grow and develop and the work that is in progress to support them to achieve their full potential the issues affecting specific groups: o looked after children and other vulnerable groups o children and young people with long-term conditions some of the key service improvements that are taking place in o paediatric unscheduled care o child and adolescent mental health services o the Early Years Collaborative the consultations that have taken place with children and young people to inform service developments
The report made recommendations for health and social care services in each of these areas.
There followed a detailed discussion on the report by the Board. Dr Somerville advised that she would present the report to both local authorities and the Argyll & Bute CHP Committee and the Highland Health & Social Care Committee. A number of issues were raised during discussion, including:
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the high percentage of children in Highland in residential care. In response Dr Somerville advised that the local authority in Highland was sighted on the high percentage of children in residential care. The Chair also advised that in terms of meeting needs of children that they should receive appropriate care and often this was in a setting away from home. reference was made to the use of the term Gypsy Travellers in the report and David Alston advised that the recognised term was Gypsy / Traveller. The latter term encompassed settled gypsy / travellers which were omitted in the first. Dr Foxley referred to transitions to adult services and the role of colleges in vocational training. He also highlighted the 27-30 month health check, which helped to reduce social inequalities. In relation to those in remote and rural areas the issue was less about poverty and more about the disparity in relation to fuel. Transport was a big issue for children and families in remote and rural areas.
The Chair welcomed the Annual Report by the Director of Public Health and looked forward to further feedback once Dr Somerville had presented the report to the operational units and local authorities.
The Board a Noted the report and the implications for children’s services.
116 NHS Highland Financial Position as at 31 August 2013 Report by Nick Kenton, Director of Finance
Mr Nick Kenton, Director of Finance updated on the financial position to 31 August 2013. This report highlighted the financial forecast and progress on savings plans, based on the first quarter of 2013/14 and highlighted a current forecast of break-even for the financial year. However, this was dependent on a £9.6m improvement to achieve this, an improvement of £200k since the last report to the Board.
The breakdown of the position by unit was: £m Raigmore (8.6) South & Mid (ASC) (4.6) Adult Social Care - Central 1.7 North & West (1.3) Forecast non-recurrent benefits 3.7 Others (0.5)
Detailed financial positions for each Operational Units were detailed in section 4 of the report. South & Mid were projecting break-even within the NHS components on the budget and the overspend related entirely to the Adult Social Care element. In terms of Adult Social Care, the overall savings target was currently forecast to be delivered and the £4.6m was made up of an increase in expenditure over 2012/13 as follows: £m New/FYE of care packages 1.1 Prior vacancies likely to be filled 0.5 2012/13 Non-recurrent budgets 1.5 Previous year accounting adjustments 1.3
This was offset by an underspend of £1.7m within the central Adult Social Care budgets.
The most significant overspend related to Raigmore Hospital and could be broken down into the following elements:
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£m 2012/13 non-recurrent carry forward 2.6 Increase expenditure to meet TTG/Access targets 1.8 Expenditure on cancer & rheumatology drugs 0.3 Locum costs due to sickness, maternity and capacity 1.7 Clinical supplies/other pressures 2.3
Nick Kenton updated on measures which were now in place in Raigmore Hospital, including a review of governance arrangements and accountability and establishment of business case rigour. An Organisational Development Plan had been put in place in relation to budget management and budgets were being signed off by relevant managers. The overall financial position for NHS Highland was still very challenging but there was still time to address the issues.
Sarah Wedgwood welcomed the reassurance in relation to the systems now in place in Raigmore Hospital. The Chair was reassured that the Director of Finance now had more control in relation to Raigmore and plans were in place. Updates on the Raigmore position were also regularly received at the Improvement Committee and the Highland Health & Social Care Committee.
Dr Foxley asked about the detailed work reported to Highland Health & Social Care Committee and the Chair confirmed that this information could be circulated to all Board members. Myra Duncan, Chair of the Highland Health & Social Care Committee confirmed that all Board members were welcome to attend any meeting of the Committee.
Ms Wilkinson referred to the focus on the revenue budget and asked that the Board not lose sight of the capital budget. Alasdair Lawton confirmed that regular updates were submitted to the Asset Management Group. The Chair asked that the next Finance Report to the Board include a more detailed update on the position in relation to Capital.
The Board a Noted the forecast out-turn of break-even overall. b Noted the requirement of a £9.6m improvement to achieve this. c Agreed that the work reported to the Highland Health & Social Care Committee on the Raigmore Financial position be circulated to all Board members for information. d Remitted to the Director of Finance to include a more detailed update on the Capital position in the next Finance Report to the Board.
117 Draft Scottish Budget 2014/16 Report by David Garden, Head of Financial Planning on behalf of Nick Kenton, Director of Finance
This report informed the Board of any potential implications that the draft Scottish Government budget for 2014-16 has for Highland NHS Board’s financial revenue plans as set out in the Local Delivery Plan.
The draft baseline inflation uplift notified for 2014-15 in table 1 was 2.68%, before the Change Fund reduction (which was anticipated). This was marginally lower than the assumption in the Five Year Plan of 2.70%. The overall uplift for 2014-15 was 2.8% when allowing for a movement towards NRAC parity. In addition to a baseline uplift NHS Highland will, for the first time, receive an additional allocation towards NRAC parity of £1.5m. The overall figure for 2015-16 at 2.2%, includes an adjustment for an integration fund. The baseline uplift for 2015/16 was 1.8%, which was lower than the previously advised indicative rate of 2.0%.
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The Board a Noted the draft Scottish Government Budget 2014-16 and its impact on the Board’s Local Delivery Plan.
118 Endoscopy Business Cases Reports by Eric Green, Head of Estates, on behalf Nick Kenton, Director of Finance
(a) Reconfiguration of Endoscopy Services – Standard Business Case – NHS Highland provides endoscopy services at Raigmore as the main site for endoscopy in Highland. At present the procedures are carried out in the ground floor of the tower block. The rooms do not comply with modern standards and require upgrading. This business case is to ensure that the service continues and is compliant with all relevant standards.
(b) Endoscopy Decontamination Services for NHS Highland – Standard Business Case – At present decontamination is carried out in an area adjacent to the procedure rooms using purpose built equipment. However, following a review of the national standards it is now recommended that endoscopy decontamination is carried out in a purpose built facility with machinery similar to that used for surgical instruments. This business case is to ensure that the service continues and is compliant with all relevant standards.
Eric Green, Head of Estates presented the reports to the Board and confirmed that the proposed changes to Endoscopy and Decontamination would deal with capacity and patient flow issues as well as guidelines on space utilisation. The business cases had been discussed with clinicians and managers and would provide an improved service for patients. There was a query in relation to how service users were involved and Mr Green confirmed that there had been patient consultation and a patient had been involved in the design. It was also noted that an RPIW in Endoscopy had also looked at patient flow issues and more efficient use of space.
The Chief Executive welcomed the business cases which would result in an Endoscopy Suite at Raigmore Hospital which was fully fit for purpose.
The Board a Approved the Endoscopy Procedure Business case, noting the improvement this would make in compliance with national standards and in the patient environment. b Approved the Endoscopy Decontamination Business case, noting the improvement this would make in compliance with national standards.
119 Infection Control Report Report by Liz McClurg, Infection Control Manager and Dr Jonty Mills, Consultant Microbiologist on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control
Ms Heidi May, Board Nurse Director presented the report to the Board. Ms May advised that data in relation to Staphylococcus aureus bacteraemia rates were red this quarter and were higher than the target trajectory. Work had been done regarding the figures and NHS Highland was still on target to meet the annual target and the figures were lower than for the same quarter last year. The national target for Clostridium difficile had been adjusted to 32.0 (100,000 OBDs) to be achieved by March 2015 with NHS Highland currently at 27.7. Catheter Associated Urinary Infection was now a formal SPSP workstream and Ms May would update on this in due course.
The Executive Summary of the main Infection Control Report, which summarised the key information in the report, is detailed below:
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Table 1 – NHS Highland Infection Prevention & Control targets and performance data
Group Target NHS NHS Highland Scotland Clostridium Age 15 and New 27.7 Green difficile over Target April – June 2013 32.0 (not validated, HPS (100,000 report will be OBDs) to published 02/10/13) be achieved by 03/15
Staphylococcus Age 15 and 24.0 27.93 Red aureus over (100,000) April 12 – March for this bacteraemia AOBDs 2013. (not quarter validated)
Hand Hygiene 95% 95% 98% Green
Cleaning 90% 95% 96% Green
Estates 90% 97% 97% Green
Antimicrobial Hospital- 95% AMAU 95% Green prescribing based Empiric Ward 4A 96% Green prescribing
Surgical Compliant New audit process Amber antibiotic for Colorectal prophylaxis Surgery not fully compliant.
Primary Care Less than 7% Amber empirical 5% prescribing
Source: – Health Protection Scotland/ISD/Local data.
A circular had also been received in relation to Antimicrobial Resistance CMO(2013)14 which linked to the presentation at the Board Development Session on 30 September on Carbapenemase Producing Enterobacteriaceae (CPE) and non-prescribing control measures to prevent cross transmission of CPE in acute settings. A Working Group had been set up to monitor this and would report to the Control of Infection Committee. Ms May also updated on recent inspections in the Belford Hospital on 22 August and Caithness General Hospital on 9 September, both of which had received positive feedback.
In relation to Infection Prevention and Control staffing, it was noted that a second Infection Control Nurse had been recruited. Liz McClurg, Infection Control Manager had formally retired at the end of September, although she had agreed to continue to work 2 days per week until the new Infection Control Manager takes up post in the New Year. The Board welcomed the improvements and the Board Medical Director suggested that the culture in relation to infection control and prevention was changing with people being more open and honest.
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The Chair acknowledged the work of Liz McClurg in her role as Infection Control Manager and extended the Board’s thanks for her contribution to infection prevention and control.
The Board a Noted the performance position for the Board and the progress to keep infection under control.
120 Winter Plans 2013/14 Report by Tracey Ligema, Area Manager, West, North and West Operational Unit on behalf of Deborah Jones, Chief Operating Officer
Tracey Ligema, Area Manager, West, North and West Operational Unit spoke to the report. In February 2013, the Cabinet Secretary for Health and Wellbeing announced a significant programme of change to emergency and urgent health care services through the Local Unscheduled Care Action Plan (LUCAP). Accompanied by an investment of over £50 million in the next three years, the programme will improve the provision of unscheduled care in the acute hospital setting as well as focussing on the need to prevent admission wherever possible and to expedite appropriate, timely discharge. A critical component of the LUCAP is the assessment of the issues to be addressed and the actions necessary to avoid any unacceptable delays to the admission of emergency patients during winter 2013/14. This has been supported by a local review of winter 2012/13.
Plans will be developed including a wide range of stakeholders and partners to ensure that all options for business continuity at times of peak demand are explored for implementation, e.g. including the commissioning of independent/third sector services. Plans will include actions to deliver the following which have been identified as essential elements: Delivery of 4/6/8/12 hour standards in A&E departments Increase community capacity to avoid admissions/expedite discharges from hospital including planning to maximise availability of homecare, social work, primary care. Maximise implementation of Anticipatory Care Plans and ensure reference to these in hospitals and by SAS Monitor and manage unscheduled activity allowing effective scheduling of elective activity to ensure delivery of the Treatment Time Guarantee Agreeing all rotas for the festive period by October 2013 Ensure senior decision making capacity is available during the festive period Agreeing and testing surge/escalation plans and business continuity plans Preparing for potential Norovirus outbreaks Delivering seasonal flu vaccinations to staff and the public
The Chief Executive advised that Deborah Jones, Chief Operating Officer had given a presentation at a national meeting in relation to winter planning and suggested that this information, including the graphs would be useful to circulate to Board members.
Dr Alston referred to integration and whether the business continuity plans also related to care services. It was confirmed that these plans were in place. Mr McLennan asked about problems in relation to sufficient out of hours cover by GPs and cross-boundary cover. Ms Ligema advised that there were some areas where it was difficult to have sufficient out of hours cover by GPs and the arrangements were flexible across NHS Highland. The Group would consider this further at future meetings.
The Board a Noted the progress towards Winter Planning and its integration with the Local Unscheduled Care Action Plan (LUCAP).
75 18 b Noted the actions to improve sustainability of Out of Hours Primary Care provision. c Noted the actions to sustain and improve performance against Emergency Department 4 hour target. d Agreed that the relevant graphs referred to should be circulated to Board members for information.
121 Chief Executive’s and Directors’ Report – Emerging Issues and Updates Report by Elaine Mead, Chief Executive
This month’s report incorporated updates on: NHS Highland Annual Review Letter Freedom of Information Update Immunisation Programmes Update Implementation of the Allied Health Professions (AHP) National Delivery Plan Patient Management System Implementation Regional Planning – North of Scotland Planning Group and West of Scotland Planning Group
The Chief Executive referred to the update on the implementation of the Patient Management System highlighting the revised timescale for going live which had been revised to 3 March 2014. Ms Mead also referred to the NHS Highland response to the Allied Health Professionals National Delivery Plan (AHP NDP) which was developed following a Scottish Parliamentary debate in November 2011 regarding AHP contribution to Health service delivery. A further report would be submitted to the Board regarding the various workstreams, including self-management. Mr Creelman referred to the Freedom of Information Update and noted that two requests were not categorized. The Board Secretary confirmed that he would clarify this point. The Chair referred to the updates from the North of Scotland Planning Group and the West of Scotland Planning Group and noted that the Board had received an annual report from the North of Scotland Planning Group but not from the West of Scotland Planning Group.
The Board a Noted the emerging issues and updates report. b Noted that a further report would be submitted to the Board regarding the various AHP workstreams, including self-management. c Remitted to the Board Secretary to clarify the query relating to the Freedom of Information Update. d Agreed that the Annual Report of the West of Scotland Planning Group should be submitted to a future meeting of the Board.
122 Date of Next Meeting
The next meeting of the Board will be held on Tuesday 3 December 2013 at 8.30 am in the Board Room, Assynt House, Beechwood Park, Inverness.
The meeting concluded at 1.15 pm.
76 FOLLOW UP FROM BOARD ACTION PLANS – FEBRUARY 2012 ONWARDS19 Highland NHS Board Those items shaded grey are due to be removed from the Action Plan as they have been completed, or will be considered at 3 December 2013 the next Board. Item 2(b)
Meeting Item Action / Progress Outcome
Board 07/02/12 Highland Health & Social Care To review the governance arrangements once the structure had Deferred December 2013 Partnership – Proposed been operational for one year. Board Feb 2014 Governance Arrangements Governance Committees – Review To review the mechanisms for governance committees to report Work in Progress of Assurance to Board to the Board. Deferred December 2013 Board April 2014 Highland Council – Adult & Consideration to be given to the style of assurance report Chair / Chief Executive Children’s Services Committee required from Highland Council as the Lead Agency for Work in progress / ongoing discussions Children’s Services. with Highland Council. Board 05/02/13 – To take forward work in progress in relation to assurance in respect of Children’s Services.
Board 14/08/12 NHS Highland Standing Orders Standing Orders deferred to December Board Meeting. Board 04/12/12 – Deferred Scheme of Delegation to 05/02/13 Board Work in progress re Standing Orders. Organ Donation Committee Terms of Reference for Organ Donation Committee to be Clinical Gov. Committee – 02/10/13 reviewed and considered by Clinical Governance Committee.
Board 09/04/13 Matters Arising Pyramid / Pyramis System – Progress report on the Improvement Committee – 01/07/13 / development of the Data Warehouse system to be submitted to 02/09/13 – Deferred the Improvement Committee Improvement Committee – 04/11/13
Board 04/06/13 NHS Highland Adult Social Care Agreed that there should be a review within 12 months of the Future Board – October 2014 Practice Forum – Terms of Forum coming into operation. Reference
Board 13/08/13 Membership of Committees Revised membership should be until 30/06/14 with a further Board June 2014 report to the Board in June 2014.
Governance Review To consider the submission of governance committee minutes to Work in Progress the Board as part of the review of governance arrangements. Board April 2014
Progress on Evaluation of Service A future updatet would be submitted to the Board on the Armed Future Board – Feb 2014 Integration Services Covenant and the care of veterans. 20
Meeting Item Action / Progress Outcome
Board 13/08/13 NHS Highland Workforce Staff Governance Committee to consider the need for a longer Actions within Everyone Matters 20:20 Development Plan 2013/14 term Workforce Plan for NHS Highland. Workforce Vision relating to long-term planning will be considered by Staff Governance Committee. Review of Committees Final Committee Membership list to be circulated to Board Board 03/12/12 members once complete.
Minute of Meeting of 13 August NHS Highland Financial Position – to amend the figure for the Completed 2013 2012/13 non-recurrent carry forward in relation to Raigmore to £2.6m.
Board Rolling Action Plan Hospital and Community Health payments to GPs in Argyll Audit Committee – 11/03/14 & Bute – Director of Finance to write to Scottish Government regarding the position and provide written feedback to the Audit Committee.
Matters Arising An update on assurance in relation to the Highland Council Board 03/12/13 Adult & Children’s Services Committee would be submitted to the next meeting of the Board.
Argyll & Bute CHP Committee Noted that a full report on the Inspection of Children’s Services Board 03/12/13 in Argyll & Bute would be submitted to the December Board meeting.
Highland Health & Social Care Amend the reference on page 10 of the report to the “Choice and Completed Committee Transport Policy” to read “Choice and Transfer Policy”
Invitation extended to all Board members to attend the next Completed HH&SCC Development Day on 1 November 2013.
Hospital Standardised Mortality Ratios (HMSR) should be a Incorporated in Balanced Scorecard standing item on the agenda for the HH&SCC. reporting to HH&SCC
Improvement Committee DNA rates suggested as a potential issue to highlight in the next MT to consider for next NHSH NHS Highland newspaper. Newspaper
Highland Council – District Recommended that the reporting mechanisms in relation to Future Board Partnerships District Partnerships should be reviewed again in three months Feb/April 2014 to ensure relevant issues were being included on the agendas.
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Meeting Item Action / Progress Outcome
National Strategy for Learning Further report updating on the development of plans in both Future Board Disability partnership areas and detailing specific outcomes should be Feb/April 2014 submitted to a future meeting of the Board.
Board 01/10/13 National Telehealth and Telecare Director of Adult Care to contact Highlands & Islands Enterprise Report to Board Members Delivery Plan for Scotland regarding the query on broadband coverage.
NHS Highland Financial Position The work reported to the HH&SCC on the Raigmore Financial Circulated to Board Members by e-mail position to be circulated to all Board members for information. 21/11/13
To include a more detailed update on the Capital position in the Board 03/12/13 next Finance Report to the Board.
Winter Plans 2013/14 The relevant graphs referred to should be circulated to Board Circulated to Board Members by e-mail members for information. 21/11/13
Chief Executive’s Report Implementation of the Allied Health Professions (AHP) Board 03/12/13 National Delivery Plan – a further report would be submitted to the Board regarding the various AHP workstreams, including self-management.
Freedom of Information Update – to clarify the query relating Circulated to Board Members by e-mail to the requests not categorized. 21/11/13
Regional Planning – Annual Report of the West of Scotland Board 03/12/13 – 2012 Report included Planning Group should be submitted to a future meeting of the as part of CEs Report Board. Future Board – 2013 Report to be submitted to Board in 2014.
3 22 23 Highland NHS Board 3 December 2013 Item 2.1 UPDATE ON VACANCIES TO BE FILLED FOLLOWING REPORT TO BOARD ON 13/08/13 – PROPOSED COMMITTEE MEMBERSHIP
Community Health Partnerships Committee Current Membership Highland Health & Social Care Committee Myra Duncan – Chair Rhona MacDonald Gillian McCreath
Argyll & Bute Community Health Partnership Robin Creelman – Chair Elaine Wilkinson Local Authority Member
Governance Committees Committee Current Membership Audit Committee Mike Evans – Chair Michael Foxley Alasdair Lawton Gillian McCreath Adam Palmer
Clinical Governance Sarah Wedgwood – Chair Committee Graham Crerar from 01/01/14 Michael Foxley Iain Kennedy Rhona MacDonald
Staff Governance Alasdair Lawton – Chair Committee Robin Creelman Myra Duncan Adam Palmer Elaine Wilkinson
Endowment Funds Mike Evans Committee Rhona MacDonald Gillian McCreath Adam Palmer Elaine Wilkinson
Remuneration Sub- Garry Coutts – Chair Committee Sarah Wedgwood – Vice-Chair Robin Creelman Myra Duncan Alasdair Lawton Adam Palmer
Highland Council Committees Committee Current Membership Adult and Children’s Myra Duncan Committee Gillian McCreath Margaret Somerville
Integrating Care in the Highlands Programme Discussions ongoing with Highland Council Board 24
Joint NHS Highland and Argyll & Bute Council Committee Committee Current Membership Argyll & Bute Health and Care Strategic Robin Creelman – Chair Partnership Local Authority Member – John McAlpine
District Partnerships Committee Current Membership Ardersier, Badenoch & Strathspey & Nairn Graham Crerar from 01/02/14 (Garry Coutts will cover until 2014)
Assynt, Skye & Lochalsh & Wester Ross Myra Duncan
Caithness David Alston
East Ross Okain McLennan (until 31/01/14) Alasdair Lawton (from 01/02/14)
Inverness East Gillian McCreath
Inverness West Adam Palmer
Lochaber Michael Foxley
Mid Ross Sarah Wedgwood
Sutherland Mike Evans
Non-Executive Representation on other NHS Highland Committees Committee Current Membership Area Control of Infection Committee Okain McLennan – Chair (until 31/01/14) Gillian McCreath – Chair from 01/02/14 Graham Crerar from 01/01/14
Health & Safety Committee Elaine Wilkinson – Chair
Pharmacy Practices Committee Okain McLennan (until 31/01/14) Elaine Wilkinson Graham Crerar from 01/01/14
Risk Management Steering Group Sarah Wedgwood
Spiritual Care Committee Sarah Wedgwood
Asset Management Group Alasdair Lawton – Chair Elaine Wilkinson
Organ Donation Committee Gillian McCreath
Carbon Management Board Graham Crerar from 01/01/14
Non-Executive Representation on other Committees/Groups Committee Current Membership National Appeal Panel for Entry to Okain McLennan (until 31/01/14) Pharmaceutical Lists Elaine Wilkinson 25 Highland NHS Board 3 December 2013 Item 3.1
Argyll & Bute Community Health MINUTE OF MEETING OF THE Partnership ARGYLL & BUTE CHP COMMITTEE Aros Lochgilphead Argyll PA31 8LB www.nhshighland.scot.nhs.uk/
J03-J07 - Mid Argyll Community Hospital & 23 October 2013 Integrated Care Centre, Lochgilphead
Present Mr Robin Creelman, Chairman, Argyll & Bute CHP Mr Derek Leslie, Director of Operations, Argyll & Bute CHP Dr Michael Hall, Clinical Director, Argyll & Bute CHP Ms Elaine Garman, Public Health Representative, Argyll & Bute CHP Ms Elizabeth Reilly, Area Dental Committee Representative Ms Liz McMillan, Staffside Representative Mr Duncan Martin, Chairman, Public Partnership Forum Councillor Elaine Robertson, Argyll & Bute Council Representative Ms Glenn Heritage, CVO Representative Ms Elaine Wilkinson, Non-Executive Member
In Attendance Mr George Morrison, Head of Finance, Argyll & Bute CHP Mr Stephen Whiston, Head of Planning Contracting & Performance, Argyll & Bute CHP Mr David Logue, Head of HR, Argyll & Bute CHP Ms Fiona Campbell, Clinical Governance Manager, Argyll & Bute CHP Ms Sheila Ogilvie, Infection Control Nurse, Argyll & Bute CHP Mrs Sheena Clark, PA to Director of Operations - Minute Secretary
Apologies Ms Pat Tyrrell, Lead Nurse, Argyll & Bute CHP Ms Mary Wilson, AHP Representative, Argyll & Bute CHP Mr David Ritchie, Communications Manager, Argyll & Bute CHP Councillor George Freeman, Argyll & Bute Council Representative Jim Robb, Head of Service, Adult Care, Argyll & Bute Council Mr Michael Roberts, Vice Chair, Public Partnership Forum Ms Dawn Gillies, Staffside Representative
1. CHAIRMAN’S WELCOME
The Chairman opened the meeting by welcoming everyone to the Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead.
2. APOLOGIES
Apologies for absence were noted as above.
3. CONFLICTS OF INTEREST
Councillor Robertson declared that she is a member of the Board of West Highland Housing. 26
4. MINUTE FROM PREVIOUS MEETING
4.1 Minute of Meeting held on 21 August 2013
The Minute of the meeting on 21 August 2013 was accepted as an accurate record of the meeting.
The Committee Approved the content of the Minute.
5. MATTERS ARISING FROM PREVIOUS MEETING HELD ON 19 June 2013
Mobile Phone Coverage – Mr Leslie reported that as a result of difficulties being experienced by staff in some areas of the CHP, where appropriate, ad hoc changes were being made to allow staff to revert to using Vodafone until issues with the new provider have been resolved.
6. NHS Highland Organisational Issues
6.1 Highland NHS Board –1 October 2013
Mr Creelman reported on a potentially stabilised financial position of Raigmore Hospital.
The Committee Noted the above update.
6.2 NHS Highland Annual Review – Letter from Cabinet Secretary for Health & Wellbeing
The circulated letter summarised the main points discussed during the various meetings in Inverness on 19 July 2013. Mr Leslie highlighted the robustness of the visit and the action points arising from the Annual Review and associated meetings.
In response to an enquiry from Mr Creelman at today’s meeting regarding the current status of integration discussions, Councillor Robertson undertook to request an update from Council colleagues and advise the Committee accordingly.
The Committee Noted the content of the circulated letter.
6.3 Director of Operations Report
Mr Leslie referred to the circulated report and highlighted:
Islay Clinical Services Review Update At the Steering Group meeting held 13 September the project meeting structure was reviewed. It was agreed that the Clinical Workforce sub-group has fulfilled its function and is no longer required.
The communications and engagement sub-group is scoping out the process and timeline for engaging and involving the community and staff about the proposed model and short/medium/long term actions to be progressed. There is a focus on service sustainability.
The Kithstone report on the outcome of the review was presented and circulated to the group for comments. The finalised report and associated actions will be presented to the CHP Core team in November and to the CHP Committee in December. 2 27
Gordon Peterkin of Kithstone is due to meet with CHP managers on Friday 25 October to provide a summary and feedback on his consultations with the 3 Islay GP Practices.
Kintyre Continuing Care Beds – Campbeltown Hospital Discussions are continuing with the Scottish Health Council to evaluate and review the involvement and engagement process in the extent of service change. Further action to formalise the position will be considered subsequently.
An Approach to Building Sustainability of Health & Care Services in Remote & Rural Areas The SGHD recently announced £1.5 million funding over three years for NHS Highland to test and evaluate models for the delivery of sustainable health and social care services in remote and rural areas which would have application across Scotland. Argyll & Bute CHP have contributed to the proposal, with Mid Argyll, Kintyre and Islay three of the four test areas identified for further development. Challenges around the sustainability of remote health care services in Argyll and Bute include attracting and retaining GPs to work in rural health care providing the “triple duty role” of day time GP work, GP out of hours and duty doctor providing A&E and acute medical inpatient services in our community hospitals. This is not attractive to new GPs in terms of pay, lifestyle, a 24/7 work commitment, training and skills maintenance. The funding will support some action research, a health economist examining the cost of delivering services in remote areas, looking at ways of using telehealth to support local service delivery, testing new ways of working/roles with the SAS and supporting education and training for the MDT.
Opiate Substitute Prescribing During the Cabinet visit to Campbeltown on 28 August the Scottish Government advised a panel of experts would be made available to support local discussions between the Health Board, Local Authority, 3rd sector and community members about a substitute prescribing service and what models might be considered appropriate to meet the needs of the people of Kintyre.
Further information has been provided to community representatives in relation to the efforts to establish an opiate substitute prescribing service in Kintyre. This continues to show clear evidence of service need in Kintyre in comparison with Mid Argyll.
From the data available to us there is clear evidence of service need in Kintyre where there have been 101 drug related referrals to services since 2010 and during the same period just 19 such referrals to services in Mid Argyll. In terms of currently active cases there are 15 in Kintyre and just 1 in Mid Argyll. This is further evidenced by the fact that 12 people are registered with the needle exchange in Kintyre and none in Mid Argyll.
Health Care in the Ross of Mull & Iona Following the recent resignation of the incumbent GP providing GMS to the Ross of Mull, the CHP has responded to community concerns about recruitment. By acknowledgement the CHP recognises that recruitment to very remote and rural practices and particularly island posts is very difficult as evidenced by the time it has taken to recruit to posts in Islay, Jura, Inveraray Southend, Mallaig and the Small Isles. The reason for this can include the onerous commitment of on-call, the isolation of single handed practices, limitations in the supporting infrastructure including, roads, mobile phone coverage, housing, access to specialist support e.g. NHS 24, telemedicine, on going training and cross working to maintain skills, etc.
Through its experience of working through these issues in the last few years and most recently with the support of the Scottish Government helping fund a number of pilot schemes under its “An Approach to Building Sustainability of Health and Care Services in Remote and Rural Areas” initiative, the solutions to recruitment include:
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o Community engagement and involvement is essential, to ensure the community can participate in the process to attract candidates, by provide support re advertising and promoting the job opportunity, demonstrating the benefits of rural and island living as well as what active support the community can offer e.g. establishing a first responder scheme, suggestions regarding alternatives etc. o Greater team working with other agencies, Ambulance service, Fire, Social Work. etc. o Integration and cross working with adjacent GP practices. o Examining alternative ways of providing services including how other health practitioners can deliver services e.g. Orkney. o Interviewing and appointing the right candidate/s
The CHP’s intention is over the coming months to work with relevant stakeholders on the Isle of Mull and the community in the Ross of Mull & Iona to explore the issues and examine service options which will enable a sustainable GP service to be provided to the population.
Throughout the process outlined above until its conclusion the CHP will continue to provide a GP service to the Ross of Mull & Iona by the use of long term Locum GPs.
Mull Progressive Care Centre (PCC) Garry Coutts, NHS Highland Chair is to respond to a letter received from Mull Community Council expressing concern about ongoing issues they have with, in particular, the Bowman Court element of the Mull Progressive Care Centre and the accompanying allegation that the Argyll & Bute CHP has “failed under article 174 of the EU Lisbon Treaty to protect the interests of the island communities of Mull and Iona”. The current status and differences in approaches to integration will be clarified, together with an emphasis on the good partnership working through the Argyll & Bute Health & Social Care Partnership, together with confirmation that as things currently stand in Argyll & Bute it is the Council that has primary and statutory responsibility for adult social care.
Councillor Robertson reported on concerns by West Highland Housing Association on the perceived lack of response from Argyll & Bute Council and NHS Highland to the recent press article regarding Mull PCC.
Mr Leslie responded by confirming the partners’ agreement to undertake a review of the first year’s operation which will cover:
to examine and reaffirm the model of care clarify issues relating to management and leadership work with Health and Social Work staff to examine in detail how the model works within the campus confirm roles and responsibilities, specifically in relation to service provision and risk management provide or organise any additional briefing or training as required engage with service users and carers, and clarify the purpose and use of the communal area and kitchen
The review will be conducted over 3 months and it is anticipated that a report will be produced at end January 2014.
Patient Management System (PMS) Update Following the agreement of the NHS Highland PMS Programme Board to necessarily reschedule the “go live” date to 3 March 2014, extensive data migration work is being progressed to merge the patient data from the existing PAS systems into the new and unified PMS.
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Work is continuing to rigorously test all data that will be transferred from the two existing PAS. This testing will continue in phases until February 2014. The Programme Team has identified “super users” and other service personnel who will test that data migration has been successful.
The building of all the outpatient clinics has started. The process was tested by building the most “complex” clinics first on the basis that these would highlight any issues. This phase cleansing exercise is also being carried out to ensure complete data integrity before the build process.
Work is about to commence on the letter templates that need to be created for communication with patients and this is scheduled to be completed in January 2014.
The creation of Standard Operating Procedures (SOPs) for all the administrative processes that will be undertaken by PMS users is at an advanced stage. Once signed off, these SOPs will be located in a specific section of the Intranet so that all relevant staff can have full access. This will also ensure that staff are using the correct and current NHS Highland agreed procedures.
The SOPs are essential to allow the training packages to be created in line with how NHS Highland requires the new PMS to be utilised.
The training team are creating comprehensive training packages which will be used to train all of our staff. Training will be delivered mostly during January and February 2014 using an innovative blend of physical training courses and training via WebEx facilities. Dates are in the process of being confirmed and these will be detailed on the Intranet along with booking information.
Significant work is also taking place to ensure that all the technical components required by the system are in place. These include ensuring that:
printing is available in all appropriate locations; interfaces to 3rd party systems e.g. cancer tracking, theatre etc are in place for the go live date; all the necessary central infrastructure is in place and tested; speed of access to the new system is appropriate on all sites across NHS Highland.
With regard to communications, regular presentations on the progress being made in relation to implementation of the programme are being delivered on a monthly basis in Inverness, Wick, Fort William, and Lochgilphead.
Challenges associated with the specific Argyll & Bute CHP element of PMS implementation are being addressed through a specific Operational Interfacing Group. To reflect the importance of addressing these complex issues the Argyll & Bute CHP Director of Operations has been invited to join the overreaching PMS Programme Board.
The Committee Noted the content of Director of Operations Report.
7. Clinical Governance
7.1 Clinical Governance & Risk Management Report
Mr Creelman advised on comments by Dr Ian Bashford, Board Clinical Director, commending the detail of the Argyll & Bute CHP report.
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Ms Campbell spoke to the circulated report and highlighted and summarised a number of items.
Risk Management
Incidents The information from Datix reported a total of 519 incidents were reported within Argyll & Bute during quarter 2.
Cowal & Bute – 80 (15.7%) Helensburgh – 12 (2.3%) Mid Argyll & Kintyre – 253 (48.7%) Oban, Lorn & Isles – 163 (31.4%) Outwith – 11 (2.1%)
Ms Campbell advised that the increased figure is possibly due to increased reporting, rather than in actual incidents.
In the last financial quarter slips trips and falls remained in the highest category of incidents. The top category for each locality:
Cowal & Bute – transfer / discharge (15) - the incidents related to Scottish Ambulance Transfers, mainly on Bute. Helensburgh – communication & confidentiality (2) Medication (22) Mid Argyll & Kintyre – falls (56) Oban, Lorn & Isles – falls (47)
During Quarter 2 the incidents reported in Argyll & Bute were graded as follows:
Low - 282 (54.3%) Medium - 191 (36.8%) High - 4 (0.7%)
The remaining incidents have not yet been graded.
There were 6 incidents graded with a consequence of major or extreme, 3 of which are the subject of a Significant Event Review. Mid Argyll, Kintyre and Islay - 3 Cowal & Bute - 3
The overall outcome for Argyll & Bute:
No injury / harm – 294 (56.6%) Near Miss – 44 (8.4%) Injury / harm – 154 (30%) Property damage – 27 (5.2%)
There have been no RIDDOR incidents since April 2013.
Pressure Ulcer Prevention Across NHS Highland the trends in Hospital Acquired Pressure Ulcers show the overall number remains fairly constant, with the reduction in Grades 3 and 4 ulcers being sustained.
There has been recent increase in capacity of Tissue Viability specialist nursing support within NHS Highland; this will deliver additional support to the clinical staff in ensuring that adherence to standards for pressure ulcer prevention is maintained across all areas.
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In addition, a short life group has been established to develop an action plan to raise awareness, and develop prevention strategies, across community and primary care settings. This will include working with carers and staff in Care Homes and Care at Home services.
Falls Prevention As with Pressure Ulcer prevention considerable amount of work is underway to reduce the incidence of falls in both hospital and community settings. Application of evidence based interventions, in the assessment and management of risk in those likely to sustain falls, is being tested in Lorn and Islands Hospital in Oban.
Audit of compliance with Clinical Quality Indicator Falls Prevention are carried out each month across all wards in Argyll and Bute. High percentage compliance with the standards for identifying and managing risk of falls is required in each ward.
Work is underway to align the approach to Falls Prevention using the SPSP Care Bundle and this will alter how performance is reported in the future. NHS Highland has established work group led by Associate Director for AHPs to progress this further.
Ms Campbell stated that the higher number of reported incidents in acute hospitals reflects the different patient groups than in community hospitals. She will arrange for clarification on the reporting of falls in the community to be included in the next report to the Committee.
Disruptive, Violent & Aggressive Behaviour While incidents related to disruptive, violent and aggressive behaviour are the second highest category reported, the numbers for Argyll and Bute are consistently lower than those of the other operational units. Training and support for staff is delivered throughout the year to ensure that staff have the right communication and management skills to deal effectively with potential incidents.
Ms Campbell advised that one patient can contribute to higher reporting. The reported figure for Islay related to one particular patient and focussed work is being undertaken with this patient.
Health Improvement Scotland Adverse Event Review On 23 September 2013, Health Improvement Scotland (HIS) published the NHS Highland report in relation to the management of adverse events review visit which took place on 07 August 2013.
The following areas of good practice within NHS Highland were noted: consistent approach to patient, family and carer involvement strong local governance structure with cohesive local teams, and openness and transparency in sharing learning across the organisation.
A number of challenges in how adverse events are managed within NHS Highland were noted. The review team found that further improvements could be made in terms of assurance of consistency in the practice of managing adverse events across the four operational units, consistency in approach to investigations and the use of IT systems to their full potential.
Ms Campbell commented on some of the recommendations made:
ensure a consistent process to recording the engagement with patients, families and carers – this will result in a more robust and meaningful process. ensure there is a consistent process for developing and monitoring action plans and outcomes – the CHP has a good and robust monitoring system.
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ensure lessons learned from individual adverse events as well as thematic learning are captured, shared and implemented across the NHS board – the auditing process will be strengthened to ensure that any changes produce achievable results. Although challenging, this should be a key message in all Board reports and encourage shared learning.
Actions to address some of the recommendations have already been implemented and further improvement work is underway.
Additionally, on 13 September 2013, HIS published: Learning from adverse events through reporting and review: A national framework for NHSScotland.
A consistent and standardised approach will be measured against Standards and final guidance will be issued to ensure compliance with the published framework.
Ms Campbell stated that feedback to staff from individual Datix incidences will vary depending on the type of incident. There is acknowledgement that there is currently a gap within the reporting process and ways are being considered to ensure that staff are aware that Datix is being actioned and that dialogue between the manager and member of staff occurs. She advised that changes in the Datix system will improve the reporting and lead to improvement in any inappropriate usage, i.e. incorrect reporting on Datix system.
Ms Wilkinson enquired how recommendations and outcomes are addressed within the CHP. Ms Campbell advised on the Significant Event Review (SER) process and the robust systems currently in place. The Datix system is also utilised to provide an up-to-date position report.
Dr Hall emphasised that relevant staff are involved in the SER process and that they are provided with an explanation of why a review is being carried out. In some instances, staff can find the process challenging but learning across the CHP and NHS Highland is encouraged in order to focus on common issues. It is recognised that there are some areas of the process requiring improvement and this is being addressed.
Mr Creelman reiterated that SER reporting and the process undertaken is the sign of a healthy approach to dealing with any adverse events.
Complaints Of the 9 complaints received in August 2013 the themes contained within complaints can be broadly categorised as follows:
Transfer 1 Dental Services: access/waiting times/treatment 5 Care / Treatment 3
Although there is an emphasis on the quality of the response provided to patients/complaints, rather than meeting the 20 day target, Ms Campbell advised that ways to speed up the process will be considered.
External Reviews
Joint Inspection of Children’s Services in Argyll and Bute The final report from the Care Inspectorate was received in September 2013. The inspection of services to children took place over 22 weeks earlier this year and involved inspections, reviews of case records, interviews of families and young people ,meetings with staff and elected members. They looked at the work of the Community Planning Partnership to improve the lives of children in Argyll and Bute and considered services to children and young people provided by NHS, Council, Police, Independent and Third Sectors.
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The inspectors recognised:
The strong commitment to prevention and early intervention A very positive culture of partnership working at all levels The flexible approach to working with families to improve outcomes for children and young people Sound work to promote strong and resilient children, young people and families
The inspectors also highlighted three areas of good practice which are:
Getting it right antenatal – our interagency approach to identifying and supporting vulnerable pregnant women, which is having a significant impact on giving unborn babies the best start in life Early intervention service –this service provides high quality intensive support to vulnerable children and young people Nurse coordinators – working to support children in care, families affected by homelessness and Gypsy traveller families
They identified areas for improvement as: Secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children Complete and implement the Integrated Children’s Services Plan Continue to develop rigorous and systematic joint self-evaluation to improve outcomes for children and young people Ensure continued leadership and direction is provided to implement the planned improvements for services for children, young people and families
Quality & Safety
Scottish Patient Safety Programme Acute Services:
As part of the Scottish Patient Safety Programme (SPSP) Hospital Standardised Mortality Ratio (HSMR) data is published quarterly for acute hospitals to assess progress in reducing mortality over time.
A target of a 15 percent reduction in the HSMR by December 2012 was originally set by the SPSP. This has been extended to a 20% reduction by December 2015.
In the latest period at Lorn & Islands hospital there were 29 deaths recorded at 30 days following admission and the HSMR was 0.99. This figure ended a period of four consecutive increases in the HSMR. A result of these recent trends is that the overall improvement rate of the HSMR at the hospital has been slowed down and currently stands at 12%.
Dr Hall commented that the CHP looked at the ‘triggers’ and each death was reviewed, i.e. blood results, case notes. The identification of an upward trend would be a cause for concern and in the instance of an unexpected death a Significant Event Review (SER) would be carried out. No obvious reasons have been identified for the instances reported in the previous quarter which provides a degree of assurance that there was no significant cause.
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Health & Safety
NHS Lothian HSE Prosecution Following the recent prosecution by the Health and Safety Executive of NHS Lothian following an assault on a community psychiatric nurse in the home of a patient that she was visiting, the CHP Health & Safety Team is progressing the following actions:
Identifying the numbers of lone workers in the CHP Undertaking an audit of attendance at Management of Violence and Aggression training Auditing compliance with the Lone Working Policy Providing support to managers in undertaking violence and aggression risk assessments.
Moving & Handling Two streams of work in relation to moving and handling are being progressed:
1) Competency Model – this will replace the annual classroom training and in the first instance will be introduced to hospital staff, with assessment of key workers taking place on an ongoing basis within the workplace.
2) Integration of Moving and Handling - as joint group was tasked to take forward work relating to the integration of moving and handling as part of Workstream 5: Reshaping Care for Older People. A working group comprising NHSH and A&B Council representatives has been progressing aspects of joint working relating to Moving and Handling.
Some problems have been identified in relation to delivering joint training as NHS Highland and Argyll & Bute Council deliver different training approaches:
Argyll and Bute Council delivers a neuromuscular approach to training delivered by ‘MovES’, a company which validates their own moving and handling training. NHSH/A&B CHP operates a self-validated system of training. Previously NHSH followed the MovES approach but this has not recently been the case.
In order to fully integrate the moving and handling service a common approach to training needs to be agreed. Information is being gathered to inform an option appraisal to assist decision making.
Mr Martin commented on the risk in non-clinical settings and enquired about the 3rd Sector training in moving and handling. Ms Heritage responded that there is a specific contract for working with people in their own homes but the opportunity to bring together groups for unified training could be considered.
Fire Safety
Fire Risk Assessments Fire risk assessments carried out by the CHP Risk Advisor, Fire Safety, using the 3i system continue to progress. Garelochhead; Kilcreggan; Campbeltown, Islay, Lorn & Islands, Dunoon, Rothesay, Mid Argyll and Mull and Iona Community Hospital are now complete and have been issued. Action plans are being prioritised locally. Assessment of Victoria Integrated Care Centre, Helensburgh is under way.
Some premises are now due an annual audit. Where there has been no material change to the building or the risk, the site duty holder will check the risk assessment against work completed in the action plan and report this back to the fire advisor who will update the 3i system.
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Where there have been material changes (e.g. extension work, change of use or risk) then the duty holder will inform the fire advisor so that an update of the risk assessment can be made.
Compartmentation Survey Part of the capital funding request has been released to start some of the much needed compartmentation works. Partial funding for Lorn & Isle and Cowal Community hospitals has been made available. Work will be prioritised in line with the recent Scottish Fire and Rescue Service audit letters.
Unwanted Fire Alarm Signals In the last quarter there were 10 incidences of unwanted fire alarms, with 6 considered to be avoidable. All incidents are reviewed and advice provided by Scottish Fire Authority to minimise the risk of recurrence.
Possible Fire Service Strike Action
The Fire Service Union has initiated industrial action in England & Wales. Negotiations are still ongoing in Scotland. To ensure that the CHP is prepared for any possible action and consequential reduction in response from the Fire service all Locality Managers and Clinical Services Managers have been to asked to ensure that local plans are robust and tested and additional training for all in-patient areas with a particular focus on practical use of fire extinguishers has been offered.
The Committee Noted the content of the Clinical Governance & Risk Management Report.
7.2 Infection Control Report
Ms Ogilvie referred to the circulated report which updated the CHP Committee of the current status of Healthcare Associated Infections and infection control measures in Argyll & Bute CHP and NHS Highland.
Staphlococcus Aureus Baceraemia (SAB) (including MRSA) – there have been no cases of SAB in Argyll & Bute since the last report.
Clostridium Difficile (CDI) Target - there have been a total of 9 cases (7 patients / 2 recurrences) of Clostridium difficile infection detected in hospital settings in Argyll & Bute CHP since 1 April 2013. A further 4 patients have been diagnosed in the community setting. This represents an increase on the last 2 years.
Initial examination of the data available does not appear to suggest cross infection has been a factor in the increased number of infections diagnosed. The 4 patients diagnosed in community settings were in different locations with no links related to hospitalisation or other healthcare intervention. With the exception of Cowal Community Hospital, the hospital patients diagnosed were unrelated in terms of time and/or place.
3 patients in Cowal Community Hospital were diagnosed as having CDI in April, August and September respectively. No infection alert triggers have been breached and initial investigation does not suggest an outbreak situation. Nevertheless, the situation warrants further scrutiny to detect and rectify any preventable factors which may increase the risk of infection acquisition to current and future patients.
A further review was carried out on the epidemiology and clinical history on Cowal patients on 17 October 2013.
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Ms Garman emphasised the need for liaison between hospitals to identify any risk of infection. Ms Ogilvie stated that there is a process for information sharing between all hospitals.
Hand Hygiene - the current National Hand Hygiene Campaign, including the collection, analysis and publication of bi-monthly hand hygiene data by Health Protection Scotland (HPS), concluded on 25 September 2013 with the publication of the 27th bi-monthly Hand Hygiene Monitoring Audit Report.
Mr Creelman enquired about progress in involving public participation in carrying out hand hygiene audits. Ms Ogilvie agreed to discuss this further with Ms Tyrrell who will advise accordingly.
From 1 October 2013 individual Health Boards are responsible for monitoring and reporting hand hygiene compliance data. NHS Highland will continue to report compliance in the bi- monthly report to the Board.
All areas in Argyll and Bute continue to demonstrate compliance with the standards.
Cleaning & Healthcare Environment – in Argyll & Bute the monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 96.2% compliance in July and August 2013 for domestic monitoring and 97.4% for estates monitoring in July and August 2013.
Outbreaks/Incidents - there have been no outbreaks or incidents in Argyll and Bute since the last report.
Standards for Healthcare Associated Infection (HAI)
All hospitals in Argyll and Bute continue to work to implement the standards to prevent HAI.
NHS Highland Nurse Director and Lead Nurse for Mental Health visited Argyll and Bute Hospital on 13 September to review the work that has been undertaken and to identify further requirements to ensure safe delivery of care in view of the extended timescale for completion of the new facility. As a result of this visit a number of areas for action were identified and these have been prioritised in the action plan the delivery of which will be overseen through the Hospital HAI Task Force Group, chaired by the Director of Operations.
Flu Immunisation Programme
The annual flu immunisation programme has commenced with all those at high risk being immunised through their primary care services.
In addition all health and social care staff in Argyll and Bute are being encouraged to take up the offer of free seasonal influenza immunisation in order to protect themselves and their patients.
Ms Ogilvie reported that there are different approaches and initiatives throughout the CHP to deliver the immunisation to staff, with some areas utilising ad hoc trolleys around wards and departments. It is important that the programme is publicised widely.
Ms Heritage agreed to raise awareness of the programme within the voluntary sector and the importance of carers being immunised.
The Committee Noted the content of the Infection Control Report.
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7.3 Health Improvement – Summary of Director of Public Health Annual Report
Ms Garman referred to the previously circulated annual report for 2013 which concentrates on children and young people in the Board area and makes recommendations for health and social care services to improve the health of this section of the population.
Focussing on children and young people for this year’s report is timely for Argyll and Bute as the Community Planning Partnership has recently undergone a pilot joint inspection of children’s services by the Care Inspectorate.
The report describes:
the demographic features of the population aged under 18 years in NHS Highland key public health challenges that children and young people face as they grow and develop and the work that is in progress to support them to achieve their full potential the issues affecting specific groups: o looked after children and other vulnerable groups o children and young people with long-term conditions some of the key service improvements that are taking place in o paediatric unscheduled care o child and adolescent mental health services o the Early Years Collaborative the consultations that have taken place with children and young people to inform service developments
The report makes recommendations for health and social care services and summarises key information relevant to the planning of safe, effective and efficient services which, if used, will lead to improvements in health for children and young people.
Ms Garman advised that much of the detail of the annual report is incorporated in the Argyll & Bute CHP’s Children’s Services Plan which will be the focus for delivery of the recommendations in the annual report.
The child health surveillance system is an important tool for a universal service and is understood by the different stakeholders involved with Children’s services.
The Committee Noted the content of the Health Improvement Report.
8. Financial Governance
8.1 Report
Mr Morrison referred to the circulated paper and advised that for the six months ended 30 September 2013, Argyll & Bute CHP recorded an overspend of £340,000. This is a slight increase of £21,000 on the overspend reported at the end of August.
The five main factors creating the overspend continue to be; medical locum costs in Dunoon and Oban nurse staffing costs in Lorn & Islands Hospital an increase in commissioned services costs an overspend on the General Medical Services budget unachieved savings
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Mr Morrison advised that appointments have now been made to long term consultant vacancies covered by locums within Lorn & the Isles and Cowal & Bute
Referring to the NHS Greater Glasgow & Clyde SLA, Mr Morrison reported that until the position with NHS GG&C is clarified the main patients’ services SLA settlement will be between £47m, which the CHP is offering, and £50m requested by NHS GGC. NHS GG&C are currently in discussions with NHS Highland regarding the settlement agreement and the Committee noted this current position.
With regard to the Salaried Dental Service, it has been assumed that the service will be funded at cost and therefore a nil variance has been reported at month 6. SGHD has yet to announce the level of funding being made available for this service in 2013/14.
The CHP’s savings plan in 2013/14 totals £2.4m. Savings in prescribing, commissioned services and depreciation look likely to be achieved. However the savings targets for Localities (totalling £1.05m) and management & corporate services look challenging.
Argyll & Bute CHP is continuing to forecast a year-end break-even position; however this is dependent on management action to achieve this outturn. If action is not taken to address cost pressures and unachieved savings, the CHP could overspend by £0.7m. The escalating overspends in Oban, Lorn & Isles Locality and Commissioned Services are causing particular concern.
The Committee:
Noted the financial position at month 6. Noted the requirement for management action to achieve a year-end break-even position.
9. Staff Governance
9.1 PDP/R and eKSF Implementation
The circulated report detailed that at end September 2013 the CHP has 8.66% of all staff (12.03% excluding Bank staff) with reviews and personal development plans signed off.
In order to improve the proportion of staff that have an annual review, there needs to be a focus on the following:
Addressing issues of missing data re. a number of staff who do not have one or more of the following: named manager, e-mail address, KSF outline or review. Specific actions are being undertaken to address this and these will continue until completed - actions by Workforce Development Facilitator and line managers
Ongoing work in each area to ensure that all bank staff have an identified manager, outline and review - actions by Workforce Development Facilitator and line managers.
Planning and spreading reviews throughout the year - actions by line managers.
Ensuring and improving quality of reviews and evidence - actions by line managers and staff.
Mr Creelman expressed his concern about the quality of the process for completing eKSFs and PDPs. Mr Logue provided assurance that any quality issues are being addressed and a staff survey is being undertaken to monitor the outcome of the qualitative work in completion
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Mr Leslie reported that he has received confirmation from Managers that targets will be met within their areas of responsibility. He also stated that any capacity issues are openly discussed and dealt with sensitively but with rigour to improve performances.
The Committee :
Noted the current position. Noted the need to embed this in practice and use to support and direct staff development in line with CHP and NHS Highland objectives. Noted the need to ensure reviews and PDPs are planned for the next 6 months. Noted the need to ensure bank staff have a review.
9.2 Minute of Partnership Forum (PF) Meeting of 15 August 2013
The draft minute was circulated for information.
Mr Creelman referred to the format of the meeting which he acknowledged is conducted in the spirit of partnership. He stated that non-executive attendance would be welcomed.
Referring to the Integrated Equipment Store, it was agreed that Mr Leslie will include an update in the Director of Operations Report to the next meeting. It was also noted that David Ross is to attend the next meeting of the Partnership Forum in November to provide details of progress in the implementation of the service.
The Committee Noted the content of the circulated draft Minute.
10. Partnership Working
10.1 Children’s Services – Joint Pilot Inspection Report (see previous reference – External Reviews)
Mr Leslie advised that the full report will be presented at the Highland NHS Board meeting in December 2013.
He referred to the Committee to the findings in the circulated report which are clearly set out and highlighted:
a number of strengths three areas of good practice areas for improvement
The Committee Noted the content of the circulated report.
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10.2 Change Fund – 2013-2014 – Mid Year Review
The report to the Joint Improvement Team and the Scottish Government provided reassurance that progress is being made in relation to Change Fund processes and performance. Areas reported on were:
examples of impact learning from what hasn’t worked as well as anticipated option appraisal approaches use of data and information any improvement support required budget 2013/14 assessment of spread of new approaches and improvements
Responding to an enquiry from Councillor Robertson, Mr Leslie confirmed that the Change Fund investment is for a period of 4 years, ending 31 March 2015. The Committee expressed some concern regarding the financial sustainability of the work undertaken in all the areas where Change Fund money has been invested, following the cessation of the funding. It was agreed that this will be further explored at a Development Session of the Committee in early 2014.
The Committee Noted the content of the circulated Mid-Year Progress Report.
11. Performance Management
11.1 NHS GG&C Service Level Agreement (SLA) Update
The circulated report updated the Committee on progress with regard to Service Level Agreements for services provided to the Argyll & Bute population for 2013/14.
Mr Whiston advised that the roll forward value of the Acute SLA, based on the 2012/13 payment, has been agreed at £44,740,715 to which there will be an inflationary uplift of 2.76%.
Discussions concerning the additional £5 million sought by GG&C are continuing, with the funding gap attributed to the Cross Boundary Flow Model, which can be attributed to activity growth, changes in service provision and changes in the model itself and which GG&C wish to adopt in preference to the Tribal Model currently in use.
SLA documentation captures inpatient and day case activity. The Acute SLA agreement with GG&C is in the process of being reviewed and refreshed to reflect updated legislation and guidance as well as the current service profile. Although GG&C will not formally sign off the SLA due to the funding issues it is anticipated that this will be a working document by November.
As part of a recommendation arising from an internal audit report the NHS Highland Board Audit Committee requested that a set of quality indicators be established for inclusion within SLAs. The purpose of these indicators is to provide a mechanism for reviewing the quality of care provided by other health boards so that formal regular assurance is received to ensure that services provided by other NHS Boards are meeting the specified quality standards.
It was agreed that the National Standards for Clinical Governance and Risk Management, October 2005 should be used as appropriate quality standards within SLAs with other NHS Boards as there is no updated guidance from Healthcare Improvement Scotland at present.
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The CHP has also developed a list of reports which are required in order to provide regular assurance against these quality standards and is currently going through an iteration process with GG&C to establish which performance reports are available aligned with GG&C governance and performance processes and which ones require to be developed over an agreed timeline.
The proposals were endorsed by NHS Highland’s Audit Committee in September 2013 and will now be included in the revised Acute SLA documentation as well as any other SLAs being developed or renewed with other NHS Boards.
The CHP continues to meet with senior management of NHS GG&C to consider and address operational and financial issues pertaining to the services it commissions. The 2 sets of meetings are:
SLA Finance Group – meets quarterly to oversee the SLA financial arrangements. SLA Operational Review Group – meets quarterly to review and monitor the operational delivery of services against the SLA.
The responsibility for service input SLAs (community and non-clinical services) sits with operational managers who should be regularly meeting with NHS GG&C colleagues to review the services being delivered in line with the specification, standards and key performance indicators set out in the SLA. The contracting department is available to support these reviews as required.
The CHP Core Team have agreed that should reviews not be taking place, despite attempts from the responsible officers from Argyll and Bute CHP, the provider will be notified at the beginning of each year by the Head of Planning, Contracting & Performance at the formal SLA Finance meeting with providers, that there will be a reduced payment in the SLA unless a satisfactory review meeting is concluded.
Finance and planning managers meet with locality management, clinical services managers and medical records officers on a six monthly basis to monitor the delivery of outreach services to each locality. Any issues arising should be addressed by locality management with the relevant GG&C operational manager and escalated to the planning department should any significant issues arise and fail to be addressed between the operational managers. All formal variations to clinics are issued by the planning department.
As in previous years, values for both service input and outreach SLAs will be uplifted to the basis of actual cost, the 2013/14 value has therefore yet to be finalised.
Work is underway to develop separate SLAs with GG&C for Laboratories, Radiology and Mental Health which were previously components of the Acute SLA. Having separate SLAs and activity schedules for these services will allow the operational managers and clinicians involved to have more ownership of the SLAs, a better understanding of the services included in the SLA and closer scrutiny of the activity and associated costs.
The 2013/14 Laboratories proposal from GG&C based on current identified activity shows a £53,566 funding shortfall whilst the Radiology proposal shows a funding gap of £46,034. GG&C have confirmed that they will be looking for the additional funding within this financial year. The CHP Head of Finance and Head of Planning Contracting and Performance will be reviewing the costs of these and the Mental Health SLA with GG&C colleagues throughout the remainder of this year.
The CHP has served notice on a number of SLAs, as detailed in the report, which will terminate on 31st March 2014.
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In addition to purchasing services from GG&C, the CHP also purchases services from other providers, including other Scottish Health Boards and voluntary organisations. The CHP also commissions services jointly with Argyll & Bute Council.
In 2013 SLAs and Contracts have been signed off with the following:
Nine GP’s to provide a Medical Incident Officer Service throughout Argyll & Bute, the 2013/14 value of these is expected to be £2,700 with additional payments in line with call out activity, training requirements and the purchase of equipment Seven independent general dental practices across Argyll and Bute to provide clinical dental services for the emergency dental service, the value of the contracts in 2013/14 will be on an activity/call out basis Buchanan’s to deliver an Orthotics service across Argyll & Bute CHP, the expected cost of this for 2013/14 is £51,480 with additional costs for supplies
Work is also underway or planned to develop SLAs and Contracts with the following:- Cowal Hospice Trust for the provision of Palliative Care Services in Cowal Locality. Two independent optometrists to provide Optical Coherence Topography Scans in the Campbeltown and Oban areas. An independent optometrist to provide a hospital based optometry service in Lorn and Isles Hospital to support the Ophthalmology clinics. Argyll and Bute Council for the provision of domestic and catering services in Mull and Iona Community Hospital.
Work is also underway to develop SLAs and Contracts by Argyll & Bute CHP to other commissioners: An independent dental practice for the lease of Campbeltown Dental Centre which is expected to commence by November 2013. An independent dental practice for the lease of Oban Dental Centre which is expected to commence by November 2013. An independent dental practice for the purchase of domestic services and access to a Local Decontamination Unit in Oban Dental Centre. Argyll and Bute Council for the purchase of domestic, cleaning & catering services at Gortonvogie Residential Home on Islay.
The Committee:
Noted the status of SLAs with NHS Greater Glasgow & Clyde, other Health Boards & providers and for services purchased from the CHP. Noted the progress of updating the Acute SLA in line with the Audit Committee’s recommendations on quality standards. Noted the progress of ongoing monitoring and review procedures.
11.2 Delayed Discharge Report
The Delayed Discharge weekly briefing of 1 August 2013 was circulated for information.
Mr Leslie reported that the weekly briefing as at 15 September 2013 had been received, reporting a total of 11 delayed discharges, all with attributed exemption codes. No breaches were reported.
The Committee Noted the details of the circulated report and the verbal update.
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12. Mental Health Modernisation Update
Mr Leslie referred to specific points in the report:
Project/Service Management - a paper is currently being developed which proposes a change in the management arrangements for community mental health services which will be taken to the CHP Core Team in October for approval. In summary the proposal, if approved, would result in the Programme Director having a more direct role in the management of the Community Mental Health Teams through the Locality Clinical Service Managers thereby bring community mental health services and hospital services under the same management and governance arrangements.
Capital Project Stage 1 Approvals - no further progress due to the need to bundle the project with another capital project. Mike Baxter, Property & Capital Planning, Scottish Government is visiting Argyll & Bute Hospital on 12 November to discuss the uncertainty regarding the “bundle” and the further delay this would incur.
Inpatient Services The bed compliment is currently 27 (with a target of 22) plus 3 minimal supervision places in the refurbished Firgrove building.
Upgrade works on the IPCU single rooms has commenced resulting in a temporary reduction to 4 beds and a permanent reduction to 5.
Plans to relocate the MAPS/Clinical Psychology/OPD from the portakabin to Cowal Ward are being finalised and work has commenced.
Further alterations and upgrade works are being considered by the HEI & Risk working group following the recent visit by the Director of Nursing, including the closure of the Lees Centre and the relocation of the eHealth training room.
Staff Redeployment - 2 of the 5 inpatient Health Care Assistants that remained displaced after the redeployment exercise last year have now been redeployed into permanent posts
New Posts - a temporary increase in the nursing establishment has been agreed to support the patient transfer retrieval service. This will result in an additional 4 staff being appointed on fixed term contracts.
Enabling Funds: the CHP has been successful in securing project enabling funding, totalling £191k, to support works which require to be undertaken before the new hospital is built. These include: demolition of some existing building; widening of the access road to the new hospital site; completion of the site master plan; and relocation of the Blarbuie Woodland work area to another part of the site.
CMHS Team Base - both Kintyre and Dunoon CMHS bases should be operational by the end of October.
The Committee Noted the current key issues and progress against the action plan.
13. Noting
13.1 Audit Scotland Report – NHS Financial Performance 2013
Mr Morrison referred to the summary of key messages within the annual report which Audit Scotland has produced on the financial performance in the NHS, and recommended the
19 44 following paragraphs as of particular interest to members of the Committee; 29, 35, 41, 83, 84 and also case study 5 on page 38. . The key messages made by Audit Scotland include;
NHS Boards tend to focus on breaking even each year. Longer term financial planning needs to improve. All NHS Boards achieved their financial targets in 2012/13. Although savings targets were largely achieved, there was an overreliance on non- recurring savings. This will increase the financial challenge in 2013/14. Demand for healthcare is rising and good progress has been made in improving outcomes for patients. Vacancy rates in medicine and nursing have increased resulting in more use of agency and bank staff and increased spending on private sector healthcare.
The Committee Noted the content of the circulated report and the summary of key messages.
13.2 Draft Minute of eHealth Group
The Draft Minute of eHealth Group Meeting of 14 August 2013 was circulated for information.
The Committee Noted the content of the circulated draft Minute.
13.3 CHP Committee Meeting Dates 2014
The dates were previously circulated for information. Mr Leslie acknowledged that the dates may require to be reviewed to take in account Council meeting dates which have yet to be announced.
The Committee Noted the dates for 2014.
14. AOCB
There were no AOCB items.
15. DATE, TIME & VENUE FOR NEXT MEETING:
Wednesday 18 December 2013, RSR Braeholm, Helensburgh
20 45 Highland NHS Board December 2013 Item 3.2
HIGHLAND HEALTH & SOCIAL CARE GOVERANCE COMMITTEE Report by Deborah Jones, Chief Operating Officer
The Board is asked to:
Note that the Highland Health & Social Care Governance Committee met on Thursday 7 November 2013 with attendance as noted below. Note the Assurance Report and agreed actions resulting from the review of the specific topics detailed below.
Present: Myra Duncan, Board Non Executive Director – Chair Jan Baird, Director of Adult Care Helen Bryers, Head of Midwifery Shirley Christie, Staffside Representative Mr Quentin Cox, Area Medical Committee Representative – Consultant David Garden, Head of Financial Planning Gavin Hogg, Patient/Public Representative Deborah Jones, Chief Operating Officer Malcolm Jones, Area Dental Committee Representative – Dental Practice Advisor Rhona MacDonald, Board Non Executive Director Margaret MacRae, Staffside Representative Gillian McCreath, Board Non Executive Gill McVicar, Director of Operations – North & Mid Linda Munro, Elected Member, Highland Council Brian Robertson, Head of Adult Social Care Nigel Small, Director of Operations – South & Mid Kate Stephen, Elected Member, Highland Council Katherine Sutton, Associate Director, AHPs Jo Veasey, Divisional General Manager, Medicine and Diagnostics Dr Chris Williams, Area Medical Committee Representative – GP
In Attendance: Brenda Dunthorne, Head of Finance, Raigmore Hospital (Item 4.2) Gillian Grant, Team Leader (Contracts) Dr Rod Harvey, Clinical Director, Raigmore Hospital (Item 4.2) George McCaig, Head of Business Support, Adult Social Care Brian Mitchell, Board Committee Administrator Kenny Oliver, Board Secretary
Apologies: David Flear, Patient/Public Representative Bren Gormley, Elected Member, Highland Council Fiona MacFarlane, Pharmacist Representative Ailsa McInnes, Area Optometric Committee Representative Helen Morrison, Associate Director (NMAHP Workforce Planning and Development) Adam Palmer, Staff Side Representative Bob Summers, Head of Health & Safety Philip Walker, Head of Personnel Mhairi Wylie, Public/Patient Member Representative – Voluntary Sector 46
AGENDA ITEMS
Update on Professional Executive Committee Update on Establishment of Performance and Finance Sub Committee Feedback from Development Session on 26 August 2013
Financial Position Report as at 30 September 2013
Presentation on Raigmore Hospital Financial Stabilisation Plan
Operational Unit Local Delivery Plans - Six Month Progress Reports/Presentations
Adult Services Balanced Scorecard
2013/2014 Highland Health and Social Care HEAT Targets Balanced Scorecard and Exception Reports from Improvement Committee
Care Homes – Update Report on Monitoring of Care Inspectorate Quality Standards Monitoring the Delivery of Contracted Services Promoting Safe, Effective and Quality Discharge – Managing Patient Choice Issues The Highland Quality Approach to Strategic Commissioning – Strategic Commissioning Plan for Adult Care 2014-2019 Update on Maternity Services in the HHSCC – Current Position on Implementation of Maternity Services Strategy and Identification of Corporate Services Risks Chief Operating Officer Report
Operational Unit Reports
Minute of Meeting of the Adult Support and Protection Committee held on 20 August 2013 Consideration of Future Agenda Items
Committee Function and Administration
DATE OF NEXT MEETING
The next meeting will be held on Thursday 9 January 2014 in the Board Room, Assynt House, Inverness at 9.30pm.
2 47 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
1 TOPIC: Declarations of Interest Issues Assurance Actions Do members have any interest to No declarations were made. declare in relation to any Item on the agenda?
2 TOPIC: Assurance Report and Rolling Action Plan – 4 July 2013 Issues Assurance Actions Need to update Rolling Action Agreed regular updates required from Named Officers. Action: Plan Action Plan to continue to be updated – Named Officers/ Committee Administrator When will report on charging for BR advised early report can be given as issues being Agreed early report be considered by Committee, Social care services, and effect of considered at this time. identifying relevant trends, risks etc – Head of welfare reform be received at Adult Social Care Committee?
3.1 TOPIC: Professional Executive Committee – Verbal Update – Deborah Jones, Chief Operating Officer Issues Assurance Actions What progress is being made in Terms of Reference circulated, including reference to Action: relation to establishment of PEC? role and function, proposed membership, and Agreed consideration be given to extension of operational and reporting arrangements. Paul Davidson membership as requested – PEC Chair/Chief agreed to Chair at least first six meetings. QC asked Operating Officer that consideration be given to including membership Agreed further update to next meeting – Chief from Healthcare Science and Area Psychology Forums. Operating Officer
3 48 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
3.2 TOPIC: Update on Establishment of Performance and Finance Sub Committee – Kenny Oliver, Board Secretary Issues Assurance Actions What progress is being made in KTO advised Terms of Reference agreed and invitations Actions: relation to establishment of Sub seeking representative membership issued. One Ensure dates aligned to THC meeting schedule Committee? membership position remains to be confirmed. Dr R where possible – Board Secretary MacDonald and Mrs G McCreath to be Non-Exec members, Ms K Stephen and Mrs L Munro THC members, Mr Q Cox (with Dr H Bryers as deputy) to be clinical representative. Dates of meetings to be scheduled to align to PEC and relevant financial reporting cycle.
3.3 TOPIC: HHSCC Development Session 26 August 2013 – Formal Feedback – Myra Duncan, HHSCC Chair Issues Assurance Actions What were the outcomes from the Circulated report summarised discussion including Action: Development Session on Health members’ considerations as to causes of health Agreed Committee will scrutinise plans and Inequalities? inequalities and priorities for action to help reduce the reports presented to it for evidence that health same. Also outlined were group discussions on role of inequalities have been considered and actions to HHSCC in this area. In summary a number of themes address any identified have been embedded – and actions widely supported such as distribution of All members resource to match need, development of practical process to consider all inequalities as part of Committee business, and move to work in ways that support individuals and community resilience, capacity building, and better engagement by communities and service users.
4 49 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
How do HHSCC ensure DJ stated Operational Unit Delivery Plans should include Agreed Committee and associated Groups inequalities are considered? this and outline what being undertaken to support that should ensure scrutiny of embedding of agenda. Committee reports can be structured to include inequalities considerations as part of impact assessment data. Agreed actions should be Commissioning activity etc – Dir. Public embedded in all Committee activity. It was emphasised Health/Committee Administrator inequalities agenda much larger than just Health. View Agreed aspects relating to inequalities be expressed more can be done, such as in relation to referenced in Operational Unit Local Delivery Maternity and Early Years services. Recognise is huge Plans – Directors of Operations subject and that capacity building and commissioning activity important.
3.4 TOPIC: HHSCC Development Session 1 November 2013 – Initial Feedback – Gillian McCreath, Non-Executive Board Member Issues Assurance Actions How successful was the Advised Quality Improvement Team had led useful Action: Development Session on Session. Issues raised included current Committee Agreed Operational Unit Delivery Plans should Governance and Assurance? focus on Adult Social Care and the need to ensure an be a focus for Committee Business, with relevant active membership. To be considered as part of the reporting, with relevant local reporting – overall NHSH governance framework review. Chair/Chief Operating Officer Emphasised Committee not able to provide assurance, scrutiny and review of all aspects and as such scrutiny Agreed report on formal feedback to next by Sub Groups very important. NHS Board and other meeting – Director of Quality Improvement Committees should reference and tie-in to HHSCC where appropriate.
4.1 TOPIC: HHSCC Financial Position as at 31 July 2013 – David Garden, Head of Financial Planning Issues Assurance Actions What is the financial position in Report indicated position to 31 July 2013, highlighting Action: year and where are current forecast overall breakeven position by 31 March 2014, financial pressures? subject to the improvement of £9.5m required to deliver the forecast. A break down of the current reported overspend forecast was given, including movement on Tertiary activity.
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Particular issues highlighted by Dirs of Operations included Independent sector care spend and budget allocation, fewer opportunities for Non-recurrent savings, and service provision in remote and rural areas. Everyone has a role to play in achieving savings.
Noted work ongoing to look at increased need for individual care packages.
What are the particular issues in Advised remote and rural activity, and associated budget Highland? allocation formula considered to be an issue requiring further discussion. Consideration of results of Loughborough University work on that aspect may be beneficial. DG advised issue in relation to pressures relating to drug expenditure (Integrated Pharmacy) in Raigmore. What is the Committee role in Scrutiny will be via relevant Sub Groups and members Agreed exception report on Raigmore drug consideration of overall financial able to raise specific issues via these Sub Groups and at expenditure be brought to next meeting – position? Committee meetings. Officers are available to respond Director of Operations, Raigmore to Members’ individual queries.
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TOPIC: Presentation on Raigmore Hospital Financial Stabilisation Plan – Jo Veasey, Acting Director of Operations/Brenda 4.2 Dunthorne, Head of Finance/Dr Rod Harvey, Clinical Director Issues Assurance Actions What is the current financial Presentation given to Committee providing overview Action: position in relation to Raigmore outlining forecast overspend standing at £8.6m. Hospital and what actions are Recurring savings of £1.4m been secured and being taken as part of the unachieved savings in-year of £1m. Action on issues Stabilisation Plan? relating to governance, internal controls, staff and clinician engagement, recovery workstreams and organisational development was outlined. Relevant risks identified as Raigmore Senior Management Team (RSMT) and Service manager capacity, clinical disengagement, inability to identify additional recurring savings, inability to curtail non-pay spend and strategic drift.
The key message was there is a committed, cohesive RSMT working in partnership with staff and the Corporate Team to achieve financial balance moving forward.
What is the level of clinical and RH advised initial discussions held and will be an staff engagement at this time? evolutionary process. Nursing and AHP Leads attend Clinical Forum in an ‘In Attendance’ capacity and invite extended to HSMA. View expressed that Partnership working remains an issue at Raigmore although is improving. Need to ensure strong feedback routes are introduced.
What relevant training are staff The Learning and Development budget is being used to members currently receiving? provide targeted training for relevant staff on areas such as complaint handling and finance. Current focus on aspects of Lean such as elimination of waste and use of 5S methodology.
7 52 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
Committee noted the work that was ongoing and the emerging outcome which is showing a stabilisation of overspend. It expressed support for the RSMT and staff in continuing to address the issues.
4.3 TOPIC: Operational Unit Local Delivery Plans – Six Month Progress Reports/Presentations – Directors of Operations Issues Assurance Actions North and West Operational Unit GMCV gave short report on progress with Local Delivery Action: Plan including aspects relating to Integration; Caithness Committee members to consider and indicate Adult Services Review; Skye, Lochalsh and Wester Ross particular areas of focus for future reporting – Services Redesign; Belford Hospital; Community ALL Members Hospital Development, Rural General Hospital functions; Older Adult Mental Health Services; Remote and Rural Sustainability; Medicines Management; and Care Experience and Assurance activity. All work underpinned by leadership development activity, embedding of Highland Quality Approach, development of Lean Leaders, and customer care sessions.
South and Mid Operational Unit NS spoke to circulated report providing an update on key aspects of Unit development plan and highlighted activity in relation to Psychological Therapies Redesign and Mental Health Rehab Service Redesign.
What are reasons for introduction NS advised highlighted existing theatre capacity issues of vasectomy service in Nairn and potentially represented good use of resources Hospital? outwith Raigmore. This would free theatre capacity in Raigmore and was a good test case for peripheral surgical activity, delivering care closer to home. Relevant GPs were undergoing relevant training and development to provide service. DJ advised further option testing for peripheral surgical activity was to take place. 8 53 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
What Workforce Planning activity DJ advised this is referenced in actual Plans and is is included in LDPs? being developed further. There was acknowledgement there could be stronger reference within local plans.
TOPIC: Adult Services Balanced Scorecard Exception Report (Respite Care Bed Nights) – Brian Robertson, Head of Adult Social 4.4 Care Issues Assurance Actions What are the current usage Balanced Scorecard, as reported to the Improvement Action: patterns relating to the total Committee circulated. BR spoke to report outlining Agreed Respite Care services are to be an area number of bed nights and daytime current usage patterns, and advised the trajectories for of focus within the next Operational Unit Delivery hours for respite care? the number of respite bed nights been running below Plans – Dirs of Operations target levels for number of months. Possible factors were outlined including temporary suspension of admissions, Norovirus outbreaks in Care Homes, recent loss of a Care Home from the Highland sector, a reduced availability of beds, and the impact of increased numbers of people utilising Self Directed Services. Moving forward, actions to address performance will be taken by Dirs of Operations. Business Support to provide detailed reports to allow operational management to understand trends and reasons, enabling further exception/assurance reports to be brought to Committee.
9 54 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
What are the issues relating to GMcV advised overall capacity is sufficient but need to capacity? consider if this in the right area and of the right type etc. Highlighted that respite care in remote and rural areas is expensive to deliver. Changes in delivery likely to be opportunistic in nature. KS emphasised respite within a Care Home setting not always required or appropriate and Community Development Workers have key role to play in this area. NS added that also need to consider in-house services, how this is provided and how that is used, and include this within LDPs.
Committee noted Respite care to be an area of focus in the next Operational Unit Delivery Plans.
4.5 TOPIC: HHSC HEAT Targets Balanced Scorecard – Kenny Oliver, Board Secretary Issues Assurance Actions What are HEAT Targets relevant Copy of Balanced Scorecard circulated, along with Action: to Health and Social Care and exception reports relating to Access Targets for what is current performance Raigmore Hospital, key Diagnostic Tests at Raigmore against these? and in North and West Op Unit, and SMR01 Return Rate for Raigmore. Noted these are monitored by the Improvement Committee.
How does use of Golden Jubilee Advised no patient is obliged to attend Golden Jubilee Need to ensure patients are aware of their Hospital fit with policy of patient- against their wishes. Only those most appropriate given choices in relation to travel for care – Dir of centred care? choice to travel. Need to learn from both positive and Operations, Raigmore negative feedback from patients to ensure a patient- centred approach.
What is the nature of patient Agreed Committee would benefit from hearing patient travel within Highland for experience stories and noted NHS Board also expressed treatment? interest in this subject. Such feedback from patients very important. Consideration should be given to aspects such as availability of public transport in remote and rural areas. 10 55 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
5.1.1 TOPIC: Update on Monitoring of Care Inspectorate Quality Standards – Jan Baird, Director of Adult Care Issues Assurance Actions What is the approach taken to Report indicated providers not always able to sustain Action: support residents in Care Homes service delivery at the quality required by the Care not meeting Care Standards? Inspectorate, with wider ramifications for NHSH. Recent activity resulted in one closure and two enforcement notices. Service delivery remains contracted responsibility of provider, with NHSH having contractual responsibility to ensure standards maintained. Operational staff including those with Professional Leadership roles provided considerable support, with continued focus on safety and wellbeing of residents. Elected member notification protocol in place. GPs involved in considering all patient needs. Need to ensure patient reviews are comprehensive and across all aspects of service. What is the process to be Director of Adult Care to lead review of actions taken in Agreed report on outcome of review and learning implemented to capture the relation to recent Care Home closure, capture learning to next meeting – Director of Adult Care learning from recent activity? and build into agreed process. Review will include number of focus groups and will report before end of calendar year. This will enable process to be encapsulated in Strategic Commissioning Plan and will set out expectations in relation to improving and sustaining quality and high standards. Committee noted feedback from staff regrading multi- professional support from NHSH throughout the situation and in developing improvements in care and systems. Recognised as a benefit of integration.
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What systems are in place for Relevant professionals made aware of issues and Report on contracts and monitoring, single point ensuring information shared Service Improvement Lead has role to play. Escalation of contact and escalation routes to next meeting appropriately? routes for concerns should be clear for all involved. – Director of Adult Care Communications process should be improved to ensure Press and public aware of the range of positive activity in this area and actions taken to provide support. Streamlined, responsive and transparent process required. Targeted work on contracts/monitoring underway, including single point of contact for issues, and relevant escalation routes.
5.1.2 TOPIC: Monitoring the Delivery of Contracted Services – George McCaig, Head of Care Support Issues Assurance Actions What are the outcomes of the Circulated report summarised outcomes from 34 Action: second quarter reviews? What contracts monitored during Q2 and the progress made progress made resolving issues in resolving issues highlighted by monitoring in Q1. from first quarter reviews? Multi-disciplinary approach being developed for What work is being undertaken to monitoring service quality, commencing with Care Further report to next meeting – Head of Care broaden the scope of monitoring Homes, outwith Care Inspectorate process. Workshop Support and extend the framework to was chaired by Director of Quality Improvement with a cover in-house services? number of issues identified as indicated. A second workshop developed ideas for processes and measures to be included in monitoring system. Outputs included decision to pursue two-tier model; identification of self-assessment infection control and environmental surveys, complaints, Review outcomes and Adult Support and Protection cases; identification of the need for a dashboard and reporting/escalation mechanisms; and recognition that the framework should cover internal as well as external service providers. A third workshop is scheduled for November 2013.
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5.2 TOPIC: Promoting Safe, Effective and Quality Discharge – Managing Patient Choice Issues – Deb Jones, Chief Operating Officer Issues Assurance Actions What are the issues surrounding DJ spoke to report outlining complex interplay between Action: patient choice of accommodation personal and statutory responsibilities, and care on discharge from hospital? capacity. Report sought to establish a context of guiding principles to assist patients, carers and clinicians in understanding what can be fraught, life-changing decisions. Clear evidence unnecessary prolonged hospital stay can be detrimental to a person’s physical and mental wellbeing, with associated consequences. Patient choice can affect delays in discharge for a variety of reasons. Issue of choice is not new one and local authorities in Scotland have a duty to arrange places for people in a care home of their choice, subject to certain criteria being met. Principles applied in managing choice were outlined, and these include patient not having an entitlement to remain in hospital once they are ready for discharge and the decision to discharge being based on clinical need only. A number of key practice issues require to be addressed, including improving function of multi-disciplinary team meetings, consistent setting of Estimated Dates of Discharge (EDD), supporting all involved to plan for EDD, and scheduling to ensure care packages in place when and where they are needed. Refusal to make a choice does not mean patient can remain indefinitely in hospital.
Committee noted work ongoing at national level in this area.
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Can we provide real life examples Examples can be prepared and consideration should be Agreed Communications Plan be developed and to illustrate the issues involved? given to developing an appropriate communications plan submitted to Committee – Chief Operating to engage the public in discussions to understand the Officer implications of the Choice issue. View expressed that a Noted detailed report on all aspects of local programme of events following discharge may be consideration, including Communications Plan to beneficial for patients and carers to understand what will be submitted to NHS Board in 2014 – Chief happen. Operating Officer
TOPIC: The Highland Quality approach to Strategic Commissioning – Strategic Commissioning Plan for Adult Care 2014-2019 – 5.3 Gillian Grant, Team Leader (Contracts)
Issues Assurance Actions What is the position in relation to Report outlined the approach to developing the Highland Action: development of a Strategic Strategic Commissioning Plan and commissioning Noted a more detailed Commissioning Intentions Commissioning Plan? intentions for Adult Care, including relevant Values and Plan for 2014/2015 would be submitted to the Principles. It was important that the Plan is developed in Committee for sign off at next meeting, setting association with stakeholders and that underpinned by a out priority actions for reducing/increasing activity clear project structure, co-production approach, – Head of Strategic Commissioning governance arrangements and communications plan. The relevant Project Initiation Document also circulated.
A series of eight desired Outcomes were also outlined. Overall the project sought to deliver a high level, concise researched and evidenced five year Commissioning Plan that can be signed off by the NHS Board on 1 April 2014.
DJ advised this is critical to consideration of benefits of integration. The Adult Strategic Commissioning Group a key stakeholder and there is need to work with Independent and Voluntary Sectors as appropriate. Director of Adult Care been requested to facilitate Workshop Event to begin process. Service Improvement Groups actively engaged in writing Plan. Staffside members and involvement will be further considered.
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TOPIC: Update on Maternity services in the HHSCC – Current Position on Implementation of Maternity Services Strategy and 6.2 Identification of Corporate Services Risks – Dr Helen Bryers, Head of Midwifery Issues Assurance Actions What progress is being made in Report outlined that the NHSH Vision for maternity Action: relation to Maternity Services services is that these be women and family centred Agreed Director of Social Work, THC, be Strategy? whilst encompassing safety, effectiveness and requested to provide update on associated accessibility in order to achieve the best possible start in activity affecting Maternity Services, including life for new families and children. Each of these key pre-birth activity. themes included a set of principles, and Operational Units have priorities and implementation plans around these. Implementation plans are monitored through the Maternity services Strategy Co-ordination Group (MSSCG). The key areas providing focus for activity were outlined, along with a summary of activity and workforce establishment in Maternity Services, and an outline of the existing priorities both within Operational Units and Highland wide. Closer working with THC Childrens Services has identified common workstreams to deliver the aim of reducing stillbirths, and infant and maternal morbidity and mortality as indicated. Current challenges to Maternity Services related to sustainability of Out of Hours maternity care, Sonography workforce pressures, Obstetric and midwifery workforce issues, technology, and improving the Highland wide maternity services structure.
What is being done to improve Working with the three Schools of Midwifery in Scotland, the existing workforce position? one of which is hosted within the NHS Grampian area and NHSH actively involved in recruitment activity. It is difficult to ensure appropriate candidacy from Highland with a view to ‘growing own workforce’.
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7.1 TOPIC: Chief Operating Officer Report – Deborah Jones, Chief Operating Officer (COO) Issues Assurance Actions Delayed Discharge Scottish Govt briefed on position and causes of DD in Action: Highland, including unavailability of residential and nursing home placements and care at home services. Advised to strategically commission solutions over time. Proposals for interim care facilities tested with Government and commitment received to support NHSH in dealing with Care Inspectorate on regulatory issues. Worked with independent care at home providers to initiate rapid expansion of capacity and that now coming on stream.
Use of embargoed resources will allow access to care at home capacity in association with development of longer term approach to improving quality as part of Commissioning Strategy. In-reach service for Raigmore developed and having an effect. Plan to run local events in Operational Units to consider ways to increase capacity, facilitated by JIT. COO maintains oversight and is meeting Scottish Government representatives to discuss position.
Integrating Care in the Highlands Partnership Agreement detailed need for THC to – Legal Services continue to provide legal advice as required across Adult Social Care function. Dubiety as to the decision relating to delegation of charging orders has been subject to reassurance from Queen’s Counsel. It would be beneficial to draft a commission setting out services required by Social Work Service and provide agreement as to detail of that service. Work has begun so as to set out the four elements of necessary legal support function required. Draft Commission to be considered by Integrating Care in the Highland Programme Board in December 2013.
16 61 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
Patient Management System Extensive data migration work being progressed to Draft Commission to be submitted to next merge patient data from existing systems to new unified meeting – Director of Adult Care system. Data testing to continue until February 2014. Activity in relation to building clinics continues, and work on letter templates for communication with patients is about to begin. Creation of Standard Operating procedures for all administrative processes at an advanced stage and will allow training packages to be created and delivered in early 2014.
7.2 TOPIC: Operational Unit Reports – Directors of Operations Issues Assurance Actions North and West Operational Reported position has deteriorated due to accrual of Action: Unit Report Adult Social Care costs and a high cost care package Financial Position attributed to the Unit. Main overspends relate to ASC, RGHs and locum costs, and Out of Hours services.
Waiting Times Belford Hospital Radiology waits occurred as direct result of limited, once per month visits from Oban, which does meet current demand. Subject to ongoing discussion.
Delayed Discharge Number of breaches in Caithness General Hospital in relation to specialist services. Considerable work ongoing, including RPIW to embed changes to the way patient flow is managed to avoid further breaches.
17 62 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
Continues to be issues in meeting targets in North where availability of suitable placements are an issue. Looking to make clinical environment more appropriate where discharge not possible and cases monitored on a weekly basis. Patients supported by re-ablement packages wherever appropriate.
Skye Hospitals Three workshops exploring relevant Options now held in Agreed report on the process to date to be addition to a clinical workshop. Meeting with considered at the next meeting – Director of Government resulted in request to change the order key Operations (North and West) steps are progressed. Have been advised to conduct formal public consultation as constitutes major service change. NHSH will then receive recommendation on preferred Option which, if approved, would move into the business case process and completion of final Agreement. Process timetable outlined and anticipated will be considered by NHS Board in May 2014.
Out of Hours and Unscheduled Pressure on rotas in Inner Moray Firth evident and action Care required to address. GMcV explained service not hosted within Unit and budgets devolved to Operational Units. National recruitment issues around OoH to be discussed at national Workshop.
Harmsworth Unit, Caithness Consideration being given to temporary reopening as extension of existing Newton Wing and provide 8 additional beds to be used as step down from acute interventions at Caithness General Hospital.
South & Mid Operational Unit 2014 target not being met at this time although subject to Psychological Therapies HEAT steady improvement. Significant ongoing work Target underway to help achieve target.
18 63 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
Financial Position Forecast of a £4.8m overspend, relating entirely to Adult Social Care budgets. Ongoing increases in Independent Sector Care overspend without corresponding funding offset. Adult Care Advice Allocation Group established to take detailed, proactive governance and support role in relation to set up and review of the types of packages.
Inverness Care Homes Clachnaharry licence to operate cancelled and multi- professional team established to provide additional support for residents, including in relation to sourcing suitable alternative care settings. Detailed de-brief and Significant Event reviews are planned. Highview admissions been suspended following Care Inspectorate Report and owners required to develop action plan in response to findings.
Badenoch & Strathspey Service Number of workshops taken place to support Agreed report on the process to date to be Re-Design development of options for future models of hospital and considered at the next meeting – Director of community services and support the strategic case for Operations (South and Mid) change. Likely that emerging options will constitute major service change. Next stage is to carry out formal consultation with local people around preferred options. Actively engaged with Scottish Health Council.
Raigmore Operational Unit Report indicated forecast overspend of £8.527m, with Financial Position contributing factors outlined. The position improved slightly from that for Month 5. Significant pay cost pressures relating to locum spend, Waiting List Initiative payments to meet access targets and additional drug spend.
Older People in Acute Care Inspection was considered positive with areas of Detailed report to the next meeting – Dir of (OPAC) – Unannounced strength evidenced and areas where improvement Operations, Raigmore Hospital Inspection required. Action Plan developed and submitted to Health Improvement Scotland.
19 64 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
7.3 TOPIC: Minute of Meeting of Adult Support and Protection Committee held on 20 August 2013 Issues Assurance Actions Any issues arising from Minute? No Issues reported. Action: Noted Minute.
8.1 FUTURE AGENDA ITEMS AND DEVELOPMENT SESSION TOPICS
Meeting on 9 January 2014: Report on Financial Impact of Enforcement of Embargoes on Admissions to Care Homes – David Garden Highland Health and Social Care Financial Plan 2013/2014 – David Garden Suspension of Admissions to Care Homes – Discretionary Lifting of Embargoes – Brian Robertson Outcome from Review of Nurse Staffing Levels across Medical and Surgical Division (DOO’s Report) – Dir of Operations, Raigmore Anticipatory Care Planning Activity – Ken Proctor Report on Adult Support – Jan Baird Report on Skye and Badenoch & Strathspey Service Redesign – Director s of Operations (North & West and South & Mid)
Items for 9 January 2014 – from Assurance Report: Update on Professional Executive Committee – D Jones Progress on Evaluation of Service Integration – Brian Mitchell NoSPG Report on Review of Oncology Services – Chief Operating Officer Formal feedback from Governance and Assurance Development Session – Linda Kirkland Exception Report on drug expenditure at Raigmore Hospital – Dir of Operations, Raigmore Update on monitoring of Care Home contracts, single point of contact and escalation routes – Jan Baird Monitoring the Delivery of In-house Services – George McCaig Strategic Commissioning Intentions Plan 2014/2015 ( including priority actions for reducing/increasing activity) – Simon Steer Draft Commission for Integrating Care in the Highlands Legal Services – Jan Baird Older People in Acute Care, Raigmore – Detailed Report on Unannounced Inspection – Dir of Operations, Raigmore Hospital Committee and Development Session Timetable for 2014 – Committee Administrator
20 65 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
Future Meetings: Quarterly – Risk Registers – due 7th March 2013 – Directors of Operations in Operational Unit Reports then quarterly thereafter Quarterly – Care Inspectorate Inspection Reports in Highland (incl comparator data pre and post integration, Action plans, timescales for action and interim support arrangements) – Brian Robertson Standing – Adult Support and Protection Committee Minutes Standing – Financial Position Updates – David Garden Standing – Suspension of Admissions to Care Homes – Exception Reports – Brian Robertson Standing – Adult Social Care Balanced Scorecard Update on progress with reconfiguration of Raigmore Hospital Tower Block (include in Dir. of Operations Report) – Dir of Operations, Raigmore Transitions – update on progress with Strategy – Chief Executive Report on Implications of Welfare Reform on Charging for Social Care Services (include relevant trends, risks etc) – Brian Robertson Developing the Highland Strategic Commissioning Plan for Older People and Effect on Care Groups – Simon Steer Reablement Strategy – Brian Robertson Case mix profile for relating to Emergency Department admissions – Deb Jones/Margaret Brown (include in COO report) – Report to NHS Board October 2013 Local Delivery Plans Six Monthly Update – due May 2014 – Directors of Operations Local Delivery Plans Year End Progress Report – due March 2014 Savings Plan 2013/2014 (linked to Financial Plan 2013/2014) – David Garden Health and Safety Update Report on impact from services provided to ex-military personnel – Heidi May Care Home Risk Management Processes – George McCaig Strategic Commissioning and Training 2014-2019 – Deb Jones (COOs Report Item) Skye, Lochalsh and Wester Ross Service Redesign – due January 2014 - Gill McVicar Managing Patient Choice Communications Plan – Chief Operating Officer Update on associated activity affecting Maternity Services, including pre-birth activity – Dir of Social Work, Highland Council Consideration of Patient Feedback/Stories Role of Committee Lay Members Infection Control Arrangements within Care Homes
21 66 HEALTH AND SOCIAL CARE COMMITTEE – ASSURANCE REPORT Meeting on Thursday 7 November 2013
Development Sessions: Self Directed Support (DVD Presentation) – RAS monitoring, mgt of identified risks, identification of ‘What Ifs’, and Staff Awareness Health Inequalities – Completed 26 August 2013 Reablement, Delayed Discharge and Shifting the Balance of Care Remote and Rural Sustainability Primary Care Highland Health and Social Care Committee Governance Review – Completed 1 November 2013 Care Inspectorate Inspection Criteria Use of Information Technology (ePatient Records, PMS, Community Linkages)
10 DATE OF NEXT MEETING
The next meeting of the Committee will take place on Thursday, 9 January 2014 in the Board Room, Assynt House, Inverness at 9.30am
22 67 Highland NHS Board 3 December 2013 Item 3.3 CLINICAL GOVERNANCE COMMITTEE
Report by Sarah Wedgwood, Chair, Clinical Governance Committee
The Board is asked to:
Note that the Clinical Governance Committee met on 2 October 2013 with attendance as noted below. Note the Assurance Report and agreed actions resulting from the consideration of the specific items detailed below. Note the items for discussion at the next meeting to be held on 9 December 2013.
Committee Members: Ms Sarah Wedgwood, Chair Dr Ian Bashford, Medical Director Ms Elspeth Caithness, Staffside Representative Dr Michael Foxley, Non-Executive Director (from 10.10am) Dr Michael Hall, Clinical Director, Argyll & Bute CHP (videoconference) Dr Roderick Harvey, Associate Medical Director, Raigmore Hospital Mr Alasdair Lawton, Non-Executive Director Dr Rhona MacDonald, Non-Executive Director Ms Heidi May, Nurse Director Ms Elaine Mead, Chief Executive Mr Alan Simmons, Public Member Dr Ian Scott, Clinical Director, South & Mid Operational Unit Dr Jenny Wares, Public Health LAT (Locum Appointed for Training Posts) & Specialist Registrar deputising for Dr Margaret Somerville, Director of Public Health & Health Policy
Also Present: Mr Garry Coutts, Chair, NHS Highland (from 10.45am) Ms Elaine Mead, Chief Executive
In Attendance: Mrs Mirian Morrison, Clinical Governance Development Manager Miss Irene Robertson, Board Committee Administrator
Apologies – Ms Caron Cruickshank, Dr Paul Davidson, Dr Iain Kennedy, Mr Bill Reid, Mr Michael Roberts, Mr Brian Robertson, Dr Margaret Somerville and Mrs Katherine Sutton.
1 ITEMS FOR DISCUSSION The items discussed at the meeting are noted below:
(i) Case Study (ii) Questions from Lay Members (iii) Emerging Issues: CEL(2012)30 Guidance for the Safe Delivery of Systemic Anti-Cancer Therapy (SACT) Clinical Governance Committee Reporting Template (iv) Complaints: 20 day response target – revised quality indicators SPSO Annual Report 2012 – 13 (v) Incident Management – HIS Management of Adverse Events Review Report – NHS Highland September 2013 and HIS Report ‘A national approach to learning from adverse events through reporting and review – A framework’ (vi) Clinical Governance Framework – revised reporting template 68
(vii) Committees reporting to Clinical Governance Committee – Terms of Reference for Organ Donation Committee (viii) Control of Infection Committee
2 ITEMS FOR DISCUSSION AT NEXT MEETING ON 9 DECEMBER 2013 Case Study Questions from Lay Members Emerging Issues Complaints Incident Management Area Drug and Therapeutics Committee Annual Report Further items to be confirmed following agenda planning meeting on 19 November 2013
3 CONTRIBUTION TO CORPORATE OBJECTIVES
This performance report demonstrates how NHS Highland is achieving its corporate objective of ensuring that services delivered are of high quality and clinically effective.
4 GOVERNANCE IMPLICATIONS
This performance report has a direct impact on clinical governance and demonstrates performance against responding to complaints, clinical effectiveness activity, patient safety and NHS Healthcare Improvement Scotland reviews.
5 IMPACT ASSESSMENT
This report does not require impact assessment.
Sarah Wedgwood Chair, Clinical Governance Committee
22 November 2013
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CLINICAL GOVERNANCE COMMITTEE ASSURANCE REPORT 2 OCTOBER 2013
1) TOPIC: CASE STUDY presented by Dr Ian Scott, Clinical Director, South & Mid Operational Unit
Issues/Risks Assurance Actions Second case study presented to the Clinical The Committee was assured a thorough Remind all staff that an SER can run in parallel Governance Committee (CGC) based on an investigation had been undertaken. The with the disciplinary process. SER rather than a complaint. The incident following learning points were highlighted: occurred in November 2012 and is still ongoing. Primary duty of SER to establish facts as Reminder to operational units that It is a very complex case involving many soon as possible to ascertain whether communication with families is paramount in the different professionals, locations within NHS care provided was appropriate or sub- event of a serious incident and the offer of a Highland and different processes. The case optimal to prevent further events. face to face meeting must be made in all cases. has demonstrated the challenges of undertaking SERs to be investigated in an open and an SER especially when other bodies are supportive environment without The HIS framework for the investigation of involved e.g. Procurator Fiscal. individuals feeling threatened. SERs has now been produced – operational NHS Highland disciplinary process may units will be expected to adhere to it. run in parallel to an SER but the outcome of the Review cannot be used All SERs must be recorded on DATIX. as evidence to support a disciplinary claim. Action: Communication with the family is Clinical Effectiveness Team / Operational paramount; the organisation must Units Quality & Patient Safety Committees / respond to their queries when something All staff undertaking SERs has gone wrong and there must be the offer of a face to face meeting to provide a frank and honest account of what happened.
2) TOPIC: QUESTIONS FROM LAY MEMBERS
Issues/Risks Assurance Actions (a) Living Wills This issue will be addressed within a revised This issue is recorded in the Committee’s rolling Revised policy to be included on future CGC Resuscitation Policy to be developed by the action plan to be included in a future agenda agenda. Resuscitation Committee. when the revised policy has been approved by Action: Committee Administrator
3 70
the Resuscitation Committee. The Resuscitation Committee reports to NHS Highland through the CGC.
(b) Final Arbiter of Clinical Risk This issue related to the adoption of a specific The Chief Executive confirmed that she as the Issue to be removed from Rolling Action Plan. piece of equipment for eye surgery in Raigmore. Accountable Officer is the final arbiter in such Action: Committee Administrator Question was asked who would be the final cases assisted by the Clinical Advisory Group. arbiter in the process.
3) TOPIC: EMERGING ISSUES
Issues/Risks Assurance Actions (a) CEL 30 Guidance for the Safe Delivery of Systemic Anti-Cancer Therapy (SACT) Letter from Fiona Campbell, Macmillan Clinical NHS Highland has identified the latter two CGC will be notified when a Lead Clinician has Nurse Specialist, Oncology/Chemotherapy to postholders but has been unsuccessful in been appointed. the CGC stating that the Board must identify a appointing a Lead Clinician. Action: Cancer Service Manager, Raigmore Lead Clinician for Systemic Anti-Cancer Hospital Therapy services supported by a senior pharmacist and a senior nurse.
(b) CGC Reporting Template CGC has adopted an assurance report template A full minute will be taken for a period to monitor The assurance report will be drafted during the similar in style to that of the Improvement whether or not the assurance report is sufficient course of the meeting and circulated to the Committee for reporting to the Board. for individual Board members. Committee before its next meeting. Action: Chair / Committee Administrator
4) TOPIC: COMPLAINTS
Issues/Risks Assurance Actions Performance against the current 20 day target The CGC agreed the revised quality indicators To amend the KPI reporting template to include for responding to complaints continues to be recommended by the Short Life Working Group. the revised standard. challenging. NHS Highland is consistently The Committee also agreed that building on the Action: Board Administration Team
4 71 underperforming; the position in July was 48% work completed by the Short Life Working against the 80% target. The Short Life Group using LEAN methodology to examine Working Group recommended revised quality current practice two further pieces of work were indicators to 80% of simple complaints to be needed. Firstly, the establishment of a strategic Meeting of the Strategic Group to be arranged. responded to in 20 days and all complaints to group comprising Sarah Wedgwood, Elaine Action: Committee Administrator be responded to in 40 days. Mead, Heidi May and Mirian Morrison to examine complaints performance, quality indicators, and issues raised within the SPSO annual report; and secondly, the Strategic To identify members of the operational group. Group to identify actions which would then be Action: Chief Executive remitted to an operational group to take forward.
The SPSO annual report for 2012-13 Further analysis to be undertaken of the SPSO Further analysis of the SPSO annual report to highlighted a rising number of complaints which annual report to identify common themes and be undertaken and presented to a future CGC. were upheld or partially upheld. Main issues areas of focus for improvement for reporting Action: Clinical Governance Development relating to health complaints were back to CGC for further consideration. Manager communication between health professionals, between health professionals and patients and To include in rolling action plan. finally better written information in complaints Action: Committee Administrator letters.
Health and Social Care complaints are subject The SPSO advised that processes should be To make appropriate changes to reporting to different legislation and investigation amalgamated, however this would require templates; notify operational units of the processes. NHS Highland is now responsible legislative change so not imminent. In the changes to timescales; and ensure all for complaints about services formerly provided meantime social care complaints once operational units have a mechanism to monitor by the Highland Council. Systems are not completed should be sent to the Clinical and record all social care complaints to be integrated. Effectiveness Team for inclusion in performance included in performance reporting systems. reports. Action: Clinical Effectiveness Team
5) TOPIC: INCIDENT MANAGEMENT
Issues/Risks Assurance Actions Report 1: Performance Report for Quarter 1 Operational units receive a similar report for Trend data to be included in future reports to the highlighting incident activity and details of major monitoring and management purposes. Similar CGC. and extreme incidents. reports are also sent to Falls Steering Group, Action: Clinical Governance Support Team
5 72
Tissue Viability Leadership Group, Medicine A total of 2908 incidents were reported Sub Group and a number of other related throughout NHS Highland during Quarter 1. operational groups. Not all Adult Social Care services have access Inputting of paper based reports is being to IT support to record incidents on DATIX. undertaken centrally by the Clinical Governance Paper based system in place at present. Support Team. CGC requested trend data to be included in the report in future to monitor improvement or otherwise. A comprehensive training programme is being rolled out in the use of DATIX as all incidents are to be recorded on DATIX.
Report 2: Healthcare Improvement Scotland NHS Highland received a very good report from A report on implementation of the (HIS) Management of Adverse Events Review HIS on its management of adverse events. recommendations to be presented to a future Report - NHS Highland September 2013 The CGC was assured that current systems are CGC. Twelve recommendations to be addressed robust and that in most cases serious incidents Action: Clinical Governance Development relating in the main to involving families, are investigated thoroughly. However it noted Manager consistency of approach and dissemination of that further work is required to ensure learning. consistency of approach across all operational To include in rolling action plan. units, and all incidents are to be reported on Action: Committee Administrator DATIX.
Report 3: HIS ‘A national approach to learning A Short Life Working Group chaired by Myra All recommendations and elements of the HIS from adverse events through reporting and Duncan, Non-Executive Director has provided a national framework to be in place by April 2014. review – A framework’ strong foundation on which to build. This group The CGC to receive a progress report in six This report was published in September 2013 is now to stand down and operational units will months time. and NHS Boards are mandated to implement adopt the framework and ensure consistent Action: Clinical Governance Development the new framework. practice in adopting the recommendations made Manager in the HIS review. All SERs are to be recorded on DATIX. To include in rolling action plan. Action: Committee Administrator
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6) TOPIC: CLINICAL GOVERNANCE FRAMEWORK
Issues/Risks Assurance Actions The CGC has revised its method of gaining The CGC discussed the revised reporting The Chair of the CGC to attend operational assurance that operational units are monitoring template. The Chair of the CGC and a member units Quality & Patient Safety Committees and high priority quality and safety issues. Clinical of the Clinical Governance Support Team will report back to the Committee in the new year. Directors are now members of the CGC and attend operational units Quality & Patient Safety Action: Chair / Committee Administrator case studies are used to highlight relevant Committees to explain and discuss the new issues. The Committee recently adopted the template. The CGC agreed in principle with the To include in rolling action plan. system of identifying 3 key learning points from need for such a template however it is Action: Committee Administrator the case studies and these will be cascaded to Important that this system does not duplicate operational units Quality & Patient Safety nor be an additional system. Committees (chaired by Clinical Directors). The Committee was mindful that the Health and The Chair to discuss governance relationships A revised reporting template to identify and Social Care Committee (HSCC) is establishing between the HSCC and the CGC to avoid escalate relevant issues to be populated by a Professional Executive Committee to which duplication and appropriate consideration of operational units for submission and corporate operational issues could be escalated operational issues and processes. consideration by the CGC would provide a for consideration. Action: Chair simple monitoring system and provide assurance that relevant topics and systems are being identified and actioned.
Exception reports from the Clinical Directors. The Committee agreed that in addition to exception reports it would continue to receive the minutes from operational units Quality & Patient Safety Committees.
An issue was raised in relation to mortality rates This issue is being investigated and the A report to be brought to the CGC in February – a high number of deaths expressed as a Committee will be advised of the outcome. 2014. percentage of total discharges in March this Action: Associate Medical Director, year and HSMR data published by ISD has Raigmore Hospital shown an upward trend over the last four quarters. To include in rolling action plan. Action: Committee Administrator
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7) TOPIC: COMMITTEES REPORTING TO CLINICAL GOVERNANCE COMMITTEE
Issues/Risks Assurance Actions A suggestion that the NHS Highland Organ The CGC discussed and approved the Organ Revised Terms of Reference to be submitted to Donation Committee report to the CGC to Donation Committee Terms of Reference a future CGC. provide assurance to the Board that appropriate subject to a number of changes: A representative from the Organ Donation procedures are in place to support current policy Under ‘Purpose’ – recommended third Committee to discuss and clarify issues raised surrounding organ donation. bullet point “Maximise overall number of to a future CGC. organs donated” should be the first bullet Action: Ian Bashford The focus is very much on acute care however point. it was noted that in the last 3 years 100% of The number for a quorum needs to be To include in rolling action plan. organ donations have been from ITU. More confirmed Action: Committee Administrator awareness is needed among the population. Deputies should count towards a quorum Annual report to be submitted to CGC Develop an organ donation policy and identify champions throughout the organisation.
8) TOPIC: CONTROL OF INFECTION COMMITTEE
Issues/Risks Assurance Actions Issues contained in the draft minute of meeting The CGC received and noted the draft minute. The Control of Infection Committee to submit an of the Control of Infection Committee held on 31 The Control of Infection Committee provides Annual Report to the CGC . July 2013. assurance to the Board through reports to the Action: Infection Control Manager CGC. Issues can be escalated to the Board as appropriate. To include in rolling action plan. Infection control reports are included on every Action: Committee Administrator public Board agenda.
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9) KEY LEARNING POINTS FOR THE ORGANISATION FROM THE CASE STUDY PRESENTED BY DR IAN SCOTT
1 These relate to the adoption of the HIS framework and recommendations made within the Review of Highland:
Mandate to report and record all SERs on DATIX. Consistent approach to involving the family. Communication with the family to be swift and honest. Disciplinary process can run in parallel to SER process.
9 76 77 Highland NHS Board 3 December 2013 Item 3.4 IMPROVEMENT COMMITTEE Report by Elaine Mead, Chief Executive
The Board is asked to:
Note that the Improvement Committee met on Monday 4 November 2013 with attendance as noted below. Note the Assurance Report and agreed actions resulting from the review of the specific topics detailed below and the Balanced Scorecard (attached).
Panel: Mr Garry Coutts, Chair Dr Ian Bashford, Medical Director Cllr Alasdair Christie, The Highland Council Dr Iain Kennedy, Non-Executive Director Ms Elaine Mead, Chief Executive Ms Sarah Wedgwood, Non-Executive Director
Also Present: Ms Elaine Wilkinson, Non-Executive Director
In Attendance: Mr Bill Alexander, Director of Health and Social Care Mr Kenny Oliver, Board Performance Manager Miss Irene Robertson, Board Committee Administrator
Apologies – Ms Margaret Brown, Mr Robin Creelman and Dr Roderick Harvey
Respondents: Mrs Myra Duncan, Chair, Highland Health & Social Care Governance Committee Ms Brenda Dunthorne, Head of Finance, Raigmore Hospital (item 2b) Ms Maxine Johnston, Alzheimer Scotland Regional Manager, Highlands, Western Isles and Orkney (item 8) Ms Deborah Jones, Chief Operating Officer Mr Nick Kenton, Director of Finance (item 2b) Mr Derek Leslie, Director of Operations, Argyll & Bute CHP (videoconference) Mrs Gill McVicar, Director of Operations, North & West Highland Operational Unit (videoconference) Ms Carolanne Mainland, Alzheimer Scotland Service Manager (item 8) Ms Ruth Mantle, Alzheimer Scotland Dementia Nurse Consultant (item 8) Mr Michael Perera, Projects Manager – Mental Health, South & Mid Highland Operational Unit (item 8) Mr Nigel Small, Director of Operations, South & Mid Highland Operational Unit Dr Margaret Somerville, Director of Public Health Mrs Katherine Sutton, Associate Director, AHPs (item 1a(i)) (videoconference) Mrs Jo Veasey, Divisional General Manager, Medical & Diagnostic Division, on behalf of the Director of Operations, Raigmore Hospital 78
TOPICS DISCUSSED
1 Integration – Quality and Improvement
a. Scorecard for Adult Social Care (i) Delivery of Falls Prevention Action Plans (ii) Delayed Discharges
b. Scorecard for Children’s Services (i) Breastfeeding
2 Review of Board Assurance Report Actions
a. Telecare/Enhanced Telecare Services, Argyll & Bute CHP b. Financial Position - Highland and Operational Units
3 Balanced Scorecard
3.1 Heat Targets
a. Child Healthy Weight, Argyll & Bute CHP
3.2 Standards
a. Access Targets, Raigmore Hospital - 12 Weeks Outpatients / TTG / RTT b. Access Targets, Raigmore Hospital and North West Highland Operational Unit - 8 Key Diagnostic Tests c. Cancer – 62 day target, Raigmore Hospital d. SMR Completion Rates, Raigmore Hospital
4 Children’s Fluoride Varnish
5 eHealth Business Intelligence Programme
6 Chronic Pain Service
7 Local Unscheduled Care Action Plan
8 Dementia – new target for access to dementia services post-diagnosis and dementia registrations in general practice
9 NHS Highland Annual Review 2013 Cabinet Secretary’s response
DATE OF NEXT MEETING
The next meeting will be held on Monday 6 January 2014 in the Board Room, Assynt House, Inverness at 1.30pm.
2 79 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
The Committee’s role and remit is to scrutinise NHS Highland’s performance and ensure remedial action is taken, as required. NOTE: To ensure the quality of reporting to the Committee those papers being submitted are required to contain more associated commentary and follow the prescribed template as agreed.
1 INTEGRATION – QUALITY AND IMPROVEMENT Issues/Risks Assurance Actions Scorecard for Adult Social Care: An exception report on provision of respite bed nights to be submitted to the next meeting of the Indicators 25 and 26 Respite bed nights and Health and Social Care Committee. respite day hours: Action: B Robertson The trajectory for respite bed nights is not currently being met. Presentation of target figures relating to The targets shown in the Scorecard are Indicators 25 and 26 in the Scorecard to be cumulative. Presentation of the figures to be revised. revised to ensure clarity. Action: K Oliver Indicator 13 Reducing the number of falls The action plans for management and Action plans to continue to be implemented. related A&E admissions: prevention of falls developed by the Action: Directors of Operations Impact of falls on older people’s quality of life Operational Units are being progressed. and ability to live independently. Unscheduled care pathways are being A copy of the Scottish Government Health & Implications of falls for health and social care developed with Scottish Ambulance Service for Social Care Directorate Cost Consequence service delivery. which four test sites have been identified in Analysis report to be obtained to enable NHS A mechanism has still to be developed to collect North Highland. This work will be a key focus Highland to assess the cost implications of data in respect of patients attending A&E for the newly appointed Community Falls Lead implementing the proposed care bundles to departments as a result of falls. for North Highland. prevent falls. Work is ongoing to reduce falls with harm in the Action: K Sutton inpatient setting under the Scottish Patient Safety Programme. A very robust approach will be taken to implementing care packages which it is expected will evidence a significant impact on trajectory for falls reduction across the inpatient setting. A similar approach could be applied in Highland to measure performance in community sites.
3 80 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
NHS Highland has recently been included in a trial arrangement, under the auspices of the Scottish Government, to reduce falls in the care home setting and our new Community Falls Lead will lead on this work as a priority. Delayed Discharges: While the position remains very challenging Ongoing actions to continue. Further Deteriorating position, NHS Highland’s there has been a significant drop in the number engagement with private care sector in relation to performance being the second worst in Scotland of patients delayed. A range of measures is increasing capacity including cost considerations. in terms of four and six week delays. The two being implemented. Consideration is being Action: Directors of Operations principle causes are: given to interim care facilities and use of The level of residential and nursing home appropriate housing options, and an in-reach Continue discussions with HIE and Skills placements temporarily closed to admission service to Raigmore Hospital has been Development Scotland, who are developing a The unavailability of Care at Home developed. Work is also ongoing with skills investment plan, with a view to highlighting independent care providers to try and increase care at home as a growth sector for the future There are also a significant number of complex capacity; however there are cost implications in and increasing home care capacity. cases contributing to the position. terms of their charges which exceed the Action: Chair Challenges in recruiting to posts within the home national contract rates. care sector. It is anticipated that the remedial actions being taken will lead to sustainable improvement.
Children’s Services Scorecard:
Indicator 16 95% of initial Looked After Indicator 16: Children health assessments to be included Action has been taken to address the issues. in Childs Plans: Confident of return to trajectory. Below trajectory; a number of issues are impacting on the position.
Indicator 7 Newborn babies exclusively Indicator 7: breast- fed at 6 – 8 weeks review to increase Work is underway to improve the rate of return to 36%: of the 6 – 8 week review forms. The target is not being met. A range of actions is already in place to Issue relating to data collection and return of increase breastfeeding awareness, support review forms to ISD. mothers to breastfeed and improve breastfeeding rates. 4 81 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
2 REVIEW OF BOARD ASSURANCE REPORT ACTIONS Issues/Risks Assurance Actions Stroke: The Stroke pathway is under review, several Position report to be submitted to the next Issue raised regarding step down from the work streams are ongoing. An update on the meeting of the Improvement Committee on 6 Stroke Unit to care at home. position is scheduled for the January 2014 January 2014, to include all measures and not meeting of the Improvement Committee. just HEAT targets. Action: P Findlay / C Goskirk
Drug and Alcohol Treatment Waiting Times: Ongoing activity to continue across Highland to get back on trajectory. Argyll & Bute CHP: Argyll & Bute CHP: Action: Directors of Operations Feedback on client satisfaction with services in Arrangements are in hand to increase Argyll & Bute CHP. Addictions Nurse staffing capacity in the areas experiencing the longest waits. Client satisfaction with services is being monitored by means of the Treatment Perception Questionnaire which evidenced an 81.6% satisfaction rating during 2012-13.
Telecare/Enhanced Telecare Services:
Argyll & Bute CHP: Argyll & Bute CHP: Ongoing activity in Argyll & Bute CHP to To promote the application of telehealthcare Overall a very positive position. The 2013-14 continue. across the CHP and ensure a consistent target for fitting enhanced telecare packages Action: D Leslie approach to responding to clients’ needs. has been exceeded. To enable universal access to enhanced telecare, aids and adaptation. Report on position in North Highland to be submitted to the next meeting of the Improvement Committee. Action: B Robertson / G McVicar / N Small
5 82 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
Financial Update – position at 30 September 2013 (month 6):
Highland position: Highland: Current reported potential overspend forecast at A slight improvement in the position from the Ongoing actions to continue. Delivery of savings £9.5m: last report. Overall a break even position and progress towards achievement of break even Operational Unit savings to be identified continues to be forecast by year end to be monitored on a monthly basis. Adult Social Care budget: increasing dependent on delivery of savings targets, Action: Directors of Operations number of care packages required successful management of emerging, in-year coupled with a reduction in income from cost and service pressures and availability of Analysis to be undertaken of data from the clients any non-recurring central resource. Highland Council in relation to its management of Cost and service pressures adult social care provision and financial Emergence of forecast deficit on tertiary forecasting to ascertain if the approach now cases due to high cost out of area being taken by NHS Highland to deliver services placements for adolescent differs in any respects. psychiatry/eating disorder patients. Action: B Alexander / E Mead / N Kenton
North & West Operational Unit: North West Operational Unit: Forecast overspend – high cost adult social care There is recognition at national level that OOH package, OOH, medical locums within Rural services are more costly. With regard to RGH General Hospitals (RGH) and vacant GP staffing two substantive appointments have practices. been made. The vacant GP practices are advertised on a regular basis, however they remain unfilled.
South & Mid Operational Unit: South & Mid Operational Unit: Forecast overspend relating to adult social care. Confident of making the required savings and Impact of additional care packages. achieving break even on the health budget. The Unit is now on track to meet its share of the overall savings on adult social care, however break even will not be achieved on the independent care sector budget.
6 83 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
Argyll & Bute CHP: Argyll & Bute CHP: Current service pressures relating to medical Plans are in place to delivery the necessary locums in both primary and secondary care. savings. Break even is predicted. Funding of out of area specialist treatment for eating disorders.
Raigmore: £8.5m overspend forecast. Significant cost Raigmore: pressures in relation to locum costs to cover There has been a slight improvement in the Raigmore: sickness absence and maternity leave and position. Work is ongoing with regard to Update required for the January 2014 meeting of additional activity towards meeting access increasing rigour and governance of processes. the Improvement Committee. targets. There are also cost pressures around A new process for approval of locum use has Action: J Veasey / B Dunthorne drug costs, particularly cancer drugs. been introduced; action is also being taken in relation to procurement and controlling spend. Discussion is taking place with the Consultant Oncologists regarding cancer drugs and associated costs with a view to finding a way forward.
3 BALANCED SCORECARD 2013 – 2014
3.1 BALANCED SCORECARD - HEAT TARGETS Issues/Risks Assurance Actions Child Healthy Weight, Argyll & Bute: A range of initiatives is underway to improve A further report to be prepared for submission to A number of issues have impacted on the ability the position. The CHP is working with the the January 2014 Senior Management Team to deliver interventions. Education Department to establish an meeting indicating the anticipated timescale for Taking a second BMI measurement at the end appropriate programme and support the returning to trajectory. of the programme is particularly challenging, delivery of interventions in schools across Action: D Leslie however this will no longer be done as it has not Argyll & Bute. Learning from North Highland’s been shown to be effective. experiences of delivering healthy weight programmes will be applied.
7 84 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
3.2 BALANCED SCORECARD – STANDARDS Issues/Risks Assurance Actions Access Targets, Raigmore - 12 weeks Action plans have been developed to address Focused action on areas of pressure to continue. Outpatients and Treatment Time Guarantee: the issues in those specialties under pressure. Action: Director of Operations The targets are not being met. Breaches are Discussions are ongoing with the Scottish occurring in a number of specialties which are Government to utilise the Golden Jubilee A report on the use of capacity at the Golden experiencing significant pressures. Hospital to provide treatment for Orthopaedic Jubilee to be prepared for the Chair. patients. Action: J Veasey
Access Targets – 8 Key Diagnostic Tests:
Raigmore Hospital: Raigmore Hospital: Raigmore Hospital: Pressures in Endoscopy service; staffing Following the Rapid Process Improvement The work underway to address capacity issues capacity issues. Workshop (RPIW) there has been a sustained and improve waiting times to continue. Future Radiology – delays in CT and MRI scanning and decrease in the number of patients waiting reports to include plain film. reporting. more than 4 weeks within Endoscopy, and Action: Director of Operations options to address capacity issues are under consideration. A range of actions is ongoing to address the reporting backlog of MRI and CT scans and plain film. The reporting format is being refined to demonstrate the total waiting time for each patient thereby enabling more accurate performance monitoring and targeted action planning.
North & West Operational Unit: North & West Operational Unit: North & West Operational Unit: Ongoing actions to continue. (i) Belford Hospital (i) Belford Hospital Action: G McVicar Target not achieved. Limited visiting radiology Discussions are ongoing with Argyll & Bute service from Oban insufficient to meet current CHP to negotiate an increase in the visiting demand. Radiology service.
8 85 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
(ii) Caithness General Hospital (ii) Caithness General Hospital Target not achieved. Pressures on Endoscopy A range of actions is being taken including service; backlog of surveillance scopes. An provision of additional scope sessions and it is RPIW planned for November was postponed. anticipated that the target will be met by end December 2013. The RPIW will be arranged for early next year, meantime issues identified from early observations of the process will be addressed and learning from the RPIW work in Raigmore has been shared.
Cancer Services – 62 day target, Raigmore: A range of actions is in place to increase Ongoing activity to continue to achieve a return Deteriorating position. While the number of capacity; we are also working closely with to planned performance. breaches is small the impact on cancer waiting colleagues in NOSCAN and the other Cancer Action: Director of Operations, Raigmore times is considerable. The main issues are lack Centres with the aim of creating a robust, Hospital of capacity in Urology, Breast Surgery and sustainable service. Oncology, and delays in Radiotherapy. There are capacity issues across Scotland.
SMR Completion Rates, Raigmore: An agreement has been reached with NHS Ongoing actions to address coding staff capacity Issue around clinical coding capacity – difficulty Greater Glasgow & Clyde for that Board to to continue. in recruiting to vacant posts. provide some input. It is anticipated that this Action: Director of Operations, Raigmore Substantial backlog of coding. additional resource will enable the backlog of Hospital Impact on implementation of new Patient coding to be cleared by March 2014 in time for Management System (PMS). the implementation of PMS. However getting back on trajectory will be very challenging with current staffing levels.
9 86 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
4 TOPIC: CHILDREN’S FLUORIDE VARNISH Issues/Risks Assurance Actions Currently not meeting trajectory. There are a A range of actions is in place to address the Ongoing activity to get back on trajectory to number of issues and challenges impacting on issues. While not on trajectory NHS continue. performance against the target. Highland’s performance remains consistent Action: C Lush with that of other Boards and is above the Scottish average.
5 TOPIC: eHEALTH BUSINESS INTELLIGENCE PROGRAMME Issues/Risks Assurance Actions To develop a pan-Highland Data Warehouse which Good progress with the Data Warehouse Discussion to take place with NHS Highland and will extract data from multiple systems and hold project continues to be made although Highland Council IT Teams regarding strategy for this data in one common storage area in a implementation of PMS has impacted on the managing data systems. A joint report to be structured format for reporting purposes. timescales for delivery of some of the prepared for the next meeting of the Issue around capacity within the eHealth Team to elements. Improvement Committee. The position regarding progress this development, priority currently being adult social care analysts to be clarified. given to the implementation of the new Patient Action: B Alexander / D Jones Management System. A query was raised regarding the use of the Pyramid system which is in use within the Argyll & Bute Partnership and is also used by The Highland Council as a performance management tool. This system was discussed at the January 2013 meeting when it was agreed that a stocktake be undertaken of the position in terms of development of data reporting systems and discussed with partners to ensure systems were compatible and met everyone’s requirements. The Committee was advised that since integration adult social care analysts no longer use the Pyramid system. The need for community systems was also highlighted to enable Highland Council staff as well as health workers to carry out their roles. 10 87 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
6 TOPIC: CHRONIC PAIN SERVICE Issues/Risks Assurance Actions Growing demand for the service together with A range of measures is in place to try and Ongoing actions to continue. The increase in consultant staffing capacity issues have resulted address capacity and demand issues. consultant referrals to the service to be explored. in TTG requirements not being met. Efforts to Action: G McVicar secure locum cover have been unsuccessful. There is increasing pressure in relation to return The work of the Chronic Pain Team to ensure inpatient treatment. An ongoing programme of continuing service provision in challenging returns for treatment is required. circumstances was acknowledged. The number of new outpatient referrals is increasing with patients experiencing delays. In particular there has been a substantial increase in referrals from other consultants to the service. The number of consultants trained in pain management is small; it is a very specialised skill requiring two years’ training.
7 TOPIC: LOCAL UNSCHEDULED CARE ACTION PLAN Issues/Risks Assurance Actions Fluctuating demand for unscheduled care. Impact A National Unscheduled Care Plan has been A report on progress with implementation of of delayed discharge on unscheduled admissions developed to implement a programme of LUCAP to be submitted to the Health & Social and winter planning. changes to the way in which emergency and Care Committee. Performance against the four hour target in A&E urgent health care services are provided. Action: J Veasey Departments. This will be complemented by the Local Impact of medical receiving on A&E Department in Unscheduled Care Action Plan (LUCAP). A Raigmore. range of actions is being implemented Issues relating to discharge planning in Raigmore. through LUCAP both in acute hospitals and Sustainability of OOH provision. the community to ensure the right care is provided at the right time in the right place.
11 88 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
Consideration is being given to alternative models of OOH services to ensure sustainable provision for the future. Some measures have been introduced to improve discharge planning, work is also underway to maximise the use of the discharge lounge and staffing capacity. Additional central funding coupled with redesign work has enhanced staffing capacity in A&E, however there remains a need for 24/7 senior decision making cover.
8 TOPIC: DEMENTIA - New target for access to dementia services post-diagnosis and dementia registrations in general practice Issues/Risks Assurance Actions New target set for 2015. Issue around ensuring all The Dementia Sub Group is sighted on the The Health & Social Care Committee and Argyll the data is captured relating to the number of delivery of the target. & Bute CHP to ensure data is collected. people diagnosed with dementia and the number Personal outcome plans are to be developed Action: Directors of Operations of people who have taken up the offer of post- with a view to building support and capacity diagnosis support. for individuals to self manage. A report on performance against the target to be By 2015-16 all people newly diagnosed with submitted to the Improvement Committee in six dementia will have a minimum of twelve months’ months’ time (April 2014 meeting). post-diagnostic support. Consideration needs to Action: K Proctor / M Perera be given to the level of support that people may require following that period.
12 89 IMPROVEMENT COMMITTEE – ASSURANCE REPORT Meeting on 04 November 2013
9 TOPIC: NHS HIGHLAND ANNUAL REVIEW 2013 Issues/Risks Assurance Actions Letter received from the Cabinet Secretary for Overall a positive report acknowledging Ongoing activity to continue; action points Health and Wellbeing summarising the main points progress made against a number of work identified in the Cabinet Secretary’s response to discussed and actions arising from the Annual steams and the considerable work ongoing to be progressed. Review and associated meetings held on 19 July address the areas requiring improvement. Action: Executive Leads 2013.
10 FUTURE AGENDA ITEMS
Meeting on 6 January 2014: Telecare/Enhanced Telecare Services CAMHS Stroke Update Data Systems
Future Meetings: Dementia Targets (April 2014 meeting) Detect Cancer Early Programme Insulin Pump Therapy Update Quality Outcomes Framework Dashboard for data scrutiny around waiting Adult Social Care Indicators: Respite Care; Complaints; and Accessing Mental Health Services Keep Well
11 DATE OF NEXT MEETING
The next meeting of the Improvement Committee will take place on Monday 6 January 2014 in the Board Room, Assynt House, Inverness at 13:30.
13 NHS Highland - "At A Glance" HEAT Targets Summary of the Operational Units performance as per the Balanced Scorecard reported90 to the Improvement Committee on 4th November 2013 Targets with a delivery date by the end of March 2014 e d n t e t o u t e i s t r t d B i i e a o s d p D M e W o r n e y r P a & o & r l e h d l h m h t r t v t y g i n a r i u l g o o a o r e o
B Target M R N S A D Child Healthy Weight Interventions Jun-13 N/A N/A N/A Mar-14 Smoking Cessation - 2 most deprived data zones Jun-13 N/ACurrently reported at Board Level Only Mar-14 Smoking Cessation - general smoking population Jul-13 N/A N/A N/A Mar-14 Child Fluoride Varnish Applications Mar-13 N/ACurrently reported at Board Level Only Mar-14
Financial Performance Aug-13 Mar-14 Cash Efficencies Aug-13 Mar-14
Rate of attendances at A&E Aug-13 N/A Mar-14 Targets with a delivery date beyond March 2014 e d n t e t o u t e i s t r t d B i i e a o s d p D M e W o r n e y r P a & o & r l e h d l h m h t r t v t y g i n a r i u l g o o a o r e o
B Target M R N S A D Early Access to Antenatal Services Jun-13Currently reported at Board Level Only Mar-15 Detect Cancer EarlyCurrently reported at Board Level Only Apr-15
Reduce Carbon emmissions Mar-13Currently reported at Board Level Only Mar-15 Reduce Energy Consumption Mar-13Currently reported at Board Level Only Mar-15
Faster Access to Specialist CAMHS - 18 weeks Aug-13 Dec-14 No Trajectory Reduce IVF Waiting TimesData sources being developed Mar-15 4 Hour A&E Wait Sep-14 Faster Access to Psychological Therapies Aug-13 N/A Dec-14
Reduction in Emergency bed days for patients aged 75+ Mar-13 N/A Mar-15 Delayed Discharges - 14 days Sep-13 Mar-15 No Trajectory Access to Dementia SupportData sources being developed Mar-16 MRSA/MSSA Bacterium Jun-13Currently reported at Board Level only Mar-15 C. Diff Infections Jun-13Currently reported at Board Level only Mar-15
NHS Highland - "At A Glance" Standards e d n t e t o u t i s r t d B i i e o s d p M e W o r n e r P a & o & l h d l h m h t r t t y g n a r i u g o o a o r o
B Target M R N S A Alcohol \Brief Interventions Aug-13 N/A Standard Inequalities Targeted Cardiovascular Health checks Aug-13 N/A Breastfeeding at 6-8 week- Target 36% Dec-12 N/A N/A N/A MMR uptake rates - target 95% at 5 years old Jun-13 N/A
Sickness Absence - 4% target May-13 Standard SMR return rate - 90% of SMR1 returns received within 6 weeks Jul-13 No Trajectory Complaints Mar-12 Awaiting measure from Clinical Gov Comm. No Trajectory Same Day Surgery Rate Jul-13 N/A Outpatients - DNA rate - Target 6.9% Aug-13 No Trajectory Reduce Pre Operative stay May-13 N/A eKSF & PDP's - Target 80% Sep-13
Suspicion of cancer referrals (62days) (Due for Delivery Dec 2010) Jun-13Reported at Board Level only Standard All Cancer Treatment (31days) (Due for Delivery Dec 2010) Jun-13Reported at Board Level only Standard 18 weeks Referral to Treatment (Due for Delivery Dec 2010) Sep-13Currently reported at Board Level only Standard New Outpatient Waiting times - 12 weeks - Completed N/A New Outpatient Waiting times - 12 weeks - Ongoing Aug-13 New Outpatient Social Unavailability New Outpatient Medical Unavailability 12 week Treatment Time Guarantee (TTG) - Completed Waits Aug-13 12 week Treatment Time Guarantee (TTG) - Ongoing Waits Aug-13 Admission Waiting List - Social Unavailability Admission Waiting List - Medical Unavailability Hip surgery - 98% of patients treated within 24 safe operating hrs Sep-13 N/A N/A N/A 8 Key Daignostic tests - Completed Waits N/A 8 Key Daignostic tests - Ongoing Waits Aug-13 N/A Return Waiting List - Completed Waits Return Waiting List - Ongoing Waits Insulin Pumps - Under 18's Sep-13 Reported at Board Level only Insulin Pumps - Over 18's Sep-13 Reported at Board Level only Drug & Alcohol Treatment: Referral to Treatment Jun-13 N/A N/A N/A N/A Standard
Reduce Occupied Bed days for long term conditions Mar-13 N/A Reduce Average Length of Stay for Continuous Episode of care N/A End of Life Care Measure No Trajectory Dementia (Unvalidated - validated position available annually) Mar-13 N/A Standard 90% of patients diagnosed with stroke admitted to a stroke unit Sep-13 N/A Standard 91 Highland NHS Board 3 December 2013 Item 3.5 Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk/
DRAFT MINUTE of MEETING of the AREA CLINICAL FORUM 26 September 2013 – 1.30 pm Board Room, Assynt House, Inverness
Present Dr Iain Kennedy, Chair Rev Dr Derek Brown, Area Nursing, Midwifery & AHP Committee Mrs Mary Burnside, Area Nursing, Midwifery and AHP committee Mr Quentin Cox, Area Medical Committee Dr Doug Hutchison, Vice Chair Mr Duncan Martin, Patient Representative Mr Rob Peel, Raigmore Hospital Dr Boyd Peters, South & Mid Operational Unit (from 2.10 pm) Dr Anne Pollock, Area Health Care Science Forum Mr Ian Rudd, Area Pharmaceutical Committee Mrs Margaret Steventon, Area Optometric Committee Mr Ray Stewart, Employee Director Mrs Pat Wells, Patient Representative
In Attendance Ms Elaine Mead, Chief Executive (from 2.05 pm) Dr Rhona MacDonald, Board Non-Executive Member (from 1.45 pm) Mr Bill McKerrow, Associate Post Graduate Dean, North Deanery, NHS Education for Scotland (Item 5 only) Ms Heidi May, Board Nurse Director (from 2.00 pm) Mr Ken Proctor, Associate Medical Director Mrs Christine Thomson, Board Committee Administrator
1 WELCOME AND APOLOGIES
Dr Kennedy welcomed those present to the meeting. Apologies were received from Ian Bashford, Colin Crawford, Paul Davidson, Mary Morton and Margaret Moss.
1.1 DECLARATIONS OF INTEREST
Iain Kennedy declared that he was Executive Partner at Riverside Medical Practice and a member of the Scottish General Practitioners Committee of the BMA.
2 MINUTE OF MEETING HELD ON 8 AUGUST 2013
The following amendments were made to the minute of the meeting held on 8 August 2013:
1. On page 1 attendance list it was noted that Paul Davison was Clinical Director as opposed to Clinical Lead. 2. Item 4.3 third line replace the word “He” with “Mr Cox” 3. Item 4.6 Line 6 after the word therapist add “and clinical psychologist” 92
The minute of the meeting was then proposed by Duncan Martin and seconded by Doug Hutchison and thereafter accepted as a true record.
3 MATTERS ARISING
3.1 Cancer Services
Quentin Cox requested an update on the situation regarding cancer services following the attendance of Dr Stephen Thomas at the meeting. Iain Kennedy advised that he had presented the Board with the recommendations of the ACF, which recommendations had been noted. When Elaine Mead later joined the meeting she confirmed that progress had been made with a number of meetings having since taken place where the focus had been on the recruitment of additional colleagues. She advised that a second locum had joined the team who would be allocated there for a longer period than usual. She advised that there were also issues with the recruitment of Medical Physicists and that a DVD of oncology in Raigmore Hospital would be made to highlight the state of the art facilities available, Research and Development etc The aim was to make the DVD available on youtube to raise interest in the posts at application stage. She further advised that it was likely that ‘Head and Neck’ work would be transferred from Grampian to Raigmore and that oncology could therefore work as a collaborative across the North of Scotland.
3.2 Update on Ordercomms
Dr Anne Pollock reported that there was no progress to report but that as PMS was delayed it was likely that Ordercomms would also be delayed.
3.3 Asset Management Group – Update on ACF Representation
It was noted that Ian Rudd had been appointed the ACF representative on the Asset Management Group, with Mary Morton as reserve. Ian Rudd advised that he would provide a written report in advance of the ACF meetings for inclusion in the agenda papers.
4 REPORTS/MINUTES FROM PROFESSIONAL ADVISORY COMMITTEES
4.1 Area Nursing, Midwifery and AHP Advisory Committee
There had been circulated the minute of the meeting of 6 August 2013. In addition, Rev Brown reported that a further meeting had taken place on 24 September 2013 at which the role and participation in the Committee had been discussed. He advised that several ideas had been considered such as values, attitudes, behaviours and cultures in which we work, and the concepts of individual responsibility and collective accountability. These ideas would be collated but he stressed that the qualitative measures should not override the protection of patients from harm and advised that the idea was to attempt to instil a simple “do as you would be done by” attitude.
4.2 Area Dental Committee
Duncan Railton reported on the meeting held on 28 August 2013, advising that the position of Consultant in Restorative Dentistry had been filled with the successful applicant due to commence employment within the next few weeks.
He further advised that with regards to procurement, since NHS dentists were independent practitioners they did not have access to NHS contracts. It was noted that access to the procurement could possibly lead to savings but would definitely lead to ease of practice. 93
4.3 Area Medical Committee
There had been circulated the minute of meeting of 6 August 2013. A further meeting had taken place on 24 September 2013. Among the issues discussed were outpatient appointments and patients on waiting lists who cancel due to unrelated illness. The suggestion originally made was that in the case of a patient who became unfit to undergo surgery the consultant should write to the patient asking them to advise him/her when they were fit again. However, it was felt that this could be a problem to vulnerable and older patients, and was therefore an unreliable method.
As regards access targets, and the 12 week outpatient waiting time, it was noted that the letter to patients offering them appointments at the Golden Jubilee Hospital had been altered to advise that they could opt to refuse the offer.
As regards veterans, Heidi May queried whether NHS Highland could meet the national covenant requirements. Quentin Cox advised that it was not clear on the SCI gateway referral where this should be entered as the front page was not seen by the GP but was seen by patient booking. Iain Kennedy suggested that it could be written in the body of the text if the patient was a veteran. On the secondary care side Mr Cox confirmed that the scheme ensured that veterans obtained priority over other patients referred at the same time but not given priority over patients of greater clinical urgency.
It was further noted that a paper would be submitted to the GP Sub-committee.
At this stage it was agreed to consider the item on supporting Remote and Rural Healthcare
5 HIGHLAND QUALITY APPROACH (ELIMINATE HARM, ELIMINATE WASTE AND MANAGE VARIATI0N)
5.1 Supporting Remote and Rural Healthcare – Report by NHS Education for Scotland
Mr W McKerrow, Associate Post Graduate Dean, North Deanery, NHS Education for Scotland (NES) was welcomed to the meeting. He summarised the work of NES emphasising the role of education in remote and rural health care advising that multi disciplinary educational packages relevant to remote and rural communities had been established many of which were web based. He stressed various initiatives such as the development of an education programme for the role of Rural Generic (Health and Social Care) Support Worker; delivery of education for the Rural General Workforces across Scotland to assist in developing a sustainable workforce structure; and work to establish an agreed definition for Rural Nurse Practitioner skills and competencies across the remote, rural and Island Boards.
A further initiative had been the development of the Scottish School of Rural Health and Wellbeing with key partners such as NHS Highland and NHS 24 to increase the production of training, education and research for the remote, rural and island health and social care workforce. He emphasised the encouragement of individuals to look after their own health and well being.
As part of education, it was considered that there was a need to explain to prospective doctors, early in their studies, the reality of life in a rural community.
Mr McKerrow advised that every student at Aberdeen University would have the opportunity to attend a rural hospital as part of their training and stressed that there would be more recruitment to medical school from remote and rural if there were more opportunities in the area. 94
Boyd Peters stressed that recruitment and retention was just as important as education and advised that the OOH targets were not being met and that both education and support had to be available. It was suggested that this could be accomplished by a team approach to OOH using a blend of professionals.
Mr McKerrow advised that various solutions had been investigated such as: identifying what happens in other countries such as Australia where those working in the outback receive financial incentives for a period of time; a skills mix where approval is given for different professionals performing different tasks; and engagement with politicians. He also advised that there was difficulty in recruiting to rural fellowships. Anne Pollock advised that discussion had taken place regarding the labs several years ago and Mr McKerrow undertook to establish the latest on this again emphasising the multi-disciplinary nature of remote and rural.
Duncan Martin expressed surprise that the list of partners did not include the Scottish Ambulance Service. It was noted that while the ambulance service was important, if patients understood their own condition they would be more likely to manage it themselves at home.
Rob Peel advised that there were potentially 8 vacant physician posts and that 4 training fellows are required at any given time. Mr McKerrow stressed that there were 18 places on the remote and rural programme which were consistently oversubscribed.
On a query from Margaret Steventon it was noted that there was an optometrist employed in NES. From a dental point of view Duncan Railton advised that incentivised recruitment had been in place for some time and that there were a considerable number of people interested in remote and rural working.
Elaine Mead stressed that early solutions to the issue of remote and rural were required as there was real pressure on OOH. She highlighted the need for shared care and maximisation of the input of all professions.
Mr McKerrow advised that NES and territorial boards require to work together and that it was necessary to ensure that initiatives were well founded, well researched, audited and evaluated as progress was made.
Iain Kennedy thanked Mr McKerrow for his attendance at the meeting advising that all present had been enthusiastic about the support for remote and rural healthcare by NES.
6 REPORTS/MINUTES FROM PROFESSIONAL ADVISORY COMMITTEES
6.1 Area Optometric Committee
Margaret Steventon reported that a pilot scheme of e-health electronic referrals was still ongoing and that a possible roll out date of 2014 was being considered, but that this would require links into the SCI Gateway. She further advised of the Improving Eye Care Programme by which the Scottish Government plans to introduce an e-Ophthalmic programme in High Street clinicians across Scotland which will change the manner in which people are referred for specialist eye care treatment.
As regards the Patient Rights Act she reported that Mirian Morrison, Clinical Governance Development Manager had attended the meeting to discuss the requirements for independent practitioners to provide information to the NHS Board on the number of complaints they have received. It was noted that Mrs Morrison intended to visit all Professional Advisory Committees to highlight the requirements of the Act and encourage compliance. 95
As regards the Francis Report, various issues had been considered and it was noted that a response to the report would be collated for presentation to the Committee.
6.2 Psychology Advisory Committee
There had been circulated the minute of meeting held on 14 August 2013. In addition Doug Hutchison advised that the outcomes of the Demand Capacity Activity and Queue meeting (DCAQ) on 11 September were being actioned and that the aim was to further streamline the referral process. He advised that the Outcome Data Collection system would be piloted for one month commencing 1 October 2013. It was also noted that there was increased pressure on clinical accommodation as, under the terms of the lease for Larch House, no patients were permitted in the building.
As regards the NHS Whistleblowing Policy which had also been discussed, Ray Stewart suggested that this should be highlighted by all the Professional Committees.
Heidi May considered that a recurring theme in clinical groups was that of escalation and suggested that there was a culture of “learned helplessness” with staff often not understanding when the seriousness of a situation warranted escalation. It was noted that professional responsibility to speak up should be part of the everyday job. It was agreed that the Forum should revisit this theme of professional escalation and that this should be considered as an agenda item on the next meeting of the Forum.
6.3 Healthcare Scientists Forum
There had been circulated the minute of the meeting held on 1 August 2013. Anne Pollock advised that Ryan Cooper had resigned as Chair and member of the Forum and it was uncertain whether the Forum would continue to exist.
The difficulty in striking a balance between engaging staff and freeing staff to become involved was noted and it was agreed that support of colleagues and senior staff was required to cover time away from the job. It was noted that the Health Care Science Lead and the Chair of the HCSF should ideally be two different people but that the new Health Care Science Lead could fulfil this role in the interim.
It was noted that the original reason for setting up the professional groups was to enable the voice of the clinicians to be heard at Board level. Elaine Mead stressed that the groups had to be enabled to make a difference and suggested the creation of a virtual group where information could be cascaded both upwards and downwards.
If the HealthCare Science Forum was not able to continue, it was agreed to co-opt Anne Pollock to the Area Clinical Forum in the interim.
Iain Kennedy wished to record his thanks to Ryan Cooper for his significant and enthusiastic contribution to the Area Clinical Forum over the past 2 years.
At this stage Ian Rudd joined the meeting and Rob Peel left the meeting.
6.4 Area Pharmaceutical Committee
There had been circulated minute of meeting held on 29 July 2013. In addition, a further meeting had taken place on 16 September 2013 at which it was noted that the national action plan entitled the “Prescription for Excellence” would shortly be published. This was a Scottish Government publication regarding the development of pharmaceutical care in the community, in particular the chronic medication service. This document had since been published and it was agreed that this would be considered as an agenda item for the next meeting of the ACF. 96
The Forum noted the updates from the Professional Advisory Committees.
7 HIGHLAND QUALITY APPROACH (ELIMINATE HARM, ELIMINATE WASTE AND MANAGE VARIATI0N)
7.1 Developing Health Board Local Delivery Plans to Support Delivery of the 2020 Vision for Health & Social Care.
There had been circulated correspondence from John Connaghan, Health Workforce and Performance Directorate of the Scottish Government regarding plans to develop Health Board Local Delivery Plans to support the delivery of the 2020 vision for Health & Social Care and seeking views by 10 September 2013. Although this deadline had since passed Elaine Mead suggested that it would be helpful if the ACF fed into the Board position internally and it was agreed that feedback be sought from the 12 priority areas identified in the document, these being person-centred care, safe, primary care, unscheduled care, integrated care, care for multiple and chronic illnesses, early years, health inequalities, prevention, workforce, innovation, efficiency and productivity.
7.2 Highland Health & Social Care Balanced Scorecard
Iain Kennedy reminded the Forum that at its meeting on 8 August members were requested to consider the targets which the ACF considered to be most relevant and to report to the Board accordingly. Elaine Mead advised that there was a team already immersed in this task trying to identify the correct indicators and advised that some of the indicators had been commissioned by the Highland Council and were therefore unable to be removed. It was noted that much of the information was quantitative based but that there was a need also to obtain quality outcomes.
The Forum Noted the need to obtain quality outcomes.
8 DRAFT ACF DEVELOPMENT PLAN
There had been circulated report by Iain Kennedy advising of the outputs from the ACF Development Session. These had been transformed by the facilitator, Scott Dunn, into an action plan. He advised that in association with the Vice Chair this action plan would be turned into specific actions and it was agreed to submit a refined action plan to the next meeting of the Forum to allocate specific individuals to the actions. In addition, he confirmed that a follow-up meeting with Scott Dunn would take place in 2014.
The Forum Agreed that a final action plan would be submitted to a subsequent meeting.
9 NHS HIGHLAND ANNUAL REVIEW
There had been circulated letter from the Cabinet Secretary regarding the Annual Review which had taken place on 19 July 2013. The comments were generally considered positive and it was agreed that the Executive Directors should be asked for their opinion on the effectiveness of the ACF, in due course, and that this should be considered at a future meeting of the Forum. 97
The Forum Agreed to seek the opinions of the Executive Directors on the effectiveness of the ACF after ACF Members had agreed the ACF Development Action Plan.
10 HEALTH PROMOTING HEALTH SERVICE
There had been circulated correspondence from Dr Aileen Keel CBE, Deputy Chief Medical officer, regarding progress towards the creation of a Health Promoting Health Service with the vision of incorporating health improvement into daily interactions within hospital settings with the aim of changing the behaviour of patients, visitors and staff. It was noted that more strategic clinical leadership within Boards was required and it was agreed that the Forum offer assistance to the local lead on Health Promoting Health Service, Dr Margaret Somerville, Director of Public Health.
The Forum Agreed that the Chair write to the Director of Public Health offering ACF assistance with clinical leadership in the pursuit of a Health Promoting Health Service.
11 NHS HIGHLAND BOARD MEETING – 1 OCTOBER 2013
11.1 National Strategy for Learning Disability – NHS Highland Position Statement
There had been circulated a report by Jonathan Gray, Nurse Consultant, Learning Disabilities and Jan Baird, Director of Adult Care on behalf of Elaine Mead Chief Executive. It was noted that it was important for staff to understand the nature of disabilities and considered that the report should be distributed widely.
11.2 National Telehealth and Telecare Delivery Plan for Scotland – the Highland Position
There had been circulated a report by Jan Baird, Director of Adult Care, on behalf of Elaine Mead, Chief Executive regarding the National Telehealth and Telecare Delivery plan for Scotland and the Forum agreed to consider how to make maximum use of telehealth and telecare facilities for the future. It was considered that further information was required to make a balanced viewpoint.
11.3 What are the Leadership Lessons to be Learned from the Integration of Health & Social Care in North Highland?
There had been circulated a report from Evan Beswick, Service Manager, Administration, Raigmore Hospital.
11.4 SIGN 130: Brain Injury Rehabilitation in adults
There had been circulated a report by Nigel Small, Director of Operations South & Mid Operational Unit, on behalf of Deborah Jones, Chief Operating Officer. It was agreed to highlight the lack of AHP membership on the Improvement Group.
11.5 NHS Highland Asset Strategy 2013
There had been circulated a report by Eric Green, Head of Estates, on behalf of Nick Kenton, Director of Finance 98
11.6 NHS Highland Financial Position as at 31 August 2013
There had been circulated a report by Nick Kenton, Director of Finance.
11.7 Infection Prevention and Control Report
There had been circulated a report by Liz McClurg, Infection Control Manager and Dr Jonty Mills, Consultant Microbiologist/Infection Control Doctor on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control.
11.8 Chief Executive’s and Directors’ Report
There had been circulated Chief Executive’s and Directors’ Report.
The Forum Noted the circulated reports.
12 FOR INFORMATION
12.1 Attendance Record
Members were advised the Attendance Record would be updated and circulated after the meeting.
The Forum Noted the attendance record.
12.2 Dates of Future Meetings
28 November 2013
13 ITEMS FOR FUTURE ACF MEETINGS
Future Agenda items were noted as follows:
Highland Quality Approach – Point of Care update Scottish Government Community Hospitals’ Strategy Refresh Boyd Peters Professional escalation Prescription for Excellence - Ian Rudd ACF Development Plan
14 DATE OF NEXT MEETING
The next meeting will be held on 28 November 2013 at 1.30pm in the Board Room, Assynt House Inverness.
The meeting closed at 5.15 pm 99 Highland NHS Board 3 December 2013 Item 3.6(a) Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 HIGHLAND NHS BOARD Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk
MINUTE of MEETING of the NHS Board Asset Management Group Wednesday 11 September 2013 – 12.00 noon Boardroom, John Dewar Building, Inverness
Present: Alasdair Lawton, Non Executive Director and Chair Carol Marlin, Monitoring Accountant Deirdre Brindle, Capital Accountant Malcolm Iredale, Head of Procurement Bob Summers, Head of Health and Safety Ray Stewart, Staffside Rep Eric Green, Head of Estates (by VC) Derek Leslie, Director of Operations, A&B (by VC)
In Attendance: Lynda Main, Personal Assistant (minutes) Brenda Dunthorne, Head of Finance, Raigmore on behalf of Chris Lyons Ian Rudd, Principal Pharmacist on behalf of Iain Kennedy, ACF
1 WELCOME/INTRODUCTIONS
Alasdair Lawton welcomed everyone to the meeting.
Apologies for absence were received on behalf of Nick Kenton, John Bogle, Bruce Merchant, Mike Hall, John Crossley, Ian Scott, Alex Javed, Elaine Wilkinson and Bill Reid.
2 MINUTE OF THE MEETING HELD ON 23 July 2013
The minutes were approved.
3 MATTERS ARISING
Matters arising will be picked up on the agenda.
4 MONITORING REPORTS
As reported last month the contingency sum currently stands at £640k but with the anticipated disposals this amount could rise to £1.269m. Several forecasts have been received from managers, allowing more robust forecasting. To date 17% of total budget has been spent, leaving £14.3m still to spend by the year end. Estates hold the biggest budget this year therefore carries the highest risk, the endoscopy scheme in particular. Malcolm Iredale added that schemes like this need to be fast tracked after approval. 100
Action
Managers to keep Carol Marlin updated on their schemes.
5 ENDOSCOPY BUSINESS CASES
Two Business Cases were issued to the Group, one for Endoscopy Decontamination Services and the other for the reconfiguration of Endoscopy services. There are concerns about the revenue tail for the reconfiguration of services, an additional £45k of equipment is required which Carol Marlin is looking into potential funding sources(early detecting cancer?) and also an additional band 2 post – initially it was assumed no extra staff or equipment would be required.
Brenda Dunthorne had discussed the Decontamination Business Case with Anne Cosh, Head of Decontamination Services, NHS Highland and she advised that certain instruments would need to be decontaminated in a particular way and because of the time involved in doing this a significant number of new ENT scopes would be required. Carol Marlin added that additional costs required to be identified before submission to the Board.
The Group concluded that they would gather as much information to present to the Board; papers are due in tomorrow – Thursday 12 September. Carol Marlin would progress.
Actions:
Carol Marlin to look at figures for both Business Cases in order to present to the Board.
6 RAIGMORE OUTPATIENTS AND CAFÉ AREA BUSINESS CASE
An environmental health issue has been identified around the café area in the foyer at Raigmore. The Endowments Committee have offered support for the café aspect of this project.
**At this point Ray Stewart declared an interest as Head of the Endowments Committee**
The current cost estimate of the whole project is £480k with the café and associated works costing around £200k. There are however a number of options around the café. Toilets have to be provided but whether NHS Highland has to provide a café is in doubt.
The AMG agreed to support in principle this being put forward into the Capital Plan for next year and would discuss the café work with the Endowments Committee.
Actions:
Confirmation of costs to be brought to future meeting.
7 BUSINESS CASE FOR THE REPLACEMENT OF CATERING TROLLEYS, RAIGMORE
Some of the catering trolleys in use at Raigmore are around 12 years old and are no longer keeping food at the optimum temperature, 4 in particular are urgently in need of replacement. There is currently no rolling programme for the replacement of catering trolleys. 2 101
Alasdair Lawton suggested Brenda Dunthorne should come back to a future meeting with a plan for the replacement of catering trolleys for the whole of Highland not just Raigmore. The Group agreed in principle to the rolling programme, some of which will be required in the current year.
Actions:
Brenda Dunthorne to take a plan for the replacement of catering trolleys back to a future meeting.
8 THEATRE INSTRUMENTS – 2014/15 CAPITAL PLAN
It was queried which budget surgical instruments came under; Brenda Dunthorne didn’t think this was included within the medical equipment allocation, although previously some items had been purchased through the medical equipment route. The theatre manager is listing all equipment both revenue and capital for a rolling replacement programme and Brenda Dunthorne will report back to a future meeting. This could be included in the capital plan for rolling programmes.
Actions:
Brenda Dunthorne to report back to a future meeting.
9 ISOLATOR BID
Replacement of two negative pressure isolators and two positive pressure isolators at Raigmore pharmacy is required; the two negative pressure isolators are being funded with early detecting cancer funding. The bid for the two positive pressure isolators has been put through the scoring system and scored highly; the failure of this equipment will cause disruption to chemotherapy. The four isolators could be installed at once which will reduce down time.
Ian Rudd will speak with Peter Mutton who submitted the bid in order to get a robust estimate on installation costs.
In an email to Nick Kenton, John Crossley queried if this fit into the medical equipment category as it was an installation. Before making a decision on this, Alasdair Lawton would like to get a view from Nick Kenton.
Actions:
Ian Rudd to report back on installation costs.
Nick Kenton to give a view on the above.
10 A&B INTEGRATED EQUIPMENT SERVICE – PURCHASE OF PREMISES IN HELENSBURGH
The Group were asked to approve the purchase of premises in Helensburgh from the council for use as a central store for A&B Integrated Equipment Service, the cost of the purchase is £240k. If the group agreed to this purchase through Capital funding then a benefit to revenue will result, as these funds are currently indentified with the A&B CHP Change Fund allocation. It was proposed to use the contingency to funds this scheme, though if necessary a revenue to capital virement
3 102 could be sought. This purchase has the support of Nick Kenton in assisting the current revenue position of the Board.
The Group gave approval to proceed.
11 DATE OF NEXT MEETING
The next meeting will be held on Tuesday 22 October 2013 at 2.00 pm in the Ante Room, Assynt House, Inverness.
The meeting concluded at 1.35 pm.
4 103 Highland NHS Board 3 December 2013 Item 3.6(b) Assynt House Beechwood Park Inverness IV2 3BW Tel: 01463 717123 Fax: 01463 235189 HIGHLAND NHS BOARD Textphone users can contact us via Typetalk: Tel 0800 959598 www.nhshighland.scot.nhs.uk
MINUTE of MEETING of the NHS Board Asset Management Group Tuesday 22 October 2013 – 2.00 pm Ante Room, Assynt House
Present: Alasdair Lawton, Non Executive Director and Chair Nick Kenton, Director of Finance Carol Marlin, Monitoring Accountant Bruce Merchant, Public Representative Elaine Wilkinson, Non Executive Director Brenda Dunthorne, Head of Finance Ian Rudd, Principal Pharmacist John Crossley, Section Head – Medical Physics Ian Scott, Clinical Director – South & Mid
In Attendance: Sylvia McFarlane, Personal Assistant (minutes) Heather Cameron, Architectural Technician on behalf of Eric Green George Morrison, Head of Finance, Argyll & Bute (VC) on behalf of Derek Leslie Ian Ross, Head of eHealth Infrastructure Services on behalf of Bill Reid
1 WELCOME/INTRODUCTIONS
Alasdair Lawton welcomed everyone to the meeting.
Apologies for absence were received on behalf of Eric Green, John Bogle, Alex Javed, Bob Summers and Michael Hall.
2 MINUTE OF THE MEETING HELD ON 11 SEPTEMBER 2013
The minutes were approved.
3 MATTERS ARISING
Catering Trolleys – not on agenda – Still waiting for catering lead with a wider view across Area – to be carried over to the next meeting.
4 MONITORING REPORTS
No changes to SG funding this month though spend available for disposals is not showing at £0.710m. Expenditure changes show the approval for the equipment store in Helensburgh as agreed at the previous AMG meeting. Outwith the meeting NK agreed to the urgent purchase of a dishwasher at Belford. 104
The original funding for Dingwall & Drumnadrochit HS’s was £1.5m for each project. Slippage of £0.4m has been identified against Dingwall. It has been agreed by SG that we can look to manage the full resource of £3m for the 2 projects over the 3 years, and, although it looks like Dingwall will underspend, early indications are that Drumnadrochit could overspend.
This brings the in year slippage to £1.1m to date, the priority for allocating the in year slippage has to be given to advancing spend from 14/15 to preserve the integrity of the capital allocation.
Tables 1&2 and Appendix 1 show the spend to date by scheme – total spend to month 6 is at 22%, which is £3.8m of the £17.6m available, all managers indicating budgets will be spent in full in year.
5 RAIGMORE OUTPATIENTS AND CAFÉ AREA BUSINESS CASE
This Business Case was discussed at last month’s meeting and BD confirmed that an approach has subsequently been made to the Endowment’s Committee. Approval has been given for £185k which covers the estimated costs of the Coffee Bar. Raigmore Senior Management Team to review their specific Endowment Fund and hope to provide a further £15k towards the overall project. A further bid for £278k will be made from 14/15 Capital Funds for the reconfiguration and provision of disabled toilets. This will obviously need to be considered against other bids for next year’s capital.
The group discussed the process for proposed Capital Bids especially for Operational Units who may have ad hoc equipment replacement requirements. JC confirmed that information held on medical equipment could be used to provide a rolling programme of replacement to help identify replacement dates. NK suggested that a contingency fund could be set aside for unforeseen equipment replacement needs.
Ian Rudd joined the meeting.
6 ISOLATOR BID
IR confirmed the Business Case has yet to be finalised as awaiting quotes from external contractors to confirm actual costs against estimated costs. This item to be carried forward to next month’s meeting.
7 ADDITONAL FUNDING – PATIENT MANAGEMENT SYSTEMS (PMS) IMPLEMENTATION
The PMS Business Case was approved in December 2012 and the contract commenced 1/4/13 although due to difficulties, the go live date has been revised from 11/11/13 to 3/3/14.
Additional hardware and software is required, together with the extension to the go live date this will incur added expenditure. Total funding requested £371,000 from this year’s fund. Phase 2 next year will require further capital funding.
The delay is due to data migration merging complications and the exercise has been greater than was first considered by both eHealth and the Contractor.
EW requested clarification on the split of the additional funding requested relating to the delay in the contract and the additional hardware/software. IR confirmed the hardware is not replacement PCs, it is, core hardware.
2 105
The group approved the additional funding in principal but need confirmation on the governance around approval of funding of such a significant sum against the original approved capital bid. Full approval is required within six weeks as 3 March 2014 deadline approaches.
8 eHealth REPLACEMENT PROGRAMME
IR requested £724k from this year’s budget to fund replacement of critical items as noted in his bid of 11/11/13.
The group discussed available eHealth Capital funding for next year and the remaining available capital monies from this year. The group discussed the elements which make up the bid. IR confirmed the bid was primarily to maintain what we currently have and not to enhance our systems.
The group gave approval to proceed - the £724k approval if for this year 13/14 – but is being pulled forward from the eHealth £1m allocation for 14/15.
Iain Scott left the meeting.
9 REPLACEMENT ESTATES VANS
The group were asked to approve the replacement of Estates Vans.
Estates vans are currently leased through national contract and 14 of the 22 vans are due to be replaced as the 5 year lease is coming to an end. The proposal discussed is to replace existing fleet of Vauxhall Astra, Combo and Vivaro vans with Volkswagen Caddy & Transporter vans, resulting in increased fuel efficiency and a reduction in carbon emissions. The group were advised that there is no capital costs to this as this was a revenue funded replacement lease and is included in all financial plans and forecasts.
George Morrison to look into this for A&B area.
The group gave approval to proceed.
10 SECURITY IMPROVEMENTS – QUEEN ELIZABETH WING – CAITHNESS GENERAL HOSPITAL
The group were asked to approve the upgrading of the security arrangements at CGH Queen Elizabeth Wing – Rehabilitation Unit. To modernise the security arrangements to assist staff in caring for patient group at a Capital cost of £17k for the replacement of security devices and some doors to accommodate these devices. This will ensure patient safety. The group were advised that a review of security prompted this request.
The group gave approval to proceed
11 REPLACEMENT MEDICAL AIR PLANT – CAITHNESS GENERAL HOSPITAL
The group were asked to approve the replacement of Medical Gas Manifold at Caithness General Hospital at a cost of £15k. The existing gas manifold is 25years old and has been
3 106 obsolete for a number of years and spare parts are now not available. Replacement will ensure a reliable system and reduction in oxygen costs.
The group gave approval to proceed.
12 COLL DOCTORS HOUSE
The group were asked to approve the upgrading of the Coll Doctors House at a cost of £45k. EG aware of this as discussed with Derek Leslie.
Agreed from 13/14 slippage
13 SG FEEDBACK - ASSET MANAGEMENT STRATEGY
NK advised group there had been positive feedback from Scottish Government for Asset Management Strategy. Overall document was well presented, easy to understand and achieved 4 out of 5 for the estate part of the document, and lower scores for other asset types.
14 BUSINESS CASE APPROVAL PROCESS
To be taken forward NK & EG. Bring to further meetings.
15 A.O.C.B.
JC asked the group re replacement of Medical Equipment. The group advised that bids/costing on this requirement be taken to further meeting.
Bob Summers – It was agreed that BS should be invited to attend any future AMG meetings
16 DATE OF NEXT MEETING
The next meeting will take place on Thursday 14 November 2013 at 10.00am in the Committee Room at John Dewar Building, Highlander Way, Inverness
4 107 Highland NHS Board 3 December 2013 Item 3.7
PHARMACY PRACTICES COMMITTEE MEETING – TUESDAY, 8 OCTOBER 2013 AT 12.45 PM – UNIT 1C, DISTRICT CENTRE, MILTON OF LEYS, INVERNESS, IV2 6GP
Report by Helen M MacDonald, Community Pharmacy Business Manager on behalf of Okain McLennan, Pharmacy Practices Committee Chair
The Board is asked to:
Note the decision of the Pharmacy Practices Committee.
NHS (Pharmaceutical Services)(Scotland) Regulations 2009 Provision on Control of Entry to Pharmaceutical Lists Under these Regulations each Health Board must establish a Pharmacy Practices Committee (PPC) with membership defined as 3 pharmacists, 3 lay persons and a chair who is a member of the Board. If the application being considered is in a neighbourhood where there is a dispensing doctor then a further member is appointed by the GP Sub- Committee on behalf of the Area Medical Committee.
Under the Regulations the Board unconditionally delegates its function to assess and determine the need for additional pharmacy contracts or services to the PPC and the decision of the PPC is final. The PPC is concerned only with NHS contract services and the provision of NHS pharmaceutical services.
1 Background and Summary
The Committee was asked to consider the application submitted by Sanjay Majhu of Apple Pharmacy Group to provide general pharmaceutical services from premises sited at Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP, under Regulation 5(10) of the National Health Service (Pharmaceutical Services) (Scotland) Regulations 2009, as amended.
The Committee had to determine whether the granting of the application was necessary or desirable to secure the adequate provision of pharmaceutical services in the neighbourhood in which the Applicant’s proposed premises were located.
2 Decision
The Pharmacy Practices Committee saw no pharmaceutical services within the neighbourhood and in determining adequacy witnessed that current services provided from outwith the neighbourhood are only accessed with difficulty. Therefore they agreed that it would be necessary to grant the application in order to secure adequate provision of pharmaceutical services in the neighbourhood.
In addition they also considered that future developments notably a further increase in housing would put further strain on the existing services 108
The Chair invited members of the Committee to vote on the application by Sanjay Majhu of Apple Pharmacy Group to provide pharmaceutical services at the Unit 1C, District Centre, Milton of Leys, Inverness, IV2 6GP. The Committee unanimously agreed to grant the application.
Full notes of the hearing may be viewed on the NHS Highland website via the following link:
http://www.nhshighland.scot.nhs.uk/Meetings/PharmacyPracticesCommittee/Pages/welcome .aspx
Helen M MacDonald Community Pharmacy Business Manager Integrated Pharmacy
22 November 2013
2 109 Highland NHS Board 3 December 2013 Item 3.8 The Highland Council
Minutes of Meeting of the Adult and Children’s Services Committee held in the Council Chamber, Council Headquarters, Glenurquhart Road, Inverness on Wednesday 25 September 2013 at 10.05 am.
Present:
Highland Council:
Dr D Alston Ms L Munro Mrs I Campbell Mrs M Paterson Mr A Christie (Chair) Mr M Rattray Mrs M Davidson Mrs F Robertson Ms J Douglas Ms G Ross Mr B Fernie Mr G Ross Mr K Gowans Ms J Slater Mr M Green Ms M Smith Mr E Hunter Ms K Stephen Mrs D Mackay Ms A Taylor (Youth Convener) Mr G MacKenzie (Vice Chair)
NHS Highland:
Mrs M Duncan Mrs G McCreath Dr M Somerville
Religious Representatives:
Ms M McCulloch Mr G Smith
Non-Members also present:
Mr B Clark Mr G Rimell Mrs L MacDonald Mr J Stone
In attendance:
Mr H Fraser, Director of Education, Culture and Sport Mr B Alexander, Director of Health and Social Care Mr R MacKenzie, Head of Support Services, Education, Culture and Sport Service Mr C MacSween, Head of Education, Education, Culture and Sport Service/Health and Social Care Service Mr J Steven, Head of Education (Designate), Education, Culture and Sport Service/Health and Social Care Service Ms F Palin, Head of Social Care, Health and Social Care Service Mr M Vogan, Service Information and Support Manager, Education, Culture and Sport Service Mr A Robb, Principal Service Information Officer, Education, Culture and Sport Service Mrs B Cairns, Principal Officer, Additional Support Needs, Education, Culture and Sport Service Mr E Foster, Finance Manager (Education, Culture and Sport and Health and Social Care) Mr R Campbell, Estate Strategy Manager, Education, Culture and Sport Service Ms S Russel, Principal Officer Nursing, Health and Social Care Service Mr C Munro, Highland Children’s Forum (Third Sector) Ms V Gale, Care and Learning Alliance (Third Sector) 110
Miss J Maclennan, Principal Administrator, Chief Executive’s Office Miss M Murray, Committee Administrator, Chief Executive’s Office
Also in attendance:
Ms C Baxter, Children’s Consultation Lead, Highland Children’s Forum Ms K MacKay, Infant Feeding Advisor, NHS Highland Mr P Mascarenhas, Principal Adult and Youth Services Officer, High Life Highland
An asterisk in the margin denotes a recommendation to the Council. All decisions with no marking in the margin are delegated to the Committee.
Mr A Christie in the Chair
Business
Preliminaries
The Chairman informed Members that this would be the last meeting attended by Mr Calum MacSween who was to leave the Council’s service on 27 September 2013. Mr MacSween had served the Council as both a Head Teacher and as Head of Education. Appreciation was expressed by Members for his input, professional manner and dedication towards improving the outcomes of young people in Highland. Reference was made to his achievements as a Head Teacher and the skills and experience he had brought to the service in his role as Head of Education.
Members also expressed their best wishes to Mr B Gormley and wished him a speedy recovery.
1. Apologies for Absence Leisgeulan
Apologies for absence were intimated on behalf of Mr B Gormley, Mr D Hendry, Mr T MacLennan, Mrs B McAllister and Rev C Mayo.
2. Declarations of Interest Foillseachaidhean Com-pàirt
The Committee NOTED the following declarations of interest:-
Item 6i – Ms J Douglas and Mr K Gowans (non-financial) Item 6ii – Mrs G McCreath (financial) Item 7i – Ms J Douglas, Mr K Gowans and Mrs F Robertson (non-financial) Item 14ii - Ms J Douglas and Mr K Gowans (non-financial)
Ms G Ross declared a financial interest in those items which might raise discussion on Thurso High School, as her husband was a teacher at the School, and advised that if there was any specific discussion in relation to Thurso High School she would leave the room.
Dr D Alston declared a non-financial interest in those items relating to integrated health and social care services as a Board Member of NHS Highland but, in terms of the dispensation granted by the Standards Commission, remained to participate in discussion. 111
3. Presentation: Curriculum for Excellence Taisbeanadh: Curraicealam airson Sàr-mhathais
The Head of Education undertook a presentation on progress in developing and implementing Curriculum for Excellence. This was now the tenth year of Curriculum for Excellence and a full review of the approach in Highland had been provided to Members some time earlier. In addition, there had been tabled at the meeting a Government produced summary, primarily prepared for parents.
Mr MacSween advised that the Curriculum for Excellence was the culmination of a period of 20 years of successful curriculum building and had been developed over three separate phases. It was now applied from early years, through broad general education to the senior phase and centred on developing four main capacities in young people: successful learners, confident individuals, responsible citizens and effective contributors. The challenge was to prepare young people for a world in which they would have to learn, unlearn and relearn skills, constantly have to upgrade their knowledge and for a world in which they would have to change jobs more than in any previous generation. The aim was to develop resilient learners to meet the aspiration of the 2002 National Debate Report that all children and young people should share the opportunities previously enjoyed by the majority.
Mr J Steven, Head of Education (designate) undertook a presentation on the present situation, current priorities and the next steps in implementation. He confirmed that the approach adopted in Highland had been to allow individual schools to develop their own flexibility in meeting the requirements of the Curriculum for Excellence. Key national documents had recently been produced: the Inspection Advice Note 2013/14 and the Curriculum for Excellence Implementation Plan 2013/14. These fitted well with Highland documents: Highland Steer for Primary and Secondary, Education Service 3 year strategic plan and the Highland Strategy summary.
In terms of next steps there was a huge agenda of future work and challenges. This would involve work on the Curriculum itself: the curriculum structures, how this applied to broad general education and a review of senior phases. Successful developments had been made on pastoral work for transition from primary to secondary but there was now a need for additional work in this area in the context of the Curriculum for Excellence. Literacy, numeracy and health and wellbeing were areas on which schools had appreciated flexibility and on which much developmental work had been carried out.
The skills for life, learning and work strategy was a vital aspect of Curriculum for Excellence and successes in these areas would be further developed. Much attention had been given to vocational courses but links would be forged with the University of the Highlands and Islands. The 16+ strategy would also play a vital role in ensuring positive destinations for young people.
Learning/teaching styles and assessment were constantly being developed and focussed more closely on engagement with young people. Support for learners was essential to ensure that young people received the support they needed to move onto their next stage in life. An update was provided on monitoring/tracking, qualifications and reporting to parents. Work done on profiles and examinations still played a vital role.
Schools still needed flexibility to find their way through the self-evaluation process to assess whether or not they were making the most of their resources and if they were using reliable data on which to base future developments. Communication with pupils and 112 parents was essential and the work undertaken by staff was commended. This had been supported by the work of the Quality Improvement Team, Curriculum Development Officers and partners outwith the schools. In conclusion, while significant progress had been made, it was recognised that this was an on-going process of further development.
During discussion, Members thanked Mr MacSween and Mr Steven for their presentations. It would be important to ensure examples of best practice were replicated throughout the Highlands and to build on the firm foundations that had been created. It was also important to ensure that communication with parents regarding the Curriculum for Excellence was clear and concise.
In particular, Mr MacSween was commended for the work he had undertaken, particularly at Tain Royal Academy and more generally in exposing the issue of school exclusions. Children’s needs and development had always been at the centre of his considerations and this was also reflected as a key element of the Curriculum for Excellence.
Thereafter, the Committee NOTED the presentation.
4. Membership of Sub-Committees Ballrachd Fho-chomataidhean
The Committee AGREED the following:-
Criminal Justice Sub-Committee – Mr M Green to replace Mrs F Robertson
5. Appointment of Representative to Highland Children’s Trust Cur Riochdaire an Dreuchd gu Urras Chloinne na Gàidhealtachd
The Committee was advised that the Highland Children’s Trust provided financial assistance to needy children and young people up to the age of 25 who were resident in, or had some connection to, Highland. The Trust’s Board comprised 5 Governors, one of whom was appointed by the Highland Council.
The Committee AGREED to appoint Mrs M Paterson to the Highland Children’s Trust.
6. Revenue Budget 2013/14 – Monitoring Buidseat Teachd-a-steach 2013/14 – Sgrùdadh i. Education, Culture and Sport Foghlam, Cultar agus Spòrs
Declarations of Interest: Ms J Douglas and Mr K Gowans declared non-financial interests in this item on the grounds of being Directors of High Life Highland but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that their interests did not preclude their involvement in the discussion.
There had been circulated Report No ACS/84/13 dated 16 September 2013 by the Director of Education, Culture and Sport which set out the Revenue Budget monitoring position for the four months to 31 July 2013 and the year-end outlook position.
The current estimated year-end position was an overspend of £0.855M. However, management actions were being progressed which could reduce this figure by a 113 further £0.200M. The main budget pressures, details of which were provided in the report, related to Additional Support Needs; School Transport; and Catering, Cleaning and Facilities Management. In recognition of the urgent requirement to offset the budget pressures, an instruction had been issued by the Director that only essential expenditure should be incurred and, wherever possible, filling of vacant posts should be delayed. Management actions to identify compensatory savings would continue throughout the financial year.
Clarification was provided in relation to the Devolved School Budget section of the report which should have read at section 2.6 “where a school has a surplus of 5%...”
During discussion, Members commented as follows:-
regarding the Devolved School Budgets, while acknowledging that final outturns would not be known until the end of the financial year, it was queried whether information could be presented on any potential variances on this budget since this was an area of risk; the details reported on school absence cover represented a challenging and complex situation and it was requested that a more detailed report be brought back to the Committee. In particular, information would be helpful on the impact that the lack of supply teachers had on other staff, Head Teachers and on pupils’ education. There was a need to address this issue as a matter of urgency, particularly since pressure on absence cover was most acute over autumn/winter months. It would also be helpful if the report could address long-term and short- term absences separately; in Highland there was currently a total of 9002 children who had additional support needs and staff were commended for the level of support that was currently provided. This represented a hugely complex situation with varying arrangements of support for each child. It was queried whether Area Managers would be required to account for the £921,000 overspend when setting budgets for future years and, since the Review Group would report by November this year, it was unclear why forecasts were being made from April to August 2014; it was acknowledged that there were other factors affecting services for children with additional support needs. In particular, many third sector organisations were relying on balances to fund their activities which increased the risk for the future of those services. Families had been affected by welfare reform and the Council’s budget pressures e.g. school transport. It was queried whether a family perspective could be prioritised, particularly for families on low incomes and for families with children with additional support needs; the Sutherland school transport model was entering a period of transition and it would be important to be fully apprised of all relevant issues and seek the views of the Head Teacher and Local Members. This covered a vast geographical area and transport was a key challenge to ensure that pupils were not disadvantaged. It was hoped that the most appropriate forum for this to be discussed would be the Area Committee; it would be helpful to have information on where staff vacancies were being held; in relation to school transport issues, it was queried what timescales had been put in place and what dedicated resources would be available to oversee the actions required; and it was suggested that further discussion should address how school Business Support could more effectively provide assistance for Head Teachers. 114
The Chairman confirmed that methods of monitoring and identifying variances throughout the financial year in the Devolved School Budget would be sought and an update presented to the next meeting of the Committee. The allocation model was a tool to ensure a transparent and robust way of allocating resources to schools. However, there were increasing demands on the additional support needs budget and there was a clear need for information on population growth to be built into the budget setting process.
School absence cover represented a very pertinent issue and would be reported to an early future meeting of the Committee. Officers were meeting with representatives of Primary Head Teachers in the very near future to address the issue of supply and absence cover and to establish more local ways of advertising vacancies. The meeting would also provide a forum for discussion on other issues raised during debate: a family approach to services for low income families and families with children with additional support needs. It would also provide an opportunity to address the need for shared Business Support to relieve administrative pressures on Head Teachers. The outcome of this meeting would be fed into any future report or briefing note to Members on this issue.
The Chairman also confirmed that it would be appropriate for the issue of Sutherland school transport to be discussed at the Area Committee so as to provide a local input and guidance on any potential solution.
The Committee:-
i. NOTED the current year-end position and the management actions identified so far to partially offset the known budget pressures; ii. NOTED the actions being progressed in relation to the Additional Support Needs budget; iii. AGREED that options for funding a dedicated resource to deliver efficiencies in the deployment of school transport were progressed in conjunction with the Director of Transport, Environmental and Community Services; iv. NOTED the actions being progressed in relation to School Catering, in particular the analysis of the net cost of school meal provision on a school-by-school basis; v. NOTED the progress being made with achievement of budget savings in the current financial year; vi. AGREED, in relation to Devolved School Management budgets, that a means of providing variances earlier in the financial year be explored and an update be presented to the next meeting of the Committee; and vii. AGREED that a detailed report on the issues surrounding school absence cover be presented to a future meeting of the Committee. ii. Health and Social Care Slàinte agus Cùram Sòisealta
Declaration of Interest: Mrs G McCreath declared a financial interest in this item as a foster carer and advised that if there was any specific discussion in relation to fostering she would leave the room.
There had been circulated Report No ACS/85/13 dated 16 September 2013 by the Director of Health and Social Care which set out the revenue monitoring statement for the four months to 31 July 2013.
The current estimated year-end position was an overspend of £0.163M, a deterioration from the previous monitoring position reported to the Committee which indicated a 115 balanced budget. The changed position was largely due to two factors: revised assumptions of savings from staff vacancies due to the reduced level of current vacancies and overspend on Section 22 welfare payments, details of which were provided in the report. As previously reported to the Committee, there was continuing overspend on out of authority placements and a breakdown of current placements was provided.
Responding to questions, it was confirmed that there was a clear link between those receiving assistance under Section 22 of the Children (Scotland) Act 1995 and those receiving assistance under the Scottish Welfare Fund. However, there was a cohort under Section 22 who would not normally be eligible to receive assistance under the Scottish Welfare Fund. This was an issue that was currently being investigated with the Depute Leader of the Council and the Chair of the Finance, Housing and Resources Committee to ensure that budgets and expenditure were aligned properly.
The Service continued to manage overspends in certain areas, particularly expenditure for looked after children, through a range of compensatory measures including savings made possible through vacancy management. The level of underspends because of vacancies in Social Care, Nursing and Education Psychology was less than last year. The Council had awarded the Service funding for additional staffing and proposals on the allocation of this funding would be presented to the next meeting of the Committee.
The overall number of looked after children had begun to fall significantly. Practitioners and the Children’s Hearing system were confident that services were now in place to avoid the need for compulsory measures. There had, as yet, not been any impact on the numbers of out of authority placements but this was expected to fall at a future date. This situation was susceptible to a range of challenges, not least welfare reform.
The Committee NOTED the budget monitoring position.
7. Capital Expenditure 2013/14 – Monitoring Caiteachas Calpa 2013/14 - Sgrùdadh i. Education, Culture and Sport Foghlam, Cultar agus Spòrs
Declarations of Interest:
Ms J Douglas and Mr K Gowans declared non-financial interests in this item on the grounds of being Directors of High Life Highland but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that their interests did not preclude their involvement in the discussion.
Mrs F Robertson declared a non-financial interest in this item as Vice Chairman of Tain Royal Academy Parent Council but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the Councillors’ Code of Conduct, concluded that her interest did not preclude her involvement in the discussion.
There had been circulated Report No ACS/86/13 dated 17 September 2013 by the Director of Education, Culture and Sport which informed Members of progress on the 2013/14 Education, Culture and Sport capital programme and sought approval for new projects as well as amendments to the budgets for several projects. The report also provided an update on the Sustainable School Estate Review and on-going measures to improve communication and performance. It also advised on a proposal to provide 116 additional accommodation at Spean Bridge Primary School and, during a summary of the report, further details of this were presented.
A review of the anticipated year-end position for all projects and budget headings was currently being undertaken and the outcome would be reported to the Committee on 13 November 2013. The report provided an update on the status of the major capital projects currently being progressed and it was highlighted that the Portree Hostel and Thurso Library projects were now on the list. The new Portree Gaelic Primary School project had also been initiated and plans were being formulated for an access road and demolition of the existing hostel.
In amplification of the report, it was confirmed that following recent developments, the Wick Community Campus would be handed over to the Council in February 2016 with the new schools becoming operational in April 2016. The school north of the river would be operational by August 2015. Revised timescales had been agreed with Hub North Scotland Ltd and Miller Construction UK and communicated to Local Members and the Stakeholder Group.
During discussion, Members raised a range of issues, including the following:-
with disappointment expressed at the delay in the Wick Community Campus project, it was unclear as to why the delay had occurred and a request for further information was made; the poor standard of the St Duthus School building had been raised before and it was disappointing that pupils would have to endure another winter in the building. This raised issues regarding how the Council looked after vulnerable groups. It was hoped that there would be no obstacles to progress emerging from the Planning system. A realistic timeframe for the provision of new modular accommodation was requested so as to maintain the confidence of pupils, parents and staff; it had previously been understood that the consultation on the Tain Royal Academy Associated School Group would commence in November but the report did not confirm this commitment. The November date had been advertised to Parent Councils and Community Councils and further clarification on this was requested; good progress had been made at St Clement’s School. However, parents and staff looked forward to the work continuing and particular reference was made to the car park which was still in a poor condition; it would be useful to review the main issues arising from the Ben Wyvis Primary School project. While parents, pupils and teachers were delighted with progress, there were still some negative issues outstanding that could have been prevented at an earlier stage and the review would highlight these; consideration should be given to involving the Council’s Internal Audit staff when reviewing large-scale projects rather than paying for expensive external consultants; it was hoped that for the Spean Bridge Primary School project, as with other PPP Projects, traditional janitorial support could be maintained; regarding the Wick project, Audit Scotland should be involved in addressing the activity and arrangements of Hub North Scotland Ltd as delays of this nature were costly; the buildings at the Black Isle Education Centre were now in a dreadful state and it would be costly to repair them. This facility provided services to a small number of young people but they deserved a better message of their worth. There might be 117
alternative and better ways of meeting the needs of these young people, perhaps even with third sector assistance; there were still no timescales available for the Sustainable School Estate Review in the Plockton Associated School Group. This was now becoming an issue as many parents were choosing to send their children to other schools; further clarification was requested as to why building condition surveys required to be validated as this appeared to be duplication; the introduction of a standard report for tracking issues at Ward level would be rolled out at Ward business meetings in the coming months. However, concern was expressed at this vague timeframe and, if it had already been agreed, it should be implemented straightaway; and the work carried out at Milton of Leys Primary school was particularly welcomed and had been a credit to all who had been involved.
Responding to these comments, an explanation was offered for the rescheduling of the Wick Community Campus project. The original dates were not achievable because the design and procurement packages had not progressed at the necessary pace. A combination of factors had caused delays in the design and associated work packages and a pragmatic reassessment of timeframes had been required.
Regarding the Tain Associated School Group, it was still the intention to propose a location for this facility to the November meeting of the Committee. Once a site had been agreed, proposals could be brought forward for a statutory consultation to build the campus on the site. Regarding St Duthus School, all planning issues had to be addressed in advance and a briefing note would be provided to Local Members.
The Chairman confirmed that it was important to bring back to Committee the audits and reappraisals of large-scale projects so that lessons could be learned on a continuing basis.
The Committee:-
i. NOTED the status of the 2013/14 capital programme at the end of July 2013 as detailed in Appendix 1 of the report; ii. NOTED the status of the major capital projects as detailed in Appendix 2 of the report; iii. AGREED the new projects and amendments to existing budget allocations as detailed in Section 3 of the report; iv. NOTED the status of the Sustainable School Estate Review as detailed in Section 4 of the report; v. NOTED the progress on measures to improve communication with Ward Members and on the post project review of the Ben Wyvis Primary School project as detailed in Section 5 of the report; vi. AGREED the proposed provision of additional accommodation at Spean Bridge Primary School; vii. AGREED that a timetable and update in respect of the Sustainable School Estate Review in the Plockton Associated School Group be provided to Local Members; viii. AGREED, in relation to Building Condition Surveys, that a timetable, together with an explanation of the complexity of the exercise, be provided to Members of the Committee; and ix. AGREED that a timetable for the introduction of the standard report for tracking issues at Ward level be provided to Members of the Committee. ii. Health and Social Care 118
Slàinte agus Cùram Sòisealta
There had been circulated Report No ACS/87/13 dated 16 September 2013 by the Director of Health and Social Care which updated Members on progress to date with the Health and Social Care Capital programme and provided a monitoring report on expenditure as at 31 July 2013 and an update on work being undertaken on fire safety and other health and safety capital works.
The budget for 2013/14 was £3.914M and expenditure to date was £0.677M which represented 17% of the budget. At this stage in the financial year, it was anticipated that the budget would be fully spent. Information was provided on a number of major projects, namely, Grant House in Grantown-on-Spey, Invernevis House in Fort William and Ach an Eas in Inverness. In relation to the new Children’s Unit in Caithness, contractors were on site and completion was due at the end of the June 2014.
The Committee APPROVED the report and budgetary position.
8. Performance Report – Children’s Services Aithisg air Dèanadas – Seirbheisean Chloinne
There had been circulated Report No ACS/88/13 dated 16 September 2013 by the Director of Health and Social Care which provided an update on the Performance Framework for Children’s Services.
The Performance Framework had been agreed by the Council and NHS Highland as part of the lead agency arrangements and the performance report was presented to NHS Highland as well as to the Adult and Children’s Services Committee. The report provided commentary on a number of measures where performance was not broadly on target or was otherwise of note.
During discussion, Members welcomed the progress on some indicators, particularly the increase in the number of statutory health assessments carried out within four weeks of children becoming Looked After, and commended all those involved.
In relation to kinship care, whilst recognising the efforts which had been made in recent years, disappointment was expressed that the number of Looked After Children supported in this manner remained at around 20%. A report was requested on how the Practice Model was impacting on different groups of Looked After Children and how an increase in kinship care might be achieved.
With regard to the Performance Framework, the Chairman confirmed that it continued to be refined and new performance indicators would be submitted in the future. The Committee would have the opportunity to examine the dynamics within the indicator headings and where action was needed to improve children’s services during the life of For Highland’s Children 4 (FHC4).
In response to questions, it was explained that data was collected monthly, quarterly, six-monthly and annually. The Committee usually only received new data but the full list of indicators was presented periodically and could be provided at any time. With regard to child healthy weight, the target for interventions continued to be met and was ahead of the trajectory. 119
Thereafter, the Committee:-
i. NOTED the performance information; and ii. AGREED that a report be presented to a future meeting of the Committee on how the Practice Model was impacting on different groups of Looked After Children and how an increase in kinship care might be achieved.
9. Support for Breastfeeding Taic airson Biadhadh-broillich
There had been circulated Report No ACS/89/13 dated 16 September 2013 by the Director of Health and Social Care which outlined the current breastfeeding rates in Highland and described the work underway to increase breastfeeding awareness, promotion and rates over the next few years.
The report explained that breastfeeding statistics were derived from data collected by Health Visitors, normally around 10 to 14 days post-birth and again at 6 to 8 weeks. During these contact visits, the Health Visitor recorded the method of feeding on the Child Health Surveillance Programme form. At the 6 to 8 week check, a GP carried out a medical examination of the baby and, following this, the form was returned to NHS Highland so that the data could be entered on to the national system. A HEAT target was launched in 2007 to increase the proportion of babies being fed breast milk exclusively at 6 to 8 weeks to 33.3% and statistics were provided on rates in Highland in comparison with Argyll and Bute and Scotland as a whole. These showed that, in 2011/12, nearly 40% of babies in Highland received breast milk and 31% were exclusively breastfed. Information was also provided on the work being undertaken to improve the rate of return of the 6 to 8 week review forms. A range of actions had already been implemented to support mothers to breastfeed their babies and these were detailed in the report together with proposed further actions to improve breastfeeding rates.
The Director emphasised the importance of support for breastfeeding and that it was a priority to monitor and evaluate the impact of the various activities in the report on breastfeeding rates. Rates in Highland were higher than much of the rest of Scotland but the aim was to excel and increase rates considerably. In relation to Child Health Surveillance Programme forms, it was highlighted that non-returns did not count as a “zero” towards the overall breastfeeding rate as indicated in the report.
During discussion, the following comments were made:-
the importance of peer support was emphasised and the work of peer volunteers was commended. The team approach, with volunteers receiving the same UNICEF training programme as trained staff, was welcomed; the wide range of activity being undertaken was also welcomed. In particular, the Facebook page offering support from peers, including a myth-buster section, was helpful and it would be beneficial to circulate the information contained therein to a wider audience; in relation to the re-launch of the “baby welcome” sticker scheme, it was suggested this should be on an “opt out” basis whereby all premises would be assumed to be breastfeeding friendly unless otherwise indicated; the importance of monitoring and evaluating the impact of the various activities being undertaken was emphasised and it was suggested that a progress report be presented in six months’ time; 120
it was important to promote the ease and cost-free nature of breastfeeding as well as the health benefits to both mother and baby; breastfeeding was a prime example of early intervention and preventative spend and it was important to invest in it to improve outcomes later in life; the excellent work being undertaken by the Infant Feeding Adviser was commended. However, there was currently only one such post covering Highland and Argyll and Bute and there were issues to be addressed in terms of capacity if the desired increase in rates was going to be realised. It would not be possible to offer bespoke solutions to target different areas unless capacity was increased; there were lessons to be learnt from other countries with high breastfeeding rates and it was suggested that a follow-up report examining best practice, how it could be implemented in Highland, existing resources and what else could be done to support breastfeeding be presented to a future meeting; and information was sought on the age of mothers and the level of family support they had.
In response to questions, it was explained that:-
in Raigmore Hospital, peer volunteers had assisted with the UNICEF assessment and were now very much seen as part of the team. It had been more difficult to introduce volunteers in Caithness General Hospital as it had a much smaller number of staff. However, the hospital was going for reaccreditation in February 2014 and it was intended to use the same approach as adopted in Raigmore. Work was already underway in that regard and two new volunteers had just completed their training; teenage mothers were the most likely not to breastfeed and targeted work was being undertaken which included working with family nurse practitioners and Barnardo’s Bump and providing antenatal to postnatal peer support. Three mothers, aged 16 to 19, had just undergone peer training and a new support group had been established in the Hilton area in partnership with the Archie Foundation; in relation to monitoring and evaluation, the Early Years Collaborative approach of carrying out small tests of change was proving to be an effective improvement model; and areas of deprivation in relation to breastfeeding were mapped out and could be included in the proposed follow-up report together with information on the reasons women decided not to breastfeed.
Ms V Gale, Care and Learning Alliance, highlighted that there were a significant number of third sector toddler groups throughout Highland which would be a valuable platform to promote breastfeeding and identify future peer support volunteers. It was suggested that toddler group facilitators work in collaboration with the Infant Feeding Adviser and her extended team to build upon the good work already being undertaken.
Thereafter, the Committee:- i. NOTED the actions in place to improve data collection and the work underway to support increased rates of breastfeeding; and ii. AGREED that a follow-up report, taking into account the points raised during discussion, be presented to a future meeting of the Committee. 121
10. “Being A Part, Not Apart” - Highland Children’s Forum Inclusion Report “Being A Part, Not Apart” - Aithisg In-ghabhaltais Fòram Chloinne na Gàidhealtachd
There had been circulated joint Report No ACS/90/13 dated 17 September 2013 by the Directors of Education, Culture and Sport and Health and Social Care which introduced a presentation by Highland Children’s Forum (HCF) on their inclusion report, “Being A Part, Not Apart”, which had been circulated separately as Booklet A.
The report explained that the term “inclusion” meant embracing all people, irrespective of race, gender, disability or other need. It involved equal access and opportunities and the elimination of discrimination and intolerance. For young people growing up, inclusion was about learning how to become a full and responsible member of society and being included in all aspects of that society.
HCF was contracted by the Council to represent the views of young people and families with additional needs. It had provided a series of reports on the issue of inclusion - for example, “What Difference Would There Be If Children’s Experience Framed Policy?” was published in 2005. Inclusion also formed part of the “Are We There Yet?” study in 2008. The latest report, “Being A Part, not Apart”, revisited some of the issues in the previous reports and considered whether there had been changes or improvements in the level of inclusion for Highland’s children and young people.
Ms C Baxter, Children’s Consultation Lead, HCF then undertook a presentation during which it was explained that over 500 children and young people had been consulted as well as 27 parents and 24 service providers. The consultation had been carried out in urban, rural and sparsely populated areas of Highland and the Associated School Group in each area had been approached with the proposal which took the form of an activity relevant to Curriculum for Excellence.
In terms of the children’s responses, of the range of 14 additional medical and social needs examined, the most common need was that someone the child loved had died or left home. Children, particularly at primary school age, attended a wide range of activities and the most common response, when asked if they had felt excluded, was that they had never felt excluded. There appeared to be a correlation between feeling included/excluded and happiness, wellbeing, self-esteem and confidence and contexts involving friends and family scored high in both the included and excluded responses. Whilst children with specific additional needs had positive experiences to relate, there were a number of barriers to their inclusion – for example, accessible literature for visually impaired children often had to be ordered in and there was a lack of educational options for those with Autistic Spectrum Disorders (ASD). Children with additional needs had experienced varying levels of support and understanding, with those diagnosed at the beginning of their school life appearing to fare better than those diagnosed later. For children and young people who were either non or part attenders at school, particularly those on the autistic spectrum, the amount of support was not the critical factor but rather it was the school environment they could not cope with.
Head Teachers, parents and service providers had been asked to comment on what contributed to inclusion in schools; what worked well; and barriers to inclusion, whether structural, environmental or attitudinal. Their responses, as set out in detail in the inclusion report, were summarised. 122
The report contained a number of recommendations in terms of reducing barriers. For example, in terms of attitudinal barriers, it was proposed that training be examined to ensure there was not only sufficient basic training but also more specialised training in specific conditions and behaviour management. Service providers and schools appeared to be maintaining the status quo but, to prevent regression, inclusion training and support for ASN should not be further reduced. In relation to environmental barriers, there should be more consultation with children and young people with a disability to ensure that public spaces and buildings were fit for purpose. With regard to structural barriers, children with ASD were not always best served by integration within mainstream education and planning should be more individual and timely to reduce the numbers either not in education or attending part-time.
In conclusion, there did not appear to be a significant improvement in inclusion but, equally, there did not appear to be a significant deterioration. There did seem to be some crystallisation of views – for example, the parents view that mainstream education was not the right place for children with ASD. In addition, there would be serious implications for the support of inclusion and children and young people’s experience of it if the budgetary situation became more challenging.
During discussion, the following comments were made:-
the comprehensive and thought-provoking report was welcomed; the importance of progressing the recommendations contained in the inclusion report to improve outcomes was emphasised and a cross-service report was sought in this regard; it was important that the topics in the report were taken into consideration in FHC4, the ASN Review and the next budget setting process; it was essential to recognise the rights of the child and that enforcing a policy of inclusion for all was not always beneficial to children and young people; the ASN facilities being incorporated in new school developments were welcomed; and in relation to staff training and qualifications, it was suggested that consideration be given to working with HCF with a view to sourcing funding to encourage academic and practical development.
In response to points raised, the Chairman undertook to circulate information on current staff training arrangements to Members and commented that this could be discussed at a future meeting if there was a need to enhance it. It was important to take a holistic approach and it was confirmed that the issues raised in the report would be taken into account in both FHC4 and the ASN Review and that this would ensure further scrutiny at the Committee. Some issues were not directly within the remit of FHC4. For example, it was suggested that the report be provided to the Chair of the Transport, Environmental and Community Services Committee for consideration in relation to the role of transport in inclusion.
Mr C Munro, HCF informed Members that the inclusion report would be the last major report by Ms C Baxter as she was retiring and, on behalf of the Forum, he thanked her for the quality of the report. It was emphasised that it was through the experience and voice of children and young people that agencies could measure whether the strategies in place were correct. The report highlighted a number of issues which demonstrated that the strategic direction of travel was not being delivered on the ground and it was important that these issues were examined and addressed. 123
Thereafter, the Committee:-
i. NOTED the issues raised in the report; and ii. AGREED that information on staff training be circulated to Members of the Committee.
11. Education, Culture and Sport Health, Safety and Wellbeing Policy Poileasaidh Slàinte, Sàbhailteachd agus Sunnd aig Foghlam, Cultar agus Spòrs
There had been circulated Report No ACS/91/13 dated 2 September 2013 by the Director of Education, Culture and Sport (ECS) which sought approval of the ECS health, safety and wellbeing policy document.
The report explained that it was a requirement of the Health and Safety at Work etc Act 1974 that all organisations with five or more employees have a written health and safety policy. The Council’s current policy on health, safety and wellbeing at work had been approved by the former Resources Committee in April 2011. In the intervening period, and in accordance with the requirements of the corporate policy, the ECS Service had established a Health, Safety and Wellbeing Group with multi-sector representation, including Head Teachers and Trade Union representatives. To further raise the profile of health, safety and wellbeing, a Service-specific policy had been progressed by the Group. The policy, which was appended to the report, would be underpinned by a health, safety and wellbeing manual and was intended to provide all ECS employees with a single document containing the relevant information required to discharge their respective responsibilities in relation to health, safety and wellbeing.
During discussion, Members commented that the policy largely related to health and safety legislation. The importance of promoting mental health and wellbeing was emphasised, particularly in relation to teaching staff who were known to be affected by stress at work. In addition, concern was expressed that there was no reference to bullying and it was suggested that the Council’s policies on bullying, mental health and other wellbeing issues be cited in the policy.
In response to points raised, it was explained that section 3.2 of the policy document set out the contents of the relative health, safety and wellbeing manual which included a section on stress management. During the next stage of implementation, the existing corporate policy statements for each topic in the manual would be reviewed from an ECS perspective and adapted where necessary.
Thereafter, the Committee:-
i. APPROVED the Education, Culture and Sport policy on health, safety and wellbeing; and ii. NOTED that the contents of the related manual, which underpinned the policy document, would be completed as soon as is practical.
12. Amendments to Adult Services Performance Framework Atharrachaidhean do Fhrèam Dèanadais Sheirbheisean Inbheach
There had been circulated Report No ACS/92/13 dated 16 September 2013 by the Director of Health and Social Care which included proposed amendments to the Performance Framework for Adult Services from 2013/14. 124
The report explained that the Adult Services strategic commissioning structure had been developing as part of the new lead agency arrangements. A Statistical Group had been established to ensure that data was available to populate the Performance Framework and consider new, improved outcome measures. The Group, which involved senior officers of NHS Highland and the Council, had been reporting to NHS Highland’s Improvement Committee and had made good progress in an initial overview of the Performance Framework. It had developed proposals for amendments to the Framework, as set out in the report, which had been agreed by the Council’s Adult Services Development and Scrutiny Sub-Committee and the Strategic Commissioning Group. They now required to be agreed by the Committee, and subsequently the full Council, to enable changes to be made to performance and reporting processes.
* The Committee AGREED TO RECOMMEND to the Council the amendments to the Performance Framework for Adult Services from 2013/14 as set out in the report.
13. School Meals Stakeholder Group Progress Report Aithisg Adhartais Buidheann Chom-pàirtichean Bìdh Sgoiltean
There had been circulated Report No ACS/93/13 dated 16 September 2013 by the Director of Education, Culture and Sport which explained that the Adult and Children’s Services Committee had agreed, in November 2012, that a Stakeholder Group (the Group) be formed to examine how school meal uptake could be improved. Progress had been reported to the Committee in January 2013 and this report provided Members with the second update on the progress of the group.
The report explained that improving children’s diet could have a positive impact on their health and educational attainment. The Group aimed to improve the diet of children through increasing the uptake of school meals, particularly free school meals, and to make links to curricular activity to ensure a whole school approach was taken. It had met four times to date and reviewed earlier work to explore what lessons could be learnt. Details were provided of previous pilots and measures such as onsite policies, band systems in primary schools and catering staff involvement in Parent Evenings. The Group had also sought future pilots and Head Teachers had been contacted to ask if they would volunteer to run schemes over the 2013/14 school year, or longer if required, that might increase school meal uptake. A menu of potential pilots had been circulated to prompt ideas and eleven schools had responded positively. Of those, Kingussie High School, Invergordon Academy, Charleston Academy and Cawdor Primary School had been selected and progress would be reported to the Committee.
The Committee:-
i. NOTED the progress of the School Meals Stakeholder Group; and ii. AGREED that a report on the progress of the pilot sites be submitted to a future meeting of the Committee.
14. Minutes Geàrr-chunntas
Declarations of Interest: Ms J Douglas and Mr K Gowans declared non-financial interests in Item 14ii on the grounds of being Directors of High Life Highland but, having applied the test outlined in Paragraphs 5.2 and 5.3 of the 125
Councillors’ Code of Conduct, concluded that their interests did not preclude their involvement in the discussion.
There had been circulated various Minutes of Meetings for noting or approval as appropriate.
During discussion in relation to the Adult Services Development and Scrutiny Sub- Committee Minutes, it was requested that the document referred to at item 7(iv), setting out both the outcomes in the Partnership Agreement and the relative performance indicators, be provided to Members of the Sub-Committee as soon as possible as this would provide the framework for scrutinising the delivery of adult social care.
In addition, a date was sought for the meeting to discuss governance arrangements, referred to at item 4 of the Minutes. Elected Members who had previously been involved in adult social care now felt removed from it and there were issues to be addressed in terms of the provision of information and the ability to have input. All Members dealt with the public and it was important that they understood the issues in relation to, for example, home care and delayed hospital discharge.
In response, the Chairman confirmed that the document referred to would be circulated as soon as possible. In relation to the meeting to discuss governance arrangements, a date would be set following the District Partnership Seminar on Friday 27 September 2013.
Thereafter, the Committee NOTED, and APPROVED where necessary, the following Minutes of Meetings:-
i. Highland Alcohol and Drugs Partnership Strategy Group of 8 May 2013; ii. Culture and Leisure Contracts Scrutiny Sub-Committee of 27 August 2013; iii. Criminal Justice Sub-Committee of 27 August 2013; iv.Adult Services Development and Scrutiny Sub-Committee of 30 August 2013; v. Duncraig Trust Scheme Sub-Committee of 3 September 2013; and vi.Education Transport Entitlement Review Sub-Committee of 3 September 2013.
The Committee also AGREED, in relation to the Adult Services Development and Scrutiny Sub-Committee, that the document referred to at item 7(iv) of the Minutes be circulated to Members of the Sub-Committee as soon as possible.
15. Exclusion of Public Às-dùnadh a’Phobaill
The Committee RESOLVED that, under Section 50A(4) of the Local Government (Scotland) Act 1973, the public be excluded from the meeting during discussion of the following item on the grounds that it involved the likely disclosure of exempt information as defined in Paragraph 9 of Part 1 of Schedule 7A of the Act.
16. Membership of SEEMiS Limited Liability Partnership Ballrachd Com-pàirteachas Buailteachd Cuibhrichte SEEMiS
There had been circulated to Members only Report No ACS/94/13 dated 17 September 2013 by the Director of Education, Culture and Sport. 126
Following discussion, during which Members requested sight of the associated Risk Register, the Committee AGREED the recommendations as set out in the report.
The meeting concluded at 12.35 pm. 127 Highland NHS Board 3 December 2013 Item 4.1
HIGHLAND QUALITY APPROACH – PROGRESS REPORT
Report by Linda Kirkland, Director of Quality Improvement on behalf of Elaine Mead, Chief Executive
The Board is asked to:
Note the update on the progress within the three themes of the Highland Quality Approach, Leadership and Culture, Focus and Delivery and Methodology. Note the update on the delivery of Quality Improvement (Lean) training. Note the update on the timetable of Rapid Process Improvement Workshops (RPIWs) and the proposal to generate an annual work plan effective for 2013/14. Note the emerging development of the Highland Quality Improvement System Note the establishment of the Highland Quality Approach (HQA) Leadership Group and the draft Terms of Reference.
1. BACKGROUND
1.1 The Highland Quality Approach is being embedded within NHS Highland. It comprises 3 main themes.
Leadership and Culture (who will do it) Focus and Delivery (what is to be done) Methodology (how it will be done)
1.2 This paper seeks to provide both an update on work in progress and a proposal to establish the Highland Quality Improvement Leadership Group to provide direction and governance.
2. LEADERSHIP AND CULTURE
“Leaders need to walk the lean talk” Sue Anderson, Virginia Mason Institute
2.1 In NHS Highland we aspire to release time spent on non value added activities to allow staff and leaders to spend more time on the gemba (front line) adding value by listening to patients, clients and the staff.
The work being undertaken in this work stream is both broad and in depth. The aim is to further create the culture of “Team Highland”.
2.2 National Context
The local programme sits within the national context including;
2020 Workforce Vision The National Person-Centred Health and Care Programme Integrating Health and Social Care
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2.2.1 The Scottish Government’s 20:20 Vision is that by 2020 everyone is able to live longer healthier lives living at home, or in a homely setting and, that we will have a healthcare system where:
We have integrated health and social care; There is a focus on prevention, anticipation and supported self-management; Where hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm; Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions; There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re- admission.
2.2.2 The National Person-Centred Health and Care Programme This framework supports the delivery of the person centred aims and ambitions of the Quality Strategy, using a focused improvement approach to support the testing, reliable implementation and spread of interventions and changes that are known to support health and care services and organisations to be truly person-centred.
The high level aim of the Programme is that, by 2015, health and care services are more person-centred as demonstrated by improvements in care experience, staff experience and in co-production. The programme will be designed in four work streams. These are Leadership; Care Experience; Staff experience; and co- production.
2.2.3 Values & Customer Care As part of the 20:20 vision and the person centred strategy, a drive to develop National Values and value based behaviour is underway.
2.3 Local Context NHS Highland is very well placed to contribute to the national agenda as we have had a successful customer care programme and values development programme underway for some time led by Heidi May, Board Nurse Director and Mr Quentin Cox, Orthopaedic Surgeon.
2.3.1 The Highland Partnership Forum have been very supportive and play a key role in embedding and implementing the HQA and have agreed at a recent work shop to focus on 4 main areas, supported by Ray Stewart who has recently been appointed to the role of Quality Improvement Lead Staff Experience
Cascade / Promote / Inform Staff about the Highland Quality Approach Use of Quality Improvement Tools and Resources Trying to Make Sense of Different “Things” Developing a Staff Compact
Cascading information and informing staff at large about the Highland Quality Approach is an ongoing exercise. Part of this is a training schedule
2.4 Training
A full suite of training for Lean and Improvement methods is being developed and the attached below provides some detail. The training dates are found in the HQA calendar.
http://intranet.nhsh.scot.nhs.uk/HQA/Announcements/Pages/Default.aspx
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2.4.1 The awareness training is being rolled out now and is evaluating well. This concentrates on waste and 5 s (5 s helps organise the work place and working practices) both of which are fundamental tools to help maximise our time in delivering care.
2.4.2 The administration training is for the staff supporting those leading kaizen (2-3 day improvement work) and rapid process improvement workshops (RPIW 5 day improvement events).
2.4.3 The 1-2 day training is for team leaders and managers (but available to all) and provides an overview of all the main quality improvement tools (lean) including how to undertake observations to identify value and non value processes.
2.4.4 The Certificated Lean Leader Training (5 days) delivered jointly with Tees and Esk Wear Valley is planned for January and allocation of places is on a competitive basis. This is the last planned course at certificated level.
Applications, supported by line manager, are welcomed with a closing date of 30th November. It should be noted that significant work is required both during and after training so this should be recognised both by the applicant and their manager.
To date there are 6 certificated lean leaders, 2 certified by Virginia Mason and 4 by Tees, Esk and Wear Valley. By the end of the financial year it is anticipated that the total certified lean leaders will be 13.
2.4.5 Non Certificated Lean Leader Training (4 days) is planned and a timetable is being developed.
2.4.6 Discussions are being held with both Virginia Mason and Tees Esk and Wear Valley about training a number of staff as Coaches who can deliver the training to a recognised quality standard and in time, deliver training to external organisations with a view to funding at least part of the NHS Highland programme.
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Lean leader training coach (5-6 staff) (tbc) Lean leader training (certificated) (38 staff) (5 day)
Lean leader training (non certificated) (4 day)
Team RPIW Admin Home/Away team RPIW Away leader/service support (1/2 day flow charts) team manager (1/2 day) (1/2 day main tools) (1 day) (1-2 day)
Awareness training Waste, 5 s ( 1 hour) All staff
2.4.7 The next two day learning set is 20th and 21st November with a number of colleagues from NHS Highland in attendance.
2.5 Team Highland (Brand Awareness)
The HQA triangle branding is now being seen on many different documents and a pocketsize version is being produced for staff who have completed their training.
2.5.1 A section on HQA is now available on the internet and intranet including a section “Quality in Action”.
2.5.2 Within NHS Highland the Customer Care work stream which focussed on the development of values based behaviour within some teams has shown very encouraging results was on a small scale. A wider implementation plan is being developed and will be rolled out after Christmas.
2.5.3 The introduction of Staff Awards based on the HQA is being considered and may take the form of a monthly / bi monthly HQA Team / Individual award.
2.5.4 There are good opportunities with new staff via the Induction process to introduce these staff to the HQA. In fact much of this is planned to be introduced pre employment with all recruitment material making more specific references to the HQA. Related to the approach will be the work on the Compact which will also be very visible to new and prospective employees.
2.5.5 Through the Head of Public Relations many areas of corporate communications are being looked at to make sure HQA is fully reflected including update of Staff Hand Book, further use of Social Media and write ups on all improvement work.
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2.5.6 Staff Compacts are simply the writing down of the social / psychological mutual expectations that exist alongside the more explicit employment contract that mainly is focussing on values and behaviours. They state what the employee can expect of the organisation that they work for and what the organisation can expect of them.
Evidence exists from a number of high performing healthcare and other organisations showing that compacts are widely used. Also in many ways the updated 4th Edition of the Staff Governance Standard has many similarities with the staff compact approach as for the first time it introduced “rights and responsibilities” for staff.
2.5.7 It has been accepted that NHS Highland wishes to develop a Staff Compact, the current debate is whether we require initially a different more specific Physician Compact or a move straight to the development of a more universal (all) Staff Compact.
2.5.8 The two high performing healthcare organisations that we have been partnering with in our Quality Work – Virginia Mason Medical Centre in Seattle and the Tees, Esk and Wear Valley NHS Foundation Trust developed compacts but adopted a different approach in that Virginia Mason took the Physician Compact approach and Tees, Esk and Wear Valley have a Staff Compact.
The route we will take in NHS Highland remains a live discussion.
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3. FOCUS AND DELIVERY
The cohort of trained and training of 13 Lean Leaders will have delivered a total of 19 RPIWs and 1 Kaizen event within this financial year.
The sharing of results from the various RPIWs and other improvement work is vital and a weekly report out Webex has been established advertised on the intranet and available for all to attend (see below).
3.1 The timetable for the workshops led by staff receiving training is attached at Appendix 1. To support the training in January and the existing lean leaders, it is likely that we will have approximately 50 RPIWs planned for the next financial year.
An annual work plan will be developed based on the Board priorities which will be brought back to Board in advance of the start of the financial year 2013/14.
3.2 In order to ensure that as many staff as possible can hear the work which is being undertaken, the report outs for the work will take place on Fridays between 12-1pm. Webex facility is available for those who cannot attend in person and for those close to Inverness, and who can attend, the teams will meet in Medical Education room in Raigmore Hospital (Zone 6 , Kerr suite). The success (or otherwise) of this will be evaluated over November and December.
The timetable can be found on the HQA calendar http://intranet.nhsh.scot.nhs.uk/HQA/Announcements/Pages/Default.aspx
Reporting Reporting Governance mechanism event/programme
RPIW Friday 12pm - 1 pm HQA Webex Report out Leadership 30 day Meeting Kaizen 60 day 90 day 365 report
SPSP Monthly reporting Operational unit Meeting
PDSA Tests of change
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4. METHODOLOGY
4.1 The Board are fully sighted on the use of Scottish Patient Safety Programme (SPSP), the Productive series and Lean quality improvement methods and tools in common use within NHS Highland.
4.2 The Scottish Patient Safety Programme started in 2008 and is currently bringing about a range of local improvements, including dedicated initiatives relating to sepsis, primary care, paediatric care, mental health and maternity care. The aim is to deliver an integrated and sustained programme for patient safety improvement that will support boards across all the key initiatives and in line with Scottish Government ambitions.
The SPSP is being implemented in every acute hospital in the country. The initial goals were to drive improvements in Leadership, Critical Care, Medicines Management and Peri-operative care
The SPSP is now well embedded in NHS Highland and the Board have been sighted on the success and the challenges. The programme is rolling out over all sites and is extending to other clinical areas in including maternity and General Practice.
4.3 The Productive Series supports NHS teams to redesign and streamline the way they manage and work. This helps achieve significant and lasting improvements – predominately in the extra time that they give to patients, as well as improving the quality of care delivered whilst reducing costs.
The Productive Series has adopted efficiency techniques previously used in car manufacturing and safety techniques learned in the aviation industry (Lean). These have been adapted for the NHS in a practical and innovative way.
The key to the success of The Productive Series is that improvements are driven by staff themselves, by empowering them to ask difficult questions about practice and to make positive changes to the way they work. The process promotes a continuous improvement culture leading to real savings in materials, reducing waste and vastly improving staff morale.
4.2 The National Person-Centred Health and Care Programme and the associated Staff Experience Project complements these methods and NHS Highland is in active discussions regarding implementation.
4.3 Perhaps the most challenging issue is that there are a number of initiatives and work streams locally and nationally, which are consistent and supportive of the key aims of our Highland Quality Approach. The active development of the Highland Quality Improvement System seeks to bring all of this together in one approach.
5. CONTINUOUS LEARNING
5.1 Visits and collaborations with a wide range of organisations who have had a successful impact of change and quality improvement continue. We continue to seek learning from those at the forefront of quality. Our partnership with Virginia Mason Medical Centre in Seattle and Tees, Esk and Wear Valley NHS foundation Trust have been reported on many occasions to the Board. We are now in discussions with South Central Foundation in Alaska and are exploring the model they have developed of “Nuka” which boils down to some basic ideas.
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The relationships are key to healthcare, That patient care should be integrated, There should be same day access to primary care, Customer-owners are partners in their own health care and There should be ample opportunity to offer advice and feedback.
And to make all of this happen, there should be a culture where training and retraining is valued. Nuka and the model accords very well with the Highland Quality approach, and they deliver this in a very remote and rural area.
Several staff are attending a meeting with representatives from Southcentral Foundation in early 2014, to ascertain how we may learn together. A report will follow to the Board after this has taken place.
6. HQA LEADERSHIP GROUP
6.1 The governance, direction and focus for this work is crucial and the HQA leadership group will be established to support this. The first of the meetings is planned for early next year. Draft terms of reference are attached at Appendix 2.
6.2 The Leadership Group will report through the Highland Health and Social Care Committee and the Argyll and Bute Community Health Partnership.
6.3 The diagrams in Appendix 2 show the breadth of the areas to be addressed by the Leadership Group.
7. GOVERNANCE IMPLICATIONS
Staff Governance – embedding more effective methodology around staff experience is directly contributing to adherence and improvement of the Staff Governance Standard.
Clinical Governance – It is accepted that having an increase in quality of staff experience is directly contributing to patient experience which is in keeping with the Highland Quality Approach to deliver high quality, safe and effective health care services.
Financial Impact – there is currently no identified financial impact.
8. IMPACT ASSESSMENT
This is a progress report and as such does not; at this stage require an impact assessment.
Linda Kirkland Director of Quality Improvement
22 November 2013
8 135 APPENDIX 1 LEAN LEADERS TRAINING WITH TEWVs & VMI– RPIW TIMETABLE 2013/14
Date Value Stream 1 2 Prep Start RPIW Location Workshop Lead Team Lead (12 weeks) support 13 – 17 May Radiotherapy Breast Nigel Small (1) Elaine Mead (1) COMPLETE Maryanne Raigmore Hospital TEWV – Keith Appleby Cancer Morrison 3 – 7 June Colorectal surgery Gordon Sansaver Linda Kirkland (1) COMPLETE Gill Cooksley Raigmore Hospital (VMI - Gordon Sansaver) 5-9 August Community Mental Derek Leslie (1) Gavin Hookway (1) COMPLETE Sheena Clark A&B CHP TEWVs – Keith Appleby Health 26 -30 August Pre Op assessment Linda Kirkland (2) Anne Gent (1) COMPLETE Lynda Raigmore Hospital (VMI- Lee Darrow) Thomson 2 – 6 September Radiology Results Elaine Mead (2) Rod Harvey (1) COMPLETE Gill Cooksley Raigmore Hospital TEWVs – Maureen Raine reporting 2 – 6 September Unscheduled Care Pam Cremin (1) Marie Law (1) COMPLETE Belford Hospital, TEWV - Keith Appleby (Belford) Fort William 7 – 11 October Care at Home Gavin Hookway (2) Nigel Small (2) COMPLETE South and Mid TEWV –Keith Appleby Operational Unit 7 – 11 October Primary Care Joyce Robinson (1) Derek Leslie (2) COMPLETE Sheena Clark A&B CHP TEWVs – Maureen Raine Services 14-18 October Patient Booking Anne Gent (2) Gill McVicar (1) COMPLETE Gill Cooksley Raigmore Hospital (VMI-Chris Backous) Services 21 October – 26 October Discharge Planning Esther Dickinson COMPLETE Gavin Raigmore Hospital NHSH KAIZEN EVENT 7c Hookway 11 November – 15 November Nursing and AHP Gavin Hookway Linda Kirkland COMPLETE Assynt House /John NHS H admin services Dewar 25 – 29 November Stroke Services Deb Jones (1) Ron Coggins (1) 2 September Raigmore Hospital (TEWVs – Keith Appleby) 25 – 29 November Microbiology Rod Harvey (2) Nick Kenton (1) 2 September Raigmore Hospital (TEWV – Adele Coulthard) 25 – 29 November Telecare Pam Cremin (2) Cameron Stark (1) 2 September NHS Highland TEWVs – Maureen Raine 9-13 December Haematology Gill McVicar (2) Linda Kirkland (3) 16 September Raigmore Hospital (VMI - Linda Hevish) /oncology 3 – 7 February Community Hospitals Paul Davidson (1) Joyce Robinson (2) 4 November North West (TEWVs – Chris Parsons Operational 3 – 7 February Chemotherapy Ron Coggins (2) Elaine Mead 4 November Raigmore Hospital (TEWVs – Maureen Raine prescribing 3 – 7 February Scheduling Cameron Stark (2) Marie Law (2) 4 November Corporate, (TEWVs – Keith Appleby) Emergency Surgery Inverness 12 – 16 May 2014 TBA Nick Kenton (2) Deb Jones (2) 17 February TBA TEWV - Keith Appleby 12 – 16 May 2014 Endoscopy services Anne Gent Paul Davidson (2) 17 February Caithness General TEWV -TBC
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HIGHLAND QUALITY APPROACH LEADERSHIP GROUP
DRAFT for DISCUSSION
Introduction
It is proposed to establish a Highland Quality Approach (HQA) Leadership Group to provide governance for the full range of Quality Improvement initiatives planned and underway across NHS Highland
The HQA Leadership Group is responsible to the NHS Highland Board and its primary purpose is to provide oversight, direction and governance in line with the Board Vision and Strategic Framework.
Membership
Executive Team Directors of Operations Head of Public Engagement Employee Director
Support
Highland Quality Hub (Diagram 1 below)
Overall Role and Remit
The HQA Leadership Group will embrace 3 main areas
1 Provide prioritisation, co-ordination and direction of all Quality Improvement work (diagram 2 below).
2 Ensure through active Quality assurance, adherence to the rigour and robustness of the Quality Improvement method applied (diagram 3 below).
3 Act as a Governance committee and provide assurance to the NHS Highland Board.
Reports to: NHS Highland Board
Frequency of meetings: Monthly
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Diagram 1 Highland Quality Hub Staffing and Support
Green boxes are Core Team
Purple boxes are Supporting Teams Highland Quality Hub
Service Staff improvement experience programme Supporting programmes Supporting (Care services Clinical quality E Health/ Networks (Values, Clinical planning improvement, governance including care behaviours, at home, care culture, homes) leadership compact etc)
Method Productive Clinical Virginia Mason Production System /Lean (PDSA) Series/ Quality releasing Indicators Method time to care Scottish Patient Safety Programme (PDSA)
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Diagram 2
HQA Leadership Group and Supporting Structure
REPORTS TO HHSCC & A&B CHP
Highland Quality Approach Leadership Group
Scottish Patient Safety Lean & Productive Pathways Care Inspectorate Programme Series
Primary Mental Maternity & Discharge Acute Cancer PMS Care Health Neonatal Planning
TBC TBC Executive Lead Executive Sponsor Clinical Lead Clinical Lead Process Owner Process Owner Project Manager Quality Improvement Lead
Diagram 3 HQA Role and Remit
Highland Quality Approach Leadership Group (Executives & Directors of Operations)
Once every two months Once every two months Scottish Patient Safety Programme Lean & Productive Series
Oversight Oversight Governance Governance Exception Reporting Prioritisation
Supported by individual leadership groups for Supported by
Mental Health, Acute, Primary Care, Stand Ups, Report Outs Kaizen Events Maternity & Neonatal & Rapid Process Improvement Workshops
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UPDATE ON POSSIBLE MAJOR SERVICE REDESIGN
Report by Nigel Small, Director of Operations (South and Mid) and Gill McVicar, Director of Operations (North and West) on behalf of Deborah Jones, Chief Operating Officer
The Board is asked to:
Note the strategic case for change across the areas of i) Badenoch and Strathspey and (ii) Skye, Lochalsh and South West Ross. Note the requirement to carry out formal public consultation where any proposed changes are considered to be major. Note and approve the key milestones and associated timeline.
1. Background and Summary
The Board approved an update to NHS Highland Asset Strategy 2013 at its October Board meeting on 1 October 2013. This document makes specific reference to the work underway to review and redesign services in Badenoch and Strathspey (part of South and Mid Operational Unit) and Skye, Lochalsh and South West Ross (part of North and West Operational Unit).
Discussions have been ongoing with both local communities over the past 18 months because the four hospitals – the St Vincent’s Hospital in Kingussie and the Ian Charles Hospital in Grantown (Badenoch and Strathspey) and Dr Mackinnon’s in Broadford and Portree Hospital (Skye) – are no longer conducive to delivery of modern, integrated health and social care. The ongoing engagement exercises have been taking place to develop some broad options for future models of service. It is anticipated that this phase of the work programme will be completed imminently.
NHS Highland is conducting the reviews with support from the Scottish Health Council and in line with the national guidance from the Scottish Government. Under this guidance, if the emerging proposals are deemed to constitute major service change, they must be subject to formal public consultation and, ultimately, approval by Scottish Ministers (Annex 1).
While no decisions on the future shape of local services have been made in either area, from the extensive work carried out so far there appears to be a broad consensus that the status quo is not a viable option. As the alternative options will almost certainly represent major service change then public consultation will be required.
The next stage in the process is to hold event(s) with local community stakeholders, hopefully early in December and/or January to develop in more detail a short list of options. Once these are described they will be subject to a detailed options appraisal process, which will be independently facilitated.
The outcome of the option appraisal exercises will be brought back to NHS Highland Board and this will include confirmation from the Scottish Health Council on whether they assess that the involvement has taken place in accordance with the Scottish Government Guidance.
A high-level summary of the key milestones and associated timeline is attached (Annex 2). However, if further time is requested to further support people with the options appraisal then the time-line will be refined to accommodate this. 140
2 Strategic Context and Decision Making Process
2.1 Strategic Context
The Scottish Government Health Directorate’s Capital Planning and Asset Management Division Policy CEL(2010)35 requires that all NHS Boards have a Corporate Asset Management Strategy and Plan that reflects the following policy aims:
to ensure that NHS Scotland Assets are used efficiently, coherently and strategically; to provide, maintain and develop a high quality sustainable asset base that supports and facilitates the provision of high quality health care and better health outcomes.
NHS Highland reported at their Board Meeting in June 2011 around £74m of repairs, maintenance and upgrading work to bring buildings up to minimum national requirements. Notably, however, this investment would not future-proof services.
Later in the year (August 2011), in NHS Highland News, some of the key challenges facing the people in Highland were described. In the publication, which was issued to every household in Highland, the need to look at ways of using fewer buildings and different ways of providing services were highlighted. Where services do need to be provided from buildings these need to meet with modern standards, including infection control, privacy and dignity, fire compliance and as well as being energy efficient.
In terms of Asset Management, a strategic overview and supporting principles is provided in NHS Highland’s five year Property and Assessment Strategy (2012-2017). This document was approved by the Board at its meeting held on 5 June 2012 and an updated version approved at NHS Highland Board Meeting held on 1st October 2013.
It is within this context that work is being progressed in Badenoch and Strathspey and Skye, Lochalsh and South West Ross.
Although the condition of the hospitals has prompted the review the process of generating options has not focused on buildings but rather taken a holistic look geared at how to keep people well, at home or as close to home as possible. The review also takes full cognisance of integrating health and social care and the further potential of closer working with third, voluntary and independent sector.
2.2 Decision Making Process
The investment objectives for this project have been developed from the assessment of local needs and to align with NHSScotland’s Quality Strategy Ambitions 1 and NHS Highland’s “The Highland Quality Approach” (Annex 3a and 3b).
In terms of engagement CEL(2010)04 2 provides guidance on Informing, Engaging and Consulting People in Developing Health and Community Care Services. This document also clarifies the role of the Scottish Health Council.
One of the roles of the Scottish Health Council is to ensure that the Boards involvement activity is in line with CEL 4 guidance. In particular Boards are required to demonstrate how they: work with local people to develop options which are robust, evidence-based, person- centred, sustainable and consistent with clinical standards and national policy; ensure that public stakeholders are involved in developing options and in the process to appraise options;
1 http://www.scotland.gov.uk/Topics/Health/NHS-Scotland/NHSQuality/Q/EditMode/on/ForceUpdate/on 2 http://www.sehd.scot.nhs.uk/mels/CEL2010_04.pdf 2 141
make sure that the development and appraisal of options is consistent with the approach outlined in HM Treasury guidance, ‘The Green Book’ and the Scottish Capital Investment Manual.
Should any Board proposals be considered major, in line with CEL(2010)04, they must be subject to formal public consultation (usually 3 months) and a final Ministerial decision.
2.3 Overview of Service Change Process for NHS Scotland
An overview of the service change process that Boards are required to follow is summarised (Annex 1). An update against each of the keys steps is set out below. There has been significant informal engagement and discussions in both areas for at least 18 months.
Step in Process Local Update 1 Identify strategic NHS Highland reported at their Board Meeting in June 2011 options and need for around £5.2m of repairs, maintenance and upgrading work to service change bring buildings in B&S up to minimum national requirements and £3m in Skye. 2 Initial discussion with Ongoing discussions during 2012 with regular updates with SGHD sponsor in Scottish Government Health Directorate (SGHD) sponsor. cases of potential major change 3 Develop initial A communications and engagement plan has been prepared for communications and both areas. Most recently this has been updated in consultation engagement plans in with SHC and SGHD. liaison with Scottish Health Council (SHC) 4 Undertake pre- Significant pre-engagement activity has taken place in both engagement activity areas leading to the establishment of Development Groups. In with key stakeholders addition three workshops have been held in each area (between June and October) to explain the process and generate a long list of service model options. These have been sifted by the participants to prepare a short list of options. Work is ongoing to develop and describe the short list of options in more detail.
Scottish Health Council is in the process of carrying out an Evaluation of the engagement process so far. 5 Options Appraisal in Further events have been scheduled to carry out Options line with Green Book, Appraisal exercise. It is anticipated that this will be completed SCIM and SHC by January 2014. But it should be noted that the events will guidance progress at a pace that is comfortable for the participants; and so some refinements in the time-table might be required. 6 Proposed change An Assurance Report on the Options Appraisal exercise and considered major? engagement to date will be prepared by SHC. This will form Confirm with SGHD part of the papers to be brought back to NHS Board for their sponsor consideration on whether the preferred option(s) is considered major and recommendation on formal consultation.
3 Contribution to Board Objectives
The service redesign being discussed in both areas present a significant opportunity to demonstrate the importance of all ten quality objectives for local people. The strength of the process is that it will allow a balance to be struck across all the objectives.
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4 Governance Implications
Staff Governance Staff are fully involved in the redesign process including staff-side members and this will be ongoing. There is strong clinical and senior management leadership in both areas.
Patient and Public Involvement NHS Highland has been actively involving patients, carers, community groups, politicians and members of the public on an ongoing basis and in accordance with relevant guidance.
Clinical Governance Clinical governance issues are being considered as part of the options appraisal process. Any model of service proposed will be required to be safe, effective and evidence-based. There is significant clinical engagement in both areas.
Financial Impact The short list of options identified will be subject to detailed Financial Appraisal. This has not yet taken place. However, these projects are part of Asset Management strategy, which once fully implemented should have a positive impact on the Board’s financial position.
5 Risk Assessment
The redesign of services in both areas is intended to minimise risk arising from the current conditions of the hospitals. Individual components may be required to have specific risk assessment.
6 Planning for Fairness
Individual components of the strategy will need to have an equality impact assessment as part of any options appraisal. It is too early in the process for this to take place.
7 Engagement and Communication
Significant engagement and communications has taken place in each area and is ongoing. Each phase of the redesign work has got detailed engagement and communication plans. A wide-ranging approach is being used but fundamentally the foundations have been built on delivering as much face to face engagement as possible. Stakeholders who sit on the Development Groups also have a key role to support good communications and engagement and are taking their responsibilities seriously and effectively.
Existing mechanisms and structures are also being used such as Public Partnership Forums, Community Councils, District Partnerships and alongside these regular updates for the local media and local bulletins.
The autumn issue of NHS Highland News, issued at the end of September, carried a front page article on the review of the four community hospitals.
Feed-back from the evaluation exercise which is underway will be used to refine and improve the approach and plans to support the key stages of the process (Annex 1).
Maimie Thompson Head of Public Relations and Engagement Chief Executives Office
22 November 2013
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Annex 1 – An Overview of the NHS service change process in Scotland
Identify strategic options and need for service change
Initial discussion with SGHD sponsor in cases of potential major change
Develop initial comms/stakeholder involvement plans in liaison with SHC
Undertake pre-engagement activity with key stakeholders
Options Appraisal in line with Green Book, SCIM and SHC guidance
Proposed change considered major? Confirm with SGHD sponsor
No Yes
Proceed with proportionate public Ministers decide to subject engagement as agreed with SHC proposals to Independent Scrutiny?
No Yes
Independent Scrutiny
Undertake Formal Public Consultation
SHC assurance report to NHS Board
NHS Board Decision on Service Change
Non- Ministerial Approval Major Major
Yes No Revisit proposals
Commence Business Case process (SCIM) if infrastructure investment case
Proceed to implementation
Feedback and Evaluation
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Annex 2 – Summary of high level milestone and indicative time-line
Time-line High level milestones Jun 14 Seek Cabinet Secretary Approval on Board recommendation following public consultation
Jun 14 Make recommendation to NHS Highland Board following public consultation on preferred option (s)
May 14 Analysis of public consultation and prepare board paper
Feb – Apr 14 Carry our formal three month consultation on preferred option(s)
Jan 14 Preparation of consultation documents
Jan 14 Report to Highland Health and Social Care Committee on outcomes of options appraisal process (if in a position to do so)
Jan 14 Hold further workshop events to support options appraisal process if required
Dec 13 Hold further workshops to carry out options appraisal to develop preferred option(s)
Dev 13 Update NHS Highland Board on process, progress and next steps
Nov 13 Further work to develop and describe in more detail the short list of options
Nov 13 Update local communities on process and likely next steps including via media release
Nov 13 Update Highland Health and Social Care Committee
Nov 13 Agree plan for evaluation on initial engagement activities
Oct 13 Communicate feed-back from Workshop to: i) Scottish Government, ii) Scottish Health Council, iii) Development Groups
Oct 13 Update Asset Management Strategy to Board
Oct 13 NHS Highland News distributed to all homes
Jun, Aug and Hold Workshops to identify long and short list of options and make Sep, Oct 13 strategic case for change
May 2013 Include redesign as part of Local Delivery Plan and Publish on Web
Apr 13 Appoint Project Staff to support Operational Unit with the options appraisal process and building the strategic case for change
Dec 12 Set up Skye, Lochalsh and South West Ross Development Group
Sep 2012 Set up Badenoch & Strathspey Development Group
Jan 2012 Concerted informal raising awareness and engagement about the case for change underway
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Annex 3a – Investment Objectives
The investment objectives for this project have been developed from the assessment of local needs and to align with NHSScotland’s Quality Strategy Ambitions and NHS Highland’s “The Highland Approach” as shown in the diagram below.
Project Quality Strategy The Highland Approach Investment Objectives Ambitions
To Improve the Quality of Care to Every Integrated Health and Person, Every Day Social Care
Patient/Person Improve User Centred Experience
Create a Caring Improve Access to Experience Services and Care
Maximise Flexible, Responsive and Effective Preventative Care
Relentlessly Pursue the Highest Quality Outcomes of Care Make Best Use of Resources
Safe Improve Quality and Effectiveness of Attract and Develop the Accommodation Best Teams
Improve Safety of Service Delivery
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Annex 3b – Summary description of the Project Investment Objective
Investment Objective Description
A holistic approach which focusses on meeting all the health and Integrated Health and social care needs of people. Aims to provide a seamless service Social Care where barriers between organisations, staffing structures and budgets are “not visible” to service users.
Services which focus on the individual, their preferences and Improve User choices. Respects peoples’ dignity and privacy and provides Experience services which demonstrate compassion, continuity, clear communication and shared decision-making. Develops mutually beneficial partnerships between patients, their families/carers and those delivering health and social care services.
Aims to provide easy and convenient access to the maximum Improve Access to range of services that can be safely provided locally, with short Services and Care waiting times and minimum travel distance and times. The most appropriate treatments, interventions, support and services will be provided at the right time and in the right place.
Recognises that people are individuals with unique requirements and provides services which are responsive to these individual Maximise Flexible, requirements, promoting preventative and self-care. Allows Responsive and services to be changed as peoples’ needs change over time. A Preventative Care model of service provision which proactively anticipates individual’s needs and tailors a full response to meet those needs.
Ensures that all available resources (staff, money, buildings, Make Best Use of equipment etc.) are used effectively and efficiently to support Resources services and provide good value for money i.e. maximises the benefits to patients from investment in staff time, buildings etc. Minimises waste, duplication and inefficient working practices.
Provide modern, fit for purpose, well planned and designed Improve Quality and accommodation which supports and facilitates effective and Effectiveness of efficient service delivery and provides a pleasant and calming care Accommodation environment for patients. An appropriate, clean and safe environment will be provided for the delivery of services at all time.
There will be no avoidable injury or harm to people from health and Improve safety of social care services and this will consistently be provided across service delivery the full range of service provision, wherever it is delivered.
8 147 Highland NHS Board 3 December 2013 Item 5.1
SERVICES FOR CHILDREN AND YOUNG PEOPLE IN ARGYLL AND BUTE: REPORT OF A PILOT JOINT INSPECTION
Report by Pat Tyrrell, Lead Nurse, Argyll & Bute CHP on behalf of Margaret Somerville, Director of Public Health and Health Policy
The Board is asked to:
Note the findings of the report. Discuss the actions arising from the findings.
1 Background and Summary
The pilot joint inspection of services for children and young people in the Argyll and Bute Community Planning Partnership area took place over three weeks in March 2013 and April 2013. It covered the range of services that had a role in providing services to benefit children, young people and families across the Argyll and Bute Community Planning Partnership area including the islands. This pilot inspection also took a close look at how services had responded to the agreed priorities for action set out in the Care Inspectorate’s report on a joint inspection of services to protect children published in 2011.
Inspectors reviewed documents and spoke to staff with leadership and management responsibilities. They talked with staff who work directly with children, young people and families and observed some meetings. Inspectors reviewed practice through reading a sample of records held by services who work with children and young people. Some of these children, young people and families met with and talked to inspectors.
The full report was published in September 2013 and was presented to Argyll and Bute Council in September. It is attached as Appendix 1. In addition the Argyll and Bute CPP has received a more detailed record of inspection findings. The findings and evidence in this document provide detail, which will be helpful in guiding planning for improvement. It is a technical document aimed at leaders and managers responsible for planning and delivering services for children, young people and families and is not intended to be copied and distributed in its entirety.
2 Findings
The inspection has highlighted a number of strengths which included:
The strong commitment to prevention and early intervention A very positive culture of partnership working at all levels The flexible approach to working with families to improve outcomes for children and young people Sound work to promote strong and resilient children, young people and families
The inspectors also highlighted three areas of good practice which are:
Getting it right antenatal – our interagency approach to identifying and supporting vulnerable pregnant women, which is having a significant impact on giving unborn babies the best start in life 148
Early intervention service –this service provides high quality intensive support to vulnerable children and young people Nurse coordinators – working to support children in care, families affected by homelessness and Gypsy traveller families
The areas for improvement that were identified include:
Secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children Complete and implement the Integrated Children’s Services Plan Continue to develop rigorous and systematic joint self-evaluation to improve outcomes for children and young people Ensure continued leadership and direction is provided to implement the planned improvements for services for children, young people and families
The overall inspection grades are as follows:
Providing help at an early stage Very Good Impact on children and young people Good Assessing and responding to risks and needs Adequate Planning for individual children Adequate Planning and improving services Adequate Participation of children and young people Good Leadership of improvement and change Good Improving the wellbeing of children and young people Good
As a result of the inspection findings an action plan, focussed on the areas identified for improvement, has been agreed by the Community Planning Partnership and submitted to the Care Inspectorate. This will supplement the comprehensive Integrated Children’s Services Plan which, after extensive consultation, is due to be published in November 2013. The action plan is attached as Appendix 2 to this report.
3 Contribution to Board Objectives
The ongoing evaluation and improvement of services delivered to children and young people in Argyll and Bute contributes to NHS Highland’s objectives to deliver Better Health (BH) – improving the health of the population and Better Care (BC) – enhancing the experience of care for individuals.
4 Governance Implications
The findings of the inspection have been shared with staff across Argyll and Bute. Delivery of the resulting action plan to address areas for improvement will also involve the leadership and efforts of staff across all levels of the services. Wide consultation has also taken place to consult on the Integrated Children’s Services Plan with children, young people and staff. Monitoring of the delivery of the action plan will be through Argyll and Bute’s Children and Chief Officers Groups.
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5 Risk Assessment
All risks that may affect delivery of the actions will be identified and managed through risk register.
6 Planning for Fairness
Any policies that require to be developed will be assessed according to standards.
7 Engagement and Communication
Engagement and communication of findings from Inspection have been delivered.
Pat Tyrrell Lead Nurse, Argyll & Bute CHP
22 November 2013
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4 151
Services for children and young people in Argyll and Bute 18 September 2013
Report of a pilot joint inspection 152 Contents
1. Introduction 1
2. Background 2
3. The Community Planning Partnership area 2
4. Particular strengths that are making a difference to children, young people and families 3
5. Examples of good practice 3
6. How well are the lives of children, young people and families improving? 4
7. How well are services working together to improve the lives of children, young people and families? 6
8. How well do services lead and improve the quality of work to achieve better outcomes for children and families? 8
9. Conclusion and areas for improvement 9
10. What happens next? 9
Appendix 1 Indicators of quality 10
Services for children and young people in Argyll and Bute: report of a pilot inspection 153 1. Introduction
At the request of Scottish Ministers, the Care Inspectorate is leading joint inspections of services for children and young people across Scotland. When we say children and young people in this report we mean people under the age of 18 years or up to 21 years if they have been looked after.
These inspections will look at the difference services are making to the lives of children, young people and families. They take account of the full range of work within a community planning partnership area including services provided by health visitors, school nurses, teachers, doctors, social workers, police officers, and the voluntary sector.
The inspection teams are made up of inspectors from the Care Inspectorate, Education Scotland, Healthcare Improvement Scotland and Her Majesty’s Inspectorate of Constabulary for Scotland.
A draft framework of quality indicators was published by the Care Inspectorate in October 2012. The indicators in ‘How well are we improving the lives of children, young people and families? A guide to evaluating services for children and young people using quality indicators’ were used by the team of inspectors in their independent evaluation of the quality of services. We have covered all of the quality indicators in this report and reached evaluations for eight of them which are set out in the table in Appendix 1.
This report is published following a pilot joint inspection. This means that future inspections may be carried out differently and the reports we will publish at a later date may take a different format.
2. Background
The pilot joint inspection of services for children and young people in the Argyll and Bute Community Planning Partnership area took place over three weeks in March 2013 and April 2013. It covered the range of services that had a role in providing services to benefit children, young people and families across the Argyll and Bute Community Planning Partnership area including the islands.
This pilot inspection also took a close look at how services had responded to the agreed priorities for action set out in the Care Inspectorate’s report on a joint inspection of services to protect children published in 2011.
Inspectors reviewed documents and spoke to staff with leadership and management responsibilities. They talked to staff who work directly with children, young people and families and observed some meetings. Inspectors reviewed practice through reading a sample of records held by services who work with children and young people. Some of these children, young people and families met with and talked to inspectors. Inspectors are very grateful to all of the people who talked to them as part of this pilot inspection.
Services for children and young people in Argyll and Bute: report of a pilot inspection 1 154
As the findings in this joint inspection are based on a sample of children and young people inspectors cannot assure the quality of service received by every single child in the area.
3. The Community Planning Partnership area and the context for services for children and young people
Argyll and Bute has a population of over 89,500 and is Scotland’s second largest local authority by area. It has the third lowest population density, and has the most inhabited islands. The population is decreasing which is in contrast to Scotland as a whole. The number of children under the age of 16 is projected to fall by 8.7% by 2035.
Predicted population decrease of children Population of Argyll and Bute under 16: 89,500 8.7% by 2035
The Argyll and Bute Community Planning Partnership has A Single Outcome Agreement members from the public, private, voluntary and community is an agreement between the Scottish Government sectors, and the Ministry of Defence. The Partnership has a and community planning new Community Plan and Single Outcome Agreement for the partnerships which sets out period 2013 to 2023, which sets out the vision for achieving how they will work towards improving outcomes for improved long-term outcomes for communities in Argyll Scotland’s people in a way that and Bute. This includes key priorities for children and young reflects local circumstances and people. The partnership has overseen the development of a priorities. new vision for services for children and young people: Working together to achieve the best for children young people and families. The Child and Adult Protection Chief Officer Group The Integrated Children’s Services Plan is for services oversees planning and continuous improvement and the which work with children and Argyll and Bute Children’s Group is responsible for updating young people. It sets out the an integrated children’s services plan for 2013 to 2016. This priorities for achieving the vision for all children and young new plan will set out what services will do to achieve the vision people and what services need using the Getting it right for every child approach. to do together to achieve them.
2 Services for children and young people in Argyll and Bute: report of a pilot inspection 155 4. Particular strengths that are making a difference to children, young people and families
• The strong commitment to prevention and early intervention.
• A very positive culture of partnership working at all levels.
• The flexible approach to working with families to improve outcomes for children and young people.
• Sound work to promote strong and resilient children, young people and families.
5. Examples of good practice
Getting It Right Antenatal Getting it Right Antenatal is having a significant impact on giving unborn babies the best start in life. It is a highly successful approach to identifying vulnerable pregnant women at an early stage and to providing coordinated support in partnership with other services to improve their parenting skills. This support includes the provision of suitable housing.
Early Intervention Service Staff deliver high quality intensive support to vulnerable young people and families. They work closely with other services to give flexible support that helps young people to remain in their own communities, improves their educational achievement and promotes stable caring relationships.
Nurse Co-ordinators Nurse co-ordinators work with children and young people who are looked after away from home, families affected by homelessness, and the gypsy traveller community. They coordinate and communicate information across services and enable families to access the help they need quickly. Their work is highly effective in helping children, young people and families to stay healthy and to be involved and included within their communities.
6. How well are the lives of children and young people improving?
Staff are very effective in recognising when children, young people and families need additional help. They provide flexible support and guidance at an early stage to stop difficulties getting worse. Multi-agency screening of incidents of domestic abuse is helping to ensure that children, young
Services for children and young people in Argyll and Bute: report of a pilot inspection 3 156
people and families receive prompt and appropriate assistance. The Getting it right for every child approach is developing very well and most staff carry out their responsibilities with confidence and skill. Vulnerable pregnant women are identified quickly and provided with very effective support. Staff gather comprehensive information and share this appropriately to promote the well-being of children and young people. They maintain detailed and up-to-date records of observations and concerns.
The Getting it right for every child approach is being Getting it Right for Every Child implemented successfully and staff are highly committed to is the Scottish Government’s working together. Children and young people are benefiting approach to making sure that all children and young people get from effective collaborative work which promotes prevention the help they need when they and early intervention. Vulnerable children are getting the help need it. For more information, they need at an earlier stage to improve their well-being. search “GIRFEC” online.
Children and young people feel safe within their communities due to the proactive approaches services take to promote safer communities. Staff in education, youth services and police help children and young people to acquire the skills they need to keep themselves safe in a wide range of situations which may place them at risk. Young people living in residential units feel safe in their homes. Children and young people are safer and better protected from harm and abuse due to considerable improvements in the recognition and response to children and young people at risk. Staff work well together A framework to assess risks to consider all aspects of children’s and young people’s well- and needs is an orderly way of exploring, understanding and being when they respond to concerns. Where necessary, recording what is happening in children are moved quickly to suitable accommodation in order children’s lives. to keep them safe.
The health of children and young people is improving. More babies are being breastfed and children have better dental health. Nurse co-ordinators ensure that the health needs of vulnerable children and young people are being met as quickly as possible. Early years services place a strong emphasis on improving healthy lifestyles through outdoor play, attention to hygiene and healthy eating. Social workers, health and education staff respond quickly to the early signs of emotional difficulty and are helping vulnerable young people to develop successful ways of managing anxiety and stress.
Children arrive in primary school better prepared for learning. Literacy rates in young children have improved. Most young people achieve well in schools and more are moving onto positive destinations. Children and young people’s educational progress is monitored carefully to identify potential barriers to their learning. More support is needed to help vulnerable children to achieve their academic potential. Most young people leaving care receive very effective support to develop the skills they need for independence. However, vulnerable young people would benefit from better access to meaningful and sustainable employment opportunities.
Children and young people living in kinship care receive helpful and responsive support. Increasingly, children and young people who are not able to remain at home are able to live in good quality family and residential placements. However, some are waiting too long before the plans for their future care are made permanent.
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Young people are very positive about the help they get to stay active, learn new skills and become more confident. However, some young people could miss out through limited access to affordable leisure and recreational activities. Young people benefit from a sense of belonging and positive attitudes within the wider community. Overall, children and young people feel included and listened to. Gypsy traveller children and young people are included and helped to overcome inequalities. Services are successfully preventing and diverting young people from anti-social activity.
Families and carers receive highly effective support from a range of services. There is a strong commitment to including fathers. Families are stronger and more resilient and this is enabling them to provide safer, more nurturing environments for their children and young people. Most families and carers are positive about the flexible help they receive. They feel valued, encouraged to be equal partners and enjoy improved experiences of parenting. They have someone whom they know, trust, and can contact when they need to. A small number of families with long-standing problems need more effective help to accept support and sustain improvements. Families, including kinship carers, would benefit from more opportunities to meet each other in suitable child-friendly places.
The diverse needs of widespread communities are considered carefully when services are being planned. Some local areas such as Tarbert benefit from a wide range of community organisations which very effectively promote health and well-being. This successful approach could be shared more widely in order to make best use of the opportunities offered by voluntary services. Members of the gypsy traveller community have been meaningfully involved in the development of services to meet their needs. Young people are involved in decision-making within their communities through youth forums and the youth bank project.
7. How well are services working together to improve the lives of children, young people and families?
The plan for integrated children’s services for the period 2009-12 has concluded. Partners have continued to work together on implementing Getting it right for every child and improving services for children in need of protection. The way in which the child protection committee carries out its work has been improved and its priorities for improvement are now much clearer and focused on outcomes. While this work The Child Protection is leading to positive improvements, partners have yet to set Committee brings together all the organisations involved in out a broader set of priorities, objectives and plans to improve protecting children in the area. services for all children, young people and families. A coherent Their purpose is to make sure plan was under development to shape the future of services for local services work together to protect children from abuse and all children, young people and families and to meet the needs keep them safe. for public accountability.
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Services are strongly committed to and use a variety of creative ways to consult and involve children, young people, families and other stakeholders when they use services. As a result, young people feel that they are listened to and their views taken into account. Vulnerable young people are benefiting from more effective opportunities to participate in service planning. There is scope to develop joint approaches to involve and consult stakeholders in designing services and shaping plans.
Partnership working is supported through respectful, open communication, and challenge. The Child and Adult Protection Chief Officers Group provides effective strategic direction and governance to the work of the Child Protection Committee and Argyll and Bute’s Children’s Group. Partners are delivering improvements in systems, processes, and practice and have made significant progress in implementing Getting it right for every child. Services are in a positive position to provide increasingly integrated and more effective services for children and young people. Increasingly, partners are making evidence based decisions about the allocation of resources towards early intervention and prevention. There is still much to do to streamline and share resources. A joint strategic approach to resource planning and commissioning is under development to manage resources more effectively.
Services are reviewing and developing their policies, procedures and guidance with the aim of improving services to protect children and support the implementation of Getting it right for every child. A helpful start has been made to developing shared policies and procedures. Staff are asked for their views and the consistent application of policies and procedures is improving. Managers in social work are committed to adhering to statutory timescales for reviewing and making plans for children.
There is a genuine commitment to improving performance and standards with a focus on outcomes. Audit activity is mainly carried out by individual services and there is a growing appreciation of the benefit of jointly assuring quality. Managers are keen to embrace new ways of working and are demonstrating a willingness to do this together through review, audit and governance groups. Services now need to develop a systematic approach to quality assurance across services. Arrangements for supporting and managing staff in health and social work services have been strengthened. Managers are aware of where they need to provide additional support and guidance to help staff raise standards.
Overall, staff recognise circumstances when children might be at risk of harm and usually take prompt action to protect them. Suitable accommodation is found for children and young people who need to be cared for in a safe place. Staff keep helpful chronologies of significant events, however, they need to improve how they use these to identify concerning patterns and risks to children and young people. Health assessments of young children carefully identify additional health needs and any support that is needed. The quality of assessment of risks and needs has improved but is still too variable. A few children experiencing neglect are not getting the help they need soon enough and a shared understanding of neglect is needed across services. A personal plan or child’s plan Staff generally work well together to plan for individual lays out exactly what support will be provided, and in what children and young people. Further work is needed to reduce way, to meet the child’s needs. the number of different plans and planning. Most vulnerable The plan also records their children and young people have a care or child protection views and wishes.
6 Services for children and young people in Argyll and Bute: report of a pilot inspection 159 plan. The quality of these plans is variable and they do not always set out all the actions needed to keep children and young people safe or improve their wellbeing. Services are working more effectively together to provide young people with a disability with the right level of support to help them move into adulthood. Independent Reviewing Officers provide effective support and challenge to staff to ensure that plans lead to action and that children and young people experience positive change. Services are improving planning for children and young people who are unable to return home but the full impact of this has yet to be realised.
Staff across services listen carefully to the views of children, young people and families. They treat them with respect and take their views in to account when making decisions. They help families understand what needs to happen to make positive improvements in their lives. High quality independent advocacy support is available to children who are looked after away from home or whose names are on the child protection register. More children and young people could benefit from this. Children and families are kept well informed even when they are mistrustful of services. Complaints about services are addressed effectively.
The Getting it right for every child approach has improved joint working across services. This and multi-agency training is contributing to a strong culture of trust and working together. There are examples of creative and flexible deployment of staff to intervene early and deliver better outcomes for children, young people and families. There is scope to introduce joint approaches to workforce planning, training and development aligned to the new integrated children’s services plan. Overall, staff receive support and challenge to help them improve their work. They are valued and highly motivated and making a positive contribution to improving the well-being of children and families.
8. How well do services lead and improve the quality of work to achieve better outcomes for children and families?
The Community Planning Partnership has overseen the development of a new vision for children’s services. Leaders have engaged staff and young people very effectively in developing this vision, which is uniting staff around a common purpose and shared values. A recently formed corporate parenting board is at an early stage in defining its responsibilities. Leaders demonstrate a strong commitment to promoting equality and inclusion and this is shared by staff.
Strategic direction has been focused appropriately on improving services to protect children and young people and in implementing Getting it right for every child. Partners have shared responsibility for addressing areas of weakness and building sustainable strengths. Leaders should now ensure the new integrated children’s services plan is completed and published. This will provide an opportunity to jointly agree how recent service reviews and plans for restructuring services can ensure that the right services are in the right places.
Leaders have been influential in promoting positive working relationships and an ethos of teamwork
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at all levels. Leaders and senior managers are becoming more visible and responsive to staff. Staff are confident about the future of services. Partners are taking steps to strengthen the capacity of leadership at all levels. Services have taken collective ownership of the findings from inspection and reviews, and have taken positive steps to make the necessary improvements to ensure children in need of protection are kept safe. Leaders now need to build on this to ensure continuous improvement in the quality of services for children, young people and families.
Leaders have made a promising start to introducing a systematic Self-evaluation means taking approach to joint self-evaluation and should build on the skills and a close look at what services knowledge that already exist to take this forward. This has been have done and how well they enhanced by the experience of the validated self-evaluation exercise have done it. It is important carried out in conjunction with Education Scotland. A new culture of because it helps people to see clearly where they need to make respect and openness to challenge is developing well. Services are improvements. becoming more self-aware and understand the areas that require further improvement. Leaders are motivated to learn and test out new ways of working. Staff would benefit from more opportunities to share best practice and benchmark against others. Services are at an early stage in developing children, young people and families in self-evaluation.
The Single Outcome Agreement features a number of key performance indicators for children and young people, and improving trends are A Single Outcome Agreement reported for most. There are steady and improving trends in child health, is an agreement between educational achievement and in positive destinations for young people the Scottish Government as they leave school. Partners are reducing outcome gaps for children and Community Planning Partnerships which sets out and young people whose life chances are at risk and are clear about how each will work towards outcomes that require further improvement and are taking appropriate improving outcomes for local steps to do so. Partners now need to measure the key outcomes being people. achieved through early intervention and preventive approaches.
9. Conclusion and areas for improvement
Services are working very well together in partnership which is underpinned by a positive culture of respect and openness. Strong leadership and direction is supporting successful collaborative working. Staff are united with a common purpose within the Getting it right for every child approach which in turn is having a positive impact on the well-being of children, young people and their families. Considerable improvements have been made in the immediate response to children in need of protection and providing help and support to children, young people and families at an early stage. Leaders are highly committed to consolidating these improvements and are clear about where to focus their work to build capacity and consistency. Together, services have made a positive start to leading and directing resources towards prevention and early intervention. Steady progress is being made against most performance indicators for children and services are highly committed to measuring the impact of their work together. There are plans to introduce systematic joint self- evaluation to support improvement.
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Inspectors are confident that services will be able to make the necessary improvements in the light of the inspection findings. In doing so the Argyll and Bute Community Planning Partnership should take account of the need to: • secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children • complete and implement the integrated children’s services plan • continue to develop rigorous and systematic joint self-evaluation to improve outcomes for children and young people • ensure continued leadership and direction is provided to implement the planned improvements for services for children, young people and families.
10. What happens next?
The Care Inspectorate will ask the Argyll and Bute Community Planning Partnership to publish a joint action plan detailing how it intends to make any improvements identified as a result of the inspection.
The Care Inspectorate and other bodies taking part in this inspection will monitor progress and continue to offer support for improvement through their linking arrangements.
Judith Tait Inspection Lead September 2013
Services for children and young people in Argyll and Bute: report of a pilot inspection 9 162 Appendix 1: Indicators of quality
Quality indicators help services and inspectors to judge what is good and what needs to be improved. In this pilot inspection we used a draft framework of quality indicators that was published by the Care Inspectorate in October 2012 called ‘How well are we improving the lives of children, young people and families? A guide to evaluating services for children and young people using quality indicators’. This document is available on the Care Inspectorate website.
Here are the evaluations for eight of the quality indictors.
How well are the lives of children and young people improving?
Providing help and support at an early stage Very good
Impact on children and young people Good
Assessing and responding to risks and needs Adequate
Planning for individual children Adequate
How well are services working together to improve the lives of children, young people and families?
Planning and improving services Adequate
Participation of children, young people, families and other stakeholders Good
How good is the leadership and direction of services for children and young people?
Leadership of improvement and change Good
Improving the well-being of children and young people Good
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This report uses the following word scale to make clear the judgements made by inspectors.
Excellent outstanding, sector leading Very good major strengths Good important strengths with some areas for improvement Adequate strengths just outweigh weaknesses Weak important weaknesses Unsatisfactory major weaknesses
To find out more about our inspections go towww.careinspectorate.com
If you wish to comment about any of our inspections, contact us at [email protected] or alternatively you should write in the first instance to the Care Inspectorate, Compass House, 11 Riverside Drive, Dundee, DD1 4NY.
Our complaints procedure is available from our website www.careinspectorate.com or alternatively you can write to our Complaints Team, at the address above or by telephoning 0845 600 9527.
If you are not satisfied with the action we have taken at the end of our complaints procedure, you can raise your complaint with the Scottish Public Services Ombudsman (SPSO). The SPSO is fully independent and has powers to investigate complaints about government departments and agencies.
You should write to SPSO, Freepost EH641, Edinburgh EH3 0BR. You can also telephone 0800 377 7330, fax 0800 377 7331 or e-mail: [email protected]
More information about the Ombudsman’s office can be obtained from the website at www.spso.org.uk
Services for children and young people in Argyll and Bute: report of a pilot inspection 11 164
Headquarters We have offices across Scotland. To find your nearest Care Inspectorate office, visit our website or call our Care Inspectorate Compass House enquiries line. 11 Riverside Drive Dundee DD1 4NY Tel: 01382 207100 Fax: 01382 207289
Website: www.careinspectorate.com Email: [email protected] Care Inspectorate Enquiries: 0845 600 9527
This publication is available in other formats and other languages on request. Tha am foillseachadh seo ri fhaighinn ann an cruthannan is cànain eile ma nithear iarrtas.
© Care Inspectorate 2013 Published by: Communications 165 APPENDIX 2 CPP ACTION PLAN
Community Planning Partnership Improvement Plan 2013 - 2014
Version 3 Revised by CPP, CAPCOG Revision Date November 2013 166
Introduction:
By the Chair of the Community Planning Partnership
The pilot Joint Inspection of services to children and young people, led by the Care Inspectorate, took place over 22 weeks in 2013 and involved inspections, reviews of case records, interviews of families and young people, meetings with staff and elected members. They looked at the work of the Community Planning Partnership to improve the lives of children in Argyll and Bute and considered services to children and young people provided by NHS, Council, Police, Independent and Third Sector. The CPP welcomed the final report from the Care Inspectorate which was received in September 2013. The inspectors recognised: The strong commitment to prevention and early intervention A very positive culture of partnership working at all levels The flexible approach to working with families to improve outcomes for children and young people Sound work to promote strong and resilient children, young people and families
The inspectors also highlighted three areas of good practice which are: Getting it right antenatal – our interagency approach to identifying and supporting vulnerable pregnant women, which is having a significant impact on giving unborn babies the best start in life Early intervention service –this service provides high quality intensive support to vulnerable children and young people Nurse coordinators – working to support children in care, families affected by homelessness and Gypsy traveller families
They identified areas for improvement as:
Secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children Complete and implement the Integrated Children’s Services Plan Continue to develop rigorous and systematic joint self-evaluation to improve outcomes for children and young people Ensure continued leadership and direction is provided to implement the planned improvements for services for children, young people and families
This action plan is designed to address the four specific areas for improvement identified by the Care Inspectorate and will supplement the more comprehensive and wide ranging Integrated Children’s Services Plan which will be published in November 2013.
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1. Secure further and continuous improvement in the quality of assessment of risks and needs and planning for individual children Outcome Actions to Achieve Success Performance Monitoring Role & Linked to Completion Outcome Measure Indicators Frequency Organisation Date Children and Streamline Robust My World Quality of Argyll & Consultant Integrated June 2014 young people assessment and care Assessment in assessment Bute’s Nurse, NHS Children receive planning processes place. improves, Children and Service Services appropriate through further 70% graded quarterly Manager, AB Plan support based on embedding of the Implementation of good or above Council a holistic needs Getting it Right for universal Child’s led assessment to Every Child practice Plan ensure they are safe and well Develop a college of Establish and expertise across the assess multi- partnership agency audit schedule Develop the framework for Child assessment and the Protection Multi Agency Toolkit. Business Improvement Guidance and Plan Training on chronologies and risk assessment with training plan
Children and Implement the Establish child’s Quality of Argyll & Consultant Integrated June 2014 young people Universal Child’s Plan assessment and assessment Bute’s Nurse, NHS Children receive support (UCP) across A&B plan audits improves, Children and Service Services tailored to their from 1st Jan 2014 70% graded quarterly Manager, AB Plan individual needs good or above Council through agreed actions detailed in 100% of the Universal children Child’s plan reporting they feel safe at review 3 168
Secure a child’s Implement the Increase the 70% Argyll & Head of Getting It March 2014 plan for permanency action number of LAAC>1yr Bute’s Children’s and Right for permanence plan through Argyll & children with a with a plan for Children Families Looked After timeously Bute’s Children permanency plan permanence quarterly Services, AB Children and Develop a system to Council Children & monitor permanence Decrease length Children & Families action plans progress of time children Families Service Plan waiting Management permanence Team order
2. Complete and implement the Integrated Children’s Services Plan Outcome Actions to Achieve Success Measure Performance Monitoring Role and Linked to Completion Outcome Indicators Frequency Organisation Date Strategic planning Conclude The plan is Outlined in the Annual Argyll & Bute’s Integrated December improves consultation on implemented and ICSP report to Children Children 2013 outcomes for 12.10.13 monitored Community Services children and young Planning Plan people Publish integrated New structure Partnership children’s services embedded plan in mid- November Develop scorecards to Develop measure performance performance framework and co- ordination of information to inform future service plan
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3. Continue to develop rigorous and systematic joint self-evaluation to improve outcomes for children and young people
Outcome Actions to Achieve Success Measure Performance Monitoring Role and Linked to Completion Outcome Indicators Frequency Organisation Date Argyll and Bute Review the existing Evidence of service 10% children Annual Argyll and Integrated June 2014 use self- framework for self- improvement based and young report to Bute’s Children evaluation to evaluation on self-evaluation people Community Children Services build capacity to involved in Planning Plan and improve Implement annual Evidence of audit service Partnership Child outcomes for programme of audit and self-evaluation planning and Protection children and and self-evaluation programme redesign Business young people across the Improvement partnership Evidence of impact 10% increase Plan of engagement of in young Communicate the Children and Young people priorities for People. attending Area improvement to staff Community Evidence of the Planning Develop a self- impact of Groups evaluation stakeholder framework. engagement Annual Youth Conference targeted specifically for 12-24 year Provide an annual olds across plan to the CPP Argyll & Bute
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4. Ensure continued leadership and direction is provided to implement the planned improvements for services for children, young people and families Outcome Actions to Achieve Success Measure Performance Monitoring Role and Linked to Completion Outcome Indicators Frequency Organisation Date The partnership CPP prioritise Leaders are visible 100% CPP Quarterly Community Single October will lead children through meetings through Planning Outcome 2013 improvements for SOA Staff understand include Child and Partnership Agreement children, young priorities and plans Children’s Adult led by Argyll & and people and Ensure co-ordination Services Protection Bute Council Integrated families and delivery of ICSP Performance Chief Children actions across information 100% Argyll Officers Services Plan partners at all levels demonstrates and Bute’s Group positive Children Ensure that children improvement meetings & young people across the review contribute to the partnership performance delivery of the ICSP data and Children, young identify Use variety of people and their actions to methods used to families tell us address areas communicate with services are for staff improving improvement
Present performance 100% staff information across report that agencies to they CAPCOG understand priorities and plans
6 171 Highland NHS Board 3 December 2013 Item 5.2
FINANCIAL POSITION AT 31 OCTOBER 2013 (MONTH 7)
Report by Nick Kenton, Director of Finance
The Board is asked to: Note the continued forecast out-turn of break-even overall. Note the requirement of a £8.5m improvement to achieve this.
1 Introduction
This paper highlights the financial forecast and progress on savings plans as at 31 October, 2013 (Month 7).
2 Key Messages
An overall break-even position forecast by 31/3/14 The year to date overspend is £4.3m The current reported potential overspend forecast at £8.5m An improvement of £1.1m on the month 5 position previously reported The current overspend is split between;
. Savings to be identified - units £3.8m . Adult Social Care (mainly S&M) £3.7m . Pressures less offsetting benefits £6.8m . Non-Recurrent Benefits Expected (£5.8m)
The Month 7 forecast in the previous year was a potential overspend of £6.9m
The shortfall on savings above was largely relates to savings carried forward from 2012/13 in relation to Raigmore. This shortfall was anticipated and was allowed for in the financial plan. The main causes of the potential overspend of £8.5m are in-year cost pressures. There are some cross-cutting themes such as the impact of medical locums (£4m net of vacancy savings) and the impact of meeting access targets (£1.9m) and cancer drugs (£0.5m).
3 Financial Position Overview
The financial position reported at the end of October continues to show a forecast of financial breakeven, recognising the significant challenge this brings in terms of the delivery of savings targets, together with successful management of in-year cost and service pressures within the overall financial bottom line.
The position to date is detailed in Table 1 (attached) and continues to be addressed through a range of management actions across NHS Highland, which leads to the projection of financial breakeven. As it stands, the current forecast can be summarised as follows; 172
Fig 1
Breakdown of Month 7 Forecasts Operational Unit N&W S&M Raigmore ASC HQ Tertiary Others HSCP A&B Corp. Central Total Heading £m £m £m £m £m £m £m £m £m £m £m
Savings Operational Savings not yet achieved/identified (0.6) (2.6) (0.1) (3.3) (0.4) 2.6 (1.1) In year non-recurrent benefits applied 0.0 3.2 3.2 Pressures Adult Social Care (0.5) (4.8) 1.5 (3.8) (3.8) In-year cost pressures (1.2) (0.4) (6.3) (0.6) (0.4) (8.9) (0.7) (0.1) (9.7) Offsetting underspends/benefits 0.5 0.6 0.3 0.2 1.6 1.1 0.2 2.9 Forecast Out-turn (1.8) (4.6) (8.6) 1.5 (0.6) (0.3) (14.4) 0.0 0.1 5.8 (8.5)
Previous Report - month 5 (1.3) (4.6) (8.6) 1.7 0.0 (0.5) (13.3) 0.0 0.0 3.7 (9.6)
Change (0.5) 0.0 0.0 (0.2) (0.6) 0.2 (1.1) 0.0 0.1 2.1 1.1
During the two month reporting period, a further of £2.1m of non-recurrent/fortuitous resource has been applied to improve the overall position however; the benefit of this is reduced by a further deterioration of £1m within budgets.
Table 5 identifies savings achievement by Unit and also highlights the increasing reliance on non-recurrent savings.
As highlighted in previous reports, the adult social care forecast needs to be considered as a whole, as well as a part of South and Mid Highland’s forecast, as the Unit positions are distorted by the removal of Care at Home budgets to a central area, for the initial part of the year. This resulted in the removal of prior year underspends in South & Mid and overspends in North & West.
The usual financial tables are attached as follows;
Table 1 presents the overall income and expenditure position, inclusive of adult social care funding transferred in from Highland Council and excluding funding transferred out to Highland Council relating to children’s services.
Table 2 provides more detail on the overall expenditure position. The budgets for South & Mid Highland and North & West Highland operational units are now integrated budgets inclusive of adult social care relating to their areas.
Table 3 shows the same information but excluding Adult Social Care.
Table 4 shows the total position on adult social care alone.
Table 5 summarises the position against savings. This highlights the fact that there is still significant work required to identify sufficient savings to deliver the financial plan.
Table 6 summarises the position with regards capital expenditure.
Table 7 presents more detail on capital expenditure as requested at the previous Board meeting
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4 Operational Performance
In summary, the breakdown of the position by unit is: £m Raigmore (8.6) South & Mid (ASC) (4.6) Adult Social Care - Central 1.5 North & West (1.8) Forecast non-recurrent benefits 5.8 Tertiary (0.6) Others (0.2)
Specific issues within operational units are as follows;
4.1 Argyll & Bute CHP – Breakeven A&B CHP is currently forecasting a breakeven position although the Unit has still deliver around £0.4m of savings, which there remains a high degree of confidence in delivering. In addition to this, the CHP continues to manage a number of pressures, the most significant of these relate to medical and surgical locums of around £0.4m.
4.2 North and West Unit – £1.8m Overspend N&W has moved adversely by £0.5m over the two month period. This relates to two main items; further costs in respect of medical locums within the Rural General Hospitals of approx £0.3m with the balance due mainly to new high cost care packages within their ASC expenditure.
4.3 South and Mid Unit – £4.6m Overspend S&M are reporting an adverse movement of around £0.2m in respect of adult social care packages which is offset by improvements within prescribing.
ASC overspends in units are offset by an underspend of £1.5m within the central Adult Social Care budgets.
4.4 Raigmore Hospital – £8.6m overspend The most significant overspend relates to Raigmore and can be broken down into the following elements; £m 2012/13 non-recurrent carry forward 2.6 Increase expenditure to meet TTG/Access targets 1.9 Expenditure on cancer & rheumatology drugs 0.5 Locum costs due to sickness, maternity and capacity 2.1 Clinical supplies/other pressures 1.5
In terms of the carry forward, the Local Delivery Plan (LDP) assumed that Raigmore would require time to deliver a balanced budget and that it was unlikely to significantly improve its achievement against this target. The under-achievement on this savings target is therefore not unexpected and is offset within the NHS Highland overall bottom line on a non-recurrent basis.
Treatment Times Guarantee (TTG) initiatives were highlighted to the Board in previous reports and are considerable.
The most significant other cost pressures within Raigmore relate to locum costs particularly in dealing with challenging capacity issues within Oncology, Haematology and Radiology.
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It should be noted that the Raigmore position had previously been on a deteriorating trend but has stabilised between months 4 and 7 with small offsetting movements in between. However, there remains an element of risk within this forecast, particularly around drugs.
The Programme Board at Raigmore has now been re-focussed to concentrate on medium to long term transformational work (in line with the Highland Quality Approach) and the task of financial recovery has been given to the Raigmore senior management team.
4.5 Out of Area (Tertiary) The forecast for tertiary has moved from a break even position to a £0.6m overspend. This is due to four high cost adolescent psychiatry/eating disorder patients placed within non-NHS facilities. The extrapolated annual cost for each of these placements is approximately £0.25m and the forecast has been revised in light of information regarding expected discharge dates.
4.6 Others (£0.2m over) including Central (£5.8m under) The majority of the £0.3m relates to overspends in facilities primarily due to overspends in Raigmore energy costs.
In terms of Central, the improvement of £2.1m relates to the application of non- recurrent benefits to the overall bottom line.
5 Actions Being Taken
It is clear that the scale of the challenge faced this year requires a co-ordinated approach with all parts of the organisation needing to contribute. Detailed actions are taking place – summary below:
Raigmore – the unit has been set a challenge of reducing its forecast overspend by £2m. This is a challenging target, but to put it into context it would still allow the unit to overspend every month for the remainder of the financial year. A £2m improvement would be achieved by reducing the level of overspend. The corporate team continue to offer close support to Raigmore, including detailed review and challenge of high spend areas such as locums, access targets and cancer drugs.
Adult Social Care – the two units have been set a challenge of reducing the forecast overspend by £0.9m. The current forecast for ASC as a whole now stands at £3.8m. The corporate team offers detailed scrutiny and challenge on this. Progress is being made in identifying measures to close this gap. In addition, discussions will be taken forward with Highland Council in line with the agreed budget protocol for managing material variances.
North & West – the unit is currently forecasting an overspend of £1.8m on its NHS budgets with the main pressures being out of hours services and locum expenditure. The challenge set for the unit is to manage this down by at least £0.8m. Measures have been identified that would address a significant portion of this challenge – with more work still to be done. Again, the corporate team will offer detailed review and challenge.
Argyll & Bute – the CHP has financial pressures particularly on locum spends but has reported a forecast break-even all year. A challenge has been set for the CHP to go beyond this and deliver and underspend of £1m. The CHP has accepted this challenge and is working to achieve this and go beyond this to reach £1.3m.
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Tertiary / SLA budget for Northern Highland – detailed reviews of these budgets are undertaken on an ongoing basis but these will now be more formalised. A modest target of £0.1m has been set for this budget.
Corporate Services – the corporate services budgets were set a challenging target of delivering 5% savings in 2013/14 – continuing the trend of recent years of targeting corporate services for higher savings than the operational units. This is on course to be delivered, and in fact Corporate Services is now forecasting a small underspend. Further measures will be taken with the aim of increasing this underspend by £0.3m to contribute to the overall position.
Non pay – an Intensive Improvement Activity analysis of procurement opportunities has recently been concluded, with significant support from National Procurement. A target of £0.7m has been set for this. This is probably a reasonable target for the full year but represents a real ‘stretch’ target to deliver this level of savings in the second half of 2013/14. There are a significant number of areas to be explored so these will need to be addressed in priority order.
Integrated pharmacy – currently forecasting an overspend of £0.2m which needs to be addressed. In addition, a challenge of £0.4m has been set regarding primary care drugs.
It is anticipated there will be further allocations slippage in the region of £1.4m.
There are a range of other measures that aim to release £0.4m
If the targets set out above are achieved this would improve the position by £8.5m and hence close the gap and provide the balanced financial plan required. However, the scale of this challenge should not be underestimated with four months of the financial year now remaining.
6 Capital
NHS Highland has a mixture of ring-fenced funded projects and ongoing replacement programmes in place to maximise the use of this year’s Capital Resource Limit (CRL). The replacement programmes have been prioritised and phased and will continue into next and subsequent years and the capital spend continues to show a forecasted position of breakeven as per the LDP
The year to date position is showing spend to date of £3.8m against a budget of £17.6m and this is consistent with previous years, where the majority of spend is in the last quarter of the year. In addition, a number of the major schemes such as Oban Dental, Raigmore Biomass, Endoscopy Decontamination and Dingwall Health Centre are scheduled to complete in the next couple of months. Detailed scrutiny is undertaken on the Board’s behalf by the Asset Management Group – key budget holders continue to offer assurance that their budgets will be spent in line with the forecasts.
The reported position is consistent with recent discussions with Scottish Government colleagues, to agree that any in year slippage on schemes will be managed within NHS Highland by advancing planned spend from 2014/15, to protect the overall funding. Recent examples of this include slippage in the current year on the Raigmore Critical Care project and Dingwall Health Centre being utilised by bringing forward planned spend from 14/15 for eHealth and Tain Health Centre and holding funds for Drumnadrochit Health Centre which starts next year.
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Additional expenditure requirements in year approved at Asset Management include an equipment store in Helensburgh, additional costs for the Patient Management System (PMS) and some Estates/Maintenance issues which have been made possible in year by the availability of funds released from disposals.
As requested at the previous Board meeting, greater detail on the capital spend is included in this report – in Table 7.
7 Conclusion
The position for Month 7 highlights a requirement to improve the position by £8.5m to deliver break-even. This represents a significant challenge to which the whole organisation is responding – not just those areas that are showing forecast overspends. Plans have now been identified to address the gap. These are at various stages of implementation and it is clear that a significant effort and focus will be required to deliver these plans over the remainder of the financial year. The details of these plans will be monitored by the Executive Team as well as through the Highland Health and Social Committee and Argyll & Bute Community Health Partnership.
8 Governance Implications
Accurate and timely financial reporting is essential to maintain financial stability and facilitate the achievement of Financial Targets which underpin the delivery and development of patient care services. In turn, this supports the deliverance of the Governance Standards around Clinical, Staff and Patient and Public Involvement.
9 Risk Assessment
Financial risks, including the potential failure to deliver the necessary Financial Targets are included on the Corporate Risk register and managed accordingly.
10 Planning for Fairness
A robust system of financial control is crucial to ensuring a planned approach to savings targets – this allows time for impact assessments of key proposals impacting on any changes to services.
11 Engagement and Communication
The majority of the Board’s revenue budgets are devolved to operational units, which report into two governance committees that include staff-side, patient and public forum members in addition to local authority members, voluntary sector representatives and non-executive directors. These meetings are open to the public. The overall financial position is considered at the full Board meeting on a regular basis. All these meetings are also open to the public. The overall financial position was described in “Health Check” which was sent to every household in Highland.
Nick Kenton Director of Finance
22 November 2013
6 NHSHighland177 TABLE1 Income & Expenditure Report as at OCTOBER 2013
Prev to Date ReportPosition Forecast OutturnAnnual Plan Initial Current Plan Actual Variance Forecast Variance from Forecast Movement Plan Plan Summary Funding & Expenditure to Date to Date to Date Outturn Current Plan Variance in month £000 £000 £000 £000 £000 £000 £000 £000 £000
509,790 509,811 SEHD -Baseline Funding 290,586 290,586 0 509,811 0 0 0 8,379 - Recurring Supplemental Allocations 4,888 4,888 0 8,379 0 0 0 (5,668) - Non Recurring Supplemental Allocations (3,306) (3,306) 0 (5,668) 0 0 0 509,790 512,521 Sub total - SGHD Core RRL 292,167 292,167 0 512,521 0 0 0
0 18,777 - Non Core Funding 10,953 10,953 0 18,777 0 0 0
509,790 531,298 SGHD Funding as at September 2012 303,120 303,120 0 531,298 0 0 0
24,992 26,110 - FHS Non Discretionary 15,231 15,231 0 26,110 0 0 0 55,697 56,299 - FHS GMS Allocation 32,841 32,841 0 56,299 0 0 0 25,734 17,142 - Recurring Pending allocations 9,999 9,999 0 17,142 0 0 0 12,174 (437) - Non Recurring Pending allocations (255) (255) 0 (437) 0 0 0
628,386 630,412 TOTAL SGHD Funding 360,936 360,936 0 630,412 0 0 0
85,966 86,318 Add- Adult Social Care Quantun Funding 50,299 50,299 0 86,318 0 0 0 (7,710) (7,889) Less - THC Childrens services Transfer (4,630) (4,630) 0 (7,889) 0 0 0
706,642 708,842 Funding 406,605 406,605 0 708,842 0 0 0
Health & Social Care Partnership
108,421 110,676 North & West Operational Unit 64,755 65,938 (1,184) 112,447 (1,771) (1,338) (433) 145,611 149,583 South & Mid Operational Unit 92,138 94,046 (1,907) 154,193 (4,610) (4,610) (1) 20,969 21,124 Adult Social Care - Central 12,719 12,480 238 19,627 1,497 1,676 (179) 132,417 135,671 Raigmore 80,560 84,992 (4,432) 144,231 (8,559) (8,575) 16 19,812 19,962 Facilities 11,214 11,213 1 20,122 (160) (179) 19 4,823 5,018 Integrated Pharmacy 2,995 2,987 7 5,229 (211) (216) 5 4,380 9,433 e health 6,112 6,117 (5) 9,433 0 0 0 19,119 19,000 Tertiary 10,822 11,203 (381) 19,610 (610) 0 (610) 14,483 14,041 Other HCP 8,169 8,233 (65) 14,037 4 (43) 47
470,034 484,506 TOTAL H&SCP 289,483 297,210 (7,727) 498,929 (14,420) (13,285) (1,136)
179,644 180,864 Argyll & Bute CHP 103,721 104,142 (421) 180,864 0 0 0
Cental Services 17,257 18,013 Corporate Services 9,808 9,652 156 17,917 96 8 88 39,706 25,459 Central Costs & Reserves 3,593 (98) 3,691 19,608 5,851 3,660 2,191
706,642 708,842 Total Expenditure 406,605 410,906 (4,301) 717,317 (8,474) (9,617) 1,143
Manangement Planned Actions 0 (8,474) 8,474 9,617 (1,143)
0 0 Surplus/Deficit Mth 7 0 4,301 (4,301) 0 0 (0) 0 Finance - Monitoring 5.2 Area Finance Rept to 31 10 13 Tables.xlsx Total Summary 22/11/2013 11:28 Income & Expenditure Report as at OCTOBER178 2013 Table 2 YTD Position Forecast Outturn Budget Prev ReportAnnual Initial Current Summary Plan Actual Variance Forecast Var From Forecast Movement Plan Plan Health & Social Care Partnership to Date to Date to Date Outturn Current Plan Variance in month £000 £000 £000 £000 £000 £000 £000 £000 £000
North & West Operational Unit 32,739 33,440 North Area - Caithness District 19,547 20,310 (763) 34,717 (1,277) (742) (535) 17,753 18,086 - Sutherland District 10,570 10,297 273 17,732 354 155 199 20,703 21,462 West Area - S,L, & WR District 12,725 13,548 (823) 22,586 (1,124) (721) (403) 28,026 28,641 - Lochaber District 16,944 17,331 (387) 28,917 (276) (243) (33) 5,441 5,185 North & West Area Mgt 2,684 2,147 537 4,566 619 213 406 104,662 106,813 North & West Operational Sub Total 62,470 63,633 (1,163) 108,518 (1,704) (1,338) (366) 3,759 3,862 N & W Hosted Services 2,284 2,305 (21) 3,929 (67) 0 (67) 108,421 110,676 Total North & West 64,755 65,938 (1,184) 112,447 (1,771) (1,338) (433)
South & Mid Operational Unit 21,030 21,717 South Area - Inverness West District 12,660 13,382 (723) 23,019 (1,302) (1,517) 215 27,459 28,296 - Inverness East District 16,503 16,940 (438) 28,913 (617) (446) (170) 25,053 25,555 - NABS district 14,866 14,660 207 25,310 245 24 221 3,334 3,304 - South Other services 1,911 1,759 153 3,175 129 1 128 15,733 15,989 Mid Area - Easter Ross District 9,316 10,044 (727) 17,506 (1,517) (1,260) (257) 17,286 17,158 - Mid Ross District 9,904 10,585 (681) 18,625 (1,467) (1,754) 286 3,604 4,376 - Mid Other services 2,549 2,570 (22) 4,430 (54) (40) (14) 2,912 2,940 South & Mid Unit Central 1,086 1,077 9 3,089 (149) 303 (452) 116,411 119,335 South & Mid Operational Sub Total 68,795 71,017 (2,222) 124,067 (4,732) (4,688) (44) 18,124 18,268 Adult Mental Health 10,564 10,531 34 18,266 2 1 1 1,214 1,190 Learning Disabilities 704 645 59 1,148 42 30 12 1,755 1,564 Substance Misuse 684 648 36 1,526 38 27 11 8,107 9,225 Dental Services 11,391 11,206 186 9,186 39 20 19 29,200 30,248 Sub Total SE CHP Hosted services 23,344 23,029 315 30,126 122 79 43 145,611 149,583 Total South & Mid 92,138 94,046 (1,907) 154,193 (4,610) (4,610) (1)
20,969 21,124 Adult Social Care - Central 12,719 12,480 238 19,627 1,497 1,676 (179)
Raigmore Operational Unit 49,547 51,964 Surgical & Anaesth. Divison 30,328 33,099 (2,771) 55,774 (3,810) (5,267) 1,457 73,889 76,936 Medical & Diagnostics Division 44,696 45,444 (748) 77,283 (347) (1,433) 1,086 2,044 2,044 Raigmore Hotel Services 1,205 1,229 (24) 2,119 (75) (106) 31 3,132 3,343 Patient Support Division 1,958 2,115 (157) 3,649 (306) (321) 15 2,023 (765) Raigmore Central 1,365 2,121 (755) 3,273 (4,038) (1,454) (2,584) 130,635 133,521 Raigmore Divisions 79,553 84,007 (4,454) 142,098 (8,576) (8,581) 5 416 549 Research & Development 243 232 11 542 7 (2) 9 1,365 1,601 ACT - Additional cost of Teaching 765 753 11 1,591 10 8 2 132,417 135,671 Total Raigmore 80,560 84,992 (4,432) 144,231 (8,559) (8,575) 16
Other H&SCP Services 19,812 19,962 Facilities 11,214 11,213 1 20,122 (160) (179) 19 4,823 5,018 Integrated Pharmacy 2,995 2,987 7 5,229 (211) (216) 5 4,380 9,433 e health 6,112 6,117 (5) 9,433 0 0 0 19,119 19,000 Tertiary 10,822 11,203 (381) 19,610 (610) 0 (610) 14,483 14,041 Other HCP 8,169 8,233 (65) 14,037 4 (43) 47 62,617 67,453 39,312 39,754 (442) 68,431 (977) (438) (539)
470,034 484,506 Total Health & Social Care Partnership 289,483 297,210 (7,727) 498,929 (14,420) (13,285) (1,136)
18,737 19,201 A & B CHP- Oban, Lorn & Isles 11,130 11,486 (357) 19,701 (500) (500) 0 16,869 17,148 Mid Argyll, Kintyre & Islay 9,887 9,857 30 17,148 0 (79) 79 7,320 7,463 A&B MH In-patient Services 4,186 4,158 28 7,363 100 100 0 12,508 12,707 Cowal & Bute 7,388 7,525 (137) 12,867 (160) (300) 140 4,857 4,900 Helensburgh & Lomond 2,862 2,817 45 4,800 100 50 50 9,231 8,811 Other clinical services 4,806 4,819 (13) 8,817 (6) 8 (14) 15,404 15,603 GMS 8,947 9,063 (116) 15,803 (200) (150) (50) 17,075 17,030 Prescribing 9,743 9,627 116 16,930 100 100 0 7,781 7,781 FHS Non Disc. Services 4,801 4,801 0 7,781 0 0 0 49,437 49,556 HCP - Glasgow & Clyde 28,324 28,348 (24) 49,598 (42) (46) 4 4,074 4,026 HCP - Other 2,309 2,608 (300) 4,361 (335) (546) 211 4,603 4,658 Resource Transfer 2,717 2,717 0 4,658 0 0 0 11,748 11,980 Central & Corporate 6,622 6,316 306 11,037 943 1,363 (420) 179,644 180,864 Total A&B CHP 103,721 104,142 (421) 180,864 0 0 0
Central Services 17,257 18,013 Corporate Services 9,808 9,652 156 17,917 96 8 88 39,706 25,459 Central Costs/Reserves 3,593 (98) 3,691 19,608 5,851 3,660 2,191
706,642 708,842 Total Net Expenditure 406,605 410,906 (4,301) 717,317 (8,474) (9,617) 1,143
Finance - Monitoring 5.2 Area Finance Rept to 31 10 13 Tables.xlsx Fin Position 22/11/2013 11:28 Income & Expenditure Report as at OCTOBER179 2013 Table 3 YTD Position Forecast Outturn Prev Budget ReportAnnual Initial Current Summary Plan Actual Variance Forecast Var From Forecast Movement Plan Plan Health excluding Adult Social Care to Date to Date to Date Outturn Current Plan Variance in month £000 £000 £000 £000 £000 £000 £000 £000 £000
North & West Operational Unit 26,058 26,632 North Area - Caithness District 15,514 15,992 (478) 27,367 (735) (447) (288) 12,843 13,159 - Sutherland District 7,674 7,346 328 12,685 474 354 120 15,438 15,966 West Area - S,L, & WR District 9,437 10,088 (651) 16,863 (897) (546) (351) 20,749 21,272 - Lochaber District 12,596 13,195 (599) 21,927 (655) (525) (130) 4,646 4,327 - West Area Mgt 2,145 1,630 515 3,742 585 163 422 79,735 81,356 North & West Operational Sub Total 47,367 48,251 (884) 82,584 (1,228) (1,001) (227) 3,759 3,862 N & W Hosted Services 2,284 2,305 (21) 3,929 (67) 0 (67)
83,494 85,218 Total North & West 49,651 50,557 (905) 86,513 (1,295) (1,001) (294)
South & Mid Operational Unit 12,985 13,294 South Area - Inverness West District 7,773 7,648 125 13,226 68 (22) 90 16,707 17,244 - Inverness East District 10,088 10,159 (70) 17,311 (67) 27 (95) 17,379 17,679 - NABS district 10,286 10,239 47 17,670 9 (160) 169 3,334 1,271 - South Other services 719 688 32 1,250 21 17 4 11,009 11,087 Mid Area - Easter Ross District 6,470 6,451 19 11,305 (218) (40) (178) 10,595 10,424 - Mid Ross District 6,018 5,858 160 10,316 108 (103) 211 3,604 4,376 - Mid Other services 2,549 2,570 (22) 4,430 (54) (40) (14) 728 3,205 South & Mid Unit Central 1,356 1,068 288 2,958 247 242 5 76,340 78,581 South & Mid Operational Sub Total 45,259 44,681 578 78,466 115 (78) 192 18,124 18,268 Adult Mental Health 10,564 10,531 34 18,266 2 1 1 1,214 1,190 Learning Disabilities 704 645 59 1,148 42 30 12 1,755 1,564 Substance Misuse 684 648 36 1,526 38 27 11 8,107 9,225 Dental Services 11,391 11,206 186 9,186 39 20 19 29,200 30,248 Sub Total SE CHP Hosted services 23,344 23,029 315 30,126 122 79 43
105,540 108,829 Total South & Mid 68,603 67,710 893 108,592 237 1 236
Raigmore Operational Unit 49,547 51,964 Surgical & Anaesth. Divison 30,328 33,099 (2,771) 55,774 (3,810) (5,267) 1,457 73,889 76,936 Medical & Diagnostics Division 44,696 45,444 (748) 77,283 (347) (1,433) 1,086 2,044 2,044 Raigmore Hotel Services 1,205 1,229 (24) 2,119 (75) (106) 31 3,132 3,343 Patient Support Division 1,958 2,115 (157) 3,649 (306) (321) 15 2,023 (765) Raigmore Central 1,365 2,121 (755) 3,273 (4,038) (1,454) (2,584) 130,635 133,521 Raigmore Divisions 79,553 84,007 (4,454) 142,098 (8,577) (8,581) 4 416 549 Research & Development 243 232 11 542 7 (2) 9 1,365 1,601 ACT - Additional cost of Teaching 765 753 11 1,591 10 8 2 132,417 135,671 Total Raigmore 80,560 84,992 (4,432) 144,231 (8,560) (8,575) 15
Other H&SCP Services 19,812 19,962 Facilities 11,214 11,213 1 20,122 (160) (179) 19 4,823 5,018 Integrated Pharmacy 2,995 2,987 7 5,229 (211) (216) 5 4,380 9,433 e health 6,112 6,117 (5) 9,433 0 0 0 19,119 19,000 Tertiary 10,822 11,203 (381) 19,610 (610) 0 (610) 14,483 14,041 Other HCP 8,169 8,233 (65) 14,037 4 (43) 47 62,617 67,453 39,312 39,754 (442) 68,431 (977) (438) (539)
382,286 397,171 Sub Total 238,126 243,012 (4,886) 407,767 (10,595) (10,013) (582)
18,737 19,201 A & B CHP- Oban, Lorn & Isles 11,130 11,486 (357) 19,701 (500) (500) 0 16,869 17,148 Mid Argyll, Kintyre & Islay 9,887 9,857 30 17,148 0 (79) 79 7,320 7,463 A&B MH In-patient Services 4,186 4,158 28 7,363 100 100 0 12,508 12,707 Cowal & Bute 7,388 7,525 (137) 12,867 (160) (300) 140 4,857 4,900 Helensburgh & Lomond 2,862 2,817 45 4,800 100 50 50 9,231 8,811 Other clinical services 4,806 4,819 (13) 8,817 (6) 8 (14) 15,404 15,603 GMS 8,947 9,063 (116) 15,803 (200) (150) (50) 17,075 17,030 Prescribing 9,743 9,627 116 16,930 100 100 0 7,781 7,781 FHS Non Disc. Services 4,801 4,801 0 7,781 0 0 0 49,437 49,556 HCP - Glasgow & Clyde 28,324 28,348 (24) 49,598 (42) (46) 4 4,074 4,026 HCP - Other 2,309 2,608 (300) 4,361 (335) (546) 211 4,603 4,658 Resource Transfer 2,717 2,717 0 4,658 0 0 0 11,748 11,980 Central & Corporate 6,622 6,316 306 11,037 943 1,363 (420) 179,644 180,864 Total A&B CHP 103,721 104,142 (421) 180,864 0 0 0
Central Services 17,257 18,013 Corporate Services 9,808 9,652 156 17,917 96 8 88 39,706 25,459 Central Costs/Reserves 3,593 (98) 3,691 19,608 5,851 3,660 2,191
618,894 621,507 Total Net Expenditure 355,248 356,708 (1,460) 626,155 (4,649) (6,346) 1,697
Finance - Monitoring 5.2 Area Finance Rept to 31 10 13 Tables.xlsx Health 22/11/2013 11:28 Income & Expenditure Report as at OCTOBER 2013180 Table 4 YTD Position Forecast Outturn Budget Prev ReportAnnual Initial Current Plan Actual Variance Forecast Var From Forecast Movement Plan Plan Summary Adult Social Care to Date to Date to Date Outturn Current Plan Variance in month £000 £000 £000 £000 £000 £000 £000 £000 £000
North & West Operational Unit 6,681 6,808 North Area - Caithness 4,033 4,318 (284) 7,350 (542) (295) (247) 4,910 4,927 - Sutherland District 2,896 2,951 (55) 5,047 (120) (199) 79 5,264 5,496 West Area - S,L, & WR District 3,288 3,460 (172) 5,723 (227) (175) (52) 7,276 7,369 - Lochaber District 4,348 4,136 212 6,990 379 283 96 796 857 North & West Unit Central 539 517 22 824 33 49 (16) 24,927 25,458 Total North & West 15,104 15,382 (277) 25,934 (477) (337) (140)
South & Mid Operational Unit 8,045 8,423 South Area - Inverness West District 4,887 5,734 (847) 9,793 (1,370) (1,494) 124 10,753 11,052 - Inverness East District 6,415 6,782 (367) 11,602 (550) (474) (76) 7,674 7,876 - NABS district 4,581 4,421 160 7,640 236 184 52 4,723 4,901 Mid Area - Easter Ross District 2,846 3,592 (746) 6,201 (1,300) (1,221) (79) 6,691 6,734 - Mid Ross District 3,886 4,726 (841) 8,309 (1,575) (1,650) 75 2,185 2,033 South Area Other Services SW 1,192 1,071 121 1,925 108 (17) 125 (265) South & Mid Unit - Central (270) 9 (278) 131 (396) 61 (457) 40,070 40,754 Total South & Mid 23,535 26,336 (2,798) 45,601 (4,847) (4,611) (236)
20,969 1,350 Adult Social Care - Central 1,628 972 655 (76) 1,426 1,473 (47) 17,113 - Care at Home 9,417 9,842 (425) 17,075 38 159 (121) 2,661 - Business support 1,674 1,666 8 2,628 33 44 (11) 20,969 21,124 12,719 12,480 238 19,627 1,497 1,676 (179)
85,966 87,335 Total Net Expenditure 51,357 54,198 (2,837) 91,162 (3,827) (3,272) (555)
Finance - Monitoring 5.2 Area Finance Rept to 31 10 13 Tables.xlsx Adult Social Care 22/11/2013 11:28 NHS Highland 181 Savings 2013/14 Position as at OCTOBER 2013 Table 5
Position to Date Forecast to achieve In Year Target Next YearSavings B/fwd New N/R ASCAchieved YTD Forecast Balance Forecast Outstanding Target Target Target Target Total Savings REC Non Rec REC Non Rec To Achieve FYE 2013/14 C/Fwd £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 H&SC Partnership
252 1,352 507 2,111 North & West Operational Unit 675 620 192 624 1,436 197 1,543 426 2,166 South & Mid Operational Unit 404 1,762 0 412 1,350 1,935 1,797 (933) 2,799 Adult Social Care 264 1,092 1,442 1 2,535 2,595 2,478 5,073 Raigmore 1,595 57 446 377 2,598 23 3,009 0 365 365 Facilities 310 55 0 0 63 77 140 Integrated Pharmacy 44 31 65 96 109 85 194 e health 116 58 20 0 78 5,151 7,697 0 12,848 Sub Total H&SC Partnership 3,408 3,620 501 2,031 3,288 435 8,504
312 2,088 2,400 Argyll & Bute CHP 1,370 630 400 400 2,000 2,000 Central Costs & Reserves 2,900 1,700 (2,600) 0 122 1,000 1,122 Corporate Services 525 403 194 0 41 556
5,585 10,785 2,000 0 18,370TotalCashEfficiencySavings 5,303 6,923 1,131 3,925 1,088 476 9,460
Finance - Monitoring 5.2 Area Finance Rept to 31 10 13 Tables.xlsx CRS 22/11/2013 11:28 Capital Income & Expenditure Report Month 7182 - 31st October 2013 Table 6
Annual Plan Position to Date Forecast Outturn Original Current Plan to Actual to Variance Forecast Variance from Plan Plan Summary Funding & Expenditure Date Date to Date Outturn Current Plan £000's £000's £000 £000 £000 £000 £000
FUNDING 5,892 5,895 NHS Highland Capital Allocation (Formula) 2,948 2,948 0 5,895 0 1,589 1,451 Radiotherapy replacement 726 726 0 1,451 0 896 896 Oban Dental 448 448 0 896 0 1,000 1,500 NDB Hub Dingwall 750 750 0 1,500 0 4,000 4,000 Raigmore/Satellite Endoscopy 2,000 2,000 0 4,000 0 1,300 1,078 Raigmore C.I.F. 539 539 0 1,078 0 200 200 Revenue to Capital Virement 100 100 0 200 0 700 700 Raigmore Biomass 350 350 0 700 0 1,520 1,520 CEEF Eco Hospitals 760 760 0 1,520 0 110 0 Retained Capital Receipts 0 0 0 0 0 (304) (304) UK GAAP Capital (152) (152) 0 (304) 0 162 0 Tain Sub Debt 0 0 0 0 0 91 Detecting cancer Early 46 46 0 91 0 266 Lochgilphead MHU 133 133 0 266 0 55 Cancer Modernisation 28 28 0 55 0
17,065 17,348 Allocation Letter Sep 2013 8,674 8,674 0 17,348 0
304 304 - Non Core Funding IFRS 152 152 0 304 0
17,369 17,652 SGHD Funding 8,826 8,826 0 17,652 0
- Pending allocations (700) Capital to Revenue (700)
17,369 16,952 Total SGHD Capital Funding 8,826 8,826 0 16,952 0
Expenditure/Commitments 1,679 1,704 Oban Dental 1,704 1,690 14 1,704 0 1,589 0 Radiotherapy replacement 0 0 0 0 0 0 0 Greater Inverness Masterplan 0 0 0 0 0 1,000 1,100 Dingwall Health Centre 228 88 140 1,100 0 1,959 1,959 CEEF Schemes 623 454 169 1,959 0 1,216 2,817 Raigmore Biomass 78 41 37 2,817 0 3,550 2,800 Raigmore Endoscopy 285 446 (161) 2,800 0 0 750 LIDGH/CGH/Belford E.D.U. 170 148 22 750 0 1,300 200 Raigmore C.I.F. Tower Block 100 33 67 200 0 242 242 Lifecycle Costs ERPCC 141 141 0 242 0 62 62 Lifecycle Costs Mid Argyll 36 36 0 62 0 50 50 Capital Salaries 0 0 0 50 0 162 0 Tain Enabling Works 0 0 0 0 0 0 Lochgilphead MHU 0 0 (0) 0 0 505 Reversionary Interest
13,314 11,684 Commitments 3,365 3,077 288 11,684 0
Rolling Programmes 1,985 2,167 Estates Backlog Main. 824 908 (84) 2,167 0 530 530 Medical Equipment 100 98 2 530 0 582 1,465 eHealth Replacement 216 126 90 1,465 0 837 861 Radiology 45 47 (2) 861 0
3,934 5,023 Rolling Programmes 1,185 1,179 6 5,023 0 Other 100 5 Raigmore SSD washer/disinfectors 4 4 0 5 0 91 Detecting Cancer Early 0 0 0 91 0 200 200 Revenue to Capital Virement 168 168 0 200 0 100 100 Dental Equipment 18 18 0 100 0 0 18 Belford Food Trolley/DW 9 9 (0) 18 0 0 110 Port Appin GP Surgery (Retained Receipt0 0 0 0 110 0 0 55 Cancer Modernisation 30 28 2 55 0 0 240 Equipment Store Helensburgh 3 3 0 240 0 (279) 136 Contingency 0 0 0 136 0 839 0 NBV Disposals 0 0 0 0 0
960 955 232 229 3 955 0
18,208 17,662 Gross Capital Expenditure 4,782 4,485 297 17,662 0
(839) (710) NBV Disposals (710) (710) 0 (710) 0
17,369 16,952 Net Capital Expenditure 4,072 3,775 297 16,952 0
0 (0) SURPLUS/DEFICIT MONTH 7 (4,754) (5,051) 297 (0) 0 183 Capital Expenditure Month 7 - 31st October 2013 Table 7
Estimated Forecast Budget SCHEMES YTD Budget YTD Spend Variance Outturn Variance £000's £000's £000's £000's £000's £000's Commitments 1,704 Oban Dental 1704 1690 14 1,704 0 Near Completion 50 Capital Salaries 0 0 0 50 0 Year End allocation 1,100 Dingwall Health Centre 228 88 140 1,100 0 Contract Awarded Aug 0TainEnablingWorks 0 0 0 0 0CRV 0 Lochgilphead MHU 0 0 (0) 0 0 CRV 1,959 CEEF Schemes 623 454 169 1,959 0 Forecast Received 2,817 Raigmore Biomass 78 41 37 2,817 0 Forecast Received 2,800 Raigmore Endoscopy 285 446 (161) 2,800 0 Forecast Received 750 LIDGH/CGH/Belford E.D.U. 170 148 22 750 0 Forecast received 200 Raigmore C.I.F. Tower Block 100 33 67 200 0 Forecast received 242 Lifecycle Costs ERPCC 141 141 0 242 0 62 Lifecycle Costs Mid Argyll PFI 36 36 0 62 0 11,684 Commitments 3,365 3,077 288 11,684 0 1,000 Raigmore Fire Compliance - Tower Block 581 650 (69) 1,000 0 Forecast received 20 Raigmore ION Water Treatment Plant 20 20 (0) 20 0 Complete 12 Raigmore Store/Loading Bay Upgrade 0 0 0 12 0 Forecast Received 30 Raigmore HV Protection 0 0 0 30 0 Forecast received 70 Raigmore Staff Accom Legionella Works 0 0 (0) 70 0 Forecast received 0 Raigmore Theatre Ventilation Upgrade 0 0 0 0 0 20 Raigmore Mortuary Water Upgrade 6 6 (0) 20 0 Forecast received 7 Raigmore Steam Valve 5 5 (0) 7 0 Forecast received 70 Raigmore Tower Block AirCon 0 0 (0) 70 0 Forecast received 40 CGH Fire Compliance 2 9 (7) 40 0 Forecast received 13 CGH Hot Water Storage Cylinder 0 0 0 13 0 Forecast received 0 CGH Roof Replacement 0 0 0 0 0 Forecast received 29 CGH Fire Alarm Phase 2 29 29 (0) 29 0 Complete 15 CGH Medical Air Plant 0 0 0 15 0 17 CGH Q E Ward Security System 0 0 0 17 0 12 Lawson Fire Compliance 11 11 0 12 0 Forecast received 65 Belford Roof 1 1 (0) 65 0 Forecast received 70 MacKinnon Mem Replace Electrical Panel 0 0 (0) 70 0 Forecast received 16 Ian Charles/St Vincents Fire Compliance 0 0 0 16 0 100 Cowal Hosp. Compartmentation Upgrade 2 2 (0) 100 0 30 Cowal Main Water Tank Replace 0 1 (1) 30 0 150 LIDGH Fire System 116 116 (0) 150 0 60 LIDGH Fire Compartmentation 0 0 0 60 0 12 A&B CMH Bases 12 12 (0) 12 0 Complete 45 Jeanie Deans Boiler Plant 0 0 0 45 0 45 Upgrade Doctors House, Coll 0 0 0 45 0 23 Community Hospital Legionella Compliance 23 23 (0) 23 0 Complete 30 Community Hospital Fire Compliance (RNI) 16 16 0 30 0 Forecast received 51 Road Surface Upgrade 0 0 (0) 51 0 100 Highlandwide Legionella Works 0 0 0 100 0 14 Assynt House Automatic Doors 0 5 (5) 14 0
2,166 Estates Backlog Maintenance 824 908 (84) 2,166 0 530 Medical Equipment 100 98 2 530 0 530 Medical Equipment 100 98 2 530 0 1465 eHealth Replacement 216 126 90 1,465 0 Forecast Received 1465 eHealth Replacement 216 126 90 1,465 0 813 Radiology 21 25 (4) 813 0 Forecast Received 48 Gamma Camera 24 22 2 48 0 Forecast Received 861 Radiology 45 47 (2) 861 0 5 Raigmore SSD washer/disinfectors 4 4 0 5 0 Complete 91 Detecting Cancer Early 0 0 0 91 0 110 Port Appin GP Surgery Extn (Retained Receipt) 0 0 0 110 0 100 Dental equipment 18 18 0 100 0 200 Revenue to Capital Virement 168 168 0 200 0 9 Belford Food Trolley 9 9 (0) 9 0 55 Cancer Modernisation 30 28 2 55 0 240 Equipment Store Helensburgh 3 3 0 240 0 9 Belford Dishwasher 0 0 0 9 0 Previous year 0 0 0 0 0 136 Contingency 0 0 0 136 0 0 NBV Disposals 0 0 0 0 0
17,662 Total Expenditure 4,782 4,485 297 17,662 0 184 185 Highland NHS Board 3 December 2013 Item 5.3
CAITHNESS GENERAL CONNECTION TO DISTRICT HEATING
Report by Eric Green Head of Estates on behalf of Nick Kenton, Director of Finance
The Board is asked to:
Approve the business case to connect CGH to the Ignis Wick District Heating Scheme. Note the savings this scheme will generate. Note the environmental benefits of this project.
1 Background and Summary
NHS Highland has set an ambitious target to reduce its carbon emissions by 30% over 5 years. This project is another significant step in achieving this target; this will reduce the carbon produced at CGH by 1200 tonnes a year. This is a step change improvement towards reaching our climate change targets.
This proposal is to connect to the established Ignis Wick district-heating scheme that has now been operating successfully for an extended period following a £2.5m investment in new biomass plant.
2 Proposal
It is proposed that Caithness General will be connected up to the scheme; the distribution pipework is already in the curtilage of the site. This will mean the end of steam production at Caithness general as all equipment that has operate on steam is now replaced, so cheaper alternatives can be looked at.
This will improve security of supply for the Hospital, however in addition to the heating scheme a back up boiler will be retained in CGH so in the event of any disruption to the district heating services can be maintained.
In addition to the environmental benefits of this proposal this will also generate a significant saving on revenue budgets of £250k per annum. The forecast price increases for Biomass going forward are much more likely to be linked to RPI than the oil price, thus providing stability going forward.
This work will be carried out in the spring / summer of next year, in order to minimise the disruption to patients.
This project does have some public health benefits in that the district heating scheme is more secure with NHSH as a tenant, this scheme helps provide affordable heat and hot water to an area of recognise deprivation in Wick.
There is also a potential to purchase green electricity in the future from this plant, further improving the environmental performance of the Site. 186
3 Contribution to Board Objectives
This contributes to the boards stated objective of delivering better value, in that it reduces the running costs of the hospital.
It also contribute to the boards objective of providing care form modern efficient green assets, this makes a significant contribution to our carbon reduction target.
4 Governance Implications
Staff Governance There are no Staff Governance issues around this project.
Patient and Public Involvement This is a simple asset replacement project that does not require patient or public involvement.
Clinical Governance This project does not involve any alteration in clinical areas; all works will be done in accordance with HAI Scribe.
Financial Impact This project will have a significantly positive impact on revenue budgets.
5 Risk Assessment
Normal Project management risk management arrangements will be followed, but this is a Low risk project. This will also remove the risk from the register of boiler failure in Caithness general as it replaces the existing 30-year-old boilers.
6 Planning for Fairness
This will ensure equality of access to patients in the area by improving the sustainability of services in Caithness General.
7 Engagement and Communication
A communication plan is in place to communicate to staff and patients what is planned and appropriate press releases will be prepared at the key milestones to inform the public.
Eric Green Head of Estates
22 November 2013
2 187
CAITHNESS GENERAL HOSPITAL BIOMASS
STANDARD BUSINESS CASE
October 2013
Second draft 188 Caithness General Hospital Biomass Standard Business Case
INDEX
Page No.
1. Executive Summary 4
2. Strategic Context 4
3. Service Specification 5
4. Options 5
5. Non Financial Benefits Appraisal 6
6. Financial and Economic Appraisal 6
7. Risk Appraisal 15
8. The Preferred Option 15
9. Project Management and Project Implementation Timetable 15
10. Post Project Evaluation 15
2 October 2013 189 Caithness General Hospital Biomass Standard Business Case
Tables
Page No.
Table 1 – Methodology for Financial Appraisal 6
Table 2 – Key elements of the costing of options 7
Table 3 – Capital Cost Assumptions 8
Table 4 – Capital Cost summary 8
Table 5 – Calculation of Optimism Bias Upper Bound 9
Table 6 – Mitigation of Optimism Bias 9
Table 7 – Capital Costs including Optimism Bias 10
Table 8 – Revenue Assumptions 10
Table 9 – Capital Charges 11
Table 10 – Recurrent Pay & Non Pay Costs 11
Table 11 – Property Costs 12
Table 12 – Property Income 12
Table 13 – Summary of Recurrent Revenue Impact 13
Table 14 – Summary of Non-Recurrent Revenue Impact 14
Table 15 – Economic Appraisal 14
Table 16 – NPV and EAC Outcomes 15
Appendices
Appendix 1 – Implementation Timetable
3 October 2013 190 Caithness General Hospital Biomass Standard Business Case
1. Executive Summary
This Standard Business Case is for the replacement of the existing boiler plant at Caithness General Hospital. The existing plant is 30 years old and beyond it’s economic life. It also burns heavy fuel oil, which is expensive and produces the most pollution of all fossil fuels. In order to ensure continuity of service this requires to be replaced.
The Climate Change Act (Scotland) 2009 sets out the Scottish Government’s environmental target for 2050 along with, as interim target, a reduction in emissions in Scotland of 42% by 2020, together with a target of 11% total heat demand being achieved through renewable sources.
In order to meet this renewable heat demand target, more appropriate and efficient plant and equipment will be required.
NHS Highland’s Strategic Carbon Management Plan, developed in early 2012 from previous work in this area, has enabled NHSH to take a leading role nationally and to secure £7m in funding.
This funding will allow NHSH to replace existing liquid fuel heating systems with biomass/dual fuel alternatives, which will reduce heat demand, reduce costs and allow continued progress towards achieving its 80% renewable heat target by 2017.
The options being considered for Caithness General Hospital are:
Option 0 – Do nothing – retaining the existing facility as it is. Option 1 – Do minimum – change fuel – retaining the existing facility but changing fuel. Option 2 – New traditional heating system – replacing the existing facility with a gas oil plant. Option 3 – New biomass heating system (chips) – replacing the existing facility with a biomass system using chips. Option 4 – New biomass heating system (pellets) – replacing the existing facility with a biomass system using pellets. Option 5 – District Heating System – joining the Wick District Heating System.
The preferred option is Option 5 – joining the Wick District heating scheme. This produces the best combination of security of supply against cost along with the best environmental benefit. This has the added advantage of being less capital intensive, freeing scarce capital for another project. This also produces the greatest benefit to the investment in that it helps secure the future of the district-heating scheme and may enable further investment in this project. This option also produces a significant public health benefit, helping to alleviate fuel poverty is an area of recognised deprivation.
2. Strategic Context
The Climate Change Act (Scotland) 2009 sets out the Scottish Government’s environmental target for 2050. As part of this, the interim target for 2020 requires a reduction of emissions in Scotland of 42% from the 1990 baseline. It also requires that
4 October 2013 191 Caithness General Hospital Biomass Standard Business Case 11% of total heat demand should come from renewable sources. More appropriate and efficient plant and equipment are required to meet the renewable heat demand target.
Two programmes of investment in NHS Scotland (NHSS) have been introduced to support achieving the proscribed environmental targets – namely the Low Carbon programme and the ECO-Hospitals Fund and these provide £24m combined investment over a 3 year period for the NHSS Estate.
In early 2012 NHS Highland (NHSH) developed its strategic Carbon Management Plan (CMP) from previous work carried out in this area, enabling NHSH to take a leading role nationally in this field and attracting approximately £7m in combined funding as a result.
The carbon footprint for all of NHSH’s building energy needs is approximately 35,000 tonnes of carbon dioxide equivalent per year (35,000tCO2e). Due to NHSH’s geography and the lack of availability of access to mains gas supplies, its heat demand is approximately 50% of these emissions (17,500tCO2e) due to the alternative use of heavy oil, gas oil and kerosene. The current Scottish Government funding means that NHSH will replace these liquid fuel heating systems with biomass/dual fuel alternatives by April 2014 and thus reduce its heat demand by 6,000tCO2e (>33%). This will reduce costs by, and provide re-investment opportunities, in the region of £1.5m/year and allow NHSH to continue to progress towards achieving its 80% renewable heat target by 2017.
3. Service Specification
The Caithness General Hospital site’s current carbon footprint is approximately 1,200tCO2e, or 14% of NHSH’s total heat emissions and consumes approximately 500,000 litres of fuel per year (20%).
Taking on board the site’s current carbon emissions, fuel consumption and costs, these can be mitigated by:
The heavy oil currently used requires around 10% of its consumption just to keep the fuel fluid, therefore a change in fuel means that approximately 50,000 litres of fuel will no longer be required, achieving a reduction of 120tCO2e Replacement of the old boiler with a modern equivalent Moving to biomass, as a renewable fuel source, should mean a reduction in price per kWh of at least 35% and 100,000 litres less in fuel demand. Biomass is essentially emissions free and should therefore achieve a saving of almost 1,200tCO2e The maintenance regime should also be less onerous than the current one.
4. Options
In order to take forward the relevant part of NHSH’s Property Asset Management Strategy, the following options have been identified for consideration:
Option 0 – Do nothing – retaining the existing facility as it is. Option 1 – Do minimum – change fuel – retaining the existing facility but changing fuel. Option 2 – New traditional heating system – replacing the existing facility with a similar traditional heating system method.
5 October 2013 192 Caithness General Hospital Biomass Standard Business Case
Option 3 – New biomass heating system (chips) – replacing the existing facility with a biomass system using wood chips. Option 4 – New biomass heating system (pellets) – replacing the existing facility with a biomass system using pellets. Option 5 – District Heating System – joining the Wick District Heating System. 5. Non Financial Benefits Appraisal
The non-financial benefits can be assessed in three key areas, security of supply, environmental benefit, and public health benefit. The non-financial benefits relate to the impact on the environment.
Option 1 Do nothing. This option ensures none of the non-financial benefits are realised and places the provision of services at risk as the plant is beyond its economic life and in danger of failure. Option 2 – Replace with other fuel. This again would do nothing to achieve any of the non-financial benefits and would not improve the sustainability of services to the hospital. Option 3 – Biomass with Chips. This would realise most of the environmental benefits, as this would replace 80% of the existing fossil fuels. It is not possible to replace 100% of the fossil fuels and balance the load due to the problems with turndown ratio off biomass on such a cyclical load. This would not realise any public health benefit either. Option 4 – Biomass with Pellets. This would realise most of the environmental benefits, as this would replace 80% of the existing fossil fuels. It is not possible to replace 100% of the fossil fuels and balance the load due to the problems with turndown ratio off biomass on such a cyclical load. This would not realise any public health benefit either. This option would also require less storage. However this would require transportation of 4 loads a week of pellets from at least Invergordon, possibly Grangemouth to Caithness. Option 5 – The Wick district heating scheme has had a troubled start and NHS Highland has been on the fringe of this project since inception. The infrastructure for this project has been installed in that the supply pipework is in the building at no cost to NHSH. However the current owners of the plant are very different from the original scheme and have the required skills and experience to operate the project sucessfully.
This has been demonstrated by the quality of the staff and engineers employed on the scheme. All have a proven track record of delivery on this type of project and there are less concerns over this scheme going forward.
They have made a significant investment in the scheme and have installed and commissioned a new boiler plant that has been working successfully for close to a year now with no issues. The company have plans to further invest in biomass Combined Heat and Power (CHP), which would produce green electricity. However this investment depends on signing up customers for the heat load this produces. Caithness General would go a long way to meeting that target. In addition to the boiler the company have oil back up system. This would give Caithness General a level of security of supply greater than any other option. This would also replace 100% of our fossil fuel, something none of the other options do.
6 October 2013 193 Caithness General Hospital Biomass Standard Business Case In addition to this the operating company have offered to negotiate a deal on the sale of electricity to NHSH if a CHP plant is installed. This would offer savings on electricity over the existing arrangements and offer the tantalising prospect of NHSH having the first 100% green energy hospital in Scotland. If we were to enter into an agreement on Caithness General with Ignis Wick we would include the old medical centre building and Poultney House care home, which would produce additional savings not possible with any of the other options.
This scheme also has public health benefits, in that the scheme produces affordable heating for the poorest area in Wick, an area of recognised deprivation where many people suffer from fuel poverty. If NHSH signs up to this scheme it goes a long way to securing a long-term future for the scheme and ensuring the people in this area of Wick benefit from affordable energy.
This option also offers control over costs going forward. Ignis are prepared to lock the price for an initial period and agree an indexation arrangement that ensures we can plan our costs going forward while still producing significant savings. They can do this as they have control over the supply chain, something we cannot achieve with any of the other options.
6. Financial and Economic Appraisal
Overview
This section presents the financial implications of investment (both capital and revenue) and also provides the economic appraisal of the short-listed options. The methodology and assumptions applied to derive the comparative cost implications of the options are outlined below.
The outputs from the cost models identified in this section form the basis of both the financial and economic appraisals of the short-listed options. The financial appraisal will be the driver for assessing affordability whilst the economic appraisal will determine value for money. It does not always follow that the option offering best value for money will also be affordable so that consideration of both appraisals is necessary.
All current guidance has been followed in completing the financial and economic appraisals, principally the Scottish Capital Investment Manual (SCIM), the HM Treasury Green Book and supplementary guidance.
The financial model for each option considers a number of key outputs from other parts of the business case including workforce requirements, revised footprint and design and uses these outputs to estimate the capital and revenue implications for each of the options being considered.
Table 1 - Methodology for Financial Appraisal
7 October 2013 194 Caithness General Hospital Biomass Standard Business Case
Revenue Costing Affordability
Capital Charges Revenue impact Workforce Transitional costs Agree Key Non Pay Input and Assumptions Estates costs advice for Phasing of costs Economic Appraisal Model of Care a decision on the Capacity Lifecycle costs Facilities preferred NPV/EAC option Location Capital Costing Risk
Split of spend Equipment Benefits Appraisal Fees Asset lives Non-financial benefits Phasing of costs
Key Financial Assumptions
The financial model is driven by key assumptions which could have a material effect on the likely operating costs of the proposals e.g.
Likely capital costs Projected capital charges (depreciation) Revenue costs (pay, non-pay and income streams) associated with the services affected by these options Variations in revenue costs as a result of these options Variations in income streams
Costing Methodologies
Each of the short-listed options has been costed with due consideration of the changes associated with each option and any changes in cost have been clearly identified and explained.
The following categories of cost have been considered for each option –
Table 2 - Key elements of the costing of the options
8 October 2013 195 Caithness General Hospital Biomass Standard Business Case
Baseline costs for – Costs for each option – Pay (workforce) Pay (workforce) Non Pay (associated with staff) Non Pay (associated with staff) Estates/Utilities (associated with Estates/Utilities (associated with the existing heating system) the new heating systems) Income Income Capital Charges (depreciation) Capital Charges (depreciation) Phasing of costs
Short-listed Options Option 1 - £’s Option 2 - £’s Option 3 - £’s
Capital Costs
The capital costs have been considered and prepared using the capital requirement of each option that has been identified by professional advisors within the Health Board. The following table summarises the main capital assumptions.
Table 3 - Capital Cost Assumptions
Costs have been calculated at September 2013 prices Include building, infrastructure and service costs but exclude steam conversion costs which are identical for all options. Fees included Contingency of 15% VAT (20%) has been added to the total capital cost.
Having applied the costing assumptions and methodologies to the options, the resultant capital expenditure is shown below:
Table 4 - Capital Cost Summary (£000’s)
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) £000’s £000’s £000’s £000’s £000’s £000’s Traditional boiler system 0 0 145.0 0 0 0 Biomass boiler system 0 0 0 461.2 461.2 0
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Previously incurred fees 0 0 142.0 142.0 142.0 0 Fees – Planning 0 0 5.0 8.9 8.9 0 Risk/contingency 0 0 43.8 84.0 84.0 0 VAT 20% 0 0 37.8 109.0 109.0 0 TOTAL 0 0 373.6 805.1 805.1 0
Optimism Bias
Optimism bias is the systematic tendency for appraisers to be overly optimistic about the key elements of the project.
The two main reasons for optimism bias in estimating capital costs are Limited definition of the scope and objectives of the proposals due to incomplete identification of the requirements resulting in the possible omission of costs at the initial stages of the project Slippage in the timescales of the project with schedules not being maintained These factors are quite separate from the 15% contingencies which are built into the estimated capital costs for each option which relate to the construction risks associated with each option.
In this exercise, optimism bias has been calculated using the HM Treasury guidance and the mitigated level bias for each option has been applied to the capital figures shown in the above table.
This procedure includes – Setting the upper bound for optimism bias to be applied to the capital costs Determining the extent of mitigation of the upper bound in light of the specific factors that relate to this project.
Full details of the optimism bias assessments for the preferred option are available separately if required and are shown in the format prescribed within the HM Treasury supplementary guidance.
In setting the upper bound, the following range of features have been assessed to determine the initial level of optimism bias to be applied – Build complexity Location Scope of scheme Extent of any service change Likely gateway review risk category
A summary of the upper bound assessment is provided in the table below.
Table 5 - Calculation of Optimism Bias Upper Bound
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating Contributory Factor - change heating heating heating System fuel system system system (chips) (pellets) Build complexity 0% 0% 3% 3% 3% 0%
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Location 0% 0% 6% 6% 6% 0% Scope of Scheme 0% 0% 1% 1% 1% 0% Extent of Service 0% 0% 5% 5% 5% 0% Changes Gateway RPA category 0% 0% 0% 0% 0% 0% Upper Bound 0% 0% 15% 15% 15% 0%
The same upper bound for optimism bias of 15% was found for options 2, 3 & 4. This is as a result of the three options being broadly similar in terms of an installation of a new heating system into an existing location with no disruption to the current service.
There is no optimism bias associated with option 1, 2 & 5 as there is no capital investment associated with these options.
It is possible to mitigate some of this optimism bias through a detailed assessment of the full range of factors set out in the supplementary guidance for mitigating optimism bias on health projects.
The level of remaining optimism bias and the extent to which the upper bound has been mitigated is shown in the table below.
Table 6 - Mitigation of Optimism Bias
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Option specific upper bound 0% 0% 15% 15% 15% 0% Mitigation factor 0% 0% 0% 0% 0% 0% Mitigated Upper Bound 0% 0% 0% 0% 0% 0%
The level of mitigation of 100% is the same for all options and this reflects the fact that this project has been under discussion for a significant length of time and the plans and designs are readily available.
The resulting optimism bias adjustments have been applied to the capital costs for each of the options and the revised capital estimates are then used to calculate the capital charges associated with each option. These revised estimates of cost are also used within the economic appraisal.
The updated capital costs are shown below:
Table 7 - Capital Costs including Optimism Bias - £000’s
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Original capital costs 0.0 0.0 373.6 805.1 805.1 0.0 Optimism Bias 0.0 0.0 0.0 0.0 0.0 0.0 Revised Capital costs incl optimism bias 0.0 0.0 373.6 805.1 805.1 0.0
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Recurrent Revenue Costs
A baseline cost for the current service was calculated and used as a benchmark against which any changes could be considered – this was the revenue cost associated with ‘do nothing’ in Option 1. In this financial case, these costs include all costs associated with running the current aged, traditional oil boiler system. The costs include capital charges (depreciation) where appropriate.
The assumptions used in the models for revenue costs for each of the options are shown below.
Table 8 - Revenue Assumptions
Costs have been calculated at 2013 prices and using 2013/14 budgets Where relevant, whole time equivalents have been considered for staffing Pay costs, if relevant, are inclusive of employer on-costs and allowances for leave. VAT is included where appropriate Capital charges are based on the capital cost inclusive of any optimism bias calculations Income relates to receipts as a result of the RHI (renewable heat income)
Capital Charges
The capital charges for the options in this case are based on the estimates for capital expenditure inclusive of optimism bias with varying lives attached to the different elements of the capital investment e.g. 38 years for the existing service installations and 25 years for the new.
In line with the current guidance, capital charges do not include a rate of return calculation. The results of the capital charge calculations are summarised below.
Table 9 - Capital Charges - £000’s
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets)
Depreciation 19.4 19.4 34.3 51.6 51.6 19.4
For each option, there is a capital charge impact directly related to the level of capital expenditure investment in each of the options with Option 0, 1 and 5 with the lowest capital charge of £19k pa although these options do not involve new capital works. Of the three other options, a new traditional boiler is the next lowest at £34k pa and the two options with biomass installations are highest at £52k pa.
Recurrent Pay & Non Pay Costs
12 October 2013 199 Caithness General Hospital Biomass Standard Business Case The pay and non pay costs associated with staff who currently work within this area have been excluded as they are consistent across all options – maintenance staff may see changes in the work that they do however the fact that a boiler will still be included for back up means that maintenance savings are likely to be minimal. At this stage, there is no requirement for any additional hours for any of the options.
The results of the recurrent pay and non pay calculations are shown below.
Table 10 - Recurrent Pay & Non Pay Costs - £000’s
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Maintenance staff 0.0 0.0 0.0 0.0 0.0 0.0 Supplies 0.0 0.0 0.0 0.0 0.0 0.0 Pay & Non Pay Total 0.0 0.0 0.0 0.0 0.0 0.0
Recurrent Property Costs
All costs associated with running the existing heating system have been included within the baseline (do nothing) and enhanced costs for each of the options have been derived or calculated. The following summarises the methods of calculating future costs for each of the elements.
Oil – based on the current (2013/14) charge for oil at Caithness General Hospital. Oil usage data has been taken from the full year of 2012/13. Changing the fuel but remaining with oil for option 1 will result in a 10% reduction in usage. The installation of biomass heating to replace most of the existing oil heating (90:10 ratio) with the 10% being included as ‘backup’ in case of failure of the biomass system Cost for the Wick District Heating biomass has been taken from a quote from the supplier.
The property costs associated with the options are summarised in the table below.
Table 11 - Property Costs - £000’s
Option 0 Option 1 – Option 2 Option 3 Option 4 Option 5 – Do Do – New – New – New – District nothing minimum tradition biomass biomass Heating - change al heating heating System fuel heating system system system (chips) (pellets) £000’s £000’s £000’s £000’s £000’s £000’ Oil 341.8 307.6 273.5 0.0 0.0 0.0 Oil – 10% backup for biomass 0.0 0.0 0.0 34.2 34.2 34.2 Biomass chips 0.0 0.0 0.0 110.7 0.0 0.0 Biomass pellets 0.0 0.0 0.0 0.0 152.2 0.0 District Heating System 0.0 0.0 0.0 0.0 0.0 122.3 External Boiler maintenance, 25.1 25.1 25.1 0.0 0.0 0.0 including Annual Service
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Boiler maintenance – call-outs / 6.5 6.5 3.2 0.8 0.8 0.0 breakdowns Boiler maint/service – biomass 0.0 0.0 0.0 30.1 30.1 0.0 Internal boiler maint & service 22.1 22.1 22.1 11.0 11.0 0.0 Maintenance materials 15.4 15.4 15.4 7.7 7.7 0.0 Total – Recurrent Property 410.9 376.7 339.3 194.5 236.0 156.5 costs Decrease from current 0.0 (34.2) (71.6) (216.4) (174.9) (254.4) (Option 0)
Recurrent Property Income
There is no income associated with the existing oil based heating system. Installation of a biomass boiler system would allow NHS Highland to claim the renewable heat income (RHI).
Projected income for the options is shown below.
Table 12 - Property Income - £000’s
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Renewable Heat 0.0 0.0 0.0 (82.5) (82.5) 0.0 Income (RHI) Total – Recurrent 0.0 0.0 0.0 (82.5) (82.5) 0.0 Property income Increase from 0.0 0.0 (82.5) (82.5) 0.0 current (Option 0)
Summary
Including all of the various streams of revenue costs, the overall recurring revenue impact of the proposals is shown below.
Table 13 - Summary of Recurrent Revenue Impact - £000’s
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Capital Charges 19.4 19.4 34.3 51.6 51.6 19.4 Pay costs 0.0 0.0 0.0 0.0 0.0 0.0 Non pay costs 0.0 0.0 0.0 0.0 0.0 0.0 Property costs 410.9 376.7 339.3 194.5 236.0 156.5 Gross recurrent 430.3 396.1 373.6 246.1 287.6 175.9 costs Income 0.0 0.0 0.0 (82.5) (82.5) 0.0 Net recurrent 430.3 396.1 373.6 163.6 205.1 175.9 costs Decrease from 0.0 (34.2) (56.7) (266.7) (225.2) (254.4) current (Option 1)
14 October 2013 201 Caithness General Hospital Biomass Standard Business Case The costs shown in the above table relate to the first full year of operating.
Option 3, a new biomass system with chips, provides the greatest revenue impact with a decrease of £267k per annum of which £83k is from the receipt of renewable heat income, a reduction of £197k from a change from oil to biomass chips and a reduction in maintenance/servicing of £20k less an increase in capital charges of £33k. Option 5, the Wick District Heating system produces the second greatest saving at £254k pa (£12k pa less than option 3).
Non-Recurrent Revenue Costs
There are no non-recurrent (transitional) costs identified for Options 2, 3 & 4 as work to install and commission a new boiler (traditional or biomass) can go ahead alongside the current heating system.
There are £142k of non-recurrent costs to be considered for Options 0, 1 and 5 which are costs that have been incurred to date on fees and work done over an extended period for this project which can not be considered capital unless there is an agreed capital scheme.
Table 14 - Summary of Non-Recurrent Revenue Impact - £000’s
Option 0 Option 1 Option 2 Option 3 – Option 4 Option 5 – Do – Do – New New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Temp boiler – not required as all 0.0 0.0 0.0 0.0 0.0 0.0 options can go ahead without Previous costs held in AUC – can only be capitalised 142.0 142.0 0.0 0.0 0.0 142.0 when option includes capital New flue for chimney – included 0.0 0.0 0.0 0.0 0.0 0.0 in capital Total non- 142.0 142.0 0.0 0.0 0.0 142.0 recurrent costs
Economic Appraisal
A discounted cash flow for each of the options has been undertaken over 40 years using a discount rate of 3.5% for years 1 to 29 and 3.0% for years 30 onwards in line with the guidance within the HM Treasury green book. The Net Present Value (NPV) and Equivalent Annual Cost (EAC) have been calculated.
The EAC is used as a comparison of options where there are different life spans as the output is an annual figure which is easily compared.
The elements considered in the analysis are
15 October 2013 202 Caithness General Hospital Biomass Standard Business Case
Initial capital expenditure for each option – exclusive of VAT but adjusted for optimism bias Any relevant lifecycle costs for building and engineering works Any relevant equipment lifecycle costs Total revenue costs for each option excluding capital charges Income Non-recurring revenue costs
The key assumptions used within the economic appraisal include
Table 15 - Economic Appraisal Assumptions
The base year for the economic appraisal is the financial year 2013/2014 Life cycle costs of building and engineering Economic appraisal period over 40 years Capital expenditure will be made within one year - 2013/14 Optimism bias has been included in the capital expenditure figures All non-recurrent costs are seen in the base year - 2013/14
The results of the economic appraisal for the options are shown below.
Table 16 - NPV and EAC Outcomes - £000’s
Option 0 Option 1 Option 2 Option 3 Option 4 Option 5 – Do – Do – New – New – New – District nothing minimum traditional biomass biomass Heating - change heating heating heating System fuel system system system (chips) (pellets) Net Present 10,185.3 9,349.4 8,633.2 3,435.8 4,450.7 3,963.8 Value (NPV) Equivalent Annual Cost 416.5 382.3 353.0 140.5 182.0 162.1 (EAC) Ranking 6 5 4 1 3 2
The analysis of the net present values (NPV) indicates that Option 3 – biomass system using chips - has the lowest life time costs. Option 5, Wick District Heating, would be the next favoured option in terms of EAC.
Summary of Key Output from Financial and Economic Appraisals
Option 3, the installation by NHS Highland of a biomass system using chips, produces the greatest recurrent revenue saving at £267k pa. This option also has the best outcome from the analysis of lifetime costs, the Net Present Values (NPV) and Equivalent Annual Costs (EAC).
The revenue associated with Option 3 is a net recurrent decrease of £267k from current budgets – although there is an increase of £33k for capital charges within this total. This option does not require any non-recurrent revenue budget to be found. The total capital outlay required for this option is £805k.
16 October 2013 203 Caithness General Hospital Biomass Standard Business Case
The second greatest revenue impact comes with Option 5 – use of the Wick District Heating system. This is also second on the lifetime costs analysis. This option does require £142k of non-recurrent revenue to be found to cover previous project costs which can not be capitalised in this option. This option requires no capital outlay and produces a reduction in recurring revenue of £254k.
7. Risk Appraisal
The following risks can be associated with the identified options:
Long term security of energy supplies to Caithness General. This risk is lowest with option 5 which offers the greatest security of supply. Uncertainty over long term pricing structure. Again this risk is lowest with option 5, subject to conclusion of a suitable commercial agreement. Risks associated with implementation of each option. There are risks of regulatory approval, disruption of services for all options, however these are greatest for the options around installing boiler plant in Caithness general. They are lowest for option 5 as the infrastructure to do this is already in place. Contractual arrangements for each option. These are low for all options, initial discussions have taken place with the CLO and Ignis Wick and it is not envisaged that there will be great difficulty in securing this agreement. Placement of a National contract for wood chips. National contract is now in place, meaning this risk is very low.
8. The Preferred Option
As can be seen from Section 6 – Financial and Economic Appraisal, Option 3 – new biomass heating system using chips, provides NHSH with the greatest revenue saving (£267K per annum), Net present Value and Equivalent Annual Costs. With this option, there is a net recurrent decrease of £267K from existing budgets – there is, however, an increase of £33K for capital charges within this total – therefore no requirement for any additional non-recurrent revenue to be found.
Option 5 – joining the Wick District Heating System – in terms of revenue impact and on lifetime costs is slightly better, however from the non-financial considerations this option is preferable. This option does require £142K of non-recurrent revenue to be found for previous project costs, which cannot be capitalised, but does not require any capital outlay and produces a £254k reduction in recurring revenue. There are no capital charges associated with this option.
The difference between option 5&6 comes down to £12k. The savings from adding the other two buildings will be greater than £12k, however we will only secure this price if we sign up Caithness General as it has by far the greatest heat load. In addition this frees scarce capital for investing in other such schemes, producing additional savings.
This option also provides the scope for further savings from the purchase of green electricity form the scheme and is an excellent opportunity to build a long term relationship with Ignis and support a scheme with real benefits for the community while still receiving the benefits required.
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Therefore the board is asked to approve the option of connecting Caithness General to the Wick District Heating scheme, subject to the satisfactory conclusion of a commercial agreement between NHS Highland and Ignis Wick.
9. Project Management and Project Implementation Timetable
This work will be project managed by estates and is expected to be complete in summer 2014 maximising the weather window to ensure minimum disruption to services.
Project management will be delivered in accordance with the NHSH project process.
10. Post Project Evaluation
On completion of this project a post project evaluation will be completed in accordance with the relevant guidance. This will be reviewed by the Asset Management group.
18 October 2013 205 Highland NHS Board 3 December 2013 Item 5.4
INFECTION PREVENTION & CONTROL REPORT
Report by Liz McClurg, Infection Control Manager and Dr Jonty Mills, Consultant Microbiologist/Infection Control Doctor, on behalf of Heidi May, Board Nurse Director & Executive Lead for Infection Control
The Board is asked to:
Note the performance position for the Board. Note the progress to keep infection under control.
1. Aim
The purpose of this paper is to update Board members of the current status of Healthcare Associated Infections (HAI) and Infection Control measures in NHS Highland.
2. Contribution to Board Objectives
One of the Board key objectives is “to reduce to an absolute minimum the chance of acquiring an infection whilst receiving healthcare and to ensure our hospitals are clean”. This report presents a comprehensive view of HAI data and activities for scrutiny and feedback from the Board.
3. Summary
Table 1 shows NHS Highland Infection Prevention & Control targets and performance data
Group Target NHS NHS Highland Scotland Clostridium Age 15 and New Target 33.6 26.4 Green difficile over 32.0 (100,000 April – April – OBDs) to be June 13 June 13 achieved by 03/15
39.7 Red July – Sept 13 Initial data from HPS
Staphylococcus Age 15 and 24.0 29.5 April 28.7 Red aureus over (100,000) – June 13 April – bacteraemia AOBDs June 13
27.1 July – Sept 13 Not yet validated by HPS. 206
Group Target NHS NHS Highland Scotland Hand Hygiene 95% 95% 98% Green
Cleaning 90% 95% 95.8% Green
Estates 90% 97% 97% Green
Antimicrobial Hospital- 95% AMAU Green prescribing based 95% Empiric Ward 4A Green prescribing 95%
Surgical Compliant Compliant Green antibiotic prophylaxis Primary Care Less than 5% 3% Green empirical prescribing
Source: - Health Protection Scotland/ISD/Local data.
4. Achievements
Catherine Stokoe has been appointed to the post of Infection Control Manager with effect from mid-late January 2014. She is currently Lead Infection Control Nurse for Northumbria Healthcare Foundation Trust. Liz McClurg will work part time until the end of this year to help support the Infection Control Manager work.
5. Challenges
To support all clinical staff in the prevention and reduction of Clostridium difficile infections. To reduce MSSA bacteraemias by engaging all clinical staff in hospitals and the community in initiatives to prevent and reduce invasive device/healthcare related infections. To engage all clinical staff to use the new infection prevention & control risk assessment process and screening for Multi-Drug Resistant bacteria (Carbapenemase producers) as per recent Interim Guidance from Health Protection Scotland, and CMO/SGHD (2013)14 letter.
6. Risks
Achieving the Clostridium difficile and SAB HEAT targets.
Jonty Mills– Consultant Microbiologist & Lead Infection Control Doctor Liz McClurg – Infection Control Manager
22 November 2013
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NHS Highland Healthcare Associated Infection Report
Key Healthcare Associated Infection Headlines New Infection Control Manager appointed to NHS Highland
1. Staphylococcus aureus (including MRSA)
Staphylococcus aureus is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. The most common form of this is Meticillin Sensitive Staphylococcus Aureus (MSSA), but the more well known is MRSA (Meticillin Resistant Staphylococcus Aureus), which is a specific type of the organism which is resistant to certain antibiotics and is therefore more difficult to treat. More information on these organisms can be found at: Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346 MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252 NHS Boards carry out surveillance of Staphylococcus aureus blood stream infections, known as bacteraemias. These are a serious form of infection and there is a national target to reduce them. The number of patients with MSSA and MRSA bacteraemias for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Staphylococcus aureus bacteraemias can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/publicationsdetail.aspx?id=30248
1.1 Staphylococcus aureus bacteraemia target From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, Staphylococcus aureus bacteraemia (including MRSA) cases are 24.0 cases or less per 100,000 acute bed days. For NHS Highland this means no more than approximately 60 cases in year ending 2015.
1.2 Trends National data published by Health Protection Scotland identifies that NHS Scotland Staphylococcus aureus bacteraemia rate April - June 2013 was 29.5 per 100,000 acute occupied bed days (AOBDs). NHS Highland’s rate for the same period was 28.7 per 100,000 AOBDs.
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Figure 1: Funnel plot of Staphylococcus bacteraemia rates for all NHS Boards in Scotland against acute occupied bed days(x 100,000), April – June 2013. Note that NHS Grampian & NHS Lanarkshire overlap.
HG =Highland
July – September 2013, there were 17 Staphylococcus aureus bacteraemia cases, (15 MSSA & 2 MRSA) with a rate of 27.1 per 100,000 acute bed days (not yet validated by HPS)
Since April 2013, the main sources of the potentially preventable Staphylococcus aureus bacteraemia cases are contaminants and invasive devices. A Consultant led action group has been formed to review the data and trends for both Staphylococcus aureus and Clostridium difficile infections to ensure that the right information is being collected in order to make informed decisions around reducing infections.
Figure 2: NHS Highland Staphylococcus aureus bacteraemia Cumulative Case numbers year on year since 2009.
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0 April May June July Aug Sept Oct Nov Dec Jan Feb March 2009-10 2010-11 2011-12 2012-13 2013-14 Heat Target to 31-3-15
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Figure 3: Quarterly rolling year Staphylococcus aureus rates per 100,000 Acute Occupied Bed Days for HEAT Target Measurement
Apr 12 - Jul 12 - Oct 12 - Jan 13 - Apr 113- Jul 13 - Oct 13 - Jan 14 - Apr 14 - Mar 13 Jun 13 Sept 13 P Dec 13 Mar 14 Jun 14 Sept 14 Dec 14 Mar 15 Actual 21.8 21.4 24.9 Performance Trajectory 26.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 Target 26.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0 24.0
1.3 MRSA Screening
MRSA screening refers to the two stage process of universal application of the clinical risk assessment (CRA) screening, followed by swab-based screening of those judged to be at risk based on response to the CRA questions or cared for within one of the high impact specialties. Swab screening refers to swabbing in two anatomical sites, nose and perineum and if present, wound sites or devices. To ensure that CRA based-screening is as effective as universal screening, a minimum of 90% compliance with application of the clinical risk assessment is required. Health Protection Scotland national audit commenced in April 2013. In NHS Highland, compliance was 98% April – June and 91% July – September 2013.
1.4 Current Initiatives
CVC insertion and maintenance and PVC maintenance are part of the 10 Key Patient Safety essentials in the Scottish Patient Safety Programme - Next Steps to Acute Adult Safety – Patients Safety Essentials and Safety Priorities. The Vascular Devices short life working group is reviewing current documentation, compliance and levels of spread of the CVC Insertion and Maintenance Bundle and the PVC Maintenance Bundle and will monitor progress of above to achieve 95% or > compliance with these bundles in all relevant applicable patient population areas with the aim of achieving 0 or 60 days between invasive device related SAB’s (50% Reduction in SABS) by end September 2014. The Group will initially focus on Raigmore Hospital before extending across Highland.
More timely feedback to clinical teams using the immediate Root Cause Analysis process for Staphylococcus aureus bacteraemia within Raigmore Hospital has allowed learning points to be put in place more quickly.
1.5 HAI Quality Improvement Facilitator (HAI QIF) posts
The recruitment process for NHS Highland HAI Quality Improvement Facilitator (HAI QIF) posts is underway and it is hoped to have 2 Facilitators in post early in 2014.
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2. Clostridium difficile
Clostridium difficile is an organism which is responsible for a large number of healthcare associated infections, although it can also cause infections in people who have not had any recent contact with the healthcare system. More information can be found at: http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx NHS Boards carry out surveillance of Clostridium difficile infections (CDI), and there is a national target to reduce these. The number of patients with CDI for the Board can be found at the end of section 1 and for each hospital in section 2. Information on the national surveillance programme for Clostridium difficile infections can be found at: http://www.hps.scot.nhs.uk/haiic/sshaip/ssdetail.aspx?id=277
2.1 Clostridium difficile HEAT Target
From April 2013, NHS Boards are required to further reduce healthcare associated infections so that by year ending March 2015, the rate of Clostridium difficile infections (CDI) in patients aged 15 and over is 32.0 cases or less per 100,000 total occupied bed days. For NHS Highland that means no more than approximately 78 cases in the year ending March 2015.
2.2 Trends
National data published by Health Protection Scotland identifies that NHS Scotland Clostridium difficile infection (CDI) in patients aged 15 and over April - June 2013 was 33.6 per 100,000 bed days. NHS Highland’s rate for the same period was 26.4 per 100,000 bed days (16 cases of which there were 8 cases in over 65 and 8 cases 15 - 64 years).
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Figure 4: Funnel plot of CDI incidence rates in patients aged over 65 years for all NHS Boards in Scotland, April – June 2013.
HG = Highland
Figure 5: Funnel plot of CDI incidence rates in patients aged 15 – 64 years for all NHS Boards in Scotland, April – June 2013.
HG = Highland
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July – September 2013, there were 27 cases of Clostridium difficile infection in patients aged 15 and over with a rate of 39.7 per 100,000 bed days (initial data from HPS). This is a rise from previous quarters. Scrutiny of the data has shown that there were no outbreaks or clusters and that the cases are located across Highland. Further surveillance is ongoing at the time of writing this report to review each case in terms of antibiotic and PPI prescribing.
Figure 6: NHS Highland Clostridium difficile infection cumulative case numbers age 15 years and over year on year since 2009.
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C 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 Heat Target to 31-3-15
Figure 7: Quarterly rolling year Clostridium difficile Infection Cases per 100,000 total occupied bed days for HEAT Target Measurement
Apr 12 - Jul 12 - Oct 12 - Jan 13 - Apr 113- Jul 13 - Oct 13 - Jan 14 - Apr 14 - Mar 13 Jun 13 Sept 13 P Dec 13 Mar 14 Jun 14 Sept 14 Dec 14 Mar 15 Actual 31.9 27.3 30.1 Performance Trajectory N/A 37.0 37.0 37.0 37.0 37.0 37.0 34.0 32.0 Target N/A 32.0 32.0 32.0 32.0 32.0 32.0 32.0 32.0
2.3 Current Initiatives
The Infection Prevention & Control Teams continue to maintain accurate real time surveillance of all Clostridium difficile infection (CDI) cases in all areas in consultation with Infection Control Doctor.
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Antibiotic prescribing data continues to be reviewed in conjunction with the Antimicrobial Pharmacist, Unit/Hospital Pharmacist and NHS Highland Antimicrobial Management Group. Work is ongoing with GPs to further reduce antimicrobial prescribing and the use of proton pump inhibitors (PPIs). The weekly and monthly surveillance reports for Clostridium difficile and Staphylococcus aureus bacteraemia are undergoing a complete review with the aim of improving the quality and usefulness. The weekly report will be an operational document and will be circulated to clinical staff and members of the Infection Control Improvement Group. The monthly report is being redesigned to provide Board members and non clinical staff with easily understood information which will be in line with the Board report. A Clostridium difficile and Staphylococcus aureus bacteraemia Action Group is being established, chaired by the Microbiology Consultant lead for Infection Control. The focus of this group will be to drive forward the work streams which will enable the Board to deliver against very challenging Staphylococcus aureus bacteraemia (SAB) and Clostridium difficile targets.
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2.4 Antimicrobial Management
Table 2: shows NHS Highland progress against the 3 national indicators.
Antimicrobial Indicator NHS Highland progress
Hospital-based empirical prescribing Data set from April 2011 to October 2013
In acute admission areas, antibiotic Ward AMAU - Compliant prescriptions are compliant with the local The clinical teams in Medicine continue to antimicrobial policy and the rationale for demonstrate achievement of the target as treatment is recorded in the clinical case median compliance has been sustained at note in above 95% of sampled cases. 95%.
Ward 4A - Compliant The clinical teams in the surgical admissions unit have achieved the target of 95% median compliance for the first time.
Surgical antibiotic prophylaxis Colorectal Surgery – Compliant Audit data in line with the national Duration of surgical antibiotic prophylaxis is methodology and recommendations remains less than 24 hours and compliant with local at a median of 100% antimicrobial prescribing policy in above 95% of sampled elective colorectal and For colorectal surgical prophylaxis, the urological surgical cases. national audit process looks at only two simple process measures - correct antibiotic choice and single dose given. In March 2013, a more detailed audit looking at 5 separate process measures was introduced. The team are working towards the target of 95%. Real time feedback on significant variance is provided to the consultant anaesthetist and surgeon when unexplained variation from guidelines is identified. Collated feedback is circulated at the end of each month.
Primary care empirical prescribing Compliant. The most recent national report uses the Seasonal variation in Quinolone use number of prescriptions to assess compliance (summer months vs. winter months) is less rather than the actual quantity of antibiotics. than 5%. Using the number of prescriptions, NHS Highland prescribers achieved the required standard with an additional 3% of prescriptions dispensed in the winter months. This measure is updated every 6 months with the next update due in January 2014.
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National Report on Hospital Antibiotic Prescribing Indicators A recent national report for the period April 2011 to September 2013 shows NHS Highland as one of only four boards in Scotland to achieve the target of 95% in medical admissions and the fifth highest performing board for the surgical admissions data. The surgical prophylaxis measure reports NHS Highland as one of seven boards demonstrating achievement of the target.
Primary Care National Antibiotic Prescribing Report Health Protection Scotland has recently published the annual report on antibiotic prescribing in primary care across Scotland for 2012/13. NHS Highland prescribers in primary care continue to have low rates of prescribing and remain the third lowest board behind NHS Orkney and NHS Lothian. In common with all other boards, the number of prescriptions has risen slightly compared to previous years. The proportion of antibiotics prescribed with a higher risk of infection with Clostridium difficile has fallen again and NHS Highland rate is below the average for Scotland. In a previous report, the use of co-amoxiclav had fallen but at a slower rate than other areas. This report highlights a reduction in the use of this drug across primary care in NHS Highland to below the national average. The proportion of antibiotics prescribed that comprise recommended agents continues to rise and now stands at 81.8% which is above the national average. For the first time, this report details antibiotic prescribing by other healthcare professional in each board. Prescribing by nurses and dentists accounts for 4% and 8.8% of all antibacterial prescriptions written in Scotland and prescribing rates are slowly rising. In summary, prescribing rates in primary care remain low with recommended agents being prescribed most often. The use of co-amoxiclav and other drug associated with CDI has fallen.
Antibiotic Prescribing Audits A number of audits have been conducted recently in Caithness General and Raigmore medical and general surgical wards. The findings and actions have been presented to the clinical teams at audit sessions and other clinical meetings. A common theme is an issue in documenting decisions around antibiotic therapy choices. Variation from guidelines is expected if patient needs or the complexity of illness warrant alternative treatment but this can only be assessed during the audit if details are recorded in the medical record. The use of an antibiotic sticker has been promoted to all groups to improve documentation.
Piloting of new antimicrobial prescribing indicator NHS Highland Antimicrobial team recently carried out a small pilot of a potential new data collection tool for the Scottish Antimicrobial Prescribing Group (SAPG). This will inform and shape new antimicrobial prescribing indicators to support the CDI HEAT target. The new indicator assessed whether the duration of antibiotic therapy is documented in the patients’ notes or drug kardex in a downstream medical and surgical ward. This information has been fed back to SAPG for review at their next meeting.
European Antibiotic Awareness Day, 18th November This year, the focus is on raising public awareness of avoiding unnecessary antibiotic use and helping prescribers address patient expectations. Working with the NHS Highland Communications team, the Antimicrobial Management Team will utilise a variety of social networking sites and a press release to promote targeted use of antibiotics, especially over the winter cough and cold season. A number of quizzes are available for patients, non- prescribing staff, pharmacy and lab staff and prescribers which cover many of the key messages and these will be circulated via the intranet and internet, press release and public partners. The Scottish Antimicrobial Prescribing Group have provided laminated posters and patient information leaflets which will be sent to all GP practices, community pharmacies and care homes across NHS Highland.
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3 Hand Hygiene
Good hand hygiene by staff, patients and visitors is a key way to prevent the spread of infections. More information on the importance of good hand hygiene can be found at: http://www.washyourhandsofthem.com/ NHS Boards monitor hand hygiene and ensure a zero tolerance approach to non compliance. The hand hygiene compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national hand hygiene monitoring can be found at: http://www.hps.scot.nhs.uk/haiic/ic/nationalhandhygienecampaign.aspx
3.1 National Hand Hygiene Reporting
The current National Hand Hygiene Campaign, including the collection, analysis and publication of bi-monthly hand hygiene data by Health Protection Scotland (HPS), concluded in September 2013 with the publication of the 27th bi-monthly Hand Hygiene Monitoring Audit Report.
Each Board is now responsible for monitoring and reporting hand hygiene compliance data. With effect from April 2014, percentage compliance of each staff group will be reported in the bimonthly report to the Board. In common with some of the other Boards, NHS Highland does not have an electronic system to uniformly collect the detailed data which is now required. While wards supply numbers of observations broken down by staff group, numbers of compliances are only submitted as a ward total not percentage compliance of each staff group. A spread sheet is being developed to enable Highland to collect this information until an electronic system is available. The HAI Policy Unit is reviewing electronic systems such as Lanqip to make it easier for all Boards to report this data.
3.2 Trends
NHS Highland Hand Hygiene Rolling Monthly Audit Programme continues across all clinical areas sustaining 99% compliance in September and 98% in October 2013.
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4. Cleaning and the Healthcare Environment
Keeping the healthcare environment clean is essential to prevent the spread of infections. NHS Boards monitor the cleanliness of hospitals and there is a national target to maintain compliance with standards above 90%. The cleaning compliance score for the Board can be found at the end of section 1 and for each hospital in section 2. Information on national cleanliness compliance monitoring can be found at: http://www.hfs.scot.nhs.uk/online-services/publications/hai/ Healthcare environment standards are also independently inspected by the Healthcare Environment Inspectorate. More details can be found at: http://www.nhshealthquality.org/nhsqis/6710.140.1366.html
4.1 Current Rates The recently published NHS Scotland National Cleaning Compliance for Domestic & Estates Cleaning Services quarterly report July – September 2013 shows that NHS Scotland compliance for cleaning was 95.8% and 97.4% for Estates. Table 3 shows NHS Scotland quarterly report July – September 2013 for NHS Highland. Cleaning Result % Estates Result % NHS Highland 95.8 97.0 A&B CHP 96.7 96.9 New Craigs 95.4 99.2 North & West 95.5 97.2 Raigmore 95.4 96.7 South & Mid 94.2 96.1
The monthly cleaning and estates audits as per the National Cleaning Services Specification demonstrated 95% compliance in September and 96% in October 2013 for domestic monitoring and 97% for estates monitoring in September and October 2013.
4.2 HEI Inspections Healthcare Environment Inspectors made unannounced visits to Belford Hospital on 22nd August 2013 and to Caithness General Hospital on 9th & 10th September 2013. Table 4 shows the requirements and recommendations for both hospitals. Belford Hospital Caithness General Hospital Requirement Requirements NHS Highland must ensure that all infection NHS Highland must ensure that there is control manual policies out with their review adequate provision of clinical waste bins as date are reviewed without delay. near to the point of patient contact/care.
NHS Highland must ensure that the standard and frequency of cleaning of all areas in the hospital reflect the classifications outlined within the NHS Scotland National Cleaning Services Specification (2009).
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NHS Highland must ensure that there is an adequate system in place for the cleaning of patient equipment.
Recommendations Recommendations NHS Highland should ensure that the new NHS Highland should ensure that risk ‘protocol for peripheral vascular catheter’ is assessments for the placing and use of rolled out across Belford Hospital so that staff clinical waste bins adequately reflect are using the most up to date information. potential risks to staff associated with the handling and disposal of clinical waste. NHS Highland should reinforce awareness NHS Highland should ensure that a among nursing staff of the local policy standard policy relating to the storage of relating to the selection and use of colour food in fridges and the procedure for the coded aprons. recording of fridge temperatures is implemented and followed. This policy should also tell staff what course of action should be taken when the temperature levels of the food fridges are out with the recommended safe limits.
NHS Highland should implement a system of sign off for domestic and nursing cleaning schedules. This will help demonstrate that the senior charge nurse has responsibility and accountability for cleaning within their area.
Action plans were developed following the visits; good progress has been made to address all the requirements and recommendations in both hospitals and where relevant across Highland.
5. Outbreaks Two cases of Clostridium difficile were confirmed in Ward 7C Raigmore Hospital on Monday 04/11/2013. As per NHS Highland policy, if there are 2 cases of Clostridium difficile in the same area, this is classed as an outbreak and as such the ward was closed to eliminate the risk of cross infection to newly admitted patients. The situation was closely monitored. Specialist cleaning commenced on Friday 08/11/2013 and the ward was reopened on Sunday 10/11/2013.
6. Surgical Site Infections (SSI)
Colorectal Surgical Site Infection The Colorectal and Infection Prevention & Control Teams continue to review all aspects of care to reduce the number of avoidable infections. Root cause analysis is carried out on all elective SSIs. June – August 2013, 37 elective procedures were carried out with 4 infections, a rate of 10.75% which is an improved position to the previous quarters.
Orthopaedic Surgical Site Infections There have been no orthopaedic infections since the end of July 2013. The cases shown in table 5 have been discussed and reviewed with the Orthopaedic team. 14 219
Table 5 shows the number of orthopaedic procedures with the number and rate of infections April – August 2013.
Procedure Number of Number of Rate % Procedures infections Total Hip 180 1 0.6 Replacement Hemi – arthroplasty 61 3 5
Other Neck of 65 2 3.0 Femur
Caesarean Section Infections Since October 2012, 346 emergency caesarean section procedures have been carried out with 8 infections, a rate of 2.3% and 287 elective caesarean procedures with 3 infections, a rate of 1%.
Figure 8: shows the days between infections following Elective Caesarean section since October 2012
Time betw een events Days between infection following Elective C-sections (NHSH)
250
200 s y a d
f 150 o r e
b 100 m u
N 50
0 2 2 2 2 2 2 2 2 2 2 2 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / /
7. 1 1 2 3 4 4 5 5 5 7 9 4 7 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 / / / / / / / / / / / / / / 8 0 8 0 0 5 3 9 6 7 4 9 2 0 1 3 2 2 1 2 0 0 1 1 0 1 2 2 Date of Surgery
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Figure 9: shows the days between infections following Emergency Caesarean section since October 2012
Time betw een events Days between infection following Emergency C-sections (NHSH)
250
s 200 y a D
f 150 o r e
b 100 m u
N 50
0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 / / / / / / / / / / / / / / / / / / / / 1 1 1 2 3 3 4 4 6 6 8 8 9 1 2 2 2 7 9 9 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 / / / / / / / / / / / / / / / / / / / / 2 7 6 2 2 4 7 0 4 8 5 3 8 3 4 9 8 3 1 7 0 1 2 2 2 2 0 1 0 2 1 2 2 1 0 1 1 1 0 1 Date of Surgery
7. Antimicrobial Resistance
Extensive spread of organisms resistant to carbapenems (antibiotics usually of last resort) has occurred within a number of European countries, with some countries moving to an endemic situation. The number of Carbapenemase-Producing Enterobacteriaceae (CPEs) detected within the UK has also risen, with over 70 Trusts in England having isolated a Carbapenemase producing organism. In Scotland there has been an increase in CPE detection, with 25 cases detected in 2012.
The working group, set up to ensure the Board is compliant with the actions as described in the CMO/SGHD (2013)14 letter, has developed an infection prevention & control risk assessment which is currently being tested in Raigmore and Belford hospitals. The final version will be introduced to all relevant clinical areas.
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Healthcare Associated Infection Reporting Template (HAIRT)
Section 2 – Healthcare Associated Infection Report Cards
The following section is a series of ‘Report Cards’ that provide information, for each acute hospital and key community hospitals in the Board, on the number of cases of Staphylococcus aureus blood stream infections (also broken down into MSSA and MRSA) and Clostridium difficile infections, as well as hand hygiene and cleaning compliance. In addition, there is a single report card which covers all community hospitals [which do not have individual cards], and a report which covers infections identified as having been contracted from outwith hospital. The information in the report cards is provisional local data, and may differ from the national surveillance reports carried out by Health Protection Scotland and Health Facilities Scotland. The national reports are official statistics which undergo rigorous validation, which means final national figures may differ from those reported here. However, these reports aim to provide more detailed and up to date information on HAI activities at local level than is possible to provide through the national statistics.
Understanding the Report Cards – Infection Case Numbers Clostridium difficile infections (CDI) and Staphylococcus aureus bacteraemia (SAB) cases are presented for each hospital, broken down by month. Staphylococcus aureus bacteraemia (SAB) cases are further broken down into Meticillin Sensitive Staphylococcus aureus (MSSA) and Meticillin Resistant Staphylococcus aureus (MRSA). More information on these organisms can be found on the NHS24 website:
Clostridium difficile: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=2139§ionID=1
Staphylococcus aureus : http://www.nhs24.com/content/default.asp?page=s5_4&articleID=346
MRSA: http://www.nhs24.com/content/default.asp?page=s5_4&articleID=252§ionID=1
For each hospital the total number of cases for each month are those which have been reported as positive from a laboratory report on samples taken more than 48 hours after admission. For the purposes of these reports, positive samples taken from patients within 48 hours of admission will be considered to be confirmation that the infection was contracted prior to hospital admission and will be shown in the “out of hospital” report card.
Targets There are national targets associated with reductions in C.diff and SABs. More information on these can be found on the Scotland Performs website: http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandper formance
Understanding the Report Cards – Hand Hygiene Compliance Hospitals carry out regular audits of how well their staff are complying with hand hygiene. Each hospital report card presents the combined percentage of hand hygiene compliance with both opportunity taken and technique used broken down by staff group.
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Understanding the Report Cards – Cleaning Compliance Hospitals strive to keep the care environment as clean as possible. This is monitored through cleaning and estates compliance audits. More information on how hospitals carry out these audits can be found on the Health Facilities Scotland website: http://www.hfs.scot.nhs.uk/online-services/publications/hai/
Understanding the Report Cards – ‘Out of Hospital Infections’
Clostridium difficile infections and Staphylococcus aureus (including MRSA) bacteraemia cases are all associated with being treated in hospitals. However, this is not the only place a patient may contract an infection. This total will also include infection from community sources such as GP surgeries and care homes and. The final Report Card report in this section covers ‘Out of Hospital Infections’ and reports on SAB and CDI cases reported to a Health Board which are not attributable to a hospital.
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NHS HIGHLAND REPORT CARD NHS Highland Staphylococcus aureus bacteraemia (SABs) monthly case numbers
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 120201101010 MSSA 442646645646 Total SABS 562847746656
NHS Highland Clostridium difficile infection monthly case numbers
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 262241331132 Ages 65 plus 3222124541179 Ages 15 plus 5 8 4 4 5 3 7 8 5121011
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Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Board Total 98 98 98 98 99 98 98 98 98 99 99 98
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Board Total 96 96 96 96 96 96 95 94 96 96 95 96
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Board Total 96 97 98 96 97 97 97 95 97 97 97 97
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NHS HIGHLAND RAIGMORE HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000000000000 MSSA 110132121010 Total SABS 110132121010
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 130020020010 Ages 65 plus 100100101111 Ages 15 plus 230120121121
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 99 99 98 99 99 99 99 99 97 98 99 99
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 96 96 95 94 94 94 97 96 96 96 95 96
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 97 97 94 94 94 98 95 98 96 96 97
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NHS HIGHLAND CAITHNESS GENERAL HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000000000000 MSSA 000001000000 Total SABS 000001000000
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 020100000000 Ages 65 plus 000000001201 Ages 15 plus 020100001201
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 99 99 99 99 100 99 98 98 99 100 99 99
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 96 95 97 97 96 97 97 97 97 98 96 96
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 97 99 99 96 99 100 96 96 98 97 96
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NHS HIGHLAND BELFORD HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000000000000 MSSA 000000001000 Total SABS 000000001000
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 000000000000 Ages 65 plus 000000000000 Ages 15 plus 000000000000
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 100 98 100 99 100 98 99 98 95 99 100 100
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 98 99 96 97 96 95 95 85 95 96 91 95
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 96 98 99 97 100 98 99 98 99 98 99 98
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NHS HIGHLAND LORN & ISLANDS HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000001100000 MSSA 000000000000 Total SABS 000001100000
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 000000000000 Ages 65 plus 000000010010 Ages 15 plus 000000010010
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 99 100 100 100 100 98 99 100 100 100 100 100
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 96 97 98 98 97 97 96 93 97 96 96 98
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 98 97 93 94 98 96 94 95 93 92 91
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NHS HIGHLAND NORTH & WEST OPERATIONAL UNIT COMMUNITY HOSPITALS REPORT CARD
The community hospitals covered in this report card include: Dunbar Hospital, Thurso Town & County Hospital, Wick Lawson Memorial Hospital Golspie Migdale Hospital, Bonar Bridge MacKinnon Memorial Hospital, Broadford Portree Hospital, Isle of Skye
Staphylococcus aureus bacteraemia monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000000000000 MSSA 000000000000 Total SABS 000000000000
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 000000000000 Ages 65 plus 010000100000 Ages 15 plus 010000100000
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 100 98 99 99 100 100 100 99 97 99 97
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 95 96 96 97 92 95 92 98 97 95 94 96
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 98 99 99 96 94 95 94 99 99 96 94
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NHS HIGHLAND SOUTH & MID OPERATIONAL UNIT COMMUNITY HOSPITALS REPORT CARD
The community hospitals covered in this report card include: Ross Memorial Hospital, Dingwall County Community Hospital, Invergordon Royal Northern Infirmary Community Hospital, Inverness Town & County Hospital, Nairn Ian Charles Hospital, Grantown on Spey St Vincent’s Hospital, Kingussie For the purposes of monitoring New Craigs Psychiatric Hospital is included in this report card.
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000000000000 MSSA 000000000000 Total SABS 000000000000
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 000000000000 Ages 65 plus 100000000111 Ages 15 plus 100000000111
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 98 97 97 96 96 98 98 96 99 98 97 98
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 93 95 94 95 97 95 95 95 95 95 95
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 95 95 97 97 95 97 97 96 97 97 93 97
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NHS HIGHLAND ARGYLL & BUTE CHP COMMUNITY HOSPITALS REPORT CARD
The community hospitals covered in this report card include: Argyll & Bute Hospital Lochgilphead Campbeltown Hospital Cowal Community Hospital, Dunoon, Dunaros Community Hospital, Isle of Mull Islay Hospital Mid Argyll Community Hospital & Integrated Care Centre, Lochgilphead Victoria Hospital & Annex, Rothesay
Staphylococcus aureus bacteraemia (SABs) monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 000000000000 MSSA 000000000000 Total SABS 000000000000
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 000000000010 Ages 65 plus 000001000001 Ages 15 plus 000001000011
Hand Hygiene Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 97 97 98 97 97 97 97 98 98 99 98 96
Cleaning Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 95 95 96 97 97 96 95 96 95 97 96 97
Estates Monitoring Compliance (%) Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Total 95 96 98 95 94 97 99 94 98 97 98 98
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NHS HIGHLAND OUT OF HOSPITAL REPORT CARD
Staphylococcus aureus bacteraemia monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 MRSA 120200001010 MSSA 332513523636 Total SABS 452713524646
Clostridium difficile infection monthly case numbers Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct 2012 2012 2013 2013 2013 2013 2013 2013 2013 2013 2013 2013 Ages 15-64 112121411112 Ages 65 plus 112111142745 Ages 15 plus 224230553857
28 233 Highland NHS Board 3 December 2013 Item 5.5
NHS HIGHLAND ALLIED HEALTH PROFESSIONS MUSCULOSKELETAL REDESIGN
Report by Katherine Sutton, Associate Director AHPs on behalf of Elaine Mead, Chief Executive
The Board is asked to:
Support the NHS Highland Allied Health Professionals Musculoskeletal redesign programme. Support the implementation of an appropriate NHS Highland admin hub to support the transformational change required. Support the transition of AHP services onto the TRACK care patient management system once implemented. Note the benefits to be realised as a result of full Allied Health Professionals Musculoskeletal redesign.
1 Background and Summary
The Chief Executive Officers report presented to the NHS Highland Board meeting on the 1 of October 2013 referenced the NHS Highland response to the AHP Delivery plan. Action 6.2 of the AHP Delivery Plan states; “AHP directors will drive the delivery of AHP waiting times within 18 weeks from referral to treatment, inclusive of all AHP professions and specialties (except diagnostic and therapy radiographers) with a target of 90% by December 2014. NHS Boards will be expected to deliver a maximum wait of no more than 4 weeks for AHP musculoskeletal treatment within the same period”.
To help improve efficiency of Allied Health Professional (AHP) Musculoskeletal Services (MSK) service delivery, make best use of AHP skills and reduce inappropriate referrals to Orthopaedic services, significant redesign and transformation of Scotland’s AHP MSK has been on-going since 2010, within three AHP MSK redesign Early Implementer Boards – NHS Lanarkshire, NHS Ayrshire and Arran and NHS Lothian, NHS24 has also worked with each of the pilot Boards, specifically looking at demand side solutions through provision of a telephone Musculoskeletal Advice and Triage Service (MATS).
There are many drivers for MSK pathway and outcome improvement. AHP MSK services deal with high volume demand, currently presenting at 400,000+ referrals per annum nationally. It is also estimated that between 20-30% of all General Practitioner (GP) consultations are for MSK complaints [1, 2], with 10 million work days lost annually with MSK problems. [3] In addition, people with a MSK condition are the second largest group (22%) in receipt of incapacity benefit after people suffering from mental health conditions. [4] This presentation has significant costs for the individual, but also significant impact on a wider socio-economical scale. Orthopaedic activity is also high, with duplication across general practice, orthopaedic and AHP services, all providing opportunities for integration of historical pathways and new innovative team working. There is also variation in patient experience in the following areas: ------[1] Department of Health (2006a) The Musculoskeletal Services Framework. A joint responsibility doing it differently. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4138412.pdf
[2] Jordan KP, Kadam UT, Hayward R, Porcheret M, Young C, Croft P (2010) Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskeletal Disorders.11:144. [3] NHS Scotland Information Statistical Division 2007 [4] European Bone and Joint Health Strategies Project (2005) European action towards better musculoskeletal health. A public health strategy to reduce the burden of musculoskeletal conditions. The Bone and Joint Decade, Lund, Sweden. Available at: http://www.bonejointdecade.org/default.aspx?contid=1138 234
1) Public and patient information 4) Investigations and Interventions 2) Access 5) Data collection and 3) Waiting times 6) Measurement of impact.
Experience of implementation of the NHS 24 Musculoskeletal advice and triage service within NHS Ayrshire and Arran led to a 25% reduction in referrals to the Orthopaedic service.
Implementation of Patient focussed booking within the NHS Lanarkshire AHP booking hub led to dramatic reductions in DNA rates which allowed release of clinical capacity to better meet demand for Physiotherapy services with a corresponding increase of slot utilisation to 95%.
NP and RP DNA Physiotherapy 2012/13 25.00%
20.00%
15.00% e l t i T s i
x NP DNA Rate A 10.00% Return DNA
5.00%
0.00%
In addition the NHS 24 Musculoskeletal Advice and Triage service has evidenced the following metrics:
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1. 12,000 app downloads 2. 100,000 hits in the NHS Inform MSK website 3. 15% of callers self select information only 4. 13.5% of callers triaged to self management 5. 25% reduction in referral into AHP services 6. 5% of demand triaged into return to work and leisure programmes
Based on the successes of the early implementer sites a roll out of the approach to remaining Health Boards is planned. To support this roll out two key documents have been developed;
1. The AHP MSK minimum standards framework sets out minimum standards applicable to AHP MSK services across Scotland. The purpose of the document is to ensure that people requiring MSK services, receive the quality of care and the support they require, at the appropriate time by the appropriate person.
The framework has been developed by a group of MSK clinicians, originally providing a framework back pain pathway, which has further evolved to a minimum standard framework for all AHP Musculoskeletal pathways.
Musculoskeletal conditions have been defined as problems to include a diversity of complaints and diseases localised in joints, bones, cartilage, ligaments, tendons, tendon sheaths, bursa and muscles.
The aim of the framework is to reduce the variance within MSK service provision and facilitate delivery of key quality policy directives, in particular the triple aim in the 2020 Vision of quality care, value and sustainability and a healthy population.
AHP’s working in close collaboration with medical and other colleagues is absolutely necessary to improve Musculoskeletal services. The National Standards will provide a focus on the clinical pathway, the process and a supported clinician. Application of the framework will provide consistency of approach and consistency of outcome and also act as a facilitator for the AHP MSK 4 week HEAT target.
2. The 4 Weeks AHP Developmental HEAT Target paper; this paper describes the definition of the AHP MSK developmental HEAT target and notes inclusions and exclusions in addition to the AHP MSK minimum dataset each Health Board will be required to report against as a part of KPIs against which Health Board performance will be monitored.
2 NHS Highland Plans for Implementation
To support implementation of the transformational redesign programme to support AHP MSK revised pathways within NHS Highland a Core Project Group has been established. This group meets fortnightly and is responsible for progressing the change programme to meet needs locally within NHS Highland. The group is linked to the National programme work by an NHS Highland lead who is a member of the National redesign programme board and inputs to development of National AHP MSK strategic guidance documents. In addition a further group has been established who meet monthly to assess and review the waiting times position for AHP Services in relation to meeting both the 4 week MSK HEAT target and the 18 week referral to treatment target for all AHP services. This group is responsible for establishing accurate reporting of AHP waiting times and setting appropriate trajectories to ensure all AHP services are compliant with both the 4 week MSK HEAT target and the 18 week referral to treatment target by December 2014.
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The MSK Core Project Group have to date established a project charter and driver diagram to help focus the efforts of the project and maintain focus on progress. In addition the group has undertaken observational studies and client / patient feedback prior to holding a value stream mapping (VSM) event which included a wide variety of stakeholders and delivered a future state VSM.
The VSM developed by the group maps closely against the model recommended by the earlier implementer sites and is depicted as follows;
This model affords the opportunity to implement self referral to AHP MSK services as well as reducing inappropriate demand by affording the opportunity of sign posting callers to self help guidance and opportunity for referral into working health services to support individuals experiencing MSK problems to remain at work for as long as possible or return to work as early as possible. The pathway also offers a variety of exit routes tailored to meet service user needs by facilitating them to regain and maintain independence.
Implementation of the model;
A number of priority work strands have been identified across the AHP MSK pathway:
1. Linking with the Musculoskeletal Advice and Triage Service . Accessing the national self- management platform –through NHS Inform . Introducing a national self- referral model through a single point of access . Utilising the telephone call handler protocol triage model
2. IT/ Referral Management . Electronic Referral Management as standard–electronic referral, diaries, patient tracking . Implementation of TRACK Care for AHP services . Implementation of efficient administration processes . Implementing Reminder Systems
3. Clinical Pathways . Audit compliance with evidenced based, person-centred pathways . Measure compliance against Minimum Standards Framework
4. Exit Route Solutions . Developing effective links with Leisure partnerships . Introduce an employability pathway . Develop robust MSK pathways into Specialist Pain services . Develop robust links to Mental Health pathways
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5. MSK Minimum Data Standards . Electronic record and tracking . Electronic outcome measures
To support project management for this transformational redesign programme funding has been sourced from Scottish Government to support appointing a fixed term Project Manager post to progress implementation of the five work streams that will support delivery of the redesign programme within the coming 12 months.
3 Contribution to Board Objectives
Implementation of the AHP MSK service redesign supports delivery of six of the seven characteristics of service delivery in NHS Highland: promoting good health, self care and independence high quality, integrated, equitable, needs and evidence-based, and cost-effective increasingly community-based integrated with, and complementary to, local authority, voluntary and independent sector care Delivered by healthy, flexible, well-motivated and well-trained staff working to their maximum potential and capability with zero wastage and inefficiency across all services and no unnecessary overheads.
4 Governance Implications
Staff Governance – staff side are members of the AHP MSK redesign Core working group. Implementation of the AHP MSK redesign programme will be undertaken using the tools and techniques of the Highland Quality Approach which takes an inclusive approach to progressing service redesign and change within services.
Patient and Public Involvement – Patient and service users views are being considered as a part of the ongoing service redesign again under the application of the Highland Quality Approach and through service user questionnaires. This feedback will help shape the design of the service being implemented to meet local service user need.
Clinical Governance – Change to clinical practice is being progressed and overseen through the NHS Highland AHP Leadership and Governance structures and in accordance with the “Allied Health Professional (AHP) Musculoskeletal Pathway Framework (National Minimum Standard)”.
Financial Impact – Financial impact of the service changes to be implemented will be undertaken at NHS Highland level with the support of the NMAHP Accountant as the redesign programme applies Highland wide and is transformational across Argyll and Bute and the North Highland Operational Units and Mental Health services.
5 Risk Assessment
Any changes to service delivery will be fully risk assessed prior to progression to implementation, any risks identified will be registered in the North Highland Operational Unit and Argyll and Bute risk registers any risks identified will have mitigating actions taken to reduce the potential for risks to become issues as a part of implementation.
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6 Planning for Fairness
The AHP MSK Redesign programme embraces the principles of Planning for Fairness. Work is ongoing with operational units to make sure that impact assessments are undertaken prior to any changes being implemented within the North Highland Operational Units and Argyll and Bute CHP.
7 Engagement and Communication
The NHS Highland AHP MSK service redesign has a supporting communication and engagement communications plan to ensure effective engagement and communications are undertaken which involve service users, a wide variety of stakeholders and regular updates to strategic and operational management teams.
Katherine Sutton Associate Director AHPs Corporate NMAHP Directorate
22 November 2013
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Highland NHS Board 3 December 2013 Item 5.6
CHIEF EXECUTIVE’S AND DIRECTORS’ REPORT EMERGING ISSUES AND UPDATES
1 CHILDREN’S SERVICES INSPECTION REPORT – HIGHLAND COUNCIL UPDATE
The Care Inspectorate is currently carrying out their inspection of Integrated Children’s Services within Highland Council. The inspectors were sent seven position statements with supporting documentation in advance of the fieldwork which started in the week beginning 28 October 2013.
A series of meetings were held with Highland Council staff, staff from partner organisations and some families and included a number of site visits around the Council area. Since then, a team of inspectors has been reviewing 103 sets of case records and they are expected back for another series of meetings with children, young people and frontline staff in the week beginning 25 November 2013. Initial feedback is due to take place on 6 December 2013.
The Board will be updated on the findings of the final report when they are available.
2 FREEDOM OF INFORMATION REQUESTS UPDATE
NHS Highland, in line with all public sector organisations submits quarterly statistics on Freedom of Information requests to the Scottish Information Commissioner. This provides a useful summary of the Freedom of Information activity which we will report regularly to the Board.
Quarter – July to September 2013
Total Number of Requests received – 94
Requestors– Media–30 Parliament – 17 Miscellaneous – 24 Members of Public – 13 Researchers – 10
Number of requests responded to within statutory timescale – 67 (71%)
Number of requests responded fully – 87 Number of requests partly responded to – 4 Number of requests where no information held – 1 Number of requests not responded to – 2
Number of requests for review – 4
Number of decisions from Scottish Information Commissioner – 1 (for NHS Highland) 240
3 HEALTH PROMOTING HEALTH SERVICE UPDATE – ADDENDUM TO CEL(2012)01
CEL(2012)01 –Health Promoting Health Service: Action in Hospital Settings sets out guidance on how hospitals can contribute to a reduction in health inequalities through promoting health and wellbeing in patients, their families and staff. The CEL covers 8 areas for health improvement action on tobacco, alcohol, breastfeeding, staff health, food and health, sexual health, physical activity and active travel. It also asks Boards to report on examples of innovative and emerging practice and provide evidence that hospital staff are trained in generic health improvement competencies.
The concept that "every healthcare contact is a health improvement opportunity" is central to the Quality Ambitions for both Person-centred and Effective and supports the existing health improvement work in hospital settings such as the Tobacco Policy, Healthy Working Lives (HWL), Brief Intervention Training and Health at Every Size (HAES).
NHS Highland has made good progress on a number of actions including:
piloting the National Physical Activity Pathway within Raigmore’s Paediatric Outpatient department supporting physical activity through site walking maps supporting cycling infrastructure. supporting breastfeeding, including the UNICEF Baby Friendly Initiative positive engagement of staff and management support for this area of work.
The main challenges for our hospitals are:
the number and geographical spread of hospital sites capacity to deliver health improvement training capacity to release staff to attend generic health improvement professional development programmes and get involved in health improvement actions, particularly for hospital consultants. Gaining information on some performance indicators for sexual health and smoking cessation as data on these is not routinely recorded ( ISD are looking to resolve this nationally.)
Operational units have identified local leads for each hospital and a series of meetings and workshops have been held/are planned to ensure each site is aware of the requirements of CEL(2012)01 and are supported to implement relevant local actions. Progress will be reported through Operational Unit Management teams
NHS Health Scotland is collating information on implementation of CEL(2012)01 across Scotland. NHS Highland submitted information in May 2013 and we are engaged in the national Health Promoting Health Service network which aims to share good practice, highlight risks for delivery and support local activity.
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4 REGIONAL PLANNING – NORTH OF SCOTLAND PLANNING GROUP AND WEST OF SCOTLAND PLANNING GROUP
A copy of the Briefing from the September 2013 Meeting of the North of Scotland Planning Group is circulated as Supplementary Paper 1 to this update
A copy of the Briefing from the September and November 2013 Meetings of the West of Scotland Planning Group is circulated as Supplementary Paper 2 to this update.
Following a point raised at the last meeting of the Board on 1 October 2013 a copy of the West of Scotland Annual Report for 2012 will be available on the NHS Highland website when Board papers are published one week before the meeting. http://www.nhshighland.scot.nhs.uk/Meetings/BoardsMeetings/Pages/Welcome.aspx
It is anticipated that the West of Scotland Annual Report for 2013 will be available early in 2014 and this will be submitted to the Board in due course.
Chief Executive’s Office Assynt House
22 November 2013
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NORTH OF SCOTLAND PLANNING GROUP
NHS Board Briefing 18th September 2013
A meeting of the NoSPG Executive was held on 18th September 2013. The following briefing has been prepared to update the North NHS Boards on the outcome of the meeting.
NoSPG Projects
Hyperbaric Services
NoSPG approved the recommendations within the paper for submission to NSD for progression through the NSCC process and to inform the NHS Board Chief Executives of the preferred options.
Oncology Workforce issues
An interim report carried out following site visits undertaken in the process of the review of service sustainability across NoS specialist oncology centres was submitted. It was noted the service now had almost 50% vacant oncology positions as a result of maternity leave, sick leave and vacancies being recruited into, with short term locums in place. One of the recommendations within the report was that each of the centres, as a matter of urgency, would review its caseload to ascertain what they were capable of providing safely and which services should be offered as a national mutual contingency approach. It was agreed there was a two stage process: recognise what can be done regionally in the short term; and strategy recommendations which need to bring to national forum. This would also be raised at the Scottish Cancer Taskforce group as there needed to be a national action around this.
Mr Carey agreed to bring together a meeting with clinicians to obtain a NoS position, ahead of any nationally led discussions.
NoS Neonatal MCN Quality Framework Review Report
Members agreed the implementation plan, which described actions required over a short, medium and longer term could be submitted to SGHD. The NoS Neonatal Network was supporting implementation and the identified actions will inform substantial parts of network activity over the coming years.
Working Towards an Intelligent Region
The aim of the Intelligent Region (IR) was to improve accessibility of information within the NoSPG system for all, ensuring NoSPG had access to the right information at the right time. One of the common themes was that this was almost too big to pull together but if there was a common thread i.e. sustainability; this would be something to focus on. Members endorsed the continuation on the workforce data piece of work. There were a lot of issues around imaging and it would be helpful to map out for decision on whether this was a viable piece of work to undergo under the IR concept. Ms Mead asked that the “imaging” data be worked up as a discussion paper for the next NoSPG in December.
North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles
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National Work Streams
National Update
The update report on national initiatives was noted.
NoSPG Business Management
NoSPG Clinical Leadership
NoSPG agreed the recommendation for senior clinical leadership but consideration should be given to the methodology of obtaining this leadership. Mr Cannon to work up the proposal, considering different types of clinical leadership and the requirement for each.
NoSPG Workplan – Exception Report
The NoSPG workplan and exception report were noted.
NOSCAN Review
Members accepted the recommendations within the report on the NOSCAN Structure and Operating Framework Review and work would commence on an implementation plan based on the recommendations. It was noted that specific implementation plans may need NoSPG sign off but that most recommendations would be relatively simple to implement.
NoSPG Team Changes
Members were informed that within the NoSPG team there were now three members of staff on secondment and that Mr Cannon was proposing to develop a revised structure which included recruiting temporary roles. Any new structure would be within the same cost envelope and members endorsed this proposal.
Date and time of next meeting
The next meeting will be a virtual meeting held on 4th December 2013 at 2.00 pm.
Mr Jim Cannon Director of Regional Planning North of Scotland Planning Group
18th October 2013
North of Scotland Planning Group is a collaboration between NHS Grampian, NHS Highland, NHS Orkney, NHS Shetland, NHS Tayside and NHS Western Isles
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WEST OF SCOTLAND REGIONAL PLANNING GROUP
Briefing Paper
The following is a resume of the material items from the West of Scotland Regional (WoS) Regional Planning Group meetings held on the 20th September and 15th November 2013
1 Forensic Medium Secure Bed Provision
Options presented to utilise spare capacity nationally, not supported by North of Scotland and SEAT. Outcome agreed all options including expansion of capacity in WoS presented at CE meeting for SGHD view in 2014.
2 ITU Inter Hospital Transfer Medical staffing
Identified that this service delivered by NHS GGC had been previously supported by the Deanery as part of junior doctors training across WoS. From February 2014 Deanery no longer support this training programme and so from Feb 2014 service cease in current form.
Noted NHSGGC will not need this from 2015 as new SGH will mean 2 sites with ITU provision and reduced need to transfer. GJNH use service receiving patients from all WoS Boards e.g. cardio thoracic etc.
Following discussion members agreed establish a short life working group re contingency from Feb 2014 and also forward look re consideration of a national adult transfer service has been an aspiration of the Scottish Critical Care community for many years and discussed as part of ScotSTARs creation
3 GP out of hours service – HMRC & Workforce capacity
The group received a report from HR Director Lanarkshire regarding the consequence of HMRC investigation re deduction or non deduction of tax at source and tax payment outstanding. It was noted that this was now being pursued across Scotland.
This flagged different remuneration rates of GPs for sessions across the WoS and how Lanarkshire had had to offer increase in remuneration to counter impact uplift of 5% and then had to offer further holiday sessional payments to fill rotas. As at this point nearly 20% of Christmas and New Year holiday rotas were unfilled.
NHSGG&C reported that it was also looking at 40% of holiday rotas unfilled at this time and were approaching locum agencies to cover gaps.
Members reflected examples this year across WoS when gaps in service meant contingency arrangements had to be put in place as service could not be provided closing outlying PCECs etc.
Following discussion members agreed that local pay determination was essential, but it was also felt that the “market” of available doctors had shrunk due to change in workforce. NHSGGC advised since inception number of GPs interested in participating in the rotas had fallen from 600 to 300.
It was clear the issue was not simply remuneration, but the model of provision was not sustainable. NHS Highland outlined the option being examined as part of SGHD R&R initiative re maintenance of “triple duty” role including training and remuneration. 245
Members asked Director of HR to share factual intelligence regarding the service, where we have gaps, remuneration rates, and alternative models and whether GPs were actually playing the market in reality move across boundary to get higher rate.
This to inform a further WoS discussion regarding future workforce planning and service model.
4 Radiotherapy Capacity Planning – Satellite Radiotherapy Facility
Progress continuing FBC approval in March 2014, sign off host Boards in Feb 2014.
Noted workforce issue re risks of staffing using may be some issue of sourcing additional workforce and redeployment of staff from NHSGG&C and potential gaps across Scotland
5. Medical Workforce Staffing Update
The RPG received a report that the fill rate for the main specialties in 2012/13 was reasonable, however, there were shortages in emergency medicine, paediatrics, neonatal and the GP training scheme. There would be a requirement for national discussion about the use of funding for residual posts vacant for lengthy periods.
There was potential for growth in training numbers in some specialties including paediatrics, care of the elderly, acute medicine and core medicine; this would however present a funding challenge for Boards and NES. There was also the ongoing debate about increasing the GP training programme from three to four year training and the impact this was having on hospital staffing.
Following discussion it was agreed that Medical Directors should capture the current workforce challenges and opportunities in a paper, proposing a short life national group be established to make recommendations to Scottish Government
6 Scottish Ambulance Service – Scheduled Care Programme (SCP)
A presentation on the implementation of Phase 2 of the SAS Scheduled Care Programme. • Principles of the programme • An overview of Phase 1 & 2 • How Phase 2 would be delivered • Meeting Patient Needs • Communication and Engagement
Members enquired if it was the intention of the SAS that the SCP would deliver efficiency savings. It was explained that no definitive figure had been identified but the approach was to make better use of the asset and service and in some respects, the service was not aligned to modern healthcare needs. It would be difficult to identify savings at this stage, but the review of shift patterns would assist. It was anticipated that some savings would be realised at the same time as meeting demand more effectively. Mr Whiston advised that within Argyll and Bute the SCP had not shown any efficiency gains to the service in rural areas and there was evidence of increasing incidents with regard to delays in arranging inter hospital transfers into NHS GG&C and similarly from NHS GG&C to Argyll and Bute. Mr Mitchell agreed to meet with Mr Whiston to explore the rural dimension to the Phase 2 roll out and plans for capacity enhancement outside the meeting.
Members raised the issue of rising taxi and private ambulance costs for renal dialysis patients and this remained outstanding. The SAS outlined work which was ongoing on examining metrics of use of service, Aborted journeys, booking and scheduling use of alternatives and the following action was in hand
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o Introduction of Autoplan – roll out starts in January 2014 and will be completed by August 2014. o Reconfiguration of shift patterns. o Review the performance information for the clinics where performance is not being achieved jointly and identify solutions to improve this performance December 2013. o Review abort (with own transport) information and jointly agree the appropriateness of this cohort of patients continuing to be transported by SAS. To be completed by end of December 2013. o Consider alternative transport solutions – A pilot is currently being planned with NHSGG&C, SAS and Cordia to assess viability of utilising the Cordia fleet to support renal patients. This will be progressed during November/December 2013.
7 Trauma Centre
Chief Executives meeting agreed principal of establishing four level 2 centres and each Regional planning group would be remitted to develop proposals for this. It was noted this will include a disinvestment perspective as well as consequences in revenue terms, asset utilisation and workforce issues re attractiveness in the future.
The RPG reflected that changes to the profile of service provision in DGH to support this and this will have implications for their existing services re activity and workforce skill sets.
8. Update on Robotic Surgery for Prostate Cancer
Members noted that the Cabinet Secretary had been considering advice from the National Planning Forum (NPF) and Board Chief Executives on the introduction of robotic surgery for prostate cancer in the NHS in Scotland. The following recommendations were accepted by the Cabinet Secretary:
Recommendation 1 – Given there is significant geographical variation in the type of radical prostatectomy carried out in Scotland, and there are too many surgeons carrying out too few procedures, NHS Scotland should move from open surgery to minimally invasive (laparoscopic) surgery in a few high volume centres; and
Recommendation 2 – NHS Scotland should support a research proposal that would test the clinical and cost-effectiveness of robotic surgery for prostate cancer and perhaps other conditions that might benefit from robotic surgery.
The WoS had considered the implications of this and following discussion members were concerned that progress in robotic surgery would supersede lap surgery in the time taken to train surgeons in the west. It was therefore agreed that a further piece of work be undertaken in the west to assess this taking account of the new SGH theatre development. This was remitted to the SPG group and a report would be brought back to the RPG in due course.
9 Vascular Service Reconfiguration
It was reported that Lanarkshire clinicians had agreed in principle that the service be integrated with NHS GG&C. NHS A&A clinicians were considering this noting the outcome of the to date. NHS D&G confirmed that an interim arrangement had been agreed with Carlisle for 1 year but thereafter it was expected this would transfer to NHSGG&C.
10 Police Forensic Service
It was reported from the SEAT RPG that NHS Borders and NHS Fife would not have staff in place to commence the service until August. 2014 and this had been reported to the SGHD. 3 247
SGHD had therefore asked all Boards to provide their timeline alongside their costed models by the end of November.
11 Health & Social Care Integration
Board representatives were asked to provide a brief update of their Health and Social Care Integration arrangements. Members were informed that at the CE meeting SGHD provided an update on the go live date with an expectation that HSCP should be live at April 15, but this could be progressed through to April 16. If so the imminence of the next Scotland Election may be an issue.
Dumfries and Galloway
Positive discussions with council, may be moving back to a lead agency model due to the complexities of body corporate model
Lanarkshire:
South Lanarkshire Council were keen to work collaboratively body corporate agreed North Lanarkshire just commencing the process, body corporate model
Both councils were only looking at the deminimus model and South Lanarkshire looking to appoint a transition/ interim chief officer for the South
Forth Valley:
There was a NHS Board development session next week and all 3 councils were examining the body corporate model, as well as looking at the internal relationship/ hosting of services across council areas.
Ayrshire and Arran:
Appointed Chief Officer for the North and were progressing discussions with other councils and looking to appoint other Chief Officer posts in the next couple of months
The partnership is progressing a number of work streams for integration and a paper on arrangements and high level programme had been submitted and approved at a recent Board meeting.
Greater Glasgow and Clyde:
Range of engagement with all the councils and approaches included establishing joint steering group. Overall partnerships were looking towards a corporate body model.
3 CHCP intention was to move them by variation to SOE to shadow HSCP from April 2014 and transfer 1st April 2015 subject to legislation
Glasgow City work progresses- Body corporate model all Social work, but operational issues to be addressed including hosting of services which had city wide arrangements and issue of how Chief Officer can be accountable for integrated services.
East Dun move to appoint a Project Director for transition only looking at the deminimus Body Corporate model for these services
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Renfrew looking at a deminimus model but council also looking at a internal restructuring creates a governance structure around children separate and not be part of HSCP keeping social work function in council. Further meetings planned in November.
NHS Highland Argyll & Bute CHP
Reported that following a recent meeting with new council administration it had been agreed to explore the lead agency option and a project programme of work will be developed over the coming months to progress this.
Stephen Whiston Head of Planning, Contracting and Performance Argyll & Bute CHP
November 2013
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